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ASU / Psychology / PSY 366 / What are culture specific disorders?

What are culture specific disorders?

What are culture specific disorders?

Description

School: Arizona State University
Department: Psychology
Course: Abnormal Psychology
Professor: Laniphier
Term: Spring 2016
Tags:
Cost: 25
Name: Abnormal Notes
Description: These notes cover first chapters and sections of Abnormal psych ranging from perspectives to disorders in DSM
Uploaded: 03/22/2016
54 Pages 36 Views 1 Unlocks
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Chapter 1 01/14/2016


What are culture specific disorders?



Abnormal behavior: behavior that is inconsistent with the  

individuals developmental, cultural, and societal norms, and creates distress or interferes with daily functioning

∙ Abnormal means “away from normal”

∙ Normal becomes statistical average and any deviation becomes  “abnormal

∙ Goodness of fit: understanding behavior within a specific context  Culture: shared behavioral patterns and lifestyles that differentiate  one group from another

∙ Culture –bound syndrome: originally described abnormal  behaviors that were specific to certain group or location  

 Dangerous Behavior:

∙ Most people with psychological disorders do not engage in  dangerous behavior


Hat disorders are similar to narcissism?



∙ Dangerous behavior alone is not enough to label abnormality ∙ Eccentricity: eccentric behavior may violate social norms but is  not always negative or harmful to others

 General Population

∙ About 47% of adults in U.S. suffer from psychological disorder at  some point in their lives

∙ Most commonly reported disorders in U.S. are anxiety and  depression  

o More than 20% of adults will suffer from depression  

o More than 14% will suffer from alcohol dependence

o More than 28% will suffer from anxiety  

 Influences We also discuss several other topics like What is the opportunity cost of one unit of good y?

∙ Personal characteristics (sex, race, ethnicity)  


Why is the supreme court so powerful?



o Women- anxiety depression

o Men- alcohol/ drug abuse

o Whites and African Americans suffer equally from most types  of disorders

o Hispanics more likely to have mood disorders than non

Hispanic whites

∙ Socioeconomic status: defined by family income, educational  achievement

o Disorders occur most frequently among those with lowest  incomes and education

o Downward drift: impairment that results from psychological disorder (inability to sleep, addiction) leads to job loss or  limited educational achievement  

o By age 16 one of three children and adolescents (36%) has  suffered from disorder

o Developmental trajectory: common symptoms of disorder  vary according to persons age We also discuss several other topics like Who translated the “a little night music,”?

 History of abnormal behavior

∙ Trephination: cutting away sections of skull, sometimes used for  treatment of abnormal behaviors

∙ Greeks believed the gods controlled abnormal behavior o Hippocrates:  

 Produced diagnostic classification system and model to  explain abnormal behavior

 Believed that abnormal behaviors resulted from  

environmental, and physical factors that created  

imbalance in four bodily humors (yellow bile, black bile,

blood, phlegm)

∙ In medieval Europe demons were source of all evil

∙ Emotional contagion: defined by automatic mimicry of  expressions of one person by another  

o This caused mass hysteria

∙ Johann Weyer: first to specialize in treatment of mental illness o Asylums, madhouses, extreme practices

∙ Philippe Pinel and Quaker William Tuke: changed approach to  treatment  Don't forget about the age old question of What is the descent with modification?

Memoir on Madness

Moral treatment: kindness and occupation

∙ Dorthea Dix: poor treatment of ill to public attention

 Psychoanalysis

∙ A theory that attempts to explain both normal and abnormal  behavior

o Sigmund Freud:

 Believed roots of abnormal behavior were established  

in first 5 years

o Psychoanalytic Theory:

 Structure of the mind  

 Id: basic instinctual drives, source of psychic  

energy (libido) always unconscious  

 Ego: develops when id comes into contact with  

reality, conscious and unconscious components

 Superego: imposes moral restraint on Id’s  

impulses, partly conscious partly unconscious  

 Stages of psychosocial development  

 Oral phase: sucking chewing (1-1.5)

 Anal phase: toilet training (1.5-3)

 Phallic stage: psychosexual energy on genital  

area (3-5)

 Latency phase: disinterested in opposite sex

 Genital phase: mature stage

o Psychoanalytic therapy

 Free association: tells analyst everything in mind, from  sitting in front of analyst  We also discuss several other topics like Who is matthew arnold?
We also discuss several other topics like How is hypoxanthine formed?

 Dream analysis: recount dreams  

 Insight: brining troubling material to consciousness

 Interpretation: analyst opinions

 Lengthy

 Not well funded

 Low validity and reliability

∙ Edible complex/Electra complex

∙ Does not work well for children  

 Behaviorism

∙ Based on principles that consider all behavior to be learned as  result of experiences or interactions with environment  

∙ Ivan Pavlov

o Classical conditioning

 ucs, cs, ucr,cr

∙ John B Watson

o Little albert  

∙ Operant conditioning  

o punishment  

o Reinforcement: going to increase behavior  

 Positive: giving something for purpose of rewarding  We also discuss several other topics like What human body parts can regenerate?

action

 Negative: removal of something unpleasant (seatbelt  alarm)

∙ Skinner: operant conditioning

∙ Albert Bandura: vicarious conditioning (observational learning) ∙ Fix conditions

Biological Models

∙ Biological model assumes that abnormal behavior results from  biological process of the body particularly in brain

∙ Brain scans, neuroscience

∙ Behavioral genetics

o Sir Francis Galton, Hereditary Genus

∙ Fix with a pill

 Psychological Models

∙ Emphasizes how environmental factors such as family and cultural  factors may influence the development and maintenance of  abnormal behavior

 Cognitive Model

∙ Abnormal behavior is result of distorted cognitive processes, not  internal forces or external events

∙ Individuals world view

 Humanistic Model

∙ Based on phenomenology

∙ Believe that people are basically good and are motivated to self actualize, abnormal behaviors occur when there is a failure in self actualization

∙ Carl Rogers: client therapy

 Must show empathy to the client

Genuineness/congruence  

Unconditional positive regard (therapist has respect for  

client as a human being)

 Ideal self

 Actual self

 When they overlap have greatest mental health

 When they are far apart psychopathology occurs

 Sociocultural Models

∙ Abnormal behavior must be understood within the context of social and cultural forces such as gender roles, social class, and  interpersonal resources

 Biopsychosocial Model  

∙ Acknowledges that many different factors contribute to  development of abnormal behavior  

o Biological

 Genes, hormones, sex, sns/pns (fight or flight), neuro-

(chemistry,anatomy,functioning), age, race

o Psychological

 Behaviors, emotions, cognitions

o Social

 gender

 ethnicity

 socioeconomic status

 interpersonal relationships

∙ Diathesis-stress model: begins with assumption that psychological  disorders may have a biological basis

o Predisposition outcome toward specific pathology

o Must have stress in mode for pathology to present itself o More similar to multifinality  

∙ Transactional, systemic, integrated model

 Equifinality: all pathways lead to same outcome

 Multifinality: same starting point can lead to multiple end points ∙ Risk factors: increase likelihood of psychopathology

Resilience factors: in face of risk they protect a person from  psychopathology

Psychopathology: a behavior, emotion or cognition that is deviant  from [gender, sex, culture, age, developmental, societal, cohort] in terms of  its [frequency, intensity or duration] that causes distress to self or others  and/or impairment in some important area of functioning [social,  occupation, education]

∙ Behavior:

∙ Age: chronological vs. developmental

∙ Cohort: cultural generation gap

Considering Abnormality

∙ Categorical: you meet all criteria in order to be diagnosed with  psychopathology

∙ Dimensional: we all have levels of intensity for certain pathologies o

Abnormal:

∙ Different

∙ Deviant: statistically deviant from the norm on low end ∙ Dangerous: with intent of harming self or other, involuntary  hospitalization  

∙ Dysfunctional: inability to function within society

Primary: is the disorder in itself

Secondary: comes as result of some other thing

*Categorical perspective from DSM

Transactional: each and every aspect of model impacts all other  aspects of the model

∙ Cognition: I have a snake phobia

∙ Emotion: my thought might lead to emotional reaction of fear or  anxiety

∙ Behavior: which could both lead to my behavior of avoidance  5 models:

 Diathesis-stress model: begins with assumption that psychological  disorders may have a biological basis

∙ Predisposition outcome toward specific pathology

∙ Must have stress in mode for pathology to present itself ∙ More similar to multifinality  

Equifinality: all pathways lead to same outcome

 Multifinality: same starting point can lead to multiple end points ∙ Risk factors: increase likelihood of psychopathology

∙ Resilience factors: in face of risk they protect a person from  psychopathology

Linear model

X---------- Y

Third variable models

∙ Moderating model

o Third variable changes relationship between other variables ∙ Mediating model

o Responsible for relationship between other two variables Ex: Moderating

X- female child Y- quality of father daughter relationship

Third Variable:

∙ Fathers accessibility  

∙ Family

∙ Daughters age

Ex: Mediating

X- age Y- quality of driving skills

Third Variable:

∙ experience

Translational research: scientific approach that focuses on  communication between basic science and applied clinical research ∙ “the bench”- study disease at molecular or cellular level ∙ “bedside” clinical level

*goal of most research is to publish and use data for new hypotheses  and understanding

*individual and group level, where most scientific injury happens in  abnormal psych

Ethics:

∙ Research must be conducted following “Belmont Report” ethics o Respect for persons

o Beneficence, must secure persons well-being, protect from  harm

o Justice, fairness in distribution

o Institutional Review Board (IRB) must approve all research  conducted on humans

Cellular Research:

∙ Human nervous system

o Central nervous system

 Brain/spinal cord

 Neuron

∙ Soma-cell body, soma contains nucleus

∙ Dendrites- extend from soma like fingers

∙ Axon-fiber transferring information

∙ Axon terminal-form synapses, points of  

communication

 Brain stem-oldest part of brain, controls  

biological function associated with living  

(breathing)

∙ Hindbrain

o base of stem, consists of medulla,  

pons and cerebellum. These regulate  

breathing, heartbeat, motor controls

 Cerebellum lesion- leads to  

disorders of fine movement,  

balance and motor learning

∙ Midbrain

o Coordinating center that brings  

sensory information together with  

movement  

o Reticular activating system, regulates

sleep and arousal

∙ Thalamus

o Brains relay station, directs nerve  

signals to cortex

∙ Hypothalamus

o Homeostasis, regulate blood  

pressure, body temp, body weight

∙ Forebrain

o Limbic system: deals with emotions  

and impulses (aggression, sex,  

appetite)

 Amygdala

 Cingulate gyrus  

 Hippocampus

 Memory formation  

(Alzheimer’s)

o Basal ganglia: base of forebrain,  

inhibits movement

 Parkinson’s (rigidity tremor)

 Bradykinesia (slow movement)

 Huntington’s disease  

o Cerebral cortex

 Largest part of forebrain,  

divided into two hemispheres- 4

lobes

 Left: language, cognitive  

functions, process linear  

and logical manner

 Right: spatial context,  

creativity, imagery,  

intuition

 Temporal: auditory/visual

 Parietal: sensory  

information, visuospatial

 Occipital: back of skull,  

center of visual  

processing  

 Frontal: impulse control,  

judgment, language,  

memory, motor function,  

problem solving,  

sexual/social behavior

 Corpus callosum:  

connects two hemispheres

 Reasoning, abstract thought,  

perception of time, creativity

o Peripheral nervous system

 Sensory-somatic NS: cranial nerves, control sensation  and muscle movement  

 Autonomic NS:  

 Sympathetic NS: involuntary movement, activate  body for readiness (stimulates heartbeat, blood  

pressure, dilates pupils, arousal)

 Parasympathetic NS: returns body functions to  resting levels

 Endocrine system:

 Uses hormones to regulate body functions

 Pituitary gland, adrenal, thyroid hormones,  

pancreas  

o Genes:

 Human Genome Project

 Gregor Mendel

 Law of Segregation: individual receives one of  

two elements from each parent

 Law of independent assortment: states that  

alleles (variations) of one genes assort  

independently from the alleles of other genes

 Behavioral Genetics: study of relationship between  genetics and environment in determining individual  

differences in behavior

 Family, twin and adoption studies

 Molecular genetics:

∙ Genome wide linkage analyses

o Researchers narrow search for genes  

from entire genome to specific areas  

on specific chromosomes

∙ Candidate gene association

o Compare specific genes in a large  

group of individuals who have specific

trait or disorder with well-matched  

group who do not have trait or  

disorder

o One or few genes studied at a time

o Cases: people with disorder

o Control: people without

∙ Genomewie association studies

o Uses large sample of cases and well

matched controls, unlike candidate  

studies thousands are tested for same

study

 Epigenetics: focuses on heritable changes in  

expression of genes not caused by changes in  

actual DNA but by environment

Individual Level:

∙ Case study  

o Detailed narrative of abnormal behavior and its treatment o Sometimes quantitative measurements

o Does not allow conclusions on cause of behavior

o Nothing is manipulated by observer

o Pros:

 Generate hypotheses for group studies

 Allow participants involved in research

 Illustrate important clinical issues that are not  

apparent in group based report

o Cons:

 Not causes of behavior because no control groups o Single-case designs:

 One individual

 Test for causality  

 ABAB

 Unethical at times to remover treatment

 Look at multiple behaviors or context

Group Level:  

∙ Correlational methods

o Correlation is not causation  

∙ Controlled group designs

o Analogue sample: people who have characteristics of interest and resemble treatment seeking populations not clinical  services

o Clinical sample: people seeking services for specific problem ∙ Statistical significance: mathematical probability that after  treatment, changes that occurred in the treatment group didn’t  occur by chance (quantitative)

o .05-.01  

∙ Clinical significance: whether significant finding have practical or  clinical value (qualitative)

∙ Cross-sectional design:

o Snapshot in time

o Assessed once for specific variable under investigation o Cause and effect rarely determined

∙ Longitudinal design:

o Takes place over time

o Includes at least two or more measurement periods with  same individual

Population Level:

∙ Epidemiology (broadest level)

o Disease patterns in human populations and factors that  influence

o Occurrence of psychological disorder by time, place, persons o Prevalence: total number of cases of a disorder in given  population at designated time

 Point prevalence: number of individuals at specified  point in time

 Lifetime prevalence: number of individuals in  

population known to have particular disorder some  

point in life

 Incidence- number of new case  

o Observational epidemiology

o Experimental epidemiology: manipulates exposure to either  causal or preventative factors

Nature vs. Nurture

∙ Nature-BIO

∙ Nurture- Social

∙ Monozygotic-identical

∙ Dizygotic- fraternal

Polygenetic foundation:

∙ Most pathologies

∙ More than one gene

Anxiety disorder:

∙ Physical stimulation- SNS/PNS

∙ Future oriented thoughts

o Scared/fearful-present oriented

∙ Behavioral escape/avoidance

**Features that create pathology may not be same factors that  maintain pathology

Clinical assessment: series of steps designed to gather data about a  person and his environment in order to make decisions about the nature,  status and treatment of psychological problems

∙ Always begins with set of referral questions in response (from  patient or someone close)

∙ After completed psychologist develops answers to the preliminary  questions and tells family and patient of his findings  

∙ Screenings: can help identify people who may be unaware of their problems or reluctant to mention them, and for those who need  further evaluation

o Identify potential psychological problems or predict the risk  of future problems if someone is not referred for further  

assessment or treatment

o Sensitivity: describes the ability of the screener to identify a  problem that actually exists  

o Specificity: indicates percent of time that the screener  actually accurately identifies the absence of the problem  

o False positives: occur when screening instrument indicates a  problem where no problem exists  

o False negatives: instances where the screening tool suggests  that there is no depression when the patient is actually  

depressed  

∙ Diagnosis: refers to identification of an illness

o Differential diagnosis: when they attempt to determine which diagnosis clearly describes patients symptoms

o Diagnostic assessments are more extensive then screens  provide more thorough understanding

o Etiology

o Select most beneficial treatment for patient

∙ Can be repeated at regular intervals during treatment to monitor  progress

 Functional analysis of symptoms:

∙ Behavioral psych

∙ Identifies relations between situations and behaviors (what  happens before during and after certain problem behaviors, moods, or thoughts)

 Outcome evaluation:

∙ Same measures must be consistently measured over course of  treatment

∙ To evaluate whether effective both degree of change and patients  level of functioning must be assessed

o Degree: how much patients symptoms have been reduced   Reliable change index: frequently used  

 Assessment  

∙ Standardization:

o Normative: require comparing a persons score with the  scores of a sample of people who are representative of entire  population

 Standard deviation: measure tells us how far away from the mean(average) a particular score is.  

o Self-referent comparison: equate responses on various  instruments with patient’s own prior performance, used to  examine course of symptoms over time, treatment outcome.

∙ Reliability: instruments consistency or how well produces same  result each time  

o Test-retest: consistency of scores across time

o Interpreter agreement: measures that depend on clinician  judgment  

o Validity: degree to which a test measures what it is intended  to measure

 Internal Validity: measure how strongly we can believe  our findings from our study are accurate

 Reduced as confounds are introduced

 External Validity: how far and to which populations we  can apply the findings of our study

 Generalization

 Construct validity: reflects how well a measure  

accurately assesses particular concept  

 Criterion validity: assesses how well measure  

correlates with other measures that assess same or  

similar constructs

 Concurrent: assesses the relationship between  

two measures that are given at same time

 Predictive validity: ability of a measure to predict  

performance for future date

 Clinical prediction: relies on clinicians judgment  

 Statistical prediction: results when clinician uses  

data from large groups of people to make a  

judgment about specific individual  

∙ Used in practice of evidence-based  

medicine  

 *many factors affect clinician’s choice of assessment, but most  important factors are patient’s age and developmental status  *cultural-fair assessments

*psychologist must adhere to American Psychological Association  code of ethics

∙ psychologist must only use test for which they have received  training

∙ informed consent

 Assessment Instruments

∙ Goals of assessment  

o Self-report measures: patients evaluate own symptoms o Clinician-rated measures: clinician rates symptoms

o Subjective responses: what patients perceive  

o Objective responses: what can be observed

o Structured: same set of questions per patient

o Unstructured: questions vary across patients  

o Test battery: when number of tests are given together  ∙ Clinical interviews:  

o Consist of conversation between and interviewer and patient, purpose to gather information and make judgments related  to assessment goals

o Unstructured interviews: clinician decides what questions to  ask and how

 Benefit of flexibility

 Limitation is potential unreliability  

 Increase rapport

o Structured interview: same questions per patient

 Semi-structured interview: after standard question  

clinician uses less structured supplemental questions to

gather more info

 Used in Scientifically based clinical practice and  

research

 Increase reliability

 Less flexibility  

Psychological tests:

∙ Personality: measures personality characteristics

o Depends on whether one is assessing a healthy population or  clinical sample

o Minnesota Multiphasic Personality Inventory:  

 1943, Hathaway/McKinley  

 pencil-and-paper test

 empirical keying: developed statistical analyses to  identify items and patterns of scores that differentiated various groups (only differentiated items were  

retained)

o MMPI:

 Includes statistical scales to evaluate number of test  taking behaviors

 Lie scale: identifies people who many not wish to  

describe themselves accurately  

 MMPI-2: has 567 items and 9 validity scales and ten  clinical subscales

 Concerns with ethnic minority samples

 objective

o Million Clinical Multiaxial Inventory:

 175 item true-false inventory  

 8 personality styles

 schizoid, avoidant, dependent, histrionic,  

narcissistic, antisocial, compulsive, passive

aggressive

 3 pathological personality syndromes

 schizotypal, borderline, paranoid

 9 symptom disorders scales

 anxiety, somatoform, hypomanic, dysthymia,  

alcohol abuse, drug abuse, psychotic thinking,  

psychotic depression, psychotic delusions

 adequate reliability and validity  

∙ Projective tests:  

o Low reliability- general interpretations

o Low validity  

o Good for developing repor (open up)

 Rorschach inkblot test:

 Comprehensive system: breaks inkblot tests into  complex matrix of variables that are interpreted  and scored

 Subjective

 Exner scoring system

 general

 Thematic apperception test:

 31 cards only 20 are used based on patients age  and sex

 asked to make up story about images on cards  subjective test

 specific, no scoring system

 CAT- for children, uses animals in situations

 Sentence Competence Theory

 Must complete sentence stem  

 Draw a Person

 Projective measure

o General tests of psychological functioning

 Global Assessment Functioning Scale (GAF):

 Rating assigned by clinician stating patients  

overall well being (0-100)

 Captures symptom severity and level of  

impairment  

 General Health Questionnaire:

 Gives snapshot of mental health status over  

previous weeks and can provide meaningful  

change score

 4 point scale, degree of deviation from individuals usual experience

o Neuropsychological testing:

 Tests detect impairment in cognitive functioning using  simple and complex tasks to measure language,  

memory, attention, concentration, motor skills,  

perception, abstraction, and learning abilities

 Halstead-Reitan Neuropsychological Battery:

 Evaluate presence of brain damage

 Wisconsin Card Sorting Test:

 Set shifting: ability to think flexibility as the goal  of the task changes

 Frontal lobe test

 Useful for schizophrenia, brain injuries,  

neurodegenerative diseases (Parkinson’s)

 Bender visual Motor Gestalt:

 Detect problems in visual-motor development in  children and general brain damage and  

neurological impairment

 Luria-Nebraska Neuropsychological Battery:

 Similar to Halstead-Reitan but more precise  

measure of organic brain damage

 Uses unstructured qualitative method, generating 14 scores

o Intelligence Test:

 Wechsler Adult Intelligence test

 Most commonly used

 Four index scores

∙ Verbal comprehension index (VCI)

∙ Working memory index (WMI)

∙ Perceptual reasoning index (PRI)

∙ Processing speed index (PSI)

∙ Combination of scores = IQ

 Do not and cannot reflect all types of intelligence  o Test for specific symptoms

 Brief Psychiatric Rating Scale

 Clinician-administered scale assesses many  

different psychological symptoms

 Beck Depression Inventory-II

 Depressive symptoms

 21 questionnaire  

 Beck Anxiety Inventory

 Anxiety symptoms

 21 questionnaire

 Behavioral Assessment:

∙ Functional analyses:  

o Ultimate goal of behavioral assessment  

o Clinician attempts to identify casual links between problem  behaviors and contextual variables  

∙ Begins with interview

∙ Self-monitoring: patient observes and records behavior as its  happening

∙ Behavioral observation: someone other than patient observes  behavior

∙ Event recording: monitoring each episode of identified behavior ∙ Behavioral avoidance test: asses phobias by asking patient to  approach feared situation

Psychophysiological Assessment:

∙ Measures brain structure, function and nervous system activity  ∙ EEG:  

o least invasive

o only measure that directly assesses electrical activity in brain o cannot determine functioning in specific brain region

∙ biofeedback: use of electronic devices to help people learn to  control body functions outside of conscious awareness.

Diagnosis

∙ DSM system of classification is most common in U.S.

∙ International Classification of Diseases (ICD) used in Europe and  other places

∙ Developmental, demographic, and cultural variables affect nature  and experience of abnormal behavior

Comorbidity

∙ True presence of more than one pathology (disorder) in a person at the same time

∙ Very high rate

Collateral contacts: getting patient to allow doctor to talk to another  person to gather more information on patient

Mental status exam:  

∙ Gross motor/ Fine motor

∙ Mentally stable (confident, calm)

∙ Memory

∙ Speech  

o Rhythm, rate, fluency

∙ Language

o Receptive (understanding)

o Expressive (Content, grammar)

∙ Mood  

o Affect: how you feel in moment (temperature)

∙ Attention/ concentration

∙ Auditory/visual hallucinations

∙ Insight/judgment

∙ Cognitive ability

∙ Hygiene  

∙ Orientation (person,place,time)

FAB: Functional Analyses of Behavior

∙ Antecedent (what comes before/triggers behavior)

∙ Behavior  

∙ Consequence  

FID: frequency, intensity, duration

SRI: self-report inventory

IQ test: measure cognitive ability

∙ Present intelligence  

AA: Academic Achievement test: neuro-psych assessment  ∙ Past oriented construct

∙ Relationship between brain and behavior

o Attention

o Concentration

o Memory  

o Visual special abilities  

o Fine motor skills

Error of omission: failure to do it

Error of commission: failed to do it correctly  

Control groups:

∙ Placebo

∙ Waitlist  

∙ Treatment as usual

 Quiz one:

Book suggests abnormal behavior include emotional distress and  functional impairment

Antecedent behavior consequence: functional analysis of behavior Prevalence/incidence

Clinical significance-Meaningful improvements for functional  impairment

Diathesis- Presence of predisposition to a disease

Emotions:

∙ Physiological response

∙ Cognitive symptoms or subjective distress

o Ex: specific thoughts, ideas, images or impulses, worry ∙ Avoidance or escape  

o Ex: overdoing (over sanitizing), avoiding stimulant  

o Offer temporary relief  

o Negative reinforcement  

Anxiety: common emotion characterized by physical symptoms (faster  heartbeat, tension) and thoughts or worries that something bad will happen  ∙ Future oriented response (new situation, anticipate life-changing  event)

∙ Body and mind affected by experience

∙ Anxiety disorders more common among females ( 3 to 1)  ( cultural/gender)

∙ Develop early in life, avg. age of 11

∙ Equal frequency across (Hispanics, non-Hispanic blacks, non Hispanic whites)

∙ Amygdala and insula  

∙ Serotonin: regulates mood, thoughts, behavior,  

o Selective serotonin reuptake inhibitors: increase serotonin in  neural synapses

∙ Prefrontal cortex and caudate nucleus convert sensations into  thoughts and actions

o Panic

 Panic attack: abrupt surge of intense fear or discomfort reaching a peak in minutes along with four or more  physical symptoms

 Expected: response to situational cue or trigger,  or anticipation to feared situation

 Out of the Blue: unexpected, false alarm

 Panic disorder: had at least one panic attack and  worries for more

 Ataque de Nervios; cultural variant of panic  

disorder , Latino  

 Agoraphobia: fear of marketplace, exposure to  situations including

 Public transportation

 Open spaces

 Enclosed spaces  

 Standing in line/being in crowd

 Outside the home alone

 Many develop after they develop panic disorder  Sever persistent

o Generalized Anxiety  

 Excessive anxiety and worry for at least six months  Low levels of SNS arousal  

 more common in adults, starts late teens/twenties  more common in minorities  

o Social Anxiety (social phobia)

 Fear of situations that may involve scrutiny from others  Speaking, eating, drinking, writing in presence of  others

 Performance only specified  

 Detected as early as age 8, avg. 11/13

 Chronic

 Both sexes affected equally

 Taijin kyofusho- Asian variant, young men

o Selective Mutism

 Most common in children  

 Failure to speak in specific social situations  

o Specific fear

 Anxiety about specific object or situation leading to  disruption in daily activities  

 Fear of some aspect of situation itself

 Phobia should be applied when  

 Significant emotional distress (even if able to  

engage)

 Functional impairment  

 Develop common during childhood (7)

 Blood injection Injury

 Rather than SNS being activated  

Parasympathetic NS dominates response

 Fear of needles, blood, physical injury  

 Vasovagal syncope: bradycardia (slow heart rate)  

hypotension (low blood pressure)

o Separation Anxiety

 Primarily preadolescent children  

Obsessive Compulsive (OCD)

∙ Obsessions (recurrent, persistent, intrusive thoughts) ∙ Compulsions (repetitive behavior)  

o Negative reinforcement  

∙ Extensive, time consuming, stressful

∙ Chronic

∙ More common in boys (children), men and women are equal  (adults)

Body Dysmorphic Disorder  

∙ Sometimes can cause delusions, lead to sucicide  

∙ Adolescents

Hoarding  

∙ Difficulty discarding or parting with obsessions, regardless of value Trichotillomania

∙ Hair pulling out

Excoriation

∙ Skin picking  

∙ Diagnosed when cannot stop

PTSD

∙ Begins with traumatic event

∙ Intrusion: re-experiencing through memories

∙ Negative alterations in cognitions and mood: inability to feel  emotions

∙ Can happen anytime after an event with actual or threatened death ∙ Causes distress, behavioral avoidance

∙ Can re-experience through nightmares, flashback (wakefulness) ∙ Children re-experience through play

∙ Hypervigilence (constantly on guard)

*In children fears exist along developmental hierarchy.  Nervous System

∙ Central Nervous System: brain, spinal cord

∙ Peripheral Nervous System: all other nerves

o Sympathetic: activated by stress or fear

 Fight or Flight

 General discharge of Sympathetic Nervous  

System

 You recognize threatening situation,  

Hypothalamus sends message to Adrenal Glands  

to release Adrenaline.  

o Parasympathetic : returns body to resting state

Temperament/ Behavioral Inhibitions

∙ Jerome Kagan

o Behavioral inhibition- later leads to disorder, 20% children Psychodynamic theories

∙ Freud: free-floating (generalized anxiety) resulted from conflict  with id and the ego , result from sexual or aggressive impulses ∙ Conditioning theory

o fear acquisition

 All approaches assume that anxiety disorders result  from inaccurate interpretations of internal or external  events (people process info differently)

o Fear of fear model

 After the first panic attack person becomes sensitive  and interprets any bodily change as an attack

o Anxiety sensitivity: belief that anxiety symptoms will result  in negative consequences

 Vicarious learning: observing

 Information transmission: person instructs that a  situation or object should be feared

Psychosurgery:

∙ Cingulotomy: OCD, inserting propes in top of skull called  cingulated bundle

∙ Capsulotomy: gamma knife surgery (radiation treatment), lesions  in brain tissue

Psychological treatments

∙ Free association/dream interpretation

Behavioral and Cognitive Behavioral treatment  

∙ Psychosocial treatments of choice for anxiety disorders ∙ Combines exposure with cognitive restructuring in attempt to  change negatives

∙ Does not enhance efficacy

∙ Exposure: facing the fear

o In vivo exposure: real life experiences

o Imaginal: instructing person to imagine feared event o Social skills training: group setting paired with exposure o Relaxation training: GAD, decrease physical arousal o Biofeedback: combines monitoring physical behaviors (blood  pressure, rate) with relaxation training

Treatment:

∙ Biological perspective

o Selective serotonin reuptake inhibitors

 Decreasing anxiety

 Primary go to medication

 Prozac, Zoloft

o Benzos  

 Acute onsets of anxiety

∙ Psychological perspective

o Interpersonal therapy

 Helps manage role transition, social conflicts, or  

anything interpersonally based that causes anxiety for  individual

 Not social intervention, it’s a cognitive intervention o Behavioral/cognitive intervention

 Most successful interventions for anxiety disorder

 Exposure plus response prevention (response is  

behavioral avoidance, activation SNS, compulsion)

 Imagination, virtual reality, flooding

 Guided imagery all senses

∙ Social perspective  

Abnormal Behavior Definition

Biopsychosocial model  

∙ Systemic

∙ Transactional

∙ Integrative  

∙ Able to compare model to others

Behavioral:

∙ Classical conditioning: UCS, CR, CS

o UCS(unconditioned stimulus) produces

o UCR (unconditioned response)

o CS (conditioned stimulus), neutral, does not produce UCR o UCS is repeatedly paired with CS resulting in UCR o After multiple pairings CS alones is capable of eliciting CR  (conditioned response)

∙ operant conditioning: what comes after behavior

o primary reinforcer: food, water, attention

o secondary reinforcer: acquired value b/c they are associated  with primary (money)

Cognitive:

∙ Proposes abnormal behavior is result of distorted mental  processes, not internal forces or external events, way we think and  perceive affects emotions and behaviors

o generalizing

o maladaptive cognition (uni-directional)

Psychoanalytic  

∙ Freudian  

∙ Focuses on understanding past experiences

Biological  

∙ Psychiatrist  

Humanistic

∙ Based on phenomenology: ones subjective perception of the world  is more important than actual world, people are good and self actualize

o Carl Rogers, therapist factors

 Genuineness: therapist relates to person in open honest way

 Unconditional positive regard

 Empathy

 Client-centered therapy

o Gestalt

Multifinality/ equifinality  

Diathesis stress model- psychological disorders may have biological  basis

∙ similar/different to multi and equifinality  

Resilience protect from psychopathology in face of risk

Risk factors increase likelihood of pathology

Mediating: responsible for apparent relationship

Moderating: changes relationship  

Diagnosis

∙ Categorical perspectives

∙ Dimensional perspective

∙ Process of assessment

o Referral question

o Ends with diagnosis

o Always looking for cause (etiology) of disorder o Factors that determine treatment

o Assessment methods

Biopsychosocial

∙ Referral to general practitioner

∙ Neuro imaging

∙ Mental status exam****

∙ Clinical interview (3 levels)

o Reliability

 Intereliability: similarity between two practitioner  Test retest: how overtime  

 Validity: (p.81)

 Accurate

∙ Self report, IQ test, test of academic achievement  ∙ Self monitoring

∙ Neuro psych measures- relationship of brain and behavior ∙ Personality measures

o Objective : MMPI, NEO (no interpretation)

o OCEAN factors

 Subjective: Rosharch, thematic test, sentence  completion, CAT,

 Functional Analysis of Behavior (method)

Behavioral observation

∙ Naturalistic

∙ Experimental  

Comorbidity  

∙ What is one reason may occur?

o There is a large gap between the time mental disorder begins and time they seek treatment

o DSM has increased in size  

False positive: instrument indicates disorder when there is none False negatives: instances in which screening tool suggests there is no disorder when there is

Prevalence/incidence  

Research methods:

∙ Case study

o One person

o High on neither internal or external validity

∙ Twin study

o Dizygotic/monozygotic  

o Trying to identify what is genetic and what is environment  ∙ Multi-case design  

o Baseline, assess behavior  

o Apply intervention

o Remove intervention

o Reapply  

∙ Correlation does not equal causation

Random assignment:

∙ Analogue sample: people who have characteristics of interest and  resemble treatment seeking populations but not seeking clinical  service

∙ Clinical sample: people seeking services for specific problem Independent variable: experimenter controls

Dependent variable: one you measure  

Confound: threat to internal validity  

∙ Internal validity: extent to which study design allows conclusions  that the intervention caused changes in the outcome

∙ External validity: generalize findings to situations and people  outside experimental setting

∙ Efficacy research attempts to maximize internal validity Blind and double blind:

∙ Blind: patient

∙ Double blind: patient and researcher, to remove bias

Statistical significance: mathematical probability that after treatment, changes that occurred in treatment were due to treatment Clinical significance: whether significant findings have practical or  clinical value (whether patients functioning is improved as result of  treatment and whether there are still any symptoms of disorder) Levels of intervention

∙ Longitudinal: takes place over time, same individuals at different  times

∙ Cross-sectional: snap shot in time, assessed once for specific  variable

Anxiety:

∙ All arousals of symptoms

∙ Three pillars

No ancient theories

No dates

No names

Guide four questions:

∙ Risk

∙ Benefits

∙ Confidential

∙ Opinion (will they judge me?)

Obsession:

∙ Repetitive, unwanted, intrusive, and often egodistonic  ∙ Thought, unobservable

∙ Causes anxiety

Dissociative Disorders

∙ Disruption in the usually integrated functions of consciousness,  memory, identity, emotion, perception, body representation, motor  control and behavior

∙ Steinberg

o Depersonalization: detachment from ones body

o De-realization: feeling of unfamiliarity or unreality about  ones physical or interpersonal environment

o Amnesia: inability to remember personal information o Identity confusion: unclear about ones personal identity o Identity alteration: assuming an alternate identity

∙ Dissociative amnesia: inability to recall important information of  personal nature

o When occurring after stressful/traumatic event it is  psychological not biological

 Localized amnesia: failure to recall events that occur  during certain time

 Generalized amnesia: total inability to recall ones

life

 Selective amnesia: forgot some elements of traumatic  experience

o Reversible

o Can be accompanied by dissociate fugue: purposeful travel or bewildered wandering associated with identity amnesia  Fugue means flight

∙ Dissociative Identity Disorder

o Do not recognize alters before therapy

o Psychological factors:

 Failure of normal development process of personality  integration

o Sociocultural model states DID is iatrogenic disorder  developing from cues from media and therapists and  personal experiences/observations

∙ Depersonalization/derealization disorder

o Periods of dissociation are frequent and severe

Somatic (of the body) symptom and related disorders: ∙ Somatic symptom disorder

o Person must have physical symptoms that are medical  conditions

o No medical conformation  

o Symptoms will distress and disrupt life

o Excessive thoughts feelings or actions related to physical  symptoms  

o Symptoms for min 6 months, but not same single symptom  present needed

∙ Illness anxiety disorder

o Having or acquiring a serious illness

o Does not need to have any physical symptoms, or if so mild o Hypervigilance about health and well being  

o Lots of health checking behaviors

o Fear of illness, doctors, hospital

∙ Conversion disorder

o Functional neurological symptom disorder

o All symptoms are neurologically based ( motor or sensory  domains)

o Pseudo- fake/false

o Symptoms do not match medical results

***first three, person does not intentionally produce the symptoms ∙ Factitious disorder

o Deliberately create physical symptoms in themselves or  others to assume sick role and receive reinforcement  

o Imposed on self- intentionally producing symptoms in self o Imposed on another-intentionally producing symptoms on  others

 Punishable by law

 Mother on daughter most common

∙ Malingering:

o Symptoms intentionally produced

o People who malinger do so for purpose of compensation or to avoid negative event

How is illness anxiety disorder different from specific phobia? ∙ Somatic has more intense physical symptoms

∙ SSD more use of medical personnel  

∙ IID less concerned with symptoms then what symptoms mean ∙

Health Psychology: uses principles and methods of psychology to  understand how attitudes and behaviors influence health and illness Health psychologist: study how people develop positive and negative  health habits, how stress and health are related, and which psychological  variables affect the onset and treatment of medical illness Health: state of mental, social and physical well-being, not just in the  absence of illness

Behavioral medicine: interdisciplinary field (not just psych) that  studies the relation between behavioral and biomedical science and medical psychology.

∙ Medical psychology: study and practice of psychology as it relates  to health, illness and medical treatment.

Biopsychosocial model: suggests that complex interactions among  biological, psychological, and social factors determine health.  ∙ In contrast to biomedical model, which explains illness soley as  biological process

Mind-body dualism: René Descartes, mind and body may interact but  function independently  

Freud: linked mind and body to explain hysteria (conversion disorder) ∙ Hysteria: condition he believed that unconscious psychological  conflicts caused unexplained physical complaints (physical  weakness, paralysis)

∙ Psychological and social variables influence the treatment of  medical disease, especially chronic medical illness (diabetes and  hypertension which develop slowly and persist for a lifetime)  o Doctor-patient relationship

o Expectations for treatment outcomes

o Psychological coping and adjustment

Stress: any negative emotional experience that is accompanied by  biochemical, physiological, cognitive and behavioral responses that attempt  to change or adjust to the stressor.

∙ Stressor: any event that produces tension or another negative  emotion such as fear, that prepares organism for “fight or flight” o Physical (medical disease, injury)

o Environmental (natural disaster)

o Interpersonal-social (breakup, conflict between family) o Psychological (realization that exam is tmw instead of day  after)

∙ Characteristics of an event affect the probability that is will  produce stress

∙ Perceived stress is more likely if an event has a negative outcome,  but positive outcomes can also produce stress

∙ More likely when event is perceived as uncontrollable,  unpredictable or ambiguous, or when there’s an impact on major  are of life

Appraisal process:  

∙ After stressful event, interactive  

∙ Occurs when person assess whether he or she has the resources or coping skills to deal with the event.

∙ Primary appraisal: person assess harm or threat

∙ Secondary appraisal: person identifies available skills to cope with  or overcome possible negative outcomes

∙ Coping strategies  

o Problem-focused: taking action to manage problem that is  creating stress (gathering information, comparing courses of  action, making decisions, resolving conflicts)

 More effective for managing stress  

o Emotion-focused: person focuses on managing emotional  distress that results form a stressor rather than trying to  change the situation that creates the stress

 Positive: changing thoughts to decrease distress

 Others include drinking, avoidance

Types of stress

∙ Acute: occurs when potentially threatening event and the  associated reaction last for only a brief time (burglary) ∙ Chronic: develops when threatening event continues over time  (excessive work demands, long-term poverty) and or when person  consistently feels inadequate to deal with ongoing negative  outcomes

∙ Major life events that affect the way a person lives ∙ Under any of these conditions the perceived or actual inability to  cope resuls in stress reactions with symptoms of “flight or fight”  response

Responses:

∙ Adaptive: help person react quickly and positive to potentially  harmful events

∙ Detrimental: responses disrupt functions ( stress about class  project lead to sleep and missed class)  

o Also can cause poorer health

∙ Sympathetic-adrenomedullary system (SAM)

o “revved” up feeling, increased adrenal gland stimulation  results in secretion of epinephrine and norepinephrine.  o Continuous and long-term SAM can suppress immune  functioning and produce changes in blood pressure, heart  rate

∙ Hypothalamic-pituitary-adrenocortical (HPA)

o During stress hypothalamus increases corticotrophin releasing factor (CRF) which causes increased secretion of  adrenocorticotropic hormone (ACTH) and increased cortisol  Increased cortisol helps body store carbs, reduce  

inflammation, and return body to steady state after  

stress

 Repeated HPA can change daily cortisol patterns,  compromising immune functioning and impairing  

memory and concentration

Stress and immune system:  

∙ Specific immune system: responses protect us against infections  and diseases, can result from natural or artificial processes.  o Natural: immunities are acquired through milk, or result of  having particular disease (chicken pox only once)

o Artificial: acquired through vaccination or inoculations ∙ Nonspecific immune system: responses offer general protection  against infections and diseases in four ways

o Anatomical barriers: skin, and mucous membranes, prevent  microbes from entering body

o Phagocytosis: production of more white blood cells that  destroy invaders.  

 T-lymphocytes (T-cells) secrete chemicals that attack  and kill invading microbes. Some killer (Tc) some  

helper (TH) and natural killer (NK)

 B-lymphocytes (B-cells) secrete antibodies or toxins  into the blood to kills invading bacteria and viruses  

o Inflammation: at site of infection allows more white blood  cells to move in and attack pathogens

∙ Psychoneuroimmunology: study of relations among social,  psychological and physical responses.

∙ Stress suppresses ability of immune system to function adequately  and increases susceptibility to bacteria and viruses

∙ Overall wounds heal slower, chronic disease progress more rapidly, vaccines are less effective

∙ Stress increases epinephrine and cortisol levels which decreases  activity of helper T-cells and lymphocytes used for killing toxins ∙ Under stress people develop less antibodies for vaccines making  them less effective

∙ Cell and stress variables include, time elapses since stressor  occurred, level of belief of control over stressor, age, time of day… ∙ Interpersonal interactions affect cell activity and immune  functioning  

o Hostile spouse, lonely, perceived isolation: poor immune  functioning

o Positive social support: benefits immune functioning Measuring:

∙ Acute stress paradigm: short term stress created in laboratory,  effect on physiological, neuroendocrine and psychological  responses is measured

o Approach allows researchers to examine biological responses (heart rate, blood pressure) also psychological variables  measured by interviews, questionnaires (level of chronic  stress, personality style)  

o Must be ethical  

∙ Social readjustment rating scale:  

o Measure impact of life events

o SRRS lists 43 potentially stressful life events, each with  numerical rating that estimates how much life  

“readjustment” is related to event

o Lists include both positive and negative events, both that  cause stress and affect health

o Generalizes well for “real life”, evaluate relationship between life events and health

o Does not account for individual differences, or differentiate  impact of positive and negative life events

∙ Hassle Scale & Uplift scale

o Hassle: Measures frequency and severity of day-to-day  stressors

o Uplift scale: asses day-to-day events that counteract the  negative effects of stress

o Both measure people rate frequency of daily hassles, and also rate uplifts such as completing a task or being complimented. Rate severity of hassles and intensity scores are calculated  for both hassles and uplifts.

o Like SRRS they scales rely on peoples ability to recall  activities and people who tend to feel easily stressed and  anxious may rate the severity of daily hassles differently,  creating problems for studies that examine relation between  stressors and health

Impact on health

∙ Indirect: developing poor health habits (eat fast food, drink, less  exercise, injury) these can have negative consequences indirectly  related to stress  

∙ Direct: can cause changes in nervous endocrine systems, immune  system

Physiology of stress

∙ Walter Cannon

o Proposed that continual or chronic physical stress responses  could impair a persons ability to fight illness  

∙ Hans Selye

o General adaption syndrome (GAS)

 Alarm: when body mobilized to meet threat (increases  in activity within SNS)

 Resistance: individual attempts to cope with or resist  threat

 Exhaustion: when continued efforts to overcome threat  deplete physical resources (this stage person is  

vulnerable to illness)

∙ Both GAS and fight-or-flight propose similar methods which stress  influences physiology on health, but does not address psychological and social variables that affect appraisal processes

Psychological impact of stress

∙ Stress and poorer immune functioning are associated with  increased negative moods (depression, anxiety, hostility, anger)  ∙ Depressed  

o Disrupted immune functioning  

o Increased inflammation

o Reduced NK cell activity  

o Lower lymphocyte response  

o More white blood cells

∙ Psychological disordrs associated with physical stress responses.  o Depression

o Alcoholism  

o Eating disorders

o All are linked to increased HPA activity  

o One most extreme response PTSD  

 Lower NK activity  

 Lower T-cell counts

 More physical health problems (cardiovascular,  

gastrointestinal, muscoskeletal)

Moderators of stress

∙ Variables that affect how stress is experienced and how affects  health and aspects of functioning (internal/external)

o Personality  

 Type A behavior pattern: associated with consistent  striving for achievement, impatience, time urgency, and aggressiveness towards others. Linked with coronary  heart disease

 Constantly keyed up, difficulty relaxing

 Internal moderators (personality traits)

 Negative affectivity: tendency to experience  

hostility, anxiety or depression

 Pessimistic explanatory style: blame negative  

outcomes on some stable characteristic of oneself

 Optimism: tendency to expect positive outcome

 External moderators (social support, resources)

 People with greater external resources function  

better  

 Most important predictor of health is SES, good  

immune functioning

 Social support

∙ Tangible: financial, goods (food), services  

∙ Informational: sharing of information to  

reduce stress

∙ Emotional: provision of caring can provide  

reassurance  

Sex, Race, Development issues

∙ Recurrent abdominal pain is most common complaints of childhood ∙ Men: more likely to use problem-faced coping

∙ Women: emotional-focused  

Behavior and Health

∙ Behaviors including sleeping, eating, exercise, substances have  impact on health

Psychological factors and medical illnesses

∙ HIV/ AIDS

o HIV: destroys bodies ability to fight infection and some types  of cancer  

o AIDS: is diagnosed when HIV infected people have  

particularly low number of T-cells, or when one of 26 clinical  conditions apper as resut of opportunistic infections (those  that normally don’t cause disease in healthy person)

∙ Cancer

o second leading cause of death in U.S.

o SES plays a role in cancer prevalence

∙ Chronic pain

o Diagnosed when patients primary complaint is consistent  paint that occurs without explanation  

o Acute: lasting less than 6 months

o Chronic: longer than 6 months

o Analgesic medications: opioid family (codeine, hydrocodone,  oxycodone)

o Nonmedical treatments include biofeedback, hypnosis,  relaxation training

o Pain is “fifth vital sign”  

Health psychologist

∙ Usually a Dr.

∙ Clinical: work with patient or medical team to change behaviors,  attitudes or beliefs to promote health and improved adjustment to  illness

∙ Research: work in university or medical school setting conducting  research and examine relationships between psychological and  physical variables

Interventions

∙ Primary prevention: increasing healthy behaviors among people  without disease

∙ Secondary prevention: health-promotion programs for people at  increased risk of health problems

o Areas to increase healthy behaviors education and awareness ∙ Stimulus control: behavior changing strategy based on classical  conditioning, modifying behavior by changing stimuli  

∙ Contingency contracting: relies on setting up reinforcement  program to encourage healthy behavior (token program)

What is health psychology

∙ Behavioral, psychological, social factors that promote health and  prevent illness

∙ Adjusting to acute or chronic illness, improving quality of life, and  reducing disability  

∙ Interventions

o Motivational interviewing

o Cognitive behavioral therapy

o Coping skills

Biopsychosocial  

∙ Biological

o Genetics, HPA axis, stress reactivity, effects of meditations,  disease process

∙ Psychological

o Emotions, attitudes, beliefs, perceptions, learning, coping  skills

∙ Social

o Social support, interpersonal relationships, ses, culture Cystic fibrosis

∙ Delayed puberty

∙ Limited lung functioning

∙ Limited fertility

∙ Intrusive symptoms

Experimental studies-randomized clinical trials

Correlational studies- comparing changes in studies Social connection

∙ Biological and behavioral pathways

∙ Increased capacity to adapt to stressors

∙ Lower rates of depression and anxiety

∙ Social support boosts self-efficacy

Physical pain is processed in same area as emotional or social pain Happiness

∙ Hedoinc

o Pleasure

o Satisfaction

o Absence of negative feeling

∙ Eudaimonic

o Pursuing valued goals

o Sustained effort during challenges

o Personal growth

o Purpose in life

o

o Secondary gain: environmental and behavioral  

reinforcements that enforce behavior

∙ Start by removing secondary

o Primary gain: not having to process emotional content that  lead to physical symptoms

o

o Dissociative Identity Disorder:

∙ Etiology:

o Root comes from experience of a trauma, unlike PTSD,  trauma is usually experienced in childhood

o Adults have avoidance, substance, variety of adaptive and  maladaptive resources unlike children

o Child copes by fragmenting personality, one personality but  minimum of 2 alters to 100

 Protector alter

 Adolescent

 Nurturer or caregiver

o Reason for fragmentation is for protection

o Some alters know about other alters or none at all  o Can be consistent or inconsistent with the host, and different  ages

o Also take on own physiological traits

o Switch is instant and prompted by trigger

 Trigger is situational context that alter is not able to  handle and other alter may handle better

o Most people enter therapy for depression or anxiety, or  memory difficulties

 Do not go in normally for DID

∙ Treatment  

o Goal is not to rid alters it is to integrate the alters into one  personality

o Progress by identifying one alter who is aware of the other  alters

∙ Ethics  

o Can you treat an alter if they were not the one who initiated  treatment?

o Can you send the patient into the world if during session they altered into a child?

o Iatrogenic affects, negative consequences from well intended interventions

Euthymia (equator, equal not elevated or  

lower)-----------------------------------

o Major depressive disorder

 Episodes of being in lowest possible mood state

 Unipolar

o Persistent Depressive disorder

 Short times of euthymia

 Long time of depression

 More chronic, two year time

 Do not cause functional impairment

 Struggle to maintain relationships

 They are not fun to be around, Debbie-downer

 Less severe than MDD

o Double Depression

 Unipolar

 Person experiences persistent depression disorder with overlayed major depressive disorder  

o Rarely feel normative mood state

o

o 4 major depressive disorder to consider in patient: schematic ∙ MDD ( bottom)

∙ DD

∙ bipolar 1 (mania) disorder (abnormally high elevated mood state) ∙ bipolar 2 (hypomania) (top)

o

o defining feature is in the psycho for depression

o Bipolar disorder:

∙ Length of time as well as intensity

∙ Mania: abnormally elevated euphoric or activated mood state o Pseudo psychosis in severe cases (delusional)

o Elevated self esteem

o Increased productivity

o Decreased need for sleep

o Excessive Creativity  

 Excessive talkativeness, pressured speech

 Poor concentration

o Agitation

o Risky choices that’s consequences end up in trouble legal or  injury

o Persons symptoms are so sever as reduce insight and  judgment

o Must last minimum of one week unless leading to  hospitalization prior

∙ Developmental modifier: in children if they are irritable ∙ Hypomania:

o doesn’t get so lost that is leads to hospitalization or  involvement with the law

o also does not have inflated self-esteem to point grandeur o only must last four days

∙ treatment

o first line, medications aimed to reduce lability, mood stabilize  lithium, frequent blood test

 anticonvulsant, first for seizures, mood numbed to  degree

o second line, cognitive behavioral therapy, psycho-education  to family

 helping patient to understand that meds do not take  away disorder solely due to med compliancy  

 some discontinue medications  

o Major Depression  

∙ Depressive episode

o 5 or more symptoms during same two week period, must  represent departure from previous functioning  

o at least one of five must be depressed mood or, anhedonia  (loss of interest or pleasure in activities previously loved by  the person) (social)

o in kids they can just present in irritability

∙ unintentional weight loss due to loss of appetite (bio) ∙ may see increase in appetite resulting in weight gain also  unintentional

∙ change in sleep

o hard time initiating sleep (insomnia)

o disruptive sleep (early morning wake)

o hypersomnia

∙ difficulty concentrating

∙ helplessness (nothing they can do to improve or change situation,  internal self-efficacy)

∙ hopelessness (person feels nothing is going to get better for them,  genral)

∙ worthlessness (that they have no value)

∙ guilt  

o excessive- over and over apologies

o inappropriate guilt- should not be sorry

∙ can see psychomotor retardation

∙ recurrent thoughts of death

o not only fear of dying but also suicidal thoughts

o death in general

∙ Treatment:

o SSRI

o TCA

o MAOI

o Replacing with more adaptive ways of thinking  

o Interpersonal therapy (ITT)

o how to differentiate from PDD and MDD

∙ clearly cognitive PDD

∙ MDD- glass half full

∙ PDD- higher risk for suicide because they have the energy to do it o C’yclothymia

∙ Alternates from mood levels but doesn’t meet height or depth ∙ Four episodes of mania or depression over four years time o Prevelance rates differences

∙ Unipolar- euthymia and down, PDD, MDD

∙ Women have higher unipolar mood states than men

o Co-roomination- women sit and talk about problems where as guys solve and face problem  

o Etiology:

∙ People with mood disorders have more chance of comorbidity  ∙ High rate of comorbidity in substance disorder

∙ Comorbidity with anxiety can be hard to determine which came  first  

∙ Like anxiety there is heritability genetic trait

Reciprocal gene environment model

∙ Suggest that not by chance, encoded genes cause us to seek out  environments where factors will cause genes to be expressed  (unlike diathesis stress model which says factors are expressed by  a trigger and by chance)

o

o *Genes can double the risk for pathology, for depressive and  mood disorder

puberty: process of developing or maturing from child into an adult ∙ females

o menses

o body

o breasts

o hips

o hormones

o odor

o more fat storage (breast, support pregnancy)

∙ males

o body hair

o hormones

o body odor+ oil

o voice deepens

o increased, size, speed, strength

o baby fat shed in contrast to females who gain weight o overall positive experience as opposed to females

∙ both

o growth spurt

∙ for most cultures puberty makes males closer to ideal body image,  in contrast women develop opposite of ideal image in culture *early adolescent years as early as 9

∙ 5 lbs. every in,5’= 100 lbs., 5’1”=105 lbs.

∙ person weight 85% or less of acceptable body weight ∙ person 5’ must be 85 lbs. or less before diagnosis can be applied Etiology:

∙ Anorexia nervosa

o Female, most likely to develop

o Early adolescent (13-15)

o Caucasian, (most common ethnicity)

o Middle-upper socioeconomic status

o Involved in extracurricular activities that pronounce  importance of body image (cheerleading, dance, gymnastics,  modeling, runners)

o Comes from family that places high value on outward  appearance of perfection (typical family structure)

o Poor communication within family

o Body is also betraying her due to puberty, getting in way of  extracurricular, feels out of control, begins to gain control  through dieting etc.  

o Girls not ready for maturity often revert to childhood ways,  controlling weight to look child like

o Meshment between mother and daughter, bonded, child like  security

∙ Bulimia- Nervosa

o More common in females than males

o Higher in Caucasian

o Age of onset is older, middle to late adolescent (15-17) o Does not have same demographic impact as anorexia

o Patient is looking for perfect body, and if they can achieve  they will benefit (popularity, success, achievement)  

o Weight is within 10% of expected body weight (+/-)  

1) Differential Diagnosis: get a case example to diagnose patient, one  hint leads a stray, the other is the anchor “ I would diagnose x with y” need  correct subtype and modifier and more than category, must be specific

2) the reason I diagnosed x was because y, use terminology, anchor to  symptoms focus first, give supporting data

3)Another diagnosis I considered for x was y  

4) which features led me to consider the ruled out diagnosis, which  features of the ruled out diagnosis did x not meet.  

Layout:  

2 differential diagnosis

1 short answer

multiple choice

includes:

chapter 4: Anxiety  

∙ panic attack

o exposure to panic symptoms

∙ panic disorder

o exposure to thoughts of panic attack

∙ agoraphobia

∙ specific phobia

∙ social phobia

∙ OCD, PTSD

∙ Generalized anxiety

∙ SNS and PNS arousal  

∙ Three prongs of anxiety, physiological reaction, maladaptive  cognitions, behavioral avoidance

∙ Which conditioning principle behavioral avoidance is most  associated with

∙ Definitions of obsession and compulsion, able to identify ∙ Biopsychosocial model factors that increase prevalence rate  of anxiety and mood disorders, anchor one to each ∙ Treatment biological, psychotherapy intervention (exposure plus  response prevention)

∙ Most pathologies follow typical SNS but two in particular that do  not, how are they different and what are biological characteristics  chapter 5: Somatic  

∙ somatic  

∙ symptom

∙ conversion

∙ factitious

∙ illness anxiety: thinking one has or will have a disorder (all about  body)

∙ malingering

∙ DID (know terminology)

o Treatment goal

∙ Refer back to psychoanalytic, Freudian theory  

∙ Know difficulty in treatments, gatekeepers and psychologist roles chapter 6: mood

∙ MDD

o Know BPS model for the symptoms, link symptoms to best  treatment

∙ PDD

∙ DD

∙ Cyclothymia

∙ Bipolar I

∙ Bipolar II

∙ Treatment  

∙ Euythmia  

chapter 7: eating disorders

∙ in terms of lecture covering etiology  

∙ not including diagnostic criteria  

Similar disorders: study differences

∙ Panic attack/ Panic disorder

∙ Agoraphobia/social anxiety

∙ Specific phobia/ social anxiety

∙ Panic disorder/agoraphobia  

∙ * underlying etiology similar PTSD/DID

∙ SSD from CD, IAD

∙ CD from IAD

∙ IAD/ specific phobia (situational subtype)

o IAD believes they have an illness

o Activated SNS in specific phobia

o Behavioral avoidance specific phobia

∙ MDD/PDD

∙ Bipolar I/II

∙ Cyclothymia/ Bipolar II

o Amount of time

o Negative mood state, Bipolar II goes down to MDD ∙ Factitious imposed on self/malingering

o Underlying orientation that differentiates diagnosis Chapter 14: health psychology

∙ Psychological, social and behavioral changes to cope with chronic  illness

∙ Two pathways, prevention or intervention  

∙ Construct and use of cognitive behavioral therapy, and mindfulness techniques

∙ Two types of happiness, hedonic and eudemonic  

∙ Medication and treatment adherence

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