Psychopathology (PSYC 4240) Day 7
Psychopathology (PSYC 4240) Day 7 PSYC 4240
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This 6 page Class Notes was uploaded by Selin Odman on Tuesday May 24, 2016. The Class Notes belongs to PSYC 4240 at University of Georgia taught by Miller in Summer 2016. Since its upload, it has received 12 views. For similar materials see Psychopathology in Psychology (PSYC) at University of Georgia.
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Date Created: 05/24/16
Psychopathology (PSYC 424) – Day 7 5/24/16 Agoraphobia – fear of the market place -Fear or anxiety of 2 or more of: public transportation, open spaces, enclosed spaces, standing in line or being in a crowd, being outside of home alone -Fear or avoid situations because they believe escape will be difficult or they can’t find help -Situations will almost always cause fear or anxiety -Situations are avoided or need someone to be with them; this causes a great deal of stress -This fear is considered over the top and not normal to the situation -Fear, anxiety and avoidance must last for 6 months or longer 12 month prevalence < 2% Females 2:1 ratio Treatment is exposure therapy, SSRIs and benzodiazepines Specific Phobias Overview and Defining Features -Extreme and irrational fear of a specific object or situation -The object or situations always causes intense fear and anxiety -Fear is over the top and not normal in regards to the situation -Causes life-altering distress and impairment -Avoidance and “escapeism” is a central part to all anxiety disorders; avoids triggering objects or suffers from great distress Facts and Stats -12-month prevalence: 7-9% -Females 2:1 ratio -Chronic disease with early onset in childhood Associated Features and Subtypes of Specific Phobia -Blood-inury-injection phobia: different physiological response; instead of fight or flight, your blood pressure and heart rates drop and causes you to faint -Can be strongly heritability; very evolutionary -Uniquely causes fainting -Situational phobias: public transportation or enclosed places -Natural environment phobia: events occurring in nature like heights or storms or darkness -Animal phobia: animals and insects -Other phobias: cannot really fit in a category (i.e. fear of clowns) Causes of Phobia -Direct conditioning (i.e. dog biting child) -Experiencing a panic attack in situations and your brain focuses on whatever is around -Observing (vicarious learning) of someone else’s fears -Being told about a danger (information transmission) -Biological and evolutionary vulnerability: more likely to develop fear for certain object as in inherited tendency to fear things that are dangerous to humans -But we’re not scared of guns, cars or fast-food because evolution hasn’t caught up to our society yet -Many patients don’t know the cause but it doesn’t really matter for treatment *Phobias are often comorbid; you have more than one phobia Treatment Psychological Treatments of Specific Phobias -Cognitive-behavior therapies work very well -Exposure therapy -Build anxiety hierarchy: Subjective Units of Distress (SUDs) -Start with least threatening and move onto most threatening -Starting at a too high of a level lowers treatment compliance -Use counter-conditioning like muscle relaxation, visualization, deep breathing Social Anxiety Disorder Overview and Defining Features -Mark fear/anxiety about a social situation in which individuals are exposed to scrutiny/judgment of others Social Performance situations: speaking; eating; using bathroom; writing -Fears he/she will act in a way that shows their anxiety symptoms and people will negatively judge them -Social situations always provoke fear or anxiety -Situations avoided or endured with intense distress -Fear is not proportional to situation -Causes distress and impairment that lasts for 6 months or more Facts and Statistics -12 month prevalence: 7% -Females slightly more presented than males (close to 2:1) -Onset is usually during adolescence (median age = 13) with majority of onset between 8 and 15 Causes -Evolutionary vulnerability: evolved to fear disapproving faces -Biological vulnerability: some people are just born shy. Introverted people are chronically more aroused and need less stimulation. Social/performance experiences may cause over-arousal. -Psychological factors: taught that social evaluation is important or dangerous -Direct conditioning -Observational learning -Information transmission Medication Treatment -Beta blockers and ineffective -Tricyclic antidepressants reduce social anxiety -Mono oxidase inhibitors reduce anxiety -SSRI Paxil was the first drug FDA approved for social anxiety disorder -High relapse rates once medication is discontinued Psychological Treatment of Social Anxiety -Cognitive-behavioral treatment: exposure, rehearsal, role-play in a group setting Therapists challenge automatic thought regarding phobic activities (i.e. “If I mispronounce a word, everyone will laugh at me”) -Cognitive-behavior treatments are very effective with the exposure component being the most important Obsessive-Compulsive Disorder (OCD) Obsessions- persistent, recurrent and intrusive thoughts, images or urges that someone tries to resists (“Did I turn my stove off, did I turn my stove off…”) Common worries – contamination, doubts about safety, order, aggressive or sexual imagery Ego-dystonic – feel intrusive and out of one’s own control; not consistent with “regular” thought content Compulsions- repetitive thoughts or actions that someone feels like they have to do according to rigid rules -Goals of compulsion is to prevent or reduce distress associated with the obsessions. Compulsions are either not realistic or aren’t even connected to their actual fear. Obviously excessive and can even be useless (i.e. not stepping on sidewalk cracks) *Obsessions and compulsions are time consuming or cause significant distress or impairment (i.e. showing for 2 hours a day; checking stove dozens of times) Classifier: good to fair insight (recognizes that OCD beliefs aren’t true); poor insight (thinks that their OCD beliefs are probably true); absent insight/delusions (convinced OCD beliefs are true) Facts and Statistics -12 month prevalence: 1.2% -Females are more affected (but more male children have OCD) -OCD is chronic, especially if it’s untreated -Onset is typically in early adolescence or adulthood (mean age = 20) High morbidity with tic disorders like hoarding or skin picking Causes of OCD -Genetic factors -Greater neuroticism; internalizing symptoms -Early life experiences and learning that some thoughts are dangerous or unacceptable (i.e. thoughts about sex and how that relates to religious upbringing) -Focusing too much about thoughts leads to thought-action fusion: having the thought becomes equated with the action “I thought about hitting that women with my car I did hit that woman with my car” -Linked to excessive sense of responsibility and results in guilty, Belief that some thoughts are unacceptable and must be suppressed -Difficulty dealing with uncertainty Medication Treatment of OCD -Clomipramine and other SSRIs help about 60% -Psychosurgery is used in very extreme cases: cause lesions in parts of the brain that cause obsessions -Relapse is common once medicine is discontinued Psychological Treatment of OCD -Cognitive-behavioral therapy is most effective for OCD -CBT involves exposure and response prevention (Make them do an action and then not letting them perform OCD actions) -Combined treatments are not really better than CBT alone (Reality is that very sever OCD cases treat with combined treatments) Body Dysmorphic Disorder -Preoccupation with one or more perceived defects or flaws in appearance that are not observable to other or appear slight to others -Individual has/does perform repetitive behaviors or mental acts in response to concerns (checking or avoiding mirrors) -Causes distress or impairment -Specifier: with muscle dysmorphia – believe that muscles are too small or insufficiently muscular (mostly in men) -Insight specifier: good to fair; poor insight; absent/delusional -Prevalence: 2.4%; higher among dermatology patients, cosmetic surgery patients, orthodonture patients -Slightly more common in women -Very serious disorder which can lead to suicide Treatment -Similar to OCD treatment: SSRIs and CBT Posttraumatic Stress Disorder (PTSD) -Requires exposure to actual or threated death, serious injury, or sexual violence: directly experiencing events; witnessing, in person, events; learning of events that occurred to your family or friends; experiencing repeated or extreme exposure to aversive details of traumatic events Symptoms -Intrusive: recurrent, intrusive, involuntary memories; distressing dreams’ flashbacks; intense distress at cues of events whether they be internal or external; physiological reactions to cues -Avoidance of stimuli associated with events: memories, thoughts, feelings associated with events -Negative alterations in thoughts or mood: unable to remember important details; exaggerated negative beliefs about oneself or others or the world; distorted cognitions about cause; negative emotional stress; diminished interest in participation in significant activities or detachment or estrangement from others; anhedonia (inability to feel pleasure) -Alterations in arousal/reactivity associate with traumatic events: irritability/angers; recklessness or self-destructive behavior; hypervigilance; exaggerated startle; sleep and concentration problems Facts and Stats Disturbance lasts 1 month or more Specifier: with dissociative symptoms -Depersonalization: feels detached from oneself and one’s thought/feelings or behaviors -Derealization: sense of unreality; experience of world as distorted, surreal or dreamlike Lifetime prevalence = 8.7%; 12 month = 3.5% Higher rates among veterans and certain jobs like first responders or victims of rape, combat, captivity, etc. Symptoms usually begin within 3 months of trauma but delayed expression can happen (DSM-IV; delayed onset of 6 months) Risk factors -Prior to trauma: childhood emotional problems, other mental disorders, lower education, lower SES, prior trauma, lower intelligence, female gender and younger age -During trauma: severity of trauma, perceived life threat, personal injury, dissociation. For veterans: killing enemy, witnessing or participating in atrocities Most common trauma: sexual assault, accidents, combat, natural disasters Psychological Treatment of PTSD -CBT involves graduated or massed imaginal exposure (re-experience event in a safe, controlled environment) Remember what happened in great detail and try to work through it -Can challenge thoughts and emotions attached to event; goal is to reduce negative emotions like shame, guilt or anger -Increase positive coping skills and social support -CBT is more effective than medication, but patients will usually use anti- depressants too Medications -SSRIs may help reduce anxiety and panic
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