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abnormal textbook

by: Hayoung Lee

abnormal textbook Psy 3315

Hayoung Lee
Texas State
GPA 3.9

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ch 7-9!
Abnormal Psychology
\ Etherton
Class Notes
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This 25 page Class Notes was uploaded by Hayoung Lee on Wednesday October 12, 2016. The Class Notes belongs to Psy 3315 at Texas State University taught by \ Etherton in Fall 2016. Since its upload, it has received 4 views. For similar materials see Abnormal Psychology in Psychology at Texas State University.

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Date Created: 10/12/16
Abnormal psych Textbook notes CH 7 7.1 Mood disorders: an overview  Mood disorder – disturbances of mood that are intense and persistent enough to be clearly maladaptive  Depression – emotional state characterized by extraordinary sadness and dejection  Mania – emotional state characterized by intense and unrealistic feelings of excitement and euphoria  Unipolar depressive disorders – person experiences only depressive episodes  Bipolar and related disorders – person experiences both depressive and manic episodes  Depressive episode – person is markedly depressed or loses interest in formerly pleasurable activities (or both) for at least 2 weeks, as well as other symptoms such as changes in sleep, appetite, or feelings or worthlessness  Manic episode – person shows a markedly elevated, euphoric, or expansive mood, often interrupted by occasional outbursts of intense irritability or even violence o Persist for about a week for diagnosis o 3 or more additional symptoms must occur in the same time period from behavioral symptoms to mental symptoms  Hypomanic episode – person experiences abnormally elevated, expansive, or irritable mood for at least 4 days o Must have 3 other symptoms similar to those involved in mania but to a lesser degree  Major depressive episodes – aka unipolar major depression, a mental condition in which a person must be depressed for most of every day for most days for at least 2 weeks o Also a total of at least 5/9 designated symptoms must also be present  Quiz o People diagnosed with mania would be most accurately described as experiencing periods of  Excitement and euphoria o What is the defining characteristic of a mixed episode case of a mood disorder?  Experiencing rapidly alternating moods, such as sadness and euphoria, all within one episode of the illness o The minimum required duration of symptoms for a depressive episode is ____ and the minimum required duration of symptoms for a manic episode is ____.  2 weeks, 1 week Abnormal psych Textbook notes o A person who suffers from a less-severe form of mania that lasts for a minimum of 4 days might be described as experiencing a(n) _____ episode. It is typically less disruptive of a person’s life than a full episode of mania  Hypomania o Which of the following is the most reasonable sociocultural explanation for the increased incidence of major depressive disorder in people from lower socioeconomic statuses?  Low SES leads to greater levels of adversity and life stress 7.2 Unipolar Depressive Disorders  Major depressive disorder – must be in a major depressive episode, and never have had a manic, hypomanic, or mixed episode o Single episode if only one; recurrent if more than one o Depressive episodes usually last 6-9 months if untreated  Relapse – the return of symptoms within a fairly short period of time, reflects the fact that the underlying episode of depression has not yet run its course  Recurrence – the onset of a new episode of depression, probability of recurrence increases with number of prior episodes and also when person has comorbid disorders  Specifiers – different patterns of symptoms that sometimes characterize major depressive episodes that may help predict the course and preferred treatments for the condition  Major depressive episode with melancholic features – marked symptoms of loss of interest/pleasure in almost all activities, plus at least 3/6 other designated symptoms  Severe major depressive episode with psychotic features – involves loss of contact with reality, often in the form of delusions or hallucinations  Mood congruent – delusions or hallucinations that are consistent with a person’s mood Specifier Characteristic Symptoms Melancholic Three of the following: early morning awakening, features depression worse in the morning, marked psychomotor agitation/retardation, loss of appetite/weight, excessive guilt, qualitatively different depressed mood Psychotic Delusions or hallucinations (usually mood congruent); features feelings of guilt and worthlessness common Atypical features Mood reactivity – brightens to positive events; 2/4 following symptoms: weight gain or increase in appetite, hypersomnia, leaden paralysis (arms and legs feel heavy as lead), being acutely sensitive to interpersonal rejection Catatonic A range of psychomotor symptoms from motoric Abnormal psych Textbook notes features immobility to extensive psychomotor activity, as well as mutism and rigidity Seasonal Pattern At least 2 or more episodes in the past 2 years that have occurred at the same time (usually fall or winter), and full remission at the same time (usually spring). No other non-seasonal episodes in the same 2-year period  Persistent depressive disorder – characterized by persistently depressed mood most of the day, for more days than not, for at least 2 years (1 year for children + adolescents) o 2/6 additional symptoms when depressed  Double depression – person with dysthymia has a superimposed major depressive episode  4 phases of normal response of loss o 1. Numbing and disbelief o 2. Yearning and searching for dead person o 3. Disorganization and despair that sets in when person accepts the loss as permanent o 4. Some reorganization as the person gradually begins to rebuild his/her life  Postpartum blues: changeable mood, crying easily, sadness, irritability Quiz  Which of the following details would exclude a person from receiving a diagnosis of major depressive disorder? o Having experienced a hypomanic episode in the past  What is the relationship between the experience of depressive symptoms and significant levels of anxiety? o There is a very high level of comorbidity between depressive and anxiety disorders  How might one most aptly distinguish between a relapse and a recurrence of depressive symptoms? o A relapse is a re-emergence of previous symptoms; a recurrence is the emergence of a new episode of depression  According to research presented in this module, somewhere between ____ and ___ percent of adolescents experience either major depressive disorder or subclinical levels of depression at one point o 25;40  Marcellus has been struggling with the symptoms of a major depressive episode for quite some time. Dr. Ting, his therapist, notes that Marcellus meets the criteria for a major depressive episode, and in addition seems to have lost interest or pleasure in almost all activities, and that he recently turned down a chance to go to a concert of his Abnormal psych Textbook notes favorite musician for no discernable reason. The diagnosis of major depressive disorder would probably best include the specifier of o With melancholic features 7.3 Casual Factors in Unipolar Mood Disorders  Family studies have shown the prevalence of mood disorders is about 2-3x higher among blood relatives of persons with clinically diagnosed unipolar depression than the population at large  Distinction between stressful life events that are independent of the person’s behavior and personality o Independent: losing a job because one’s company is shutting down or having one’s house hit by a hurricane o Dependent: events that may have been at least partly generated by the depressed person’s behavior or personality  Dysfunctional beliefs – negative beliefs that are rigid, extreme, and counterproductive  Depressogenic schemas – dysfunctional beliefs that are rigid, extreme, and counterproductive and that are thought to leave one susceptible to depression when experiencing stress  Negative automatic thoughts – thoughts that often occur just below the surface of awareness and involve unpleasant, pessimistic predictions  Negative cognitive triad – includes self (“I’m worthless), world (“no one loves me”), and future (“it’s hopeless because things will always be this way”)  Dichotomous or all-or-none reasoning – tendency to think in extremes  Selective abstraction – tendency to focus on one negative detail of a situation while ignoring other elements of the situation  Arbitrary inference – involves jumping to a conclusion based on minimal or no evidence  Learned helplessness – a theory that animals and people exposed to uncontrollable aversive events learn that they have no control over these events and this causes them to behave in a passive and helpless manner when later exposed to potentially controllable events. Later extended to become a theory of depression  Attributions – process of assigning causes to things that happen o 1. Internal/external o 2. Global/specific o 3. Stable/unstable  Pessimistic attributional style – cognitive style involving a tendency to make internal, stable, and global attributions for negative life events  Rumination – the process of going over and over in one’s mind or going over a thought repeatedly time and again Abnormal psych Textbook notes  According to twin studies, monozygotic twins who have a co-twin with major depressive disorder are about ____ as likely as dizygotic twins to develop depression o Twice  Levinia has been going through a very difficult time lately, with both an increase in life stressors and the emergence of depressive symptoms. If her physician were to take a sample of blood from her, it is likely that she would find elevated levels of which stress hormone? o Cortisol  Why is seasonal affective disorder much more common in the fall and winter months than in spring and summer? o Those seasons provide a reduction in the amount of available light  In a single word, what did Sigmund Freud was at the root of most people’s symptoms of depression? o Loss  Which researcher was the first to propose the idea of learned helplessness as being a significant contributing factor to the symptoms of a major depressive episode? o Martin Seligman 7.4 Bipolar and Related Disorders  Bipolar disorders – mood disorders in which a person experiences both manic and depressive episodes  Cyclothymic disorder – the repeated experience of hypomanic symptoms for a period of at least 2 years o Must be a 2 year span of numerous periods with hypomanic and depressed symptoms (1 for adolescents and children) o Symptoms must cause clinically significant distress or impairment in functioning o Greater risk of bipolar 1 or 2 disorder  Bipolar I disorder – the person experiences both manic (or mixed) episodes and major depressive episodes o Person has full blown mania  Mixed episode – characterized by symptoms of both full-blown manic and major depressive episodes for at least 1 week, either intermixed or alternating rapidly every few days  Bipolar II disorder – the person does not experience full blown manic (or mixed) episodes but has experienced clear-cut hypomanic episodes as well as major depressive episodes.  Bipolar disorder with a seasonal pattern – bipolar disorder with recurrences in particular seasons of the year Abnormal psych Textbook notes  ____ disorder is marked by repeated experiences of hypomanic symptoms for a period of at least _____. o Cyclothymic; 2 years  Why is a person who demonstrates symptoms of mania without any history of depression still given a diagnosis of bipolar disorder? o It is assumed that either they have an undiagnosed depressive symptoms or that such symptoms will occur in the future  Which of the following individuals exhibit symptoms that are consistent with a diagnosis of bipolar II? o Zenia alternates between hypomanic and depressive symptoms  In order for a person with bipolar disorder to be described as having a rapid cycling pattern, he or she would have to have at least _____ episodes of manic/depressive episodes in a given year o 4 7.5 Causal Factors in Bipolar Disorders  The average concordance rate for bipolar disorder is about ____ percent for monozygotic twins, compared to ____ percent for dizygotic twins. o 60;12  Several different neurotransmitters seem to be involved in the regulation of mood states in human beings. They include all but which of the following? o Acetylcholine  Henry suffers from bipolar disorder and experiences one or two manic episodes in a given year, more when he is not taking his medication. Between episodes, which of the following symptoms is he most likely to experience? o Substantial sleep difficulties 7.6 Sociocultural Factors Affecting Unipolar and Bipolar Disorders  Lao lives in China, where he has resided with his family for his entire life. Recently he has begun experiencing symptoms of depression. Which symptom would he most likely demonstrate, given the cultural influences of his surroundings? o Loss of sexual interest Abnormal psych Textbook notes  In the 2004 World Mental Health Study conducted by the World Health Organization, the prevalence and characteristics of psychological disorders was examined in 20 different countries. The 12-month prevalence rate of depression rate was round to be lowest in o Nigeria  Jarli is a young Australian Aboriginal who lives in a native community in the northern territory of Australia. If Jarli was clinically depressed, what types of behaviors is he likely to exhibit? o Venting of hostilities onto others might be observed 7.7 Treatments and Outcomes  Monoamine oxidase inhibitors (MAOIs) – first category of antidepressants that inhibit the action of monoamine oxidase, the enzyme responsible for the breakdown of norepinephrine and serotonin once released  Tricyclic antidepressants – increase neurotransmission of the monoamines, primarily norepinephrine and to a lesser extent serotonin, used to treat depression sometimes anxiety disorders, are thought to block the reuptake of norepinephrine and serotonin at the synapse  Selective serotonin reuptake inhibitors (SSRIs) - medication that inhibits serotonin and is used in the treatment of depression  Lithium – a common salt that consists of a soft, silver white metal; it has been found to reduce the symptoms of bipolar disorder although it has a number of negative side effects  Electroconvulsive therapy (ECT) – use of electricity to produce convulsions and unconsciousness; a treatment used primarily to alleviate depressive and manic episodes. Aka electroshock therapy  Transcranial magnetic stimulation (TMS) – noninvasive technique allowing focal stimulation of the brain in patients who are awake. Brief but intense pulsating magnetic fields that induce electrical activity in certain parts of the cortex are delivered  Deep brain stimulation – implanting an electrode in brain then stimulating that area with electric current  Brain light therapy – for non-seasonal depression  Cognitive-behavioral therapy (CBT) – originally developed by Beck, therapy based on altering dysfunctional thoughts and cognitive distortions  Mindfulness based cognitive therapy – for people with highly recurrent depression, change the way in which people relate to their thoughts, feelings, and bodily sensations Abnormal psych Textbook notes  Behavioral activation treatment – focuses intensively on getting patients to become more active and engaged with their environment and with their interpersonal relationships  Interpersonal therapy (IPT) – time limited psychotherapy approach that focuses on the interpersonal context and on building interpersonal skills  Which of the following people has the least likelihood of receiving some sort of treatment? o Ulie, who has been diagnosed with a mild to moderate case of major depressive disorder  Why might a physician be somewhat unwilling to give a person with major depressive disorder a prescription for monoamine oxidase inhibitors (MAOIs) as the first pharmaceutical approach to addressing their symptoms? o These drugs can have severe, even fatal side effects of foods containing a specific amino acid that are consumed while on the medication  Generally speaking, a person who has just started taking antidepressants should not expect to experience a significant reduction in depressive symptoms for about o 3-5 weeks  Which of the following is one of the benefits offered by transcranial magnetic stimulation for the treatment of mood disorders? o The treatment does not cause any deficit in cognitive performance or memory skills like those that occur with electroconvulsive therapy (ECT)  What type of therapy aimed at the treatment of depression involves meditation techniques that emphasize patient’s awareness of unwanted thoughts, feelings, and sensations? o Mindfulness-based cognitive therapy 7.8 Suicide: The Clinical Picture and The Casual Pattern  Suicide – intentionally taking one’s on life  Non-suicidal self injury (NSSI) – direct, deliberate destruction of body tissue (often taking the form of cutting or burning one’s own skin) in the absence of any intent to die  Concordance rate in identical: 3x higher than in fraternal  Perceived burdensomeness: feeling like a burden to others  Thwarted belongingness: feeling alone Abnormal psych Textbook notes  Acquired capability for suicide: believed to be acquired through pain or provocative experiences  The disorder that is most commonly linked to suicide is o Depression  Angelina is 12-years old, and several times a week she sits in a locked bathroom in her home and uses a razor blade to cut the insides of her thighs. The practice is painful to her, but she experiences that pain as a positive sensation rather than a negative one. Angelina’s behavior would be classified as o Non-suicidal self injury (NSSI)  While suicide is relatively rare among children, the prevalence of such behaviors increases starting at around age ___ and continues to increase to the early mid 20s. o 12  Which figure, described in your text as the “godfather of suicide research” has written extensively about what constitutes a suicidal mind? o Shneidman 7.9 Suicide Prevention and Intervention  Objectives to help coping o 1. Maintaining supportive and often highly directive contact with the person over a short period of time – usually one to six contacts o 2. Helping the person to realize that acute distress is impairing his or her ability to assess the situation accurately and to see that there are better ways of dealing with the problem o 3. Helping the person to see that the present distress and emotional turmoil will not be endless  The Food and Drug Administration (FDA) has required pharmaceutical companies to place warnings on the packaging for antidepressant medications that state that these drugs might o Increase the risk of suicidal behaviors  Since the 1960s, the availability of competent assistance at times of suicidal crisis has been expanded through the establishment of o Suicide hotlines  In classical Greece, a person who was extremely ill could o Petition the state and receive permission to end his life  Mood disorders have previously been referred to as _____ disorders, as they involve extremes of emotions – soaring elation or deep depression – that dominate the clinical picture o Affective Abnormal psych Textbook notes  Research consistently finds higher rates of depression-related problems in adolescent girls as compared to adolescent boys. Which of the following is one of the explanations for why this occurs? o Negative cognitions about attractiveness and body image are more salient for girls than for boys  How might one support the statement that the development of major depressive disorder has moderate genetic contributions? o The co-twin of a monozygotic twin with major depressive disorder is twice as likely to develop the condition as are dizygotic co-twins  Which of the following would be the correct combination of neurotransmitter activities during different stages of bipolar disorder? o Increased norepinephrine activity during manic episodes and decreased serotonin activity during depressed and manic stages  Rennette has been suffering from the symptoms of major depressive disorder for several months, and her psychiatrist has prescribed a new type of medication. She is told that she must avoid foods that contain the amino acid tyramine, including red wine, salami, beer, and aged cheese. What kind of medication has Rennette been prescribed? o A monoamine oxidase inhibitor (MAOI)  Approximately _____ percent of adolescents and young adults have engaged in at least 1 suicidal self injury behavior, often with the goal of decreasing high levels of distress and eliciting help from others o 15-20  Research of finding an increase in _____ among adolescents taking antidepressant medications vs placebos prompted the Food and Drug Administration to place a warning on the labels of such medications alerting the public to this risk o Suicidal thoughts and behaviors  In the United States, the first state to pass a Death with Dignity Act in 1994 was _____. This gave physicians legal permission to prescribe a lethal dose of medication for a terminally ill patient to ingest on their own o Oregon  Among children who are diagnosed with depression o Boys are equally likely or slightly more likely than girls to be diagnosed  EEG sleep studies of persons with depression reveal that depressed persons on the average _____ when compared to persons who are not depressed o Enter REM sleep 15-20 minutes earlier after going to bed, and spend a lower than normal amount of time in stage 3-4 sleep  It is estimated that about _____ of people with a first onset of depression have experienced a recent major stressful life event o 70% Abnormal psych Textbook notes  In addition to being effective in the treatment of severe depression, electroconvulsive therapy (ECT) has proven to be effective in treating about 80% of cases of ____. o Manic episodes CHAPTER 8: SOMATIC SYMPTOM AND DISSOCIATIVE DISORDERS  Somatic symptom disorder – a new DSM-5 diagnosis characterized by somatic (physical) symptoms and an excessive focus (in thoughts, feelings, or behavior) on these symptoms. Many people who would have been diagnosed with hypochondriasis in DSM-IV-TR will now be diagnosed with somatic symptom disorder.  Dissociative disorder – conditions involving a disruption in an individual’s normally integrated functions of consciousness, memory, or identity  Somatoform disorders – conditions involving physical complaints or disabilities that occur without any evidence of physical pathology to account for them 8.1: Somatic Symptom and Related Disorders: An Overview  Soma – body  What is the major commonality of the different somatic symptom disorders? o Bodily symptoms that cause significant psychological distress and impairment  What major change has been made to the category of somatic symptom and related disorders in DSM-5 o No distinction has been made between medically explained and medically unexplained symptoms  What percentage of the general population reports having experienced somatic (physical) symptoms in the past week? o 80% 8.2  Somatic symptom disorder o Attention to bodily sensations o Attribution of sensations to illnesses o Worry/catastrophic thinking o Help seeking  Treatment: cognitive behavioral techniques Abnormal psych Textbook notes  Allen Frances, who served as the chair of the task force that developed DSM-IV, has called the new DSM-5 somatic symptom disorder a o “loosely defined and fatally flawed” diagnosis and recommended that clinicians not use it  The historical roots of the DSM-IV category of somatoform disorders date back to o Psychoanalytic concept of hysteria and the work of Freud, Breuer, and Janet  According to cognitive behavioral formulations, somatic symptom disorder can be viewed as a disorder of both o Perception and cognition  Which of the following personality traits are considered risk factors for developing somatic symptom disorder? o Negative affect, absorption, and alexithymia  Zack, diagnosed with somatic symptom disorder, is participating in a form of cognitive therapy where his therapist has instructed him not to engage in checking his body as he routinely does and to not seek constant reassurance from others. Zack’s therapist is using the technique of o Response prevention 8.3 Illness Anxiety Disorder  When hypochondriasis occurs with no or only very mild physical symptoms, what would be the correct DSM-5 diagnosis? o Illness anxiety disorder  For how long must the preoccupation with a real or imagined illness persist before a diagnosis of illness anxiety disorder can be made o 6 months  Individuals with illness anxiety disorder o Have high anxiety about developing or having an illness. However, if somatic symptoms are present, they are mild in intensity 8.4 Conversion Disorder (Functional Neurological Symptom Disorder)  Conversion disorder – pattern in which symptoms of some physical malfunction or loss of control appear without any underlying organic pathology; originally called hysteria  Hysteria – older term used for conversion disorders; involves the appearance of symptoms of organic illness in the absence of any related organic pathology  DSM-5 criteria Abnormal psych Textbook notes o One or more symptoms of altered voluntary motor or sensory function o Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions o The symptom or deficit is not better explained by another medical or mental disorder o The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluations  Symptom categories: sensory, motor, seizures, mixed presentation of first 3  During WWI and WWII, conversion disorder was often diagnosed among soldiers  Conversion disorder occurs more frequently in women than in men  Conversion disorder often occurs along with other disorders  Primary gain – in psychodynamic theory it is the goal achieved by symptoms of conversion disorder by keeping internal intrapsychic conflicts out of awareness. In contemporary terms it is the goal achieved by symptoms of conversion disorder by allowing the person to escape or avoid stressful situations  Secondary gain – external circumstances that tend to reinforce the maintenance of disability  About 20% of persons diagnosed with conversion disorder present the symptom of la belle indifference. This term refers to the fact that o Patients exhibit very little anxiety and fear, behaviors that would normally be expected in people with symptoms such as paralysis or blindness  The sensory symptoms or deficits found with persons with conversion disorder are most found in which? o Visual  Connor is able to talk only in a whisper, although he can usually cough in a normal manner. This type of vocal system pattern, found with cases of conversion disorder, is referred to as o Aphonia  Burke conducted a study involving 10 women with conversion disorder. The findings revealed that when the anesthetic body part was stimulated, there was decreased activation in somatosensory cortex but increased activation in areas such as the anterior cingulate cortex and the insula. These results support the notion that o Sensory areas of the brain may be inhibited by overactive emotion-based processing areas of the brain  With conversion disorders, Freud thought that the reduction in anxiety and intrapsychic conflict was _____, but noted that patients often also experienced ______ as well Abnormal psych Textbook notes o The “primary gain” that maintained the condition; “secondary gain” such as receiving sympathy and attention from loved ones 8.5 Factitious Disorder  Factitious disorder – feigning of symptoms to maintain the personal benefits that sick role may provide, including the attention and concern of medical personnel or family members  Malingering – consciously faking illness or symptoms of disability to achieve some specific non-medical objective  Factitious disorder imposed on another – this diagnosis is given when a person deliberately falsifies medical or psychological symptoms in another adult, a child, or even a pet. This occurs in the absence of any external reward (e.g. insurance money). Methods might include fabrication, exaggeration of existing problems, or deliberate creation of illness or disease. The person who induces the injury or disease is given the diagnosis, not the victim who is made ill or impaired. Aka factitious disorder by proxy or Munchausen’s syndrome by proxy  Those who have factitious disorder intentionally produce psychological or physical symptoms (or both) whereas individuals with conversion disorders are not consciously producing their symptoms  Someone who fakes illness or symptoms of disability to achieve a specific nonmedical objective is malingering  A disorder in which the person seeking medical help has intentionally produced a medical or psychiatric illness in another person is factitious disorder imposed on another  Maya is 32 years and is irritated that her sister is getting so much attention around her upcoming wedding. In order to get more attention for herself, Maya begins feigning the symptoms of a major illness. She even has herself hospitalized for this phantom sickness. What psychological disorder are these symptoms? o Factitious disorder  When a personally intentionally creates his own physical symptoms in order to get some external gain – disability benefits, avoidance of military service, or extended time off from his job – he is demonstrating symptoms of o Malingering  Which of the following statements correctly identifies the difference between factitious disorder and malingering? o In the case of factitious disorder, the person receives no tangible external rewards. With malingering, the person is motivated by external incentives such as avoiding situations perceived as stressful or personal responsibilities 8.6 Dissociative Disorders: An Overview Abnormal psych Textbook notes  Dissociation – the human mind’s capacity to mediate complex mental activity in channels split off from or independent of conscious awareness  Implicit memory – memory that occurs below the conscious level  Implicit perception – perception that occurs below the conscious level  ________ memory refers to stored information that people cannot consciously recall o implicit  _______ disorders are a group of conditions that involve disruptions in a person’s normally integrated functions of consciousness, memory, identity, or perception. o Dissociative  Andrew often cannot remember what went on during his history class. He finds the class boring and daydreams during the lecture. He is so involved in his daydreaming that, frequently, he is unaware when the class has ended and is surprised when he hears classmates leaving the room. Andrew’s behavior is an example of o Dissociation 8.7 Depersonalization/Derealization Disorder  Derealization – experience in which the external world is perceived as distorted and lacking a stable and palpable existence  Depersonalization – temporary loss of sense of one’s own self and one’s own reality  Depersonalization/derealization disorder – dissociative disorder in which episodes of depersonalization and derealization become persistent and recurrent  In ______, one’s sense of the reality of the outside world is lost o Derealization  Research finds that people with derealization/depersonalization disorder have an elevated risk of developing one of several other different disorders, including o Schizophrenia  Stephanie has repeated experiences where she feels she is floating above her physical body. These experiences come on suddenly and leave Stephanie feelings unreal. Stephanie is experiencing o Depersonalization 8.8 Dissociative Amnesia Abnormal psych Textbook notes  Dissociative amnesia – psychogenically caused memory failure, failure to recall previously stored personal information (retrograde amnesia) when that failure cannot be accounted for by ordinary forgetting  Dissociative fugue – a dissociative amnesic state in which the person is not only amnesic for some  Which of the following types of memory is typically the only type of memory affected by dissociative amnesic reactions? o Episodic and/or autobiographical memory  Angela’s uncle Leo, an accountant, disappeared from his home in Dover, Delaware after his wife died from a lengthy illness. He was later found working in a casino in Las Vegas, Nevada. When located, Leo had no memory of who he was or how he got to Las Vegas. He had assumed a name, rented an apartment, and managed his daily affairs in Las Vegas without any problems. What diagnosis best fits with Leo’s behaviors? o Dissociative fugue  Brain-imaging data were evaluated for nine individuals diagnosed with dissociative amnesia. Although the sample size was small, the imaging suggested that, for these diagnosed individuals, there was a o Subtle loss of function in the right anterior hemisphere 8.9 Dissociative Identity Disorder  Dissociative identity disorder (DID) – condition in which a person manifests at least two or more distinct identities or personality states that alternate in some way in taking control of behavior. Formerly called multiple personality disorder  Host identity (personality) – the identity in DID that is most frequently encountered and carries the person’s real name. This is not usually the original identity and may or may not be the best adjusted identity.  Alter identities – in a person with DID, personalities other than the host personality  Posttraumatic theory (of DID) – the view that DID starts from the child’s attempt to cope with an overwhelming sense of hopelessness and powerlessness in the face of repeated traumatic abuse  Sociocognitive theory (of DID) – view that DID develops when a highly suggestible person learns to adopt and enact the roles of multiple identities, mostly because clinicians have inadvertently suggested, legitimized, and reinforced them and because these different identities are geared to the individual’s own personal goals  With the general public, the diagnosis of DID is often confused with the diagnosis of ____ as a result of the use of the phrase _____. o Schizophrenia; “split personality”  The original theory dealing with the origins of DID was that DID had its roots in a patient’s childhood and that DID was the result of an attempt Abnormal psych Textbook notes to cope with an overwhelming sense of hopelessness in the face of repeated traumatic abuse is called o Posttraumatic theory  Lenny’s wife, Morgan, has been diagnosed with DID. According to Morgan, she has discovered in therapy that she was abused by her father. Lenny feels Morgan’s memories are false memories and have resulted from leading questions and suggestive techniques used by her psychotherapist. Theoretically, what perspective reflects Lenny’s concerns? o Sociocognitive theory  Recent studies have compared the behavior of people diagnosed with DID with the behavior of people who are asked (after appropriate training) to stimulate DID. Individuals diagnosed with DID differed from simulators in that o Persons with DID showed more cognitive processing problems  It has been suggested that some of the increase in the prevalence of DID is artifactual and has occurred because o Therapists looking for evidence of DID in patients may suggest the existence o alter identities 8.10 Cultural Factors, Treatments, and Outcomes in Dissociative Disorders  For individuals with DID, alters are not in any meaningful sense personalities but rather reflect o A failure to integrate various aspects of a person’s identity, consciousness, and memory  An important goals of psychotherapy for persons with DID is to o Integrate the patient’s personalities into one identity that is better able to cope with current stressors  Most current forms of psychotherapy for DID are based on the assumption that the disorder was caused by o Abuse CH 8!  Important to understanding somatic symptom disorders is the fact that the affected patients o Have no control over their symptoms, but are not trying to intentionally deceive others  For an individual to be diagnosed with somatic symptom disorder, they must o Be experiencing distressing chronic symptoms and exhibit dysfunctional thoughts, feelings, and/or behaviors  One of the major criticisms of the diagnostic criteria of somatic symptom disorder Abnormal psych Textbook notes o Is that the new diagnostic criteria appear far too loose and could lead to many people being mislabeled as having a mental disorder  When hypochondriasis is accompanied by significant physical symptoms, the DSM-5 diagnosis will be o Somatic symptom disorder  Conversion disorder is characterized by o The presence of neurological symptoms in the absence of a neurologic diagnosis  Conversion disorders are found in approximately ____ of people referred for treatment at neurology clinics o 5%  Caroline’s daughter, Hailey, age 5 has spent much of her life in and out of the hospital. She often presents in the emergency room with complaints of diarrhea, constipation, and generalized abdominal pain. Hailey is thin, pale, and always appears malnourished. Extensive testing in the hospital has revealed no physical cause for Hailey’s problems. Caroline seems to enjoy talking with the health care staff and the attention she receives as the mother of a sick child. The staff notes that Hailey always recovers quickly and has a rapid weight gain while hospitalized. Some of the staff wonders if Caroline is intentionally making Hailey ill. If that is true, what diagnosis is appropriate? o Factitious disorder imposed on another  Implicit perception can be defined as o Perception in the absence of awareness  Matthew has been under significant stress at his job. He is concerned about his well being because he has episodes at work and home where friends, family, and places seem as though they are unreal or dreamlike. Matthew’s reality testing, however is intact. What DSM symptom best fits with his experiences? o Derealization  Amnesia caused by organic brain pathology is more likely to be classified as _____ amnesia, whereas amnesia that occurs following intolerably stressful circumstances is more likely to be _____ amnesia o Anterograde; retrograde  Kilstrom and others have pointed out that conversion disorders are different from the other somatic symptom disorders in that conversion symptoms _____, while somatic symptom disorders do not. o Nearly always resemble neurological problems in their clinical presentation  In cases of dissociative identity disorder, the identity that is most frequently encountered and carries the person’s real name is called the o Host Abnormal psych Textbook notes  In DSM-5, the diagnostic criteria for DID have been modified to include pathological possession. Which of the following statements can be attributed to this modification? o The change makes the diagnosis of DID more inclusive and applicable to a broader range of cultural groups  Which of the following best describes the symptoms associated with amok? o Persons afflicted exhibit violent, aggressive, or homicidal behavior which is directed at other people and objects  A promising treatment of dissociative disorders involves administering rTMS (repetitive transcranial magnetic stimulation) to the temporo- parietal junction, an area of the brain involved in o The experience of a unified self and body CHAPTER 9: Eating Disorders and Obesity 9.1 Clinical Aspects of Eating Disorders  Anorexia nervosa – intense fear of gaining weight or becoming “fat” coupled with refusal to maintain adequate nutrition and with severe loss of body weight  Binge – An out of control consumption of an amount of food that is far greater than what most people would eat in the same amount of time and under the same circumstances  Purge – refers to the removal of food from the body by such means as self induced vomiting or misuse of laxatives, diuretics, and enemas  Bulimia nervosa – frequent occurrence of binge eating episodes accompanied by a sense of loss of control over eating and recurrent inappropriate behavior such as purging or excessive exercise to prevent weight gain o Occurs on average once a week over a 3-month period  Binge eating disorder (BED) - distinct from non-purging bulimia nervosa, whereby binging is not accompanied by inappropriate compensatory behavior to limit weight gain  Medical complications o Brain and nerves: cant think right, fear of gaining weight, sad, moody, irritable, bad memory, fainting, changes in brain chemistry o Hair: thins and gets brittle o Heart: low blood pressure, slow heart rate, fluttering of the heart failure o Muscles and joints: weak muscles, swollen joints, fractures, osteoporosis o Blood: anemia and other blood problems o Kidneys: kidney stones, kidney failure Abnormal psych Textbook notes o Body fluids: low potassium, magnesium, and sodium o Intestines: constipation, bloating o Skin: bruise easily, dry skin, growth of fine hair all over body, get cold easily, yellow skin, nails get brittle o Hormones: periods stop, bone loss, problems growing, trouble getting pregnant, if pregnant, higher chance of miscarriage, having a C-section, baby with low birth weight, and post partum depression  Diagnostic crossover is common in eating disorders with transitions between the two subtypes of anorexia nervosa being very common o Transitions from the binge-eating/purging subtype of anorexia nervosa to bulimia can also occur often occur  A meta-analysis involving participants has shows that such attitudes and behaviors are significantly more prevalent in whites than in non- whites  ______, a criterion used in the DSM-IV for the diagnosis of anorexia nervosa, was eliminated as a diagnostic feature in the DSM-5 as it could not be used as a criterion for males, prepubescent girls, or with women using hormonal contraceptives o Amenorrhea  Sarah engages in binge-purge cycles with her consumption of food. She is also severely underweight. Which diagnosis is most appropriate for her? o Anorexia nervosa  Which form of eating disorder is often admired by others with eating disorders? o Restrictive type anorexia nervosa  Although there are similarities between bulimia nervosa and binge eating disorder (BED), one feature distinguishes the two. Individuals with o BED do not engage in compensatory behaviors after binging; those with bulimia nervosa do  Which demographic is most at risk for developing bulimia nervosa? o 21 to 24-year old women 9.2 Risk and Casual Factors in Eating Disorders  The tendency to develop an eating disorder has been shown to run in families  Hypothalamus – key brain structure located just above the brain stem. The hypothalamus is part of the limbic system. It is involved in a wide range of autonomic function including sleep, appetite and body temperature  Set point – the tendency of our bodies to resist efforts to bring about a marked change (increase or decrease) in weight Abnormal psych Textbook notes o Anyone intent on achieving and maintaining a significant decrease body mass below his or her individual set pint may be trying to do this in the face of internal physiological opposition, which is aimed at trying to get the body back to its original set point weight  Serotonin – a neurotransmitter that has been implicated in obsessionality, mood disorders, and impulsivity, and modulates appetite and feeding behavior o Made from an essential amino acid called tryptophan, can only be obtained from food  Perfectionism – the need to get things exactly right. A personality trait that may increase risk for the development of eating disorders, perhaps because perfectionistic people may be more likely to idealize thinness  Body Mass Index (BMI) o Healthy: 18.5 – 24.9 o Overweight: 25 – 29.9 o Obese: 30 – 39.9 o Morbidly obese: 40  Negative affect – the experience of an emotional state characterized by negative emotions. Such negative emotions might include anger, anxiety, irritability and sadness  Which of the following disorders is more likely to occur in relatives of people suffering from bulimia nervosa? o Alcohol dependence  Animal studies have demonstrated that lesions in a part of the hypothalamus called the ventromedial hypothalamus will cause the animal to o Eat voraciously and rapidly become obese  What essential amino acid is serotonin made of? o Tryptophan  In some cases of eating disorders, damage to the temporal cortex of the brain appears to be linked to anorexia nervosa and/or bulimia. The region of the brain is known to o Be involved in body image perception  Which of the following is a risk factor for disordered eating for men but not for women? o Sexual orientation 9.3 Treatment of Eating Disorders  Randomized controlled trials – involves a specific treatment group (group the researchers are most interested in) as well as a control treatment group (against which the treatment group will be compared). Participants will have an equal chance of being placed in either group because placement is determined randomly Abnormal psych Textbook notes  Cognitive behavior therapy (CBT) – therapy based on altering dysfunctional thoughts and cognitive distortions, involves changing behavior and maladaptive styles of thinking  The Maudsley model is a 10-20 session family therapy program for adolescents with anorexia nervosa that consists of three phases. Which of the following describes the focus of the second phase? o Family issues are addressed and there are negotiations for a new pattern of relationships among family members  Pike and colleagues treated 33 women who had been diagnosed with anorexia nervosa using cognitive behavioral therapy (CBT). Of the women treated, only 17% fully recovered. The limited success of CBT for patients with anorexia nervosa may be due to o The extreme cognitive rigidity that is characteristic of those with anorexia nervosa  What kind of medication is commonly used to treat bulimia nervosa? o Antidepressants 9.4 The Problem of Obesity  Medical issues: high cholesterol, hypertension, heart disease, arthritis, diabetes, and cancer o Reduced life expectancy of 5-20 years  Obesity – the condition of having elevated fat masses in the body; defined as having a body mass index (BMI) of 30 or higher  Body mass index (BMI) – an estimation of total body fat calculated as body weight (in kilograms) divided by height (in meters) squared  Which gender and ethnic group has the highest levels of obesity? o African American women  Tara has a BMI of 40. People with this BMI is considered o Morbidly obese  What percentage of the U.S. population is of normal or healthy weight? o Less than 1/3 9.5 Risk and Casual Factors in Obesity  Prader-Willi syndrome have chromosomal abnormalities that create many problems, one of which is very high levels of ghrelin o Are extremely obese and often die before age 30 from obesity related causes  Pathways to obesity: o Social pressure to be thin  body dissatisfaction  dieting  diet failure  binge eating o Negative emotions  binge eating  weight gain Abnormal psych Textbook notes  _____ is a hormone that informs the central nervous system about the status of the body’s fat reserves o Leptin  Prader-Willi syndrome is caused by ______, which causes the levels of ______ to be high o Chromosomal abnormality; grehlin  When people are given free access to food, the amount eaten each day is around ____ of what they actually need for their energy requirements o 150% 9.6 Treatment of Obesity  Three main treatment options: lifestyle modifications (diet, exercise, and behavior therapy), medications, bariatric surgery  Servings: o Meat: size of the palm of your hand o Fish: size of a smartphone o Dairy: size of a baseball o Pasta/rice: size of tennis ball o Peanut butter: golf ball  Medications: o Orlistat (Xenical): works by reducing the amount of fat in the diet that can be absorbed once it enters the gut o Lorcaserin (Belviq): target serotonin or other neurotransmitters o Contrave: combination of naltrexone (used to treat drug and alcohol addiction) and buproprion (used to treat depression and help smokers quit)  Bariatric Surgery: o Gastric bypass surgery: reduce storage capacity of the stomach o Sometimes shorten the length of the intestine so that less food can be absorbed  Importance in preventions and a few steps: o Eat fewer bites of food when you eat a meal o Take the stairs, combine a meeting with a walk, park further from your destination o Sleep more  Children typically consume an average of ____ of their daily calories at school o 30-50%  The Healthy, Hunger free Kids Act passed by Congress in 2010 attempts to improve child nutrition by o Mandating that nutritional standards be developed for all foods sold in schools Abnormal psych Textbook notes  Taylor is overweight and is currently involved in a lifestyle management program to reduce her weight. According to research, what sustained weight loss is typical for persons, such as Taylor, who are using a lifestyle management approach? o 7 pounds  The term anorexia nervosa, which literally means “lack of appetite induced by nervousness,” is a somewhat of a misnomer because _____ o A lack of appetite is not the core issue for individuals with anorexia nervosa, and individuals with anorexia nervosa may not even experience a lack of appetite  Eating disorders, particularly anorexia, have been noted with children as young as ___ years of age o 7 years  Andrew has an eating disorder characterized by a tightly controlled calorie intake and avoidance of eating in the presence of others. Which eating disorder is associated with Andrea’s symptoms? o Restrictive anorexia  Although binge-eating disorder and bulimia nervosa share a lot of the same symptomatology, there is one significant difference. Persons with ______. o Binge eating disorder are less likely to utilize “compensatory” strategies such as purging or using laxatives than are persons with bulimia nervosa  Which neurotransmitter modulates appetite and feeding behavior? o Serotonin  An area of the brain that appears to play an important role in eating behavior is the ___. o Hypothalamus  Which eating disorder typically develops after adolescence? o Binge eating disorder  Ashley, who is 15 years old, has anorexia. ______ is considered the treatment of choice for young women of her age o Family therapy  In the treatment of adults with anorexia, ______. o There is no leading effective treatment  Connor participated in a simulated jury study where he was asked to read a case vignette and then look at mug shots of 2 men and 2 women who were either thin or obese. He was asked to rate the guilt of each of these 4 individuals on a scale of 1-5. Based on a previous study, which of the individuals was he most likely to give the highest rating of guilt? o The obese woman  A person with a BMI of 27 would be considered Abnormal psych Textbook notes o Overweight  What brain changes were noted in the research with rats that were provided extended access to high fat and high sugar foods? o The rats exhibited a down regulation of activity in their brain reward circuits  _____ is an FDA approved medication for weight loss that works by reducing the amount of fat in the diet that can be absorbed once it enters the gut o Orlistat (Xenical)  Which of the following is likely to occur when the body goes into “starvation mode”? o The metabolic rate slows and the individual feels less full after eating


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