Abnormal Psych Psyc 3330 - 01
University of Louisiana at Lafayette
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This 22 page Class Notes was uploaded by Lauren Notetaker on Saturday February 6, 2016. The Class Notes belongs to Psyc 3330 - 01 at Tulane University taught by Constance Patterson in Winter 2016. Since its upload, it has received 27 views. For similar materials see Abnormal Psychology in Psychlogy at Tulane University.
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Date Created: 02/06/16
A few notes: • Pp • Unintended consequences that the work that they did, it opens it up to more diagnosis, diagnosis of more typical behaviors, and pharmaceutical companies to bring in the money • Kids with more than one problem are at a disadvantage cause we have to choose which one to treat first; comorbid, kids' with learning disabilities and adhd • Lost differences between sub groups • Plasticity if one part of the brain isn't working for some people, another part can compenstate for that function Onset of childhood disorders • Pp Attention deficit/hyperactivity disordr • Pp • Symptom onset by 12 skeptical, if you don't have it at 5 you probbaly wont at 12 • Pp AD/HD • PP What do we know about causes? • Pp • Some ppl don’t metabolize alch very well so that's why itd be harmful • Dad likely to be unemployed • Ses smoke some might be the case Treatment • ADD alone medication is enough Additional features of adhd Perhaps as many as one third of children with ADHD also have some form of internalizing disorder (a mood disorder like depression or anxiety) which complicates diagnosis and treatment Between 15% and 30% are likely to have a learning disorder hard to tease out educational neglect curriculum casualty For some, Conduct Disorder and ADHD are comorbid and we usually see the worst features of both disorders when this is the case.; the aggressiveness comes from something else With thorough evaluation and accurate diagnosis, intervention and treatment can be provided to allow people with ADHD to live very successfully. The most important problems they face are misunderstanding, poor diagnosis, inadequate intervention (e.g., reliance on medication alone), and social rejection. Learning disorders • Achievement is substantially below expected levels for age, grade, and cognitive ability (2 SD on achievement test) • Can be a disorder of learning in reading, math, or written language • Boys and girls appear about equally likely to have this problem • if their score fell into a 70, there would be worry • no difference bt boys and girls • Growing evidence that learning disabilities are based in ability to learn and use language • *Cognitive ability is average • Reading Disability is most common (410% of population) • Decoding figuring out what kinds of noises, sounds, letters make and putting them together to understand how words come together sound wise and we become automatic • fluency • comprehension Math Disability (1%) • spatial orientation • math reasoning • math calculation Dyslexia • Looking at the written word and figuring out what it says • See differences with resources • Generally associated with significant difficulty developing sound association skills (recognizing the sounds associated with letters of a language) and decoding skills (breaking down words into sounds). Because all other reading skills rely on these basic skills fluency and comprehension of what is read are also significantly affected. Difficulties range from mild to severe. • Studies of families with high and low education and literacy levels among parents have suggested a strong genetic component; higher levels of supports in highly educated families result in less severe problems over time for children who are affected by this disorder. • Note dyscalculia is a similar disorder affecting the ability to understand quantity and develop math skills In schools: learning disabilites • Written Expression Disorders are less well documented • eyehand coordination • inaccurate figure copying • disorganization • rotations • Usually identified and treated in school settings. • Having an identified “Learning Disability” allows access to specialized educational programming • Some psychiatrists do interventions • IMPACT: ◦ Struggle to achieve at level expected for age/grade ◦ Negative school experiences ◦ More likely to drop out ◦ Lower vocational attainment ◦ Higher incidence of frustration, negative mood, suicidal thoughts, and suicide attempts Treatment • Early screening and assessment • Targeted interventions to improve skills • Explicit strategy instruction • Cognitivebehavioral therapy for selfesteem ◦ Later we are in identifying it, the less good the kids will feel • Children with learning disorders are often capable of average to high achievement and should be encouraged and supported so that they can thrive • Lack of appropriately targeted intervention is the most common problem for these children Communication Disorders *Significant Problems: Use of language supports development of skills for learning and social interaction • Speech Sound Disorder – lack of clear speech, forming words but very difficult to understand • Stuttering –speech fluency is disrupted, repeated syllables or words, pauses (articulation of words); very treatable but may come out in high stress situations • LANGUAGE DISORDER: DSM5 combines expressive and receptive • Expressive Language Disorder – limited ability to use language to express thoughts • Receptive Language Disorder limited ability to process spoken language (problems with understanding what is heard) Language development • Born into a language environment • Infants attend to the sounds of their native language • They imitate others and learn to make similar sounds and gestures to communicate their needs • By age 3, language ability expands exponentially allowing ideas, concepts and complex language to build • Phonemes = basic sounds that make up a language • By age 1 children have learned to attend to the sounds in their own language and gradually lose the ability to distinguish sounds not associated with that language Phonological awareness • Awareness of relationship between sounds and symbols • Rhyme and alliteration • Sounds can be manipulated in syllables and words • Recognizing discrete sounds of letters • Blending sounds • Expressive language requires “expert” use of the language • Reading requires an understanding of sounds and symbols for decoding (word recognition) • *Poor decoding affects fluency and comprehension Causes • Brain function – evidence points to genetic component • Broca: Speech production • Wernicke: Understanding speech and written language • If specific areas of the brain are injured, function may not return – the “plasticity” of the developing brain sometimes works in a child’s favor and adjoining areas compensate or restorefunctioning that has been lost. • Recurrent ear infections (otitis media) can disrupt or delay understanding of language with impaired hearing Course and treatment' • Early identification and treatment are crucial • About 50% of cases will diminish or be remediated (effectively treated) by adolescence • About 50% will persist, but will be significantly less in adulthood • Implications for development of learning disorders makes language and speech treatment crucial for children • Social skills and cognitive behavioral treatments are also useful Elimination disorders ENURESIS: periodic voiding of urine, during the day or night, into one’s clothing or bed or onto the floor Usually involuntary (rule out medical problem) Most commonly nocturnal (bedwetting) Generally combination of disturbed family factors, psychological stressors, or other emotional problems 4.910.5% seven to seventeen year olds Usually outgrow it by adolescence (some do not) Bell and pad treatment is very effective (behavioral) ENCOPRESIS: defecating into one’s clothing, onto the floor or other inappropriate places .74.4% prevalence coexists with ODD, CD, inattention, hyperactivity, obsessivecompulsive symptoms treated with behavioral interventions, training toileting regimens, appropriate diet Disruptive mood dysregulation disorder • Unless a child has a history of bipolar disorder, then we shouldn't diagnose them with this in childhood • Recurrent episodes of temper including verbal rage or physical aggression • Anger response is exaggerated in intensity or duration • Typical mood is irritable, angry or sad • More frequently diagnosed in boys • Symptoms onset before age 10 • May be present in early childhood • May improve with maturity or may evolve into depressive disorder Motor disorders: tourette's syndrome • Comorbid with some other things so it makes it difficult to treat • TICS: repetitive involuntary movements or vocalizations • Eye blinking, facial grimacing, head jerking, foot tapping/grunting, throat clearing, sudden outbursts of words • TOURETTE’S: multiple motor tics and one or more vocal tics • Four times more common in boys; onset between ages 7 and 10 • symptoms increase in mid teens • about 8% will completely remit in adulthood, and for most, symptoms typically get better in adulthood • Comorbid conditions: poor anger control, ADHD, obsessive compulsive disorder, impulsive behavior, poor social skills – complicates diagnosis and treatment • Treatment some medications, therapy to deal with the effects of the disorder in the person’s life Autism spectrum disorders (asd) • Distinct Patterns of Behaviors: • Communication is impaired ◦ No eye contact • Restricted interests • Impaired social interactions • Symptoms vary from mild to severe across all behaviors • Previously Used Terms: • 1. Pervasive Developmental Disorder ◦ For these kids, they will rub the children's hand on jeans and it's painful for them bc they're so sensitive but after they can play with normal things • 2. Autistic Disorder ◦ Mind to sever • 3. Rett’s Syndrome ◦ Only affects girls ◦ At age 4 or 5, they lose sense of language or coordination of bod ◦ May live into 20s or 30s ◦ Sit and rock ◦ Similar in asd (autistic spectrum disorders), so it's lumped in there • 4. Childhood Disintegrative Disorder ◦ At age 2 or 3 they lose their function ◦ Short life spans ◦ Features are the same, don't know what the cause is • 5. Asperger’s Syndrome ◦ Now called Mild ASD in the dsmV ◦ Really smart people • Ppl with asd don't devleop language at all Symptoms and characteristic Impaired Social Skills – do not develop friendships *often appear disinterested in others *do not notice or understand social cues *do not understand or exhibit emotions Impaired Communication Skills – may not develop speech (30%) or have odd and unusual speech patterns *may repeat what they hear (ecolalia) *unwilling to engage in speech *may use word sounds but not real words Restricted behaviors, interests or activities *strong play or toy preferences *shiny or spinning toys or objects *intolerant of changes in routine *ritual or stereotyped behaviors Causes and course Some consider the category a “catch all” Very little definitive information about causes Some family traits are evident Rising incidence suggests environmental impact (prenatal teratogens?) Brain structure and function are implicated e.g., Amygdala – damage? – releases stress hormones, oversensitizing child to fear/stress Some level of persistence across the lifespan is probable even with high functioning autism Treatment Support and education for the family members Social and community support Research supported interventions Early speech and language intervention is key concern Social skills training Educational programming that addresses the whole child Social programming that increases connections and communication Early identification! Reactive attachment disorders • Child has not formed stable attachments to adults; been neglected, wired differently, something social that goes along with it • Evident before age 5 • Disrupted care, social deprivation, neglect ◦ Limited positive emotion ◦ Irritable, sad, fearful ◦ Inhibited, avoidant • Can be diminished with reliable caregiving and nurturance • Disinhibited Social Engagement Disorder • History of harsh punishment/emotional neglect ◦ Interact with unfamiliar adults in an overly friendly manner ◦ Superficial attachment to those they hardly know ◦ Eagerness for interpersonal contact • Patterns hard to change Major depressive disorder • Do young children lack cognitive skills to be “fully depressed” such as understanding of the future? • Children and youth do become depressed, generally after some major negative life event (e.g., losses) • Children: loss of interest in toys/games; somatic complaints such as headaches, stomach aches, irritability • Teens: present more typical profile of depression • Boys and Girls equally likely to have depression before age 13; during/after adolescence more girls develop depression; girls are more likely to get help • Emotional Symptoms: ◦ Sadness, anhedonia, descriptions of “miserable, empty, humiliated”; some get angry, agitated; tearful; overwhelming feelings of hopelessness and helplessness • Motivational Symptoms: ◦ Loss of drive, initiative, spontaneity; loss of interest in usual activities • Behavioral Symptoms: ◦ Less active, low productivity, may withdraw, may move and speak more slowly, may stay in bed • Cognitive Symptoms: ◦ Pessimistic attitude; feel confused, less intelligent, have memory problems, distractible, lose problemsolving skills; develop very negative selfview including feeling stupid, inadequate, inferior; some will feel “evil”. • Physical Symptoms: ◦ General aches and pains, headaches, digestive problems, may first be diagnosed with some medical problem Treatment of depression • Fewer studies with impact of medication on children so we're really unsure of impact • Some youth respond to treatments used for adults • BUT antidepressants found dangerous for some teens; significant suicide risk • “increase the risk of suicidal thinking and behavior in children” (‘black box warning’) • Controversy: 24% affected • *Antidepressants and CBT (cognitive behavior therapy) together produce best results • *CBT alone is no more effective than placebo • *Antidepressants alone not as effective as CBT and antidepressants combined • Short term meds • Long term cbt Nonsuicidal self injury • Intentional, selfinflicted injury involving bleeding, bruising, or pain • Contagious • Highly self critical and don’t know how else to resolve • Intense negative affect such as anxiety, angry, depressive, selfcritical feelings • Expectation that mood will improve with pain • Highly selfcritical and have difficult expressing emotions • Estimated 1417% of youth have engaged in this kind of activity at least once • Small minority engage in repeated behaviors • About even across gender • Treatment includes problem solving, coping skills, emotional expression and interpersonal skills interventions Oppositional defiant disorder • Argumentative ◦ ignore rules, requests • Defiant • Deliberately annoying • Angry – significant! • Irritable • Resentment, “holds a grudge” • Sometimes, vindictive; need an intervention • Estimated 10% children • More boys than girls • before puberty but about equal afterward • Family interventions work best, behavioral interventions, social skills training, empathy training for distorted thinking Conduct Disorders 1. Repetitive and persistent behavior pattern which violates basic rights of others or major ageappropriate societal norms or rules; hurt, cut and don't feel bad about it 2. At least 3 of the following (within 12 months and 1 within 5 months): ◦ Frequent bullying or threatening of others ◦ Frequently provoking physical fights ◦ Using dangerous weapon ◦ Physical cruelty to people or animals ◦ Stealing while confronting victim ◦ Forcing someone into sexual activity (rape) ◦ Firesetting ◦ Bed weeting ◦ Deliberately destroying others’ property ◦ Breaking into house, building, car ◦ Frequently lying ◦ Stealing items of nontrivial value without confrontation of victim ◦ Frequently staying out beyond curfew (starts before age 13) ◦ Running away from home (overnight at least twice) ◦ Frequent truancy from school (starts before age 13) • Comorbid Conditions (all can be successfully treated): ◦ Mood disorders ◦ Anxiety ◦ PTSD ◦ Learning Disabilities ◦ Thought Disorders • Accidently bump into someone, they see it as intentional and end up hurting them ◦ ADHD • Need early intervention ◦ Substance Abuse • BEST outcomes are when families receive early and comprehensive treatment (psycho education; support; parenting skills; therapy) • WITHOUT treatment youth likely unable to adapt to adulthood roles and responsibilities and continue to have problems with relationships and holding a job; often break laws or behave in an antisocial manner. Two types of conduct disorder • Childhood onset CD: • Younger than 10 • Previously diagnosed with oppositional defiant disorder, • Typically more aggressive • Likely to have few or no friendships • Greater risk of persistent conduct disorder • High risk of developing antisocial personalities as adults • Adolescent onset CD: onset at 10 or older • NOTE: girls are more likely develop adolescent onset conduct disorder. Treatment • It is VERY difficult to treat Conduct Disorder • Sequence from ODD to CD may start with ineffective parenting practices, followed by academic failure, and poor peer interactions. • *Prevention and early intervention are key to preventing escalating problems. • Treat depressed mood and comorbid conditions • Prevent involvement in a deviant peer group • Social Skills training • Cognitive Behavioral • MUST Treat: ◦ Family problems including child abuse ◦ Academic failure ◦ Brain damage, and/or ◦ Traumatic experience Anxiety, TraumaRelated, Stressor Related and ObsessiveCompulsive Disorders Stress is a normal part of life and can be useful • A moderate level of stress can have productive outcomes • High levels of stress can cause anxiety When does stress become anxiety? Signs of severe stress: • Stress and anxiety can both produce physical and psychological symptoms : • Physical symptoms can include stomach ache, muscle tension, headache, rapid breathing, fast heartbeat, sweating, shaking, dizziness, frequent urination, diarrhea, fatigue • Mental or emotional symptoms can include: • Feelings of impending doom, panic or nervousness, especially in social settings, difficulty concentrating , irrational anger, restlessness, frequent worry about small, inconsequential things Taking steps to reduce stress can be very protective of personal wellbeing and prevent more serious Problems • Lifestyle changes can help alleviate symptoms of stress and anxiety: • eating a balanced, healthy diet • limiting caffeine and alcohol consumption • getting enough sleep • getting regular exercise • meditating • scheduling time for hobbies • keeping a diary of your feelings • practicing deep breathing • recognizing the factors that trigger your stress and managing them • talking to a friend, keeping connected with those you care about (who care about you) • If frequent, uncontrollable bouts of stress and anxiety, a doctor may suggest a mental health provider: • talk therapy (CBT), relaxation training, medication Study of anxiety: • Everyone experiences it • It is helpful to study anxiety early in the study of psychopathology: many other disorders also include some element of anxiety • Common human experience based on threat, but usually short term • Duration, intensity, and degree of impact differentiates patterns of typical and ‘pathological’ anxiety Fear • A present oriented response, based on a reaction to something that evokes a fightor flight response. • Alarm function that signals danger is present • Physiological effect: automatic and strong response from the sympathetic nervous system • Experienced as negative affect Anxiety • A physiological response originating in the brain and resulting in a negative mood state characterized by physiological symptoms of muscle tension, elevated heart rate, apprehension about controlling events in the future, a subjective sense of unease, and behaviors that indicate discomfort. • Each anxiety disorder has distinct characteristics but all include: ◦ Cognitive components – self talk that reflect our thoughts ◦ Emotional components – how we feel about the experience ◦ Behavioral components – includes • Overt behaviors that others can observe (trembling, facial expression, sweat, flushing) • Covert behaviors that are physiological (heightened arousal, butterflies in stomach<>nausea) Comorbidity of Anxiety Disorders with other psychological problems • Simultaneous occurrence of two or more psychological disorders in a single individual • In one large scale study, 55% of those studied who had principal diagnosis of a depressive or anxiety disorder also had a secondary diagnosis of anxiety or depressive disorder at the time of the study; lifetime incidence was 76% • Use or abuse of drugs or alcohol often implicated in relapses (selfmedicating effects) • Unique and significant association with diseases including: ◦ Respiratory disease ◦ Gastrointestinal disease ◦ Arthritis ◦ Migraine headaches ◦ Allergic conditions ◦ Thyroid disease • Generally, anxiety disorder occurs first. • The quality of life can be very poor with the combination of anxiety and a chronic physical illness. Risk of suicide with anxiety disorders • Having any anxiety disorder increases the risk of suicide • Most do not want to die, but want the acute and pervasive discomfort that comes with anxiety to stop • About 20% of those with panic disorder have been documented as having made suicide attempts • Rate of substances use is high; this compromises judgment and is known to increase suicide risk Biological Factors in anxiety Disorders • If you take good care of yourself, less likely to get anxiety • Tendency to experience high levels of anxiety is biologically based and seems to run in families (genetic or learned?) • Tendency to panic also seems to be inherited • Polygenetic influences lead to vulnerability but genetic background does not cause anxiety or panic directly • Brain structure: Limbic system • Mediates the flow of information between the brain stem which senses and monitors bodily functions and relays the information to higher cortical functioning • Cortex can also send message of threat to septalhippocampal system • Panic attacks include activation of more midbrain structures, including the amygdala, ventromedial nucleus of the hypothalamus, and the central grey matter. What determines who develops significant Problems with anxiety? • Factors in our environment can change or sensitize brain circuits to make brain more vulnerable to anxiety (e.g., smoking among youthnicotine has sensitizing impact that appears to make people more prone to anxiety symptoms) • Events in the environment also trigger anxiety responses which can create chronic problems (e.g., trauma) Psychological factors in anxiety • Multiple psychological factors are implicated in anxiety • Sense of control / uncontrollability based on having basic needs met as a child; • Parents provide “secure home base” versus unsafe or chronically uncomfortable/unpredictable home • Freedom to explore within limits with rules that create/promote safety during development versus lack of boundaries that allow the child to be unsupported (“on their own”) Social contributions to Anxiety (and Panic) • Highly stressful times engender anxiety • Interpersonal events such as graduation, marriage, divorce, birth of a child • Losses, such as death of a family member • Pressures at work, to excel at school or job • Injury or illness • Traumatic experience (s) Triple VuLnerability model • Generalized biological vulnerability ◦ Driven quality in approach to life ◦ Easily irritated ◦ Attitudes (glass is half empty) • Generalized psychological vulnerability ◦ Overattentive to health? ◦ Hypochondriasis? ◦ Nonclinical panic • Specific psychological vulnerability ◦ May have low selfconfidence ◦ Low selfesteem ◦ Inadequate ability to cope with stress Generalized Anxiety Disorder (GAD) • Excessive anxiety and worry (more days than not; over 6 months; worry over a number of events/activities) • Person has difficulty controlling the worry • Anxiety associated with at least three factors (only one for children): ◦ Restlessness, keyed up, on edge ◦ Easily fatigued ◦ Difficulty concentrating ◦ Irritability ◦ Muscle tension ◦ Sleep disturbance • Focus on the anxiety is not limited to panic, fear of embarrassment • Significant distress • Not due to physical causes • Adults with GAD: ◦ Life is dominated by worries ◦ Most worries are about minor things ◦ Possible misfortunes to their children ◦ Major events can be debilitating • Children with GAD ◦ Worry about competence in everyday life (school/freiendships/sports) ◦ Worry about family problems ◦ Difficulty sleeping makes the anxiety worse About 3.1% of the U.S. population meets criteria for being diagnosed during a given year About 5.7% are estimated to have diagnosable GAD during their lifetime Incidence and prevalence are remarkably consistent across cultures * Few seek treatment About 2/3 are female but females seek treatment more readily Earlier onset and more gradual development than other anxiety disorders Usually onset with some life stressor Median age of onset is 31 Has a chronic course over the lifetime; relapse after treatment is common *physiological basis is strong? Triple Vulnerability model in GAD • GAD tends to run in families suggesting heritability of biological vulnerability (based on twin studies) but vulnerability appears to tendency to be anxious • Anxiety is unfocused, and often people with GAD do not react to actual sources of anxiety like those with other anxiety disorders suggesting physiological response is different: chronic tension • Highly sensitive to threat, especially personal threat • See the world as generally threatening, and do not focus on any specific threat as predominant • They do not adapt to source of anxiety resilience does not develop Treatment for GAD • Intervention with drugs is helpful – small doses of antidepressants found to be most effective • Psychological treatment is also effective using cognitive behavioral treatment • Identify content of worry • Confront worries in sessions • Use thought controlling techniques • Expand coping strategies and techniques • NOTE: For most anxiety disorders long term followup shows CBT to be best intervention Panic attack and panic disorder • 1214% of people will have one each year • An abrupt and overwhelming reaction of intense fear or acute discomfort. • Can be cued by a situation that causes anxiety (situationally bound) • Don’t know when the next attack will occur so becomes vigilant to try to avoid it (anticipates problem) • May (or may not) occur in a setting where a panic attack has occurred before (situationally predisposed) Panic Attack • Panic has elements of conditioning and we create cognitive explanations • Initial fear occurs under extreme stress; the emotional response becomes associated with external and internal cues • Cues evoke the fear response as though danger is actually present (when danger is usually not present) Characteristics: • Pounding heart • Sweating • Trembling or shaking • Feeling of choking • Chest pain / discomfort • Nausea or abdominal distress • Dizzy, lightheaded, faint, unsteady • Derealization (feelings of unreality) • Depersonalization (feelings of detachment from self) • Fear of losing control or going crazy • Fear of dying • Paresthesis (numbness or tingling) • Chills or hot flashes Panic disorder • About 2.7% of U.S. population in a one year period, and 4.7% sometime during their lifetime • Similarities in rates across cultures, but with some variations • Two thirds are women – role of cultural issues? • Men more likely to “selfmedicate” • Onset from early teens to about 40 • Children will rarely develop the disorder but there may be a bias toward not diagnosing Causes of panic disorder • A vulnerability to stress, and overreactivity to some events in daily life • Panic disorder occurs at time of high stress • Development of anxiety that another attack is likely (generalized psychological vulnerability) • Avoid situations where panic attacks may be likely What about people who Have Panic attacks but do not develop Panic Disorders? • Approximately 8 to 12 % of people experience a panic attack , usually during intensely stressful periods • Many attribute the panic attack to stress or specific events, and do not develop the expectation that they will have another panic attack nor do they attach their fears about having another attack to a situation or a place • May or may not experience others • Unlikely to overrespond to physical symptoms with catastrophic expectations or consider it dangerous Agoraphobia • Commonly, a phobic avoidance of situations which evoke significant anxiety about a repetition of a previous panic attack • Have a group of enablers • Telling themselves they'll have a problem if they leave the safety of their own home • Often think the panic attack is a complete loss of control or impending death • Panic disorder and agoraphobia often occur together but not always • In rare cases, there is no history of panic attacks • Some people are able to function to some extent (e.g., go to work) but do so with intense dread • Many spend their lives as recluses and do not leave their homes • Effort to avoid situations which evoke strong emotional responses Treatment of panic disorder • Combined Psychological and medication treatments • CBT alone and drugs alone were not very different in outcome studies with short term follow up • Long term follow up studies of what works best: CBT combined with medication or CBT alone without drug treatment? CBT demonstrated as more effective for long term well being. Why? Specific phobias • An irrational fear of a specific object or situation that markedly interferes with an individual’s ability to function • May work around a phobia • Immediate exposure evokes an anxiety response so situation or object is either avoided or endured with intense anxiety and discomfort • Almost unlimited variations of this disorder (see table 5.4 in your text) • Four major subtypes: • Animals – includes insects • Natural environment – things that occur in nature (lightening) • Situational– situations or activities (closed places/flying • Other – situations that may lead to vomiting, choking, contracting an illness • Note: bloodinjuryinjection phobia almost always differs from other types of phobic responses • Onset is not dependent on a frightening event, although this does happen (about 50%) • Social learning about fear when exposed to an object/situation • Information transmission = repeated warning about the danger posed by some situation or object • Inherited tendency to be fearful or anxious • Cultural expectations often "forbid" males from expressing fears • Treatment • Exposure based exercises with graduated levels of exposure to fear producing event or stimulus • Therapeutic supervision • Bloodinjuryinjection phobia treatment requires extra attention to muscle tension exercises which prevent fainting • Some treatments are completed in one day long session. • Follow up requires that the client spend time at home exposing him/herself to the situation/object and periodically checking in with the therapist Separation Anxiety Disorder • Use to think it was limited to children • Those exposed to domestic violence have a higher likelihood of development • Unrealistic and persistent fear that something will happen to a parent or other person important to them • May refuse to leave home or go to school • May have nightmares, physical symptoms such as upset stomach, headaches • Nightmares, and sleep disturbances • May diminish over time, OR may persist into adulthood • About 4.1% of children have diagnosable disorder • About 35% of children continue to have severe problems in adulthood Social anxiety disorder (sad) • Previously called Social Phobia • Fear of social or performance situations • Recognition that the response is unreasonable • Avoid or engage in activity with high levels of anxiety • Need to rule out substance use, medical causes • As a child may have tendency to fear angry or threatening expressions • Temperamental shyness • Genetic tendency toward social inhibition or to become anxious • When under stress, may have panic attack and attribute to social situation • May have history of traumatic social situations • About 12.1% of the population at some point in their lives (about 35 million in US) • Second to specific phobia as most common anxiety disorder • Females more likely to experience • Onset most common in late adolescence to late 20s • Younger age, lower SES, and lower education* are associated with Social Phobia • Uncommon in those over 60 Post Traumatic Stress disorder is now under “trauma and Stress related disorders” in Dsm5 • Exposed to traumatic situation • Develops ways of reliving the event (nightmares, flashbacks) • Avoids reminders of the event (flight) OR engages in “fight responses” • Restricted or numbed emotions • Gaps in memory of the event • Chronic overarousal • Irritable • Exaggerated startle response Post traumatic stress disorder • DSMV now includes broader criteria for what constitutes a traumatic event • Sexual assault is explicitly included • Recurring exposure such as that of first responders • Includes four clusters based on behavioral clusters: • Reexperiencing – spontaneous memories, recurrent dreams, flashbacks, intense or prolonged psychological distress • Avoidance – making efforts not to reexperience distressing memories, thoughts, feelings, or external reminders • Negative cognitions and mood – persistent and distorted sense of self blame, or blaming others, estrangement from others, inability to recall event or key aspects of event • Arousal – aggressive, reckless or selfdestructive behaviors, sleep disturbances, hypervigilance or related problems (“fight” aspect) • Acute = diagnosed at one month after the event • Chronic = continues more than 3 months <removed from DSM5 • Delayed onset = few or no immediate symptoms, and may take a year or more to develop • Lasts at least a month • Preschool Type for children who are younger than 6 • PTSD with prominent dissociative symptoms = feeling detached from one’s own mind or body or experiences in which the world seems unreal, dreamlike or distorted • Develops • Close exposure to traumatic event • Personal • Biological vulnerability • Family history of anxiety • Easily stressed and anxious • Less education • Early exposure to stressful or traumatic events • Family instability can be predisposing factor • Social support is buffer (protective) • High stress produces stress hormones (e.g., cortisol) which change brain structures • Course is usually chronic Obsessive Compulsive Disorder (OCD) is now under “Obsessive –Compulsive and Related Disorders” in DSM5 • Very debilitating: • Presence of recurring obsessions, compulsions or both • Time consuming, cause clinically significant distress or impairment • Obsessions = intrusive and usually nonsensical thoughts that cannot be controlled • Compulsions = thoughts or actions used to control or suppress obsessions and provide relief • May experience sense of danger, severe generalized anxiety, repeated panic attacks, and significant avoidance of events or objects that evoke anxiety
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