ABNORMAL PSYCHOLOGY PSYC 3023
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Date Created: 10/30/15
Somatofo Abnormal Psych Exam 3 Study Guide rm disorders pathological concerns of individuals with the appearance or functioning of their bodies usually in the absence of any identifiable medical condition Hypochondriasi somatoform disorder involving severs anxiety over the belief that one has a disease process without any evident physical cause Clinical d Statistics Causes Treatme Somatiza escription Anxiety and mood disorders are frequently comorbid with hypochondriasis People who are anxious that they have a disease Individuals are likely to misinterpret physical symptoms and display higher rates of checking behaviors and trait anxiety Preoccupation persists despite appropriate medical evaluation and reassurance Duration of at least 6 months Equal chance in men and women Culturespecific o Koro the belief that the genitals are retracting into the abdomen China suffers guilty about excessive masturbation unsatisfactory intercourse or promiscuity o Dhat anxious concern about losing semen 0 Hot sensations in the head or of something crawling in the head Africa 0 Burning in hands and feet PakistanIndia A disorder of cognitive or perception with strong emotional contributions Focusing on selfincreases arousal and makes the physical sensations seem more intense than they are 9 misinterpret symptoms as illness 9 anxiety increases further 9 additional physical symptoms People who have it have enhanced perceptual sensitivity to illness cues and tend to interpret ambiguous stimuli as threatening Suggests a possible genetic contribution tendency to overrespond to stress Seems to develop in a stressful life event Have a disproportionate incidence of disease in their family when they were children Learn from families that ill people receive increased attention nt Stressmanagement treatment Cognitivebehavioral therapy quotcreatequot symptoms 9 control over body health Maybe drugs that are also used to treat anxiety and depression tion disorder somatoform disorder involving extreme and longlasting focus on multiple physical symptoms for which no medical cause is evident Clinical description Statistics Causes Treatment Conversio Do not feel the urgency to take immediate action on noticing a symptom by calling the doctor or taking the medication instead they continually feel weak and ill Their entire lives revolve around their symptoms Very rare People with less than 8 systems are considered to have undifferentiated somatoform disorder instead Victims tend to be women unmarried and from lower socioeconomic groups A history of family illness or injury during childhood May have a heritable basis runs in families Strongly linked to antisocial personality disorder Impulsive and pleasure seeking Short term gain at the expense of longterm problems Gender roles females have this disorder males have antisoc No treatments have proven effectiveness Concentrate on providing reassurance reduing stress and reducting the frequency of helpseeking behaviors More appropriate methods ofinteracting with others are encouraged Antidepressant drugs More structured cognitivebehavioral treatment 11 disorder physical malfunctioning such as blindness or paralysis suggesting neurological impairment but with no organic pathology to account for it Clinical description Statistics Causes One or more conditions affecting voluntary motor or sensory function that cannot be explained by a medical condition caused by con icts or other stressors Comorbid with anxiety and mood disorders Rare Found primarily in women and typically develop during adolescence or slightly thereafter Relatively frequent occurance in males at times of extreme stress Individual experiences traumatic event 9 con ict and anxiety are unacceptable 9 repress con ict 9 anxiety continues to increase and threatens to emerge into consciousness and person converts it into physical symptoms relieving pressure of having to deal directly with con ict primary gain 9 individual receives attention and sympathy and may be allowed to avoid difficult situation or task secondary gain Major mood disorders and sever environmental stress especially sexual abuse Primary gain individuals seem not the least bit distressed about their symptoms Sociocultural tends to occur in less educated lower socioeconomic groups where knowledge about disease and medical illness is not well developed people learn to adopt symptoms they see in their families Treatment Identify and attend to the traumatic or stressful life event and remove sources of secondary gain reduce any reinforcing or supportive consequences of the conversion symptoms Pain disorder somatoform disorder featuring true pain but for which psychological factors play an important role in onset severity or maintenance Hard to diagnose and treat because there are 2 types physical and psychological and we never know if they are over exaggerating or actually feeling that much pain Munchausen Symdrome when an individual deliberately makes someone else sick atypical form of child abuse Misrepresentation of an acute or accidental medical or surgical illness not usually obvious on physical examination Perpetrator usually presents the manifestations of the abuse to the healthcare system Children sere as the vector in gaining the attention the mother desires anger is not the primary causal factor Awareness of abuse present Dissociative disorders Involve sever alterations or detachments Affects identity memory or consciousness Depersonalization Part ofa serious set of conditions with which reality experience and even the person s identity seem to disintegrate Detached from your body or your mind out ofbody experience Derealization Situation in which the individual loses his or her sense of the reality of the external world Sensations of unreality in external world people seem dead or mechanical or larger or smaller than they are Recovered memories studies done that make a child focus on a situation once every 10 weeks and ask them if they had ever had it happen to them before 9 children begin to think situation happened and go into elaborate detail about memory 9 27 of children when told their memory was false claimed that they remembered the event 9 no accuracy can t be determined General dissociative amnesia the person loses memory of all personal information including his or her own identity Selective localized amnesia memory loss limited to specific times and events particularly traumatic events Dissociative fugue sudden unexpected travel from home or customary place of work with inability to recall one s past confusion about personal identity or assumption ofnew identity partial or incomplete not caused by a substance or general medical condition Symptomsbehaviors fugue states end rather abruptly and person remembers most ofwhat happened take off and find a new place unable to remember past unable to remember how they got there often assume a new identity Causes little is known trauma and stress can serve as triggers Dissociative identity disorder presence of 2 or more distinct identities or personality states each with its own relatively enduring pattern one identity takes control of extensive person s behavior inability to recall important information that is too to be explained by ordinary forgetfulness Statistics on average have 15 identities affect highly gullible people who can get engulfed with books and stuff mostly affects females 91 ratio onset if almost always in childhood very rare to develop after age 9 high comorbidity rates amp lifelong chronic course Alters different identities or personalities Switching quick transition from one personality to another Role of Host identity that keeps other identities together Role of abuse in causing DID histories of horrible unspeakable child abuse mechanism to escape from the impact of trauma Treatment focus on reintegration ofidentities make identities aware of each other identify and neutralize cuestriggers that provoke memories of traumadissociation Eating Disorders Anorexia Bulimia N Nervosa DSM Defined as 15 below expected weight intense fear of obesity and losing control over eating anorexics show a relentless pursuit of thinness often begins with dieting proud of control over not eating noticeable thin 9 still think they need to lose weight fixated on certain body parts 2 subtypes o Restricting subtype limit caloric intake via diet and fasting o Bingeeatingpurging subtype about 50 of anorexics 20 mortality rate 12 commit suicide lots of cardiovascular and neurological disorders 9 reasons they seek treatment stop having periods dry brittle nails skin hair electrolyte imbalances Comorbid with mood anxiety and substance abuse disorders Prevalence white females from middletoupper middle class families Average age of onset 13yrs or early adolescence ervosa DSM Defined as recurrent episodes of binge eating characterized by an abnormally large intake of food within a 2hour period combined with a sense oflack of control over eating during these episodes recurrent inappropriate compensatory behavior to prevent weight gain such as selfinduced vomiting misuse oflaxatives fasting or excessive exercising on average bingeing and inappropriate compensatory behavior occur at least twice a week for at least 3 months excessive preoccupation with body shape and weight Medical consequences 0 Repeated vomiting I Salivary gland enlargement I Eroding of dental enamel on inner surface of front teeth I Electrolyte imbalance o Laxative abuse I Intestinal problems constipation permanent colon damage 0 Calluses on fingers or backs of hands Comorbid with anxiety and mood disorders substance abuse and depression are reactions to bulimia Most common psychological disorder on college campuses 68 of women in college Average age of onset 1619 Restrict food 9 binge 9 anxiety guilt and shame 9 purge 9 relief Purging reinforced instant gratification negative reinforcement stress and anxiety has immediately decreased Binge eating disorder experimental Engage in food binges without compensatory behaviors More psychopathology than nonbinging obese people Orthorexia not afraid of getting fat want to gain weight but do not want to gain weight using toxic foods Anorexia AND bulimia Fears ofweight gain Restricting of food intake Purging less common in anorexia Anorexia AND bulimia AND binge eating disorder disturbed body image Causes of eating disorders Media in uences 0 Media images and exposure Competitive environments Middle and upperclass Friendships 9 eat the same way Equating of thin to good virtuous successful etc 0 Stress and negative emotion management Dietary restraint 0 Early and frequent dieting attempts increase risk of later EDO o Occupations or hobbies where there is sever pressure to be thin Familial 0 Successful harddriven concerned about appearances avoid con ict and critical 0 Family relationships become strained when someone in the family has an eating disorder Biological 0 Hard to find twins for genetic testing 0 May be a genetic vulnerability to respond emotionally to stress 0 O O O I Responding negatively to stressful life events 0 Biological factors play a role in appetite and regulation of eating I Hypothalamus 9 may affect binge eating disorder and obesity 0 Low levels of serotonin may be partially responsible for binge eating Psychological 0 Low selfconfidence 0 Low feelings of selfcontrol o Perfectionist attitudes 0 Low tolerance for negative affect high concern over how others perceive them 0 Distorted body image 0 Intense anxiety about gaining weight 0 Like 0CD I Obsessions with food I Rituals 0 Can be triggered by traumatic events like rape Treatment Anorexia Weight restoration eating meals and snacks throughout the day or shakes Education nutrition not successful most know about nutrition info Family therapy reduce criticism and healthier communication CBT not good competition to be skinniest Bulimia Medications antidepressants SSRI s and tricyclics 0 Help reduce binging and purging behavior 0 Are not effective in the longterm CBT treatment of choice 0 Challenge distorted attitudes about eating 0 Challenge anxiety about gaining weight 0 Behavioral components to prevent purging 0 Challenge superrestrictive eating IPT interpersonal psychotherapy 0 Results in longterm gains similar to CBT 0 Focus on improving relationships with significant others in the person s life 0 Family therapy addresses all the psychosocial factors ACT acceptance and commitment therapy 0 Sit with negative emotionsbad feelings for a while 9 realize they don t need to purge to get rid of Binge eating Medications o Sibutramine Meridia I Reduces feelings of hunger o TMS transcranial magnetic stimulation I Control cravings CBT 0 Similar to that used for bulimia 0 Appears efficacious IPT o Equally as effective as CBT Selfhelp 0 Also appear effective Sleep Disorders Dyssomnias Difficulties in amount quality or timing of sleep Insomnia 0 Primary difficulty in initiating maintaining or gaining from sleep not related to other medical or psychological problems 0 Associated Features I Complain of sleepiness throughout the day I Able to sleep through the night 0 Dysfunctional thoughts I Having unrealistic expectations about how much sleep they need 9 force themselves to go to bed early 9 so concerned about trying to fall asleep that they can t 0 Treatment I Benzodiazepine or related medications 0 Short acting drugs cause only brief drowsiness 0 Long acting drugs do not stop working by morning sometimes and cause more daytime sleepiness I Prolonged use I Can cause rebound insomnia dependence I Best as shortterm solution I Shortterm medication psychotherapy I Sleep hygiene keeping bedroom place for sleep setting a regular bedtime routine for children I Relaxation and Stress Reduction 0 Reduces stress and assists with sleep 0 Modify unrealistic expectations about sleep Hypersomnia o Abnormally excessive sleep falling asleep several times a day 0 Experience excessive sleepiness as a problem 0 Primary hypersomnia Unrelated to any other condition rare 0 Facts and Statistics I About 39 have a family history of hypersomnia I Often associated with medical andor psychological conditions 0 Associated Features I Complain of sleepiness throughout the day I Able to sleep through the night 0 Treatment stimulants Narcolepsy 0 Daytime sleepiness and cataplexy o Cataplexic attacks I REM sleep precipitated by strong emotion 0 Facts and Statistics Rare Condition I Affects about 03 to 16 of the population I Equally distributed between males and females I Onset during adolescence I Typically improves over time 0 Associated Features I Cataplexy sleep paralysis and hypnagogic hallucinations o Cataplexy sudden loss of muscle tone occurs while person is awake and can range from slight weakness in the facial muscles to complete physical collapse Sleep paralysis a briefperiod after awakening when they can t move or speak that is often frightening to those who go through it Hypnagogic hallucinations vivid and often terrifying experiences that begin at the star of sleep and are said to be unbelievably realistic because they include not only visual aspects but also touch hearing and even the sensation ofbody movement I Daytime sleepiness does not remit without treatment 0 Treatment SSRI s for cataplexy Sleep apnea disorder involving brief periods when breathing ceases during sleep 0 Restricted air ow andor brief cessations of breathing 0 Associated Features I Persons are usually minimally aware of apnea problem I Often snore sweat during sleep wake frequently I May have morning headaches I May experience episodes of falling asleep during the day 0 Treatment I Lose weight medications and mechanical devices Circadian Rhythm Disorders 0 Disturbed sleep ie either insomnia or excessive sleepiness 0 Due to brain s inability to synchronize day and night 0 Circadian Rhythms Do not follow a 24 hour clock 0 Suprachiasmatic nucleus I Brain s biological clock stimulates melatonin o Treatments I Phase delays 0 Moving bedtime later best approach I Phase advances 0 Moving bedtime earlier more difficult I Use of very bright light 0 Trick the brain s biological clock Parasomnias Abnormal behavioral and physiological events during sleep REM sleep parasomnias 0 Nightmare disorder I Involves distressful and disturbing dreams I Such dreams interfere with daily life functioning and interrupt sleep I Associated features 0 Dreams often awaken the sleep er 0 Problem is more common in children than adults I Treatment 0 May involve antidepressants andor relaxation training 0 REM sleep behavior disorder I 397 NonREM sleep parasomnias 0 Sleep terror disorder I Recurrent episodes of paniclike symptoms during non REM sleep I Often noted by a piercing scream I Associated features 0 More common in children than adults 0 Child cannot be easily awakened during the episode 0 Child has little memory of it the neXt day I Treatment A WaitandSee Posture 0 Scheduled awakenings prior to the sleep terror 0 Severe Cases 0 Antidepressants ie imipramine or benzodiazepines 0 Sleep walking disorder I Usually during first few hours of deep sleep I Person must leave the bed I Associated features 0 Problem is more common in children than adults 0 Problem usually resolves on its own without treatment 0 Seems to run in families I Nocturnal eating syndrome person eats while asleep Substance use disorders E ingestion of psychoactive substances in moderate amounts that does not significantly interfere with social educational or occupational functioning Intoxication physiological reactions such as impaired judgment and motor ability and mood changes resulting from the ingestion ofpsychoactive substances Abuse Pattern ofpsychoactive substance use leading to significant distress or impairment in social and occupational roles and in hazardous situations Dependence maladaptive pattern of substance use characterized by the need for increased amounts to achieve the desired effect negative physical effects when the substance is withdrawn unsuccessful efforts to control its use and substantial effort expended to seek it for recover from its effects Tolerance requires increasingly greater amounts of the drug to experience the same effect Withdrawal responding negatively when the substance is no longer ingested Drugseeking behavior desperate need to ingest more of the substance stealing money to buy drugs standing outside in the cold to smoke Depressants Alcohol 0 Central nervous system depressant GABA system slurred speech neurons have difficulty firing Glutamate system involved in learning and memory blackouts Serotonin system mood sleep and eating behavior Withdrawal delirium condition that can produce frightening hallucinations and body tremors Wernicke s dementia confusion loss of muscle coordination and unintelligible speech 0 Fetal alcohol syndrome pattern of problems including learning difficulties behavior deficits and characteristic physical aws resulting from heavy drinking by the victim s mother when she was pregnant with the victim Sedatives calming anxiolytic anxiety reducing and hypnotic sleep inducing drugs 0 Maladaptive behavioral changes such as inappropriate moods impaired judgment impaired social or occupational functioning slurred speech motor coordination problems and unsteady gait 0 Impact brain by impacting GABA neurotransmitter system 0000 O Stimulants Most widely consumed drugs in US Amphetamines 0 Effects significant maladaptive behavior or psychological changes during or shortly after use of amphetamine two or more of the following signs increased or decreased heart rate dilation ofpupils elevated or lowered blood pressure nausea evidence of weight loss psychomotor agitation or retardation muscular weakness confusion seizures or coma o Tolerance builds quickly Opiates Hallucino Causes of o Withdrawal often results in apathy prolonged periods of sleep irritability and depression Cocaine 0 Effects short lived significant maladaptive behavior or psychological changes impairing function because ofuse of cocaine 2 or more of the following signs increased or decreased heart rate dilation ofpupils elevated or lowered blood pressure perspiration or chills nausea evidence ofweight loss psychomotor agitation or retardation muscular weakness confusion seizures or coma 0 Few negative effects are noticed at first however with continues use sleep is disrupted increased tolerance causes a need for higher doses paranoia and other negative symptoms sets in and the cocaine user gradually becomes socially isolated Nicotine o Stimulates central nervous system relieve stress and improve mood cause high blood pressure and increase the risk ofa heart disease and cancer high doses can blur vision cause confusion and lead to convulsions and sometimes even cause death 0 Highly addictive Caffeine 0 Small doses elevate mood and decrease fatigue larger doses makes you feel jittery and cause insomnia 0 Used regularly by 90 of all Americans Types morphine codeine and heroin Effects induce euphoria drowsiness and slowed breathing high doses can lead to death if respiration is completely depressed relieve pain gens LSD most common subjective intensification ofperceptions hallucinations feelings ofdepersonalization and illusions dilation of pupils increased heart rate sweating palpitations blurring of vision tremors incoordination Marijuana significant maladaptive behavior or psychological changes eg euphoria anxiety impaired judgment bloodshot eyes increased appetite dry mouth increased heart rate No major signs of withdrawal for either substance not very not at all addictive substance abuse dependence Genetics there is a genetic component much of focus on alcoholism genetic differences in metabolism multiple genes are involved in substance abuse Gender differences men greater tolerance for alcohol than women Drugs affect pleasure or reward centers in the brain inhibition of neurotransmitters for anxiety negative affect Substance abuse as a means to cope with negative affect negative reinforcement gives pleasure vs takes away pain Opponent process theory why crash after drug use fails to keep people from using pleasure comes first associate drug with pleasure or high not lows or crash Expectancy effects a person who expects to be less inhibited when she drinks alcohol will act less inhibited whether she drinks alcohol or a placebo she thinks is alcohol Exposure to drugs media family peers Cultural in uences drink heavily on new years or st patrick s day poor countries drugs readily available Treatments for substance abuse dependence Treatment will follow from how you view drug abusedependence o Moral weakness 0 Disease Two different goals of treatment 0 Controlled use 0 Abstinence Biological treatments 0 Agonist drugs I Substitution safe drugs with a similar chemical composition as the abused drug I Examples methadone and nicotine gumpatch o Agonistic treatment I Drugs that block or counteract the positive effects of substances I Examples include naltrexone for opiate and alcohol problems 0 Aversive treatments I Drugs that make use of substances extremely unpleasant I Examples include antabuse and silver nitrate 0 Efficacy of drug treatments don t work alone require high motivation Psychosocialtreatments o AANA table 101 page 419 0 Relapse prevention using cognitive and behavioral skills to avoid a recurrence of substance dependence such as by avoiding or anticipating highrisk situations Best strategy for drug prevention changes in laws regarding drug possession and use and communitybased interventions O Impulse control disorders Each is characterized by Increased tensionanxiety prior to the act A sense of relief following the act Impairment of social and occupational functioning Inermittent explosive disorder Definition Episodes during which a person acts on aggressive impulses that result in serious assaults or destruction of property Treatment cognitivebehavioral interventions helping the person identify and avoid quottriggersquot for aggressive outbursts and approaches modeled after drug treatments appear the most effective Kleptomania Definition a recurrent failure to resist urges to steal things that are not needed for personal use or their monetary value Treatment Only one case study of treatment involves either behavioral intervention or antidepressant medication usage Pyromania Definition an impulsecontrol disorder that involves having an irresistible urge to set fires Treatment almost nonexistent generally cognitive behavioral and involves helping the person identify the signals that initiate the urges and teaching coping strategies to resist the temptation to start fires Pathological gambling Defintion persistent and recurrent maladaptive gambling behavior Treatment GA 12 step program high drop out rate desire to quit is not strong cognitivebehavioral interventions Trichotillomania Defintion urge to pull out one s own hair from anywhere on the body including the scalp eyebrows and arm Treatment Clomipramine a tricyclic medication with both antidepressant and antiobsessional properties seems helpful in some cases cognitivebehavioral interventions holds promise Cyberaddictions Young et al article Major types Online gambling stock trading shopping computer games etc The Triple A Engine Accessible can turn on the computer at any time Instant gratification A ordable many activities and materials can be accessed for free Anonymous no apparent worries about who may see what you are doing 0 OO
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