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by: Jeromy Hilll


Jeromy Hilll
Texas State
GPA 3.98

T. Schepis

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T. Schepis
Class Notes
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This 25 page Class Notes was uploaded by Jeromy Hilll on Wednesday September 23, 2015. The Class Notes belongs to PSY 3315 at Texas State University taught by T. Schepis in Fall. Since its upload, it has received 5 views. For similar materials see /class/212850/psy-3315-texas-state-university in Psychlogy at Texas State University.


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Date Created: 09/23/15
Biopsychosocial Model One vs Multidimensional Models OneDimensional Models Explaining behavior in terms of a single cause Problem other information is often ignored Multidimensional Models Many factors cause and maintain suffering Abnorma1 behavior is multiply determined GeneEnvironment Interactions Reciprocal Gene Environment Model Examples include depression divorce and impulsivity NonGenomic Inheritance of Behavior Environmenta1 in uences may override genetic in uences Genes are not the whole story can turn genes on and off changing your personality etc BRAIN Cerebral cortex this is what makes personality separates us from dogs etc the Forebrain Lobes of Cerebral cortex Fronta1 thinking and reasoning abilities memory selfcontrol social interaction inhibitions interests what drives us Parieta1 touch recognition Occipita1 integrates visual input Tempora1 recognition of sightssounds and LONGTERM memory storage Limbic System Hypothalamus eating drinking aggression sexual activity Amygda1a emotions and emotional memory FEAR Neurotransmitters Main Types of Functions of Neurotransmitters Serotonin 5HT depression Gamma aminobutyric acid GABA anxiety quotturns things down Norepinephrine NE mood depression Dopamine DA reinforcement substance abuse schizophrenia G1utamate memory Neuroscience and Psychopathology Relations between brain and abnormal behavior Psychosocia1 in uences and therapy 83010 other factors in psychopathology Cultural Factors in uence form and expression of behavior Gender Factors major for psychopathology and its expression Social effects of health and behavior frequency and quality are important related to disease and psychopathology SOCIAL SUPPORT HELPS WITH ALL PROBLEMS Stigma of psychopathology Assessment Concepts Reliability consistency in measurement dart hits the same spot Validity what the test measures and how well it does so hit the bulls eye Standardization and Norms foster consistent use of techniques provide population benchmarks for comparison Assessing Culture It is important to assess culture for everyone especially for nonnative Acculturation the process of one cultural group adopting the beliefs of another group Culture impacts psychopathology Psychological Testing Projective tests how subject interprets ambiguous stimuli Rorschach project aspects ofpersonality onto ambiguous stimuli roots in psychoanalytic tradition Objective tests roots in empirical tradition minimal inference in scoring and interpretation MMPI2 548 TF items good reliability validity and norms LONG Objective Intelligence Tests intelligence IQ verbal VIQ and performance Neuropsychology and Neuroimaging Neuropsychological tests figuring out what part of the brain isn t working Nuroimaging looking for tumor stroke CAT scans etc 9110 Diagnosis Two Categorical Systems ICD10 by the WHO DSMIV by the American Psychiatric Association Purposes of the DSM System diagnosis Aid communication between professionals Aid research Evaluate prognosis and need for treatment Treatment planning Earlier DSM s had significant limitations DSM VI Basics Clear inclusion and exclusion criteria substance abuse is excluded Disorders are categorized Empirically grounded classification Five DSM IV Axes 1 Most major disorders 2 Stable enduring problems retardation personality disorders 3 Related medical conditions 4 Psychosocial problems problems with wife etc 5 GAF GlobalAssessment of Functioning Problems in the DSMIV What are the optimal thresholds for diagnosis Use of arbitrary time periods The problem of comorbidity two or more disorders for the same person lligh comorbidity is the rule clinically Comorbidity threatens the validity of separate diagnoses RESARCH METHODS Questions driving a science ofpsychopathology What problems cause distress or impair functioning DIAGNOSIS Why do people behave in unusual ways ETIOLOGY causes How can we help people behave in more adaptive ways TREATMENT Research starts w a question This is the hypothesis or quoteducated guess Not all hypotheses are testable but sci method require a testable hypothesis 9310 Balancing Internal vs External Validity Internal validity did the independent variable produce the outcomes External validity are the findings generalizable Do they apply to the population at large Internal validity is increased by minimizing confounds outside in uence Use of control groups Use of randomization assigning participants to groups randomly Statistics and Meaningfulness Statistical methods Statistics are used to help us prevent potential bias in our interpretation but bias still comes in Statistical vs Clinical Significance Statistical significant are results due to chance Clinical significance are results clinically meaningful Statistical significance does not imply clinical meaningfulness There is no clinical significance wo statistical significance Generalizability and the Patient Uniformity Myth Basically you cannot easily generalize research to an individual s case Studying Individual cases Case Study Method Nature of the Case Study Extensive observation and detailed description of clients usually 5 or less Foundation for early developments in psychopathology or in evaluation new disorders Limitations of the Case Study Lacks scientific rigor and suitable controls Internal validity is weak Often entails numerous confounds outside in uences so cannot infer causality Research by Correlation Nature of Correlation Statistical relationship between two or more variables without manipulating a variable the IV Correlation and Causation Problem of directionality Correlation IS NOT causation Epidemiological Resarch An example of correlation methods Study incidence prevalence and course of disorders Experimental Research Nature of Experimental Research Involves the manipulation of IVs say treatment types The point of ex research is to establish causal relations Premium on internal validity Limitations can t manipulate all IV s Experimental DESIGNS Group Experimental Designs the MOST common type of experimental design for treatment research called RCT s Must involve a CONTROL GROUP a control group is a similar group of individuals who receive a limited treatment for comparison no vs limited vs comparative treatment Treatment blinds and bias Studying Behavior over Time Rationale and Overview How does the problem change over time Important in prevention and treatment research TimeBased Research Strategies Crosssectional designs involves the Cohort Effect hard to control for differences based on age Longitudina1 designs involves the CrossGenerational Effect what matters today may not tomorrow Sequentia1 designs combine each 9810 Part 1 Biological Medical Treatment Medical Model of Treatment psychiatrist Relies on biological explanations for causes of disorders and their treatments examples include neurotransmitter dysfuntion serotonin in depression OR brain circuit dysfuntion frontaltemporal in some dementias Psychiatrists are unique in their ability to provide medications but that s changing Antidepressants MAOI s and TCA s MAOI s were the first class used MonoAmine Oxidizes Inhibiter They prevent the breakdown of serotonin and norepinephrine in the synapse the enzyme that breakdown serotonin is inhibited allowing them to stay between the synapse longer giving it time to fire Are effective but have dangerous side effects hypertensive crises spike in blood pressure can cause heart attack stroke and interact with many meds TCA s were developed next Very effective with fewer very dangerous side effects than MAOI s but people can overdoes on TCA s and they have more side effects falls then SSRI s Antidepressants SSRI s and SNRI s SSRI s and SNRI s were the last major class to be developed SSRI s prevent reuptake of serotonin into the neuron SNRI s also affect norepinephrine SSRI s may be or may not be as effective as MAOI s and TCA s with fewer major side effects But SSRI s still have significant side effects sexual that cause people to cease use SSRI selective serotonin reuptake inhibiter reuptake when original neuron takes the serotonin back Anxiolytics antianxiety aka sedatives or tranquilizers they act at the GABA receptor turns the volume down acute effects lower anxiety drowsiness cognitive and motor slowing amnesia first drug developed barbiturates tranquilizers severe side effects and addictive Benzodiazepines are a newer class ofmedications for anxiety are safer than barbiturates with fewer side effects and similar efficiency but they re also addictive Antidepressants usually SSRI s can be used Buspirone BuSpar is a nonbenzodiazepine anxiolytic but likely has lower efficiency Mood Stabilizers these medications are used in the treatment of mania the up part ofbipolar disorder antiseizure meds or atypical antipsychotics are also used Antidepressants may induce mania Mood stabilizer mechanisms are unclear via GABA glutamate circadian rhythms Antipsychotics used for schizophrenia and psychotic disorders these medications while effective have some of the most impairing side effects antipsychotics fall into two classes typical neuroleptic antipsychotics dev in 60 s atypical antipsychotics more common today Typical antipsychotics These medications were revolutionary They work by blocking dopamine receptors antagonizing in many brain pathways This results in their effects and side effects Extrapyramidal symptoms EPS Tardive Dyskinesia involuntary irreversible facial tics Akathesia severe restlessness Neroleptic Malignant Syndrome NMS body starts shutting down 91010 Atypical Antipsychotics Newer medications that are more selective for dopamine and may affect serotonin Atypicals are more effective on the negative symptoms of Schizophrenia Atypicals also have strong side effects weight gain diabetes rare immune cell disorders clozapine MOST effective drug also can get EPS or NMS ADHD Medications Stimulants are the firstline medication May work through direct release of dopamine are norepinephrine These are highly effective but temporary Controversy about later addiction Caffeine is a stimulant New nonstimulant atomoxitineStrattera Dimentia Medications curtain brain cells die which produce dopamine Parkinson s Dementia Due to dopamine dysfunction in the movement centers of the brain Strategy is the supplement dopamine Ldopa Alzheimer s Dementia AD While much of the mechanism for AD is structural Bamyloid acetylcholine may play a role Glutamate may be involved as well Both sets of drugs are only temporary fixes Medications for Addictions Addiction treatments are based on different processes Replacement give a similar drug to prevent withdrawl Methadone for opiates Antagonism blocks opiate receptor stops the high craving Naltrexone for alcohol Aversive when taken if you drink alcohol you will throw up Disulfiram for alcohol PART II Psychological treatments FREUD Psychoanalytic Freudian Background Structure of the Mind Id pleasure principle illogical emotional irrational Ego reality principle logical and rational balancer Superego moral principle Psychosexual Development Oral birth 18 months totally dependant on others causes overdependence on others later in life Anal 18 36 months seek control causes individual to be controlling Phallic 36 m 6 yrs gender identification edipus complex don t develop superego Latency and Genital stages adolescence onward Analysis 34 times a week for years therapist takes very detached stance use free association Psychodynamic therapy less intensive weekly until symptoms reduced interpretations come more quickly 91310 Psychodynamic Group Therapy weekly group therapy 6 indeviduals 2 therapists focus on how you interact with others interpersonal communication Therapists make interpretations based on interactions within the group towards the therapists and the group dynamic Cognitive Therapy Background unlike the quotidquot based on real thoughts Thoughts are the root of the problem so changing distorted thoughts is key Techniques Rating scales behavioral experiments thought records evaluating automatic negative thoughts Major thinking distortions Black and White thinking Overgeneralization bad at one thing bad at everything Catastrophizing Personalization and blame umping to conclusions selffulfilling prophecy Magnifying or minimizing Behaviorism Classical conditioning Pavlov Watson Pairing neutral stimuli and unconditioned stimuli Operant Conditioning Thorndike Skinner Voluntary behavior is controlled by consequences gambling Both Learning Traditions COMBINE CognitiveBehavioral Therapy CBT is combination of the principles of cognitive and behavioral therapy It is probably the most empirically supported therapy available Used for nearly all disorders but has particular uses in depressive anxiety and substance use disorders CHANGE HOW YOU ACT THINK CHANGE HOW YOU FEEL CBT 3 aspects of personality 1 Cognitions thoughts quotI am incompetent 2 Behaviors actions impersistence 3 Emotions feelings sadness anger EVENT being turned down Anxiety Disorders linked by anxiety fear that not helpful out of proportion Anxiety Futureoriented mood state apprehension about future danger or misfortune Negative affect and physical somatic tension Fear Presentoriented mood state Immediate fight or ight response to danger or threat with marked negative affect Anxiety and Fear normal adaptive emotional states for fight ight 101510 What is a Panic Attack Abrupt experience ofintense fear or discomfort Often have a few min warning Accompanied by several physical symtoms DSMIV Subtypes of Panic Attacks Situational bound cued only happen in certain situations Unexpected uncued Situational predisposed more likely to happen in a give situation but can happen randomly Panic is a quotfalsequot fear alarm Biology of Anxiety and Panic DiathesisStress inherit vulnerabilities for anxietypanic not disorder stress ACTIVATES vulnerability Biological Causes Vulnerabilities brain circuits GABA NE and SHT systems the HPA axis MAJOR systems that helps you deal with longterm stress cortesol is excreted by adrenal glands and stops brain from producing the quotstressquot chemical Limbic AMYGDALA system Anxiety and Depression are very related Psychosocial Aspects of Anxiety and Panic Began w Freud psychic reaction to danger that involves reactivation of an infantile fear situation Behavioral classical and operant conditioning and modeling Cognitive early experiences with uncontrollability unpredictability Social contributions many stressors are familial and interpersonal see other s fear and you too will become fear emotions are contagious Anxiety Disorders Excessive and uncontrollable anxious apprehension Somatic symptoms differ from panic Persists for 6 months Facts and Statistics GAD affects 4 of the general population Females outnumber males approximately 21 Onset is often insidious gradual in early adulthood GAD Features and Treatment Associated Features Often seen in quotautonomic restrictors do not process emotional component of thoughts or events Treatment of GAD Benzodiazapines or Antidepressants SSRIs CBT aimed at limiting worry time challenging assumptions about threats Panic Disorder when you let panic attacks control your life Experience of unexpected panic attack with anxiety worry or fear about having another attack can include agoraphobia fear of situation where help escape isn t easy symptoms and concern persists for 1 month or more Facts and Statistics affects about 35 ofpopulation onset is often acute beginning between ages 2529 nocturnal panic attacks 60 Panic Disorder Treatment Medications Benzodiazepines or antidepressants Antidepressants are generally the quotsaferquot choice Benzos can be used quotshortterm to prevent attacks Psychotherapies Behavioral therapy Cognitivebehavioral therapy 101710 Chain in Panic Disorder quothot panic attackquot quotI feel hot 9 quotI get panicky when I am hot Increased anxiety 9 panic attack this confirms the first thought So we need to break the association CBT for Panic Disorder Behavior In vivo Exposure expose person to situation which induces panic ntroceptive Exposure exposure to the sensations associated with panic Response Prevention through the use of relaxation techniques FIRST thing to do this shows that panic isn t caused by heat Cognitive Cognitive Restructuring this involves quotunlearningquot the response an individual s thoughts are modified to alter assumptions about symptoms quotCatastrophizing must be dealt with PTSD post traumatic stress disorder reaction to trauma determines whether you develop ptsd Requires exposure to a traumatic event personal response of experiencing fear helplessness or horror 6 the key Major symptom groups Reexperiencing nightmares etc Avoidance of trauma reminders Emotional numbing HyperVigilence Interpersonal problems are very common emotionally dead PTSD diagnosis gt1 month posttrauma otherwise it is Acute Stress Disorder PTSD cont Facts and Statistics Affects about 78 of the general population Most Common Traumas Sexual assault for females or Combat for males Accidents Subtypes of PTSD Acute early symptoms 13 months post trauma Chronic ongoing symptoms 3 months Delayedonset symptoms begin 6 months after trauma Causes PTSD Intensity of trauma and one s reaction to it must react with fear horror or helplessness Uncontrollability and unpredictability when your sense of quotsafetyquot is compromised Lack of socialcommunity support posttrauma Direct conditioning and observational learning Treatment Must fight avoidance of trauma Exposure to trauma reminders w safety option Can include quot oodingquot exposure to all EMDR Eye Movement Desensitization Reprocessing not treatment but puts them in a receptive mood to talk about the trauma Support groups group therapy if done properly SSRI s Specific PHOBIA negative reinforment Extreme irrational fear of an object or situation Recognized fears are unreasonable Still go to great lengths to avoid phobic objects Facts and Stats Affects about 11 of the general population Females are overrepresented Phobias are chronic Onset beginning between 1520 years of age Causes and Treatment Causes of Phobias Biological and evolutionary vulnerability dark snakes Direct conditioning Observational learning Psychological Treaments CBT is highly effective consistent graduated exposure response prevention 92010 Social PHOBIA not a dislike of social contact they WILL have close relationships Extreme and irrational fearshyness Focused on social andor performance situations Can t eat in public etc fear ofjudgment for others being watched Generalized subtype anxiety across many social situations must worse Facts and Statistics Affects about 13 or the general population lifetime Females lt males slightly Onset is usually during adolescence peak at 15 years Treatment the same as the other anxiety disorders exposure and response prevention relaxation 0CD obsessivecompulsive disorder arguably the strangest Obsessions Intrusive and nonsensical thoughts images or urges that one tries to resist or eliminate Resisting can increase the frequency of thoughts Compulsions Thoughts or actions to suppress obsessions Provide relief from anxiety Most display multiple obsessions Many have cleaning washing andor checking rituals 0CD cont Facts and Statistics Affects about 26 of the populations LEAST common anxiety disorder Mostly females Chronic w onset often in adolescence Causes Predisposition for anxiety that becomes 0CD Early learning that some thoughts are dangerous cant we return the new baby thoughtaction fusion the thought is like the action thinking I want to kill you is the same as doing it TREATMENT exposure and ritual prevention Exposure and Response prevention as opposed to exposure relaxation Goal here is exposure to anxietyprovoking obsessions while preventing the compulsion which the patient uses to counteract anxiety Eventually the patient learns that it is fine if they cannot perform compulsion this is often a cognition accompanying 0CD Overview Mood Disorders Gross deviations from normal mood Depressive Disorders Unipolar just the down side Bipolar both the up and the down down Major Depression more sever BUT shorter ofmood disorders Cardinal Symptoms down or depressed mood lasting at least 2 weeks Anhedonia loss ofpleasureinterest in usual activities also includes sleep disturbances appetite changes activity level changes guild or worthlessness atigue problems with concentration or decisiveness of suicidality Single episodes are highly unusual Depression has a 95 chance of again a very severe problem a strong term Dysthymia less severe but very long term milder symptoms than major depression most days rather than daily Persists for AT LEAST 2yrs Late onset typically early 20 s Early onset before age 20 more chronic w poorer prognosis MDD and Dysthymia Double Depression combo of major depression MDE and Dysthymia first to develop Associated w more severe psychopathology quot quot a more problematic future course High recurrence rates when dystymia is left untreated up Mania state of abnormally elevated mood or eXtreme irritability also includes Racing thoughts Grandiosity thinking one is especially great Pressured speech Distractibility Increased activity or Agitation Decreased need for sleep 4 hrs or less Risky Behaviors Full mania 1 week or more Hypomania 46 days 92710 Bipolar I Mania and DepressionAlternating full major depressive and manic episo average age on onset 18 tends to be chronic suicide is a common consequence FULL MANIA crazy mania for a week or more OR behavior that hospitalizes you often a break between episodes or normality Bipolar II Hypomania Depression average age of onset is 22 Few 10 cases progress to Bipolar I Tends to be chronic Cyclothymia Bipolar 3 more chronic version of bipolar but much less eXtreme for 2 years in adults age of onset is about 1214 years women gt men Cyclothymia tends to be chronic and lifelong high risk for developing other bipolar disorders often confused with quotraging hormones Types of mood disorders depression Atypical oversleep overeat weight gain Melancholic severe physical symptoms Catatonic absence ofmovement 6 worst of the three waxy exibility depression and mania Psychotic mood congruent psychosis Postpartum postchildbirth even mania Rapid cycling patter Bipolar I amp 11 4 episodes in a year Course determined by episode number and recovery seasonal patterns Delusions fixed thoughts beliefs that are unshakable Mood Reactivity when your mood reacts to events sometimes depressed patients are missing this Mood Disorder Fact 16 for major depression men and women are equally likely to get it up to puberty and after 65 36 for Dysthymia 13 for Bipolar men and women are equally represented Genetics mood disorder Family Studies rate is high in relatives of those affected having bipolar relatives increases risk for unipolar depression both go up Twin Studies concordance rate are ghigh in identical twins more sever case stronger genetic contribution vulnerability for unipolar disorder appear to be inherited speratly Neurobiology mood dis Neurotransmitters 5HT and NE the quotpermissivequot hypothesies when seratonin isn t working properly it permits other neurotransmitters to not work correctly THIS CAUSES depression Endocrine System elevated cortisol hormone through HPA dysfunction Sleep Disturbance regularly experienced by those developing depression hallmark of MOST mood disorders Sleep and HPA normalization go with recovery Stress HUGE factor in mood disorders Higher levels of stress equal poorer response to treatment longer time before remission precipitates new episodes of the disorder Context oflife events and mood What s good for you may not be good for others What s bad for you may not be as bad for others 92910 put dogs in the harness and shocked them w a lever to stop the shock another group could not stop the shock second experiment w electric oor Learned Helplessness learned helplessness is a lack ofperceived control over life events it is associated w depression Depressive Attributional Style this is NOT always bad when its good Internal quotIts my fault Stable quotThis won t change in the future Global quotThis always happens in everything All contribute to a sense ofhopelessness Cognitive Theory of Depression ways ppl THINK about the events of their lives that makes them depressed a tendency to interpret life events negatively These ppl engage in Cognitive Errors and the Depressive TRIAD think negatively about oneself think negatively about the world think negatively about the future INSERT COGNITIVE DISTORTIONS dwell on bad thoughts Mood Disorders social cultural aspects Marriage and Interpersonal Relationships marital dissatisfaction is strongly related to depression especially for males as they have better emotional support Social support lack of support predicts late onset 65 depression more support predicts recovery from depression Gender Imbalances may be due to socialization MAIOs TCAs instertboth work roughly in the same way very affective w fewer sideffects BUT can overdose Prevents breakdown SSRIs SNRIs probably not as effective but SAFTY Prevent reuptake Relapse and Maintenance Treatment within one yr of episode ending 40 chance relaps Major D is recurrent 1yr 40 15 yrs 85 Continued treatment over the first year can cut recurrence risk in half quotKindlingquot when brain is set up to quickly fall backinto depression Bipolar LITHIUM a common salt primary drug of choice for bipolar side effects may be sever thirst hand tremor Lithium has a narrow therapeutic range easy to get too much or too little acute lithium toxicity GI and neuro symptoms Chronic neuro symptoms kidney failure don t know exactly how it works Psychological Treatment emphasizes Cognitive and Behavioral therapy Cognitive Therapy cognitive errors includes behavioral components Behavioral Activation involves increased contact with reinforcing events Interpersonal Psychotherapy focuses on problematic interpersonal rel Outcomes with Psychological treatments are comparable to medications except for mania 10110 Psychological Treatments Cognitive Therapy 6 great for depression Addresses cognitive errors in thinking Also includes behavioral components Behavioral Activation 6 great for depression Involves increased contact with reinforcing events getting up and doing stuff that you used to do combat anhedonia Interpersonal Psychotherapy Focuses on problematic interpersonal relationships Outcomes w psychological Treatments are comparable to medications except mania HARD to do therapy w those suffering from mania 6 medication is necessary SUICIDE 8th cause of death in the US overwhelmingly a white and native Amer rates are increasing especially in the young Gender differences females are more likely to attempt suicide males are more likely to succeed at committing suicide Suicide Risk SAD PERSONS eX male Age 2544 or 65 erressed East suicide attempt Ethanol alcohol abuse Rational thinking loss as a schizophrenia ocial support lacking Qrganized plan a realistic one o spouse ickness generally a chronic severe illness 02 low risk 34 monitor carefully 56 notable risk 7 hospitalize Assessing Suicide Risk Increasing suicide risk Passive suicidal ideation quotI might be better off dead Active ideation quotI want to kill myself Active ideation with an unrealistic plan quotgun when patient does have one Active ideation with a realistic m Intent Actual suicidal gesture 10 410 SEXUAL IDENTITY DISORDER What is normal vs Abnormal must take into account normative statistics and cultural considerations or gender differences Sexual and Gender Identity Disorders Gender Identity Disorder Sexual dysfunctions Paraphilias GID Gender Identity Disorder feels trapped as the wrong sex NOT SEXUAL Causes are unclear gender identyt develops early 1836 months abnormal prenatal hormone levels For boys more older brothers also a factor associated with homosexuality relationships with parents Outcomes and Treatment Children homosexuality no CID is common Adolescents mainly persisting GID 50 SexReassignment Surgery 75 report satisfaction adjustment from female to male is easier Psycholsocial Treatment realign psychological gender w biological sex few large scale studies and many ethical issues Sexual Dysfunction conscenting sexual activity gone bad Affect arousal andor orgasm Pain associated w sex can lead to additional dysfunction Males and Females have parallel versions ofmost dysfunctions affect about 43 of females and 31 of males HIGHEST RATE OF ANYTHING most prevalent class of disorder in the US Sexual Desire and Arousal Disorders Hyperactive Sexual Desire Disorder LOW DESIRE 50 of complaints at sex clinics Sexual Aversion Disorder sexual contact results in extreme fear or disgust 10 of males report panic attacks during sex Male Erectile Disorder ED Female Sexual Arousal Disorder affects about 5 of males 14 of females males are clearly more troubled by the problem Orgasm Disorders Inhibited Orgasm have adequate desire and arousal but no orgasm rare in males but common complaint in females 25 report difficulty reaching orgasm only 50 report experiencing regular orgamsm Premature Ejaculation 21 ofadults males most prevalent problem Sexual Pain Disorders marked pain during sex limits desire to engage in sex Dyspareunia extreme pain during intercourse Vaginismus outer third of the vagina muscles undergoes involuntary spasm Causes of Dysfunctions Biological contributions diseases medications and drugs Psychological contributions role of quotanxietyquot vs quotdistractionquot Social and Cultural Contributions negative scripts about sexuality negative or traumatic sexual experiences lack of communication 10610 Paraphilias Arousal on inappropriate people objects often multiple paraphilic patterns of arousal High comorbidity Voyeurism observing an unsuspecting individual undressing or naked Exhibitionisnm exposure of genitals to unsuspecting strangers KEY ELEMENT risk thrill Fetishism amp Transvestic Fetishism Fethishism sexual attraction nonliving objects objects can be inanimate and or tactile examples include rubber hair usually many objects of fetishistic arousal Transvestic Fetishism Sexual arousal with the act of crossdressing men may compensate by overly masculine behavior many men do not many are married and the behavior is known to spouse Sexual Dysfuntion Treatments Education alone surprisingly effective normalizing is powerful Masters and Iohnson education with nondemand pleasuring step by step day to day where orgasm is conditioned out of the equation Erectile Dysfunction viagra or direct injection penile prosthesis or implants vascular surgery The ethics ofinsurance Viagra vs birth control Treatment paraphilias Behavioral Interventions Covert sensitization imagining act w aversive consequences Orgasmic reconditioning appropriate masturbation 70 of cases show improvement Medical Treatment for the worst of the worst Use of feminizing hormones or antiandrogens Antidepressants may have some efficacy Poorest outcomes rapist many paraphilias Paraphilias are chronic and relapse is common DISSOCIATIVE DISORDERS very different when perception of self outside world is wrong Depersonalization Disorder Sever and frightening feelings of unreality and detachment from daily life VERY RARE DISORDER There dominate and interfere with life functioning Involves depersonalization and derealization 6 two major symptoms Depersonalization feel cut of from their own body Derealization special relationships colors etc loss of special recognition exacerbated by stress High comorbidity w anxiety and mood disorders onset is around age 16 usually runs a lifelong chronic course Causes Cognitive deficits in attention Cognitive deficits in shortterm memory Cognitive Deficits in spatial reasoning Deficits related w tunnel vision and mind emptiness such persons are easily distracted Treatment little is known Dissociative Amnesia psychogenic no obvious physical cause Severe forms ofpsychogenic memory loss Generalized type inability to recall anything including their identity VERY UNCOMMON Localized or selective type failure to recall specific events Dissociative amnesia is almost always linked to or caused by overwhelming stress andor trauma DEFENSE MECHANISM Dissociative Fugue Generalized Anxiety FLIGHT related to dissociative amnesia take off to a new place unable to remember the past unable to remember how they arrived often assume a new identity 10810 Dissociative Identity Disorder DID formerly known as multi personality disord Adopt several new identities as many as 100 Identities show unique behaviors voice and posture Identifiable Alters different identities Host Identity that keeps other identities together Switch Quick transition from one personality to another Facts Stats Average ofidentities is about 15 91 females Onset is slmost always in childhood high comorbidity w a chronic course Causes horrible unspeakable child abuse Most are also highly suggestible easy to hypnotize plant false memories Mechanism to escape from impact of trauma related to PTSD Treatment focus on reintegration of identities identify and neutralize cues triggers that provoke memories of trauma dissociation Separating real problems from faking Malingering deliberately faking symptoms Related conditions Factitious disorders or factitious disorder by proxy attention seeking by using a sickness Piper and Merskey 2004 attacked DID noting these problems Claims that trauma causes DID are problematic Many ppl endure trauma wo developing DID Poor definitions of trauma More DID cases were diagnosed between 81 and 86 that in the past 200 yrs Maltreatment rates the cause haven t risen Therapists can in uence their patients in ways that can produce DID Support DID has support in the literature though Recent reports have noted that alters in DID have different patterns of eye movements different patterns ofbrain activation when processing trauma related material both would be hard to fake well So its real sometimes but often ppl are faking Somatoform amp Sleep Disorders soma body body image Hypochondriasis sever anxiety about the possibility of having a disease strong disease conviction medical reassurance does not seem to help good data on prevalence and onset are lacking chronic course Causes cognitive perceptual distortions familial history of illness sever illness and seeing attention they receive Treatment challenge illnessrelated misinterpretations provide substantial and sensitive reassurance Primary gain direct gains benefits form having illness disability Secondary gain indirect gains friends help etc things a good mom would do ifyou were sick 101110 Conversion Disorder physical imparing symptoms but wo causes Malfuntioning often involves sensory motor ares go numb etc quotLa belle indifference is key they aren t very concered w the ailment Retain most normal functions but lack awareness Facts common in the Victorian era seen today in religious groups Rare condition chronic but intermittent course Primarily in females wo onset in adolescence More likely in some cultural or religious groups Cause Posttrauma is converted into physical symptoms address primary or secondary gain distance from trauma and negative reinforcement Treatment address trauma and repression remove sources of secondary gain primary gain one need the illness but secondary is THE PROBLEM like the friend bringing some soup etc SLEEP DISORDERS Insomnia amp Hypersomnia Primary Insomnia problems initiating and maintaining sleep and or w nonrestorative sleep ONLY problem Primary Hypersomnia Sleep too much or excessive need for sleep Both are rare more prevalent in females likely to have a strong genetic component associated w medical and psychological conditions Narcolepsy daytime sleepiness w Cataplexy Cataplexy suddenonset REM due to strong emotion Narcolepsy is rare 1 equally distributed gender Onset during adolescence Symptoms often improve over time Sleep paralysis amp hypnagogic hallucinations Treatment of Dyssomnias improving sleep HYGIENE correct things that are inhibiting sleep Bedroom is a place for sleep No caffeine after 3 No exercise in evening Can t sleep get up and do something else Avoid napping Modify unrealistic expectations about sleep Use yoga or relaxation to set mood Make sure environment is comfortable Parasomnias Sleep Terror Disorder Occurs during NONREM sleep Screaming w signs of elevated arousal agitation Not easily awakened during episode Child has little memory the next day Treatment involves a quotwait and see posture if severe antidepressants or benzos chedule awakenings prior to the sleep terror Sleepwalking Disorders Somnambulism occurs during nonREM sleep in first few hours of deep sleep Difficult but not dangerous to wake a sleepwalker Runs in families and usually resolves on its own Related Nocturnal eating syndrome 101310 Eating Disorders not about food control body image success highest among whit DO NOT occur where food is scarce Anorexia nervosa and bulimia nervosa Extreme fear and apprehension about gaining weight Have strong sociocultural origins Westernized views Bingeating disorder Bulimia Nervosa binging and compensating purge AT LEAST once a week Bing Eating Hallmark of Bulimia Binge eating excessive amounts of food Lack of control Compensatory Behaviors Purging selfinduced vomiting diuretics laxatives some exercise excessively others fast Subtypes of Bulimia Purging most common subtype Nonpurging about 13 eg exercise fasting associated medical features most are within 10 ofnormal weight Purging can result in sever medical problems lack of electrolytes kidney failure heart beat irregularity associated Psychological features Most are overly concerned w body shape Fear gaining weight high comorbidity mood disorders substance abuse etc ALL bulimics binge and compensate Anorexia can be this but also must be 15 below marked bodyweight Anorexia Excessive weight loss 6 MORE SEVER than bulimia Excessive Weight loss the Hallmark Defined as 15 below expected weight INTENSE fear of obesity often begins with just Dieting Relentless pursuit of thinness through food restriction or through excessive exercise weight is never good enough eating 300 calories each day and exercising 3 hrs is not uncommon Anorexia Nervosa cont DSMVI Subtypes ofAnorexia Restricting subtype limit intake via diet and fasting Bingeeatingpurging subtype about 50 bottom line Anorexics are Bulimics that are better at purging Associated Features marked disturbance in body image high comorbidity w other psychological disorders more so than bulimia Weight loss methods have life threatening consequences Binge Eating Disorder binging wo any compensating Experimental diagnostic category engage in binges wo compensatory behaviors


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