Abnormal Psych, Exam 2 Study Guide
Abnormal Psych, Exam 2 Study Guide PSY 250
Kutztown University of Pennsylvania
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This 12 page Study Guide was uploaded by Kayla Mathias on Thursday March 10, 2016. The Study Guide belongs to PSY 250 at Kutztown University of Pennsylvania taught by Dr. George Muugi in Spring 2016. Since its upload, it has received 124 views. For similar materials see Abnormal Psychology in Psychlogy at Kutztown University of Pennsylvania.
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Abnormal Psych Exam 2 Study Guide Chapter 4—Anxiety, Obsessive-Compulsive, and Trauma- and Stressor- Related Disorders (pg. 111-160) I. Anxiety: Common emotion that causes physical symptoms such as tension and a faster heart rate. Excessive worry is also a common symptom. Anxiety is generally caused by future events. It generally goes away after the event is over, but it can become more serious and can lead to other disorders. A. Fight-or-Flight: Body’s response to a scary situation in which either fight or flight is necessary to get out of the situation 1. Hypothalamus triggers the adrenal glands to release adrenaline which enables the body to move faster or be stronger than under normal circumstances (the sympathetic nervous system (SNS) working over-time) 2. Once the danger has passed, the parasympathetic nervous system (PNS) brings heart rate and breathing back to normal B. Elements of Anxiety 1. Physical Symptoms: Panic attacks, blushing, muscle tension, fatigue, etc. 2. Cognitive Symptoms (subjective distress): Specific ideas, impulses, thoughts, or images, worry 3. Escape or Avoidance Behavior: Provide a temporary break from the stressful situation, but that negatively reinforces behavioral avoidance. C. Normal vs. Abnormal Anxiety 1. Anxiety becomes a disorder when it causes functional impairment 2. Developmental Age: Developmental hierarchy of fear includes chronological and as well as cognitive development. Ex: it is very normal for a young child to be afraid of a monster living under their bed. As they grow older, they realize that there are no such things as monsters and their fears go away. If an adult is afraid of a monster under their bed, they might be considered abnormal 3. Sociodemographic Factors: Sex, race/ethnicity, and SES should be taken into consideration when deciding if a fear is normal or not. Women are more likely to have an anxiety disorder (sometimes 3x as likely), but men are less likely to report fears than women are. D. Anxiety Disorders: Physical, cognitive and behavioral symptoms mentioned previously. Anxiety is conveyed differently from one disorder to the next. Comorbidity (more than one disorder occurring in one person) is very common in people with anxiety disorders. 1. Panic Attacks: Generally a short period during which an individual feels intense fear about any number of things. They may experience sweating, heart palpitations, chest pain, dizziness, nausea, etc. Experiencing a panic attack does not mean a person has a panic disorder, however they may possibly be a symptom on an anxiety disorder. a. Expected Panic Attacks: Caused by a situational trigger. They may happen before an anticipated situation b. Unexpected Panic Attacks: Caused by no apparent trigger. 2. Panic Disorder: Characterized by having at least one panic attack and thinking that more might happen 3. Agoraphobia: “Fear of the marketplace” or a fear of open spaces including being outside alone, standing in line or being in a crowd, public transportation, etc. People also tend to experience embarrassing physical symptoms as well as panic symptoms. Women are more likely to suffer from panic attacks and disorders than men are. Ataque de nervios is commons in people from the Caribbean and has symptoms of screaming and becoming physically aggressive. 4. Generalized Anxiety Disorder (GAD): extreme anxiety and worry that happens more often than not for at least 6 months. The worry and anxiety can be about anything and can happen at any age, though it is more common in adults 5. Social Anxiety Disorder (Social Phobia): Fear of interacting with other people because of possible scrutiny. There are some cases in which social anxiety is only experienced in certain situations. Comorbidity is very common with social anxiety. Social anxiety can begin as early as age 8 and can last for almost 2 decades. A negative developmental trajectory causes symptoms to become worse with age. 6. Selective Mutism: Most common in children. Children consistently refuse/fail to speak in certain situations 7. Specific Phobia: Fear or anxiety about or caused by a specific situation or object that causes a disturbance in normal functioning. In order for something to be considered a phobia, it must cause substantial emotional distress and cause impairment of normal function. Phobias include animal phobias, natural environment phobias, injury phobias (people have a symptom called vasovagal syncope which includes bradycardia and hypotension), and situational phobias (ex: claustrophobia) 8. Separation Anxiety Disorder: Development of anxiety and worry if one is separated from someone that they are very emotionally attached to. Most common among preadolescent children. Children may refuse to go to school or to a friend’s house and not want to sleep in their own bed at night. There may be a connection between separation anxiety in childhood and panic disorder in adulthood II. Obsessive-Compulsive and Other Disorders A. Obsessive-Compulsive Disorder (OCD): Obsessions that are joined with compulsions which lead to a very distressful situation for the individual. The obsessions are generally recurrent and often inappropriate. Compulsions are either observable behaviors (washing one’s hands multiple times) or unobservable behaviors (mental activities). Comorbidity is very common with OCD. OCD usually begins in the late teens or early 20s. Symptoms of OCD are common in other disorders such as body dysmorphic disorder and autism. B. Body Dysmorphic Disorder (BDD) (dysmorphophobia): Fixation on supposed flaws in physical appearance that apparently make the individual ugly or deformed. “Flaws” are often blown way out of proportion. Women tend to worry more about their weight and skin while men are more likely to worry about their hair and genitals. People with BDD are at a high risk of suicide. BDD is especially harmful to adolescents C. Hoarding Disorder: Having difficulty throwing out useless junk. This results in large amounts of clutter lying around the house D. Trichotillomania (Hair Pulling Disorder): Pulling one’s hair to the point that there is noticeable hair loss. Hair may be pulled from any area of the body E. Excoriation (Skin-Picking) Disorder: Picking at one’s skin until there are skin lesions III. Trauma- and Stress-Related Disorders A. Posttraumatic Stress Disorder (PTSD): Results from a traumatic event (assault, military combat, rape, etc.). When an individual encounters a situation that is similar to the traumatic event or triggers a memory, they will have a strong physiological and psychological reaction to it. Even if a person doesn’t remember all of the details about the traumatic event, they can still be triggered by certain situations. Symptoms of PTSD include negative alterations in cognitions and mood, hyperarousal, hypervigilance, and exaggerated startle response. PTSD is something that is generally thought about in relation to the military. However, it can happen to a person at any age from a young child to an elderly grandparent. Conceptual bracket creep explains why more and more people are suffering from PTSD even though they have not directly experienced a traumatic event. Fortunately, PTSD symptoms become less severe with time. IV. Etiology of Anxiety, OCD, and Trauma- and Stressor-Related Disorders A. Biological Perspective 1. Family and Genetics: Studies show that these disorders run in families. If a parent has a disorder, they child is more likely to have it, too. Twin studies show that MZ (identical) twins are twice as likely to both have an anxiety disorder than DZ (fraternal) twins are. Heritability also plays a role in whether or not a person will have a disorder. While genetics do not decide if a person will have a disorder, they can play a role. Trait anxiety or anxiety proneness (general vulnerability factor) does appear to be inherited 2. Neuroanatomy: When someone experiences anxiety, the amygdala, hippocampus, and the limbic and paralimbic systems are more active. This implies that different portions of the brain are related to different disorders. There also appears to be a difference in brain functioning of people with anxiety disorders and those without anxiety disorders. Low levels of serotonin are common in people with anxiety disorders. Medications called selective serotonin reuptake inhibitors (SSRIs) increase levels of serotonin and help decrease levels of anxiety. GABA neurotransmitters help to inhibit postsynaptic activity. Medications that allow GABA to do that can lessen anxiety. Corticotrophin-releasing factor (CRF) causes the brain to release adrenocorticotrophic hormone (ACTH) and beta- endorphins which cause depression and anxiety 3. Temperament and Behavioral Inhibition: Occurs at a very young age and causes children to withdraw from their surroundings, not speak to strangers, or refuse to play with other children and hang on to their mothers instead. Children with behavioral inhibition are much more likely to experience social anxiety later in life. B. Psychological Perspective 1. Psychodynamic Theories of Fear Acquisition: Freud believed that generalized anxiety was the result of a conflict between the id and ego. Sexual and aggressive impulses were too overwhelming for a person’s defense mechanisms and fear and anxiety were the result. Little Hans was one of Freud’s examples of this theory, even though other theories like classical conditioning and the social learning theory can explain it. 2. Behavioral Theories of Fear Acquisition: Classical conditioning is responsible for the start of anxiety disorders in many people, but it does not explain all anxiety disorders. Vicarious learning theory and information transmission also play a role in the onset of anxiety disorders. Having a bad experience or seeing someone else have a bad experience with something can cause fear or anxiety about that situation or object (vicarious learning). If someone is told that they should be afraid of something (Ex: parent telling child that a horse will bite their hand if they don’t hold it right), they will be much more likely to develop a fear of that thing or situation (information transmission). 3. Cognitive Theories of Fear Acquisition: Anxiety disorders are a result of the misinterpretation of internal or external events. Individual with anxiety disorders process information differently than people without the disorder which causes anxiety. Aaron Beck thought that maladaptive thoughts that interpret a harmless situation in a negative way cause anxiety. The fear of fear theory states that once a person has had a panic attack, they become extremely sensitive to physical symptoms that could be those of an imminent panic attack. The anxiety sensitivity theory states that anxiety symptoms will have a negative outcome like embarrassment of illness. V. Treatment of Disorders A. Biological Treatments 1. Medication: Selective serotonin reuptake inhibitors (SSRIs) correct the imbalance of serotonin by keeping serotonin in the synapse for a longer period of time. Prozac, Luvox, and Zoloft are all SSRIs. SSRIs generally work for anxiety disorders, but not for specific phobias. Benzodiazepines (Valium and Xanax) let GABA to send out nerve signals better, reducing anxiety. If any of these medications are used for too long, the body and brain develops dependence, which is unhealthy. If a person goes off of their meds without the help of their doctor, they may experience seizures. 2. Psychosurgery: Cingulotomy and capsulotomy are both types of surgery used for OCD. MRIs are used to make these surgeries very precise. 3. Other Somatic Therapies: Transcranial magnetic stimulation (Ch. 10) and deep brain stimulation (Ch. 6) B. Psychological Treatments 1. Psychodynamic Treatment: Free association and dream interpretation. Interpersonal psychotherapy (IPT) is aimed at personal conflicts, role transitions, and grief reactions. So far, ITP has been tested on people with social anxiety disorder with good results. 2. Behavioral and Cognitive-Behavioral Treatment: Behavioral therapy and cognitive-behavioral therapy have been found to be the most effective forms of treatment for adults suffering from any of the aforementioned disorders. These treatments often use exposure to the given fear to help that individual overcome it. This can be done in vivo exposure (real life) or imaginal exposure (a mental image). Virtual reality therapy is becoming a common form of CBT. Social skills training (SST) is used with exposure to help people with social anxiety disorder. Relaxation training teaches people how to relax so that they can cope with panic attacks. CBT pairs exposure with cognitive restructuring to try and change negative cognitions. VI. Ethics and Responsibility: Critical Incident Stress Debriefing (CISD) was made to intervene soon enough after a traumatic event to help prevent PTSD. It lasts for several hours and is generally done in a group setting no later than two days after the traumatic event. However, studies have shown that CISD can actually make the situation worse. Researchers believe that CISD interferes with a person’s resilience, especially since most people that are exposed to a traumatic even do not actually develop PTSD. If a treatment will harm the patient, the therapist should not do it. Chapter 5—Somatic Symptom, Dissociative and Factitious Disorders (pg. 161-192) I. Somatic (Greek word soma, meaning body) Symptom and Related Disorders: Real pain that is experienced, but can’t be completely explained by a physician A. Somatic Symptom Disorder: A person experiences at least one somatic symptom along with abnormal thought and behaviors toward those symptoms. These people often experience depression. Common somatic symptoms include headaches, stomachaches, and back and chest pain. More dramatic symptoms involve pseudoneurological symptoms like pseudoseizures B. Conversion Disorder (Functional Neurological Symptom Disorder): Involves altered motor or sensory dysfunction. Ex: If someone is being forced to do something they don’t want to do (go into the military or make a big move) their body overcompensates and become paralyzed or blind so the unwanted situation is avoided. Some people end up having an actual medical condition rather than just conversion disorder, so care must be taken when diagnosing someone. An uncommon symptom of conversion disorder is globus, causing choking, feelings of suffocation, difficulty swallowing, etc. Sensory deficits are also a less common symptom. La belle indifference (beautiful indifference) is when people with conversion disorder don’t seemed to be bothered at all by their symptoms C. Illness Anxiety Disorder: Worrying or fearing that one will become ill, in spite of medical reassurance. People with illness anxiety disorder display some of the same rituals as people with OCD such as constantly checking with their doctor to make sure that they are not sick. Transient hypochondriasis can result from a real or life- threatening illness. People fear doing activities that might trigger the illness again, even if the activity is good for their recovery. D. Factitious Disorder: Unlike somatic symptom disorders, factitious disorders occur because the person wants to be, or at least appear to be, sick. Factitious disorder is also different from malingering (physical symptoms produced to purposely get out of something) in that the physical symptoms are not produced to avoid a situation 1. Factitious Disorder Imposed on Self: People often fake things like having a fever or chest and abdominal pain. It is common that these people to the ER when young and inexperienced personnel are working so that they get more attention. Psychological symptoms may also be made up. 2. Factitious Disorder Imposed on Another: On most occasions, a mother will fake symptoms in her child, or even cause the symptoms. E. Functional Impairment: All of the above disorders can affect how much a person can work. They often go from doctor to doctor trying to find one that will give them a diagnosis and many do not like the idea that it is a psychological problem, not a physical problem. Many children are seriously injured and even die from symptoms inflicted on them by a parent. F. Ethics and Responsibility: When children are the victim of a factitious disorder, psychologists must report it to the authorities. The child must be carefully evaluated to make sure that they do not actually have a medical condition. G. Epidemiology and Sex, Race, and Ethnicity: There is currently no epidemiological data for somatic symptom disorders. Women are more likely to have somatoform and factitious disorders, but men are more likely to go to extreme measures like having fake IDs for different hospitals. H. Developmental Factors: Most common in adults, but children do have these disorders. I. Etiology 1. Psychosocial Factors: Explanations from a psychodynamic point of view say that these disorders occur because of personality, intrapsychic conflict, and defense mechanisms. Studies show that people with somatoform disorders tend to have more negative feelings and emotions. If children’s complaints about being sick are reinforced, they are more likely to get a disorder as they grow older. 2. Treatment: Education about the interaction of physical and emotional factors and how that can cause disorders. CBT focused on the symptoms can help reduce them II. Dissociative Disorders: An interruption of normal memory, motor control, consciousness, perception, behavior, identity, body representation, and emotion functions. Types of dissociative experiences are depersonalization, derealization, amnesia, identity confusion, identity alteration. A. Dissociative Amnesia: When someone is unable to remember important information about themselves. If amnesia happens after a traumatic event, it is not considered biological, but rather psychological. Dissociative fugue sometimes goes along with dissociative amnesia and causes a person to wander about in a state of bewilderment B. Dissociative Identity Disorder (DID): Also known as multiple personality disorder and is exactly that. C. Depersonalization/Derealization Disorder: Feeling detached from one’s self and/or surroundings D. Epidemiology, Sex, Race, and Ethnicity, and Developmental Factors: Dissociative disorders might be the result of other disorders like PTSD and depression. Men and women seem to suffer from these disorders equally. Dissociative disorders generally start between the ages of 15 and 22. Dissociative disorders are almost always comorbid with another disorder E. Etiology 1. Biological Factors: Different neurological disorders (head injuries, strokes, dementia, etc.) may cause symptoms of dissociative disorders. Chronic stress is also something that causes these disorders. 2. Psychosocial Factors: Sexual abuse in childhood can cause psychopathology in adulthood, but it does not predict one specific disorder or another. Even though many people believe that there is a connection between abuse (or trauma of some kind) and DID, there is very limited evidence to prove it. Having a bad (not abusive) relationship with one’s parent is more likely to cause DID than an abusive relationship is. An iatrogenic disease is caused by when a medical treatment, diagnostic procedure, or a physician makes the patient’s condition worse. The sociocultural model states that DID is an iatrogenic disease caused by therapists. F. Ethics and Responsibility: Memories can be inaccurate, but that does not mean that accounts of abuse should be dismissed. However, abuse does not mean a person has DID. G. Treatment: Antidepressants help with derealization disorder and DID. CBT uses cognitive reconstruction to help people overcome their symptoms. Chapter 6—Bipolar and Depressive Disorders (pg. 194-232) I. Bipolar and Related Disorders A. Bipolar Disorder: Formerly known as manic-depressive disorder. Individual goes from a very low mood (depressive) to a very high mood (mania). People with rapid cycling bipolar disorder may experience 4+ severe mood disturbances all in just a year. Experiencing mania and depression at the same time results in being in a mixed state. Cyclothymic disorder fluctuates between hypomania and depressive symptoms and are not as severe as episodes with mania and major depression, but can still cause impairment. 1.Bipolar I: Mania with episodes of major depression. Sometimes manic episodes are not accompanied by depression 2. Bipolar II: Hypomania (abnormal mood elevation, but not as elevated as regular mania) and major depression alternate episodes B. Epidemiology, Sex, Race, and Ethnicity, Developmental Factors, and Comorbidity: Bipolar disorder is much less common than depression and begins around the age of 18. Sex, race/ethnicity, and SES make no difference in whether or not someone will be bipolar. In children, it is difficult to tell the difference between symptoms if bipolar disorder and other disorders like ADHD and conduct disorder. Not only in bipolar disorder comorbid with things like anxiety disorder, etc., but also with thyroid disease, heart disease, and diabetes. II. Depressive Disorders A. Major Depressive Disorder (MDD): Persistently low mood and interferes with a person’s ability to enjoy any sort of activity. MDD is generally episodic. B. Persistent Depressive Disorder (Dysthymia): A chronic state of depression that is less severe than MDD, but it is continuous (lasting 2 years or longer, in some cases). Double depression is when people with dysthymia and episodes of MDD. C. Disruptive Mood Dysregulation Disorder (DMDD): Relatively new disorder in which kids from ages 6-18 have major temper tantrums that are much worse than they should be based on the situation. Some critics fear that temper tantrums are just being classified as a mental illness. D. Premenstrual Dysphoric Disorder (PMDD): Basically just PMSing on steroids E. Major Depressive Disorder with Peripartum Onset: Depression in new mothers shortly after they give birth F. Epidemiology: MDD is the most common mental illness in this country and begins between the ages of 18-43. G. Sex, Race, and Ethnicity: Women are twice as likely to suffer from depression than men are. Financial instability, lack of education, and unemployment are common factors in women with depression. Female hormones also contribute to depression. Depression is also more common among whites. H. Developmental Factors: Beginning signs of depression can include physical symptoms such as head and stomachaches, fatigue, grades and class attendance may drop, and a variety of other things. Once children reach the age of 13, rates of girls with depression increase while boys’ rates stay the same and sometimes decrease. Neuroticism is also a factor of depression. I. Comorbidity: Medical conditions are often comorbid with depression. Anxiety and substance use disorders also occur with depression III. Suicide A. Suicidal Ideation, Suicide Attempts, and Completed Suicide: Suicidal ideation is when a person starts thinking about death and suicide. Passive suicidal ideation is when a person wishes they were dead, but does not plan suicide. Active suicidal ideation is when a person starts planning their suicide. Parasuicides involve behaviors such as cutting and overdosing on drugs that aren’t actually lethal B. Who Commits Suicide: Males are more likely to succeed at committing suicide because they use methods such as hanging or shooting themselves whereas women are more likely to try and OD. Highest rates of suicide are among Native American and white men. C. Ethics and Responsibility: Rates of suicide of young children (under 12) are slowly increasing. Parents and teachers need to keep their eyes open for warning signs and take action if they notice anything unusual. D. Risk Factors for Suicide: Family history, psychiatric illness, and biological factors E. Understanding Suicide: Psychological autopsy is used to piece together details that might uncover the reason for suicide since only 1/5-1/3 of people who commit suicide leave notes. Friends and family members are generally interviewed F. Prevention: Crisis intervention, focus on high-risk groups, societal level prevention, and preventing suicidal contagion G. Treatment after Suicide Attempts: Many people do not receive the proper psychiatric care that they need after a suicide attempt. Often, psychological treatment is needed for months and sometimes years after a suicide attempt. IV. Etiology of Bipolar and Depressive Disorders A. Biological Perspective 1. Genetics and Family Studies: Bipolar disorder seems to be heritable. Genetics can also be a factor of bipolar disorder. MDD runs in families and if a close relative has depression, you will be much more likely to have it, as well. Twin studies show a genetic component in both bipolar and major depressive disorder. Environment must also be considered a factor for depression 2. Neuroimaging Studies: These studies help researchers discover which areas of the brain are affected by what disorders 3. Environmental Factors and Life Events: Stress, grief, health issues, and other life events can cause depression and bipolar disorder. Genetic control of sensitivity to the environment is when two people react differently towards the same stressful even because of their genetics. B. Psychological Perspective 1. Psychodynamic Theory: Freud said that depression was anger, caused by the loss of something, turned inward to one’s self 2. Attachment Theory 3. Learning and Modeling: Learned helplessness 4. Cognitive Theory: Dichotomous thinking, overgeneralizing, selective thinking, catastrophizing, personalizing, and personal ineffectiveness (Thinking Errors) V. Treatment of Bipolar and Depressive Disorders A. Bipolar Disorder 1. Psychological Treatments: Cognitive behavioral therapy (CBT) and Interpersonal and social rhythm therapy (IPSRT) 2. Biological Treatments: Lithium, anticonvulsants, and electroconvulsive therapy (ECT) B. Depressive Disorders 1. Psychological Treatments: CBT, Interpersonal psychotherapy (IPT), and Behavioral activation 2. Biological Treatments: Tricyclic antidepressants (TCA) and monoamine oxidase inhibitors (MAOI) (first generation antidepressants), Selective serotonin reuptake inhibitors (SSRIs) (second generation antidepressants), Electroconvulsive therapy (ECT), therapy for seasonal affective disorder (SAD), Transcranial magnetic stimulation (TMS), and Deep brain stimulation (DBS) C. Selecting a Treatment: Type and severity of symptoms must be taken into consideration before deciding on a treatment. Chapter 7—Feeding and Eating Disorders (pg. 234-247) Note: Test questions will only go up to the binge-eating disorder section. I. Anorexia Nervosa: Major restriction in diet and excessive exercise, resulting in a large drop in body weight. People with anorexia have a huge fear of gaining any weight at all. Anorexia has two forms: restricting diet and binge- eating then purging (usually by vomiting). A symptom that often occurs with anorexia is amenorrhea, or the loss of menstruation because of low body weight (under 103 lbs.) A. Epidemiology: Most common in girls and women, but occasionally happens to boys and men. Teenaged girls are the most at-risk group for anorexia. People who have suffered from anorexia often experience depression, osteoporosis, and difficulties with childbirth later in life. B. Personality: Perfectionism, obsessionality, and neuroticism are all common traits among anorexics C. Comorbidity: Anxiety and depression go along with anorexia most commonly II. Bulimia Nervosa: Uncontrollably eating enormous amounts of food and then purging by vomiting or taking laxatives. Bulimics are usually a normal weight and even overweight. A. Epidemiology: Bulimic symptoms tend to be kept a secret from friends and family members. Bulimia is more common in women, but is also found among men. Bulimia is often thought of as a culture-bound syndrome. Because of constant vomiting, the acid from the stomach eventually erodes the teeth B. Personality: Impulsivity, perfectionism, and low self-esteem are common personality traits found in bulimics. C. Comorbidity: 80% of bulimics have some sort of other mental disorder as well as bulimia. The most common are substance use, major depression, and anxiety disorders. III. Binge-Eating Disorder (BED): Frequent episodes of binge-eating, minus the purging behavior that goes with bulimia A. Epidemiology: More common in women than men. People with BED are generally overweight or obese B. Personality: Impulsivity and addictive personality traits are common among people with BED C. Comorbidity: Mood, anxiety, and substance use disorders are commonly comorbid with BED
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