ABNORMAL PSYCHOLOGY Psych 383
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Disorders of Childhood and Ado39escenC810262011 115900 AM I On Disorders in Childhood and Adolescence 0 Child psychopathology the study of disorders of childhood and adolescence o DSM I 1952 9 included childhood schizophrenia and adjustment reaction of childhood 0 DSM II 1968 9 6 childhood diagnoses o DSM III 1980 9 10 childhood diagnoses o DSM IV 1994 9 42 childhood diagnoses c 15 kids have a diagnosable disorder that causes some interference w everyday functioning 0 110 suffers more significant functional impairment 0 Pg 46 9 Mental Retardation Axis II Clinical Syndromes Axis I o Pica when a child eats a nonnutritive substance for at least one month o Tourrette s essential features include multiple motor tics and one or more vocal tics o Onset before age 7 o Persists into adulthood o More common in males than females 0 Often exists with OCD but not necessarily II Mental Retardation Axis II A Diagnostic Criteria 0 Significantly subaverage level of intellectual functioning below 70 o Concurrent deficits or impairments in present adaptive functioning o Onset before 18 years of age B Onset before the age of 18 most common time of diagnosis is around 5 or 6 yrs when entering kindergarten C Approx 1 of the population D More common in males for every 3 males there are 2 females w mental retardation E Degrees of mental retardation and prognosis o Mild IQ 50 70 85 of the retarded 6th grade level 0 Moderate 2quotd grade level Sheltered workshops o Severely Requires close supervision o Profound Requires constant aid and supervision F Etiology in approx 30 40 of all cases the cause of mental retardation is unknown 0 Hereditv inherited defect Tax Sachs disease a degenerative disease of the central nervous system most common in Eastern European and Jewish ancestry 0 Early alterations of embryonic development includes chromosomal changes or abnormalities that occur during the embryonic stage Ex Down s Syndrome the most common chromosomal disorder usually caused by an extra 21St chromosome characterized by mild to severe mental retardation can be taught to support themselves 1600 1800 children has Downs III Learning Disorders Diagnosed when the individual s achievement on individually administered standardized test in reading math or writing is substantially below that for age schooling and level of intelligence also give IQ test A Three types of learning disorders 0 Reading disorder 9 most common 0 Mathematics disorder 0 Disorder of written expression A child may have 1 2 or 3 of these disorders B Reading disorder poor reading accuracy slow reading speed poor reading comprehension picked up a little earlier than other disorders C Math disorder difficulty counting comparing numbers calculating and remembering basic arithmetic math D Disorder of written expression grammatical or punctuation errors with sentences poor paragraph organization multiple spelling errors excessively poor handwriting 0 Least common shows up latest often w other learning disorders Age of onset varies Estimated that approx 5 of children have a learning disorder Equal rates among boys and girls based on newer research Associated features IQTIFI39I 0 Learning disorder is not related to low IQ 0 Normal vision and hearing usually 0 Often affects children from bigger families Related to SES 0 0 It is thought that these kids have difficult processing sensory info 0 Low self esteem 0 Poor social skills 0 May act out in class o More likely to drop out of school 40 of kids w LD drop out of high school J Etiology 0 Genetic component 0 Prenatal things drinking smoking etc 0 Medical conditions lead poisoning etc o SES 0 Larger families K No cure but individuals can learn to compensate for it IV ADHD A Diagnostic criteria on pg 47 0 Essential feature is a persistent pattern of inattention andor hyperactivity impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development B Three subtypes of ADHD o ADHD combined type 0 ADHD predominantly inattentive type 0 ADHD predominantly hyperactiveimpulsive type C Elementary age diagnosis D Occurs in 3 5 of all elementary school children E Significantly more common in boys F 14 kids with a learning disorder also have ADHD G More social problems could have difficulty getting along with other kids most common reason kids are taken to a psychiatristpsychologist H Symptoms typically decrease into adulthood I Etiology 0 Strong genetic component 0 Prenatal exposure to toxins drinking etc 0 Being deprived of oxygen during labor 0 No strong evidence that sugar or food additives cause ADHD J Treated with stimulants which seem to have a paradoxical effect 9 Ritalin is the most commonly prescribed medication V Autistic Disorder has many other names falls under Disorders Usually First Diagnosed in Infancy Childhood or Adolescence AKA a Pervasive Development Disorder PDD A Diagnostic Criteria 0 Qualitative impairment in social interaction extreme difficulty socially interacting with someone o Qualitative impairment in communication poor language development if at all 0 Restricted repetitive impairments and stereotyped patterns of behavior interests and activities very routine engage in odd mannerisms B Asperger s Disorder another PDD separate from autism will have difficulty socially interacting will have different interests and know all the little facts about them odd behavior patterns unlike autism someone with Asperger s can develop communication skills and function but they may still have difficulty forming relationships and interacting with others 0 Autistic Spectrum Disorder autism is at one end of the spectrum and Asperger s is at the other end 0 The confusion between autism and Asperger s may be clarified in the next edition of the DSM C Onset before the age of 3 D DSM IV TR says that the prevalence is 5 cases per 10000 0 The CDC reported in 2007 that 1 out of 150 children would be born with autism could even be as common as 1 out of 100 0 These increasing statistics may be due to the fact that we are more aware of autism and the symptoms today are they including individual s with Asperger s or strictly autism E Significantly more common in males than females 0 If a female has autism she is more likely to have mental retardation F Associated features include hyperactivity and a short attention span may be more impulsive more aggressive more likely to engage in serious injurious behavior have temper tantrums etc 0 Estimated that about 70 of those with autism have an IQ below 70 o It is thought that maybe people with autism have much more potential than we realize and we just haven t figured out how to tap into that G Only a very small percentage of individuals with autism will be able to go out and live independent productive lives 0 In 13 of all cases the person can live a partially independent life 0 No cure H Used to be thought that autism was caused by the refrigerator mom the cold mother that ignores her child this is false 0 Most heritable form of psychopathology in the DSM highest genetic component 0 Biological disorder of the nervous system 0 Not entirely genetic 1 Treatment for Autism o No medication has been found to be effective 0 Behavior therapy in an institutional setting has been found to help Eliminate self injurious behavior Master the fundamentals of social behavior Develop some language skills 0 Working with autistic individuals requires a lot of patience and treatment includes very intensive therapy programs VI Disorders Associated with Defiance and Aggression A Oppositional Defiance Disorder pg 48 shows a pattern of negativistic hostile and defiant behavior for at least 6 months must have at least four symptoms causes significant impairment in functioning criteria are not met for Conduct Disorder or Antisocial Personality Disorder 0 The acting out behavior is usually limited to the home environment 0 More common in boys 0 Usually diagnosed between the age of 8 16 0 Not all children with ODD grow up to develop a conduct disorder but some do It is the case however that almost all individuals with conduct disorder previously has ODD o ODD is to attention deficit and disruptive behavior disorders as autistic disorder is to PDD B Conduct Disorder childhood onset type adolescent onset type pg 48 must show at least three symptoms in the past 12 months 0 Child violates society s norms and the rights of other people a much more significant and extreme level of ODD 0 Criteria are not met for Antisocial Personality Disorder 0 Childhood onset type onset of at least one criterion prior to 10 years of age usually male frequently display physical aggression toward others disturbed peer relationships more likely to develop adult Antisocial Personality Disorder between 25 40 will develop APD o Adolescent onset type absence of at least one criterion prior to age 10 less likely to display aggressive behaviors tend to have more normal peer relationships less likely to develop Antisocial Personality Disorder as an adult only occurs in a few cases more of the acting out teenager o More generalized than ODD o More common in males than females 0 Occurs more often in urban settings as opposed to rural settings 0 Individually will almost always experience ODD prior to developing CD C Conduct Disorder and Juvenile Delinquency o Delinquency acting unlawfully is not synonymous with conduct disorder although the two of them frequently overlap Conduct psychiatric construct Delinquency legal construct O VII Enuresis A F 0 0 F Antisocial Personality Disorder p 49 0 Can t receive this diagnosis until 18 years 0 Often time they don t feel bad about what they do don t experience remorse o PsychopathSociopath used synonymously in our case Causal factors of oppositional defiant disorder and conduct disorder 0 Genetic factors 0 Family factors 0 Peer factors 0 Social factors Treatment of oppositional defiant disorder and conduct disorder 0 Family Therapy focus on the child the parent the family the environment 0 Behavioral Control Techniques Use more reinforcement and less punishment bed wetting Diagnostic Criteria p 45 0 At least 5 years old 0 2x a week for 3 months 0 0R significantly distressing or dysfunctional 0 Not the result exclusively of medical condition or substance use Age of Onset 0 Primary Enuresis begins around 5 0 Secondary Enuresis Begins after a period of established urinary continence usually between 5 8 Prevalence 0 Between 5 10 of all 5 year olds 0 Between 3 5 of all 10 year olds o Roughly 1 of all 15 year olds Sex Ratio 0 More common in boys Associated Features 0 Low Self Esteem 0 Limited social activity afraid of having an accident 0 Associated Features are generally a bigger deal than the bedwetting itself 0 Parents can be extremely upset about it and believe the child is doing it on purpose this only exacerbates the disorder F CoursePrognosis o Often spontaneously remits 0 Not always though so treatment is suggested G Etiology 0 Children with poor impulse control 0 Maybe not as mature 0 Genetic component H Treatment 0 Medication can be used not as effective as behavior based approaches 0 Bell and Pad method Developed in the 1930s by Mowrer and Mowrer 80 success rate 2 Foil sheets connected to an alarm Cloth pad inserted in between the 2 foil sheets If the child wets the bed the circuit is completed and the alarm rings to awaken the child VII Anxiety Disorders of Childhood and Adolescence 0 Common among children 0 More common in girls than in boys 0 Typically does not continue into adolescence or adulthood o Causal Factors 0 ConstitutionalSensitivity o Behavioral inhibition don t like change More or less shy 0 Early Illnesses accidents or losses 0 Hospitalization O Overanxious and protective parents 0 Indifferent and detached parents 0 P Separation Anxiety page 50 0 Only given to someone with onset before age 18 generally given much earlier in childhood Disturbance has to last for at least 4 weeks 0 More common in girls 0 Separation Anxiety Disorder is not an extension of normal separation anxiety that children may experience in the rst few years of life B School Phobia used to be defined as an unrealistic fear that keeps children away from school today it is considered simply another symptom of Separation Anxiety Disorder 0 Characteristics Not truants Average of above average IQs Average or good students Evenly distributed between the ages of 5 and 15 Equally likely to be boys or girls Professional parents 0 The goal is to reintegrate the child into the classroom easier to do with a younger child IX Childhood Depression A May experience a period of the blues may experience symptoms of depression may experience a full blown case of depression and be diagnosed with a Major Mood Disorder clinically depressed B 10 15 of children adolescents have symptoms of depression 0 No such thing in the DSM as childhood depression children and adults will be diagnosed similarly o If the child is extremely irritable it is counted as a symptom of being sad 0 15 20 of youth will experience an episode of minor depression before the age of 20 C Before adolescence 9 more common in boys After adolescence 9 more common in girls D Causal factors 0 Genetic component 0 Prenatal exposure to alcohol 0 Learning of maladaptive behaviors 0 Exposure to early traumatic events 0 Parental divorce E Treatment 0 Medication o Psychotherapy o Supportive emotional environment 0 Play therapy X Sleeping Disorders in Childhood A Normal sleeping patterns in childhood 0 Young children typically sleep deeply through the night and should have a midday nap until around the age of 5 0 As children get older they begin to not want to go to bed and end the day so it is helpful to have an elaborate bedtime routine snack bath brush teeth bedtime story etc o Transitional object a thing used by a child to ease his anxiety about separation from his parents blanket teddy bear etc 0 Long term effects of transitional objects at age 4 Age 11 more outgoing more self confident Age 16 better adjusted 0 As we grow older we need less sleep Newborn 16 hours 5 years old 11 hours 9 years old 10 hours 13 years old 9 hours 65 years 6 hours B On sleep 0 An EEG will show what stage of sleep you are in Stage 1 falling feeling very light sleep Stage 2 spindles bursts of activity Stage 3 amp 4 have delta waves and are often grouped together REM sleep dreaming stage 0 Each sleep cycle lasts about 90 min C Sleep disturbances 1 Nightmares night terrors and sleep terror disorder Nightmares frightening dreams that typically occur during REM sleep more likely to occur later at night or earlier in the morning Nightmaresdreams are more likely to be recalled if as soon as we wake up we consciously try to remember what it was about Night terror abrupt awakening form sleep usually beginning with a panicky scream or cry that typically begins during the first third of sleep during Stage 4 and lasts about 1 10 minutes child has no memory of the night terror in the morning In order to constitute a disorder the child must meet the criteria for a sleep disorder pg 51 There is a relationship between adult sleep terror disorder and increased psychopathology it is often the case that they have some other emotional problem as well Tend to run in families More common in boys children equally common in adults 2 Sleepwalking somnambulism rising from bed usually during the first third of sleep during stage 4 and lasting only a few minutes can last up to half an hour 10 30 of children and adolescence will have at least one episode of sleepwalking o Sleepwalking disorder recurrent episodes of sleepwalking Sleepwalkers should be awakened gently so that they aren t alarmed or startled No impairment of mental activity when being awakened Individual will probably not remember the sleepwalking Make sure that there is a safe environment for sleepwalkers lock doors baby gates etc Decreases in frequency as you grow older We do not know why people sleepwalk it does run in families More common in girls children more common in men adults Eating Disorders 10262011 115900 AM I Anorexia Nervosa literally means lack of appetite induced by nervousness in actuality involves an extremely thin individual who is intensely afraid of gaining weight A Typically begins in mid to late adolescence 14 18 years average onset is 17 years can range from pre puberty to early 305 B Approx 05 which is 1 out of every 200 females will develop anorexia no evidence to show that it is increasing in frequency C 90 of all cases occur in females D 4 criteria pg 52 0 Very thin individual 0 Intense fear of gaining weight or becoming fat the more weight they lose the more afraid they are of gaining it o Disturbance in the way in which one s body weight or shape is experienced undue influence of body weight or shape on self evaluation or denial of the seriousness of the current low body weight 0 In postmenarcheal females amenorrhea missed three menstrual periods in a row males lack sexual desire E Compensatory behavior 0 Purging behavior self induced vomiting misuse of laxatives diuretics increase urination or enemas o Non purging restricting behavior fasting excessive exercise F Types of anorexia nervosa 1 Restricting type prevents weight gain by fasting andor exercising excessively limiting how much food they eat probably will not feel comfortable eating in front of others hides food 2 Binge eatingggurging type prevents weight gain by purging often preceded by binging G Associated features 0 Preoccupation with food talking about it etc o Depressive symptoms 0 High co morbidity with obsessive compulsive symptoms H Courseprognosis 0 Highly variable 0 Of individuals admitted to university hospitals long term mortality is 10 0 Death most commonly results from starvation and suicide depressive symptoms are an associated feature I Etiology 0 Biological factors chart next to pg 43 o Psychological fear of growing up need to control malfunctioning family perfectionists not receiving attention etc 0 Social stress societal pressure to be slender J Treatment o Obstacles to treatment 0 O 0 Do not acknowledge that they even have a problem Reluctant to seek treatment High treatment dropout rate 0 Kinds of treatment 0 O O Hospitalization to get them to a normal body weight Family therapy Long term support 0 No evidence that medication helps II Bulimia Nervosa literally means so hungry they could eat an ox P 0003 Typically begins in late adolescence or early adult life 20 24 years old slightly later than anorexia 1 3 of adolescent girls and young women suffer from bulimia 90 of bulimics are female 0 O O O 5 criteria pg52 Recurrent episodes of binge eating eating more than a normal amount w a sense of lack of control over eating Don t generally plan binging in advance are often ashamed of their binging behaviors and will do it in secret may have certain triggers to cause a binge most bulimics are within a normal weight range Recurrent inappropriate compensatory behaviors in order to prevent weight gain Purging self induced vomiting laxatives Nonpurging fasting excessive exercise ALL bulimics binge but NOT all bulimics purge Vomiting is the most common compensatory behavior 80 90 of all cases of bulimia Binge eating and compensatory behaviors both occur on average at least twice a week for 3 months This type of criteria is not given for anorexia Self evaluation is unduly influenced by body shape and weight Appearance is more important than it should be to the individual The disturbance does not occur exclusively during episodes of Anorexia Nervosa Anorexia takes precedent over bulimia meet the criteria anorexia 9 diagnosed with anorexia not bulimia E Compensatory Behaviors F Types of bulimia nervosa o Bulimia Nervosa Purging Type prevents weight gain by regularly engaging in purging behavior 80 90 0 Bulimia Nervosa Nonpurging Type prevents weight gain by fasting or exercising excessively G Anorexia 9 very thin Bulimia 9 not necessarily thin normal weight range H Gastricstomach problems from vomiting tooth decay dentist is often the first one to recognize the bulimia loss of hair I Bulimia is often chronic and intermittent over a period of many years seldom incapacitating J Etiology 0 Unknown but theories offered biopyschosocial models are used 0 Tends to run in families genetic component 0 Psychological factors deprived of attention K Treatment 0 Antidepressants may help limit the frequency of binge episodes 0 Cognitive behavioral therapy preferred treatment Modifying distorted beliefs about weight and food Increasing self esteem Normalizing eating patterns Cognitive Disorders I Overview 10262011 115900 AM DSM category Delirium Dementia and Amnestic and other Cognitive Disorders Cognitive disorders the predominant disturbance in this category is a clinically significant deficit in cognition that represents a signi cant change from a previous level of functioning II Delirium A F 0 III Amnesia A F For each disorder in this section the etiology is either 0 A general medical condition although the specific general medical condition may not be identifiable A substance Le a drug of abuse medication or toxin A combination of these two above factors Diagnostic criteria 0 Disturbance of consciousness o A change in cognition that is not related to dementia o The disturbance develops over a short period of time and tends to fluctuate during the course of the day acute with intense symptoms Medical diseases the trauma of surgery illicit drugs medications high fever infections 0 The most common cause of delirium is either drug intoxication or drug withdrawal Courseprognosis 0 Can occur at any age but seems to be more common among elderly people 0 Typically reversiblewill go away 0 Treatment usually involves medication of some kind 0 If left untreated for a long period of time may cause some brain damage Diagnostic criteria 0 The development of memory impairment 0 Memory disturbance causes significant impairment in socialoccupational functioning and represents a significant decline from a previous level of functioning o The memory disturbance does not occur exclusively during the course of a delirium or a dementia o Anterograde amnesia inability to learn new information o Retrograde amnesia inability to recall previously learned information Caused by brain damage due to o Strokes 0 Head injuries 0 Exposure to toxins 0 Chronic substance abuse 0 IV Dementia Not all brain damage is permanent For example Korsakoff s syndrome is an amnesic disorder caused by a de ciency of vitamin B thiamine I t can be reversed if detected early A The causes are what differentiate the different kinds of dementia 0 Most typically depressive and chronic 0 Diagnostic criteria 0 The development of multiple cognitive deficits manifested by both memory impairment and one or more of the following Aphasia the deterioration of language function oftentimes manifested by difficulty producing the names of individuals and objects ex know what something is but can t get the word out Apraxia the impaired ability to execute motor activities despite intact motor abilities sensory function and comprehension of the required task ex want to wave their hand and they understand it but they can t make it happen Agnosia the failure to recognize or identify objects despite intact sensory function ex Grandma does not know who you are Disturbance in executive functioning involves the inability to think abstractly and to plan initiate sequence monitor and stop complex behavior ex can t cook a meal because it involves too many different steps Cognitive deficits cause significant impairment in socialoccupational functioning and represent a significant decline from a previous level of functioning The deficits do not occur exclusively during the course of a delirium can be delirious and have dementia at the same time B Many different causes for why people develop different kinds of dementia brain damage Parkinson s disease etc C Course 0 O O O D In O 0 More than half of all cases are caused by Alzheimer s Age of onset is usually late in life Uncommon in children and adolescents but can occur due to head injury or brain tumor Prevalence increases with age Highest prevalence above age 85 most cases dementia is progressive and deteriorating but not all of them Dementia of the Alzheimer s type is always progressive and deteriorating Some cases of dementia may be due to the combination of medications the individual is taking V Dementia of the Alzheimer s Type A Alzheimer s is a degenerative brain disease a type of dementia where the individual just gets worse B Slightly more common in females C May be a genetic component D Will most often begin in late adulthood but not always 0 Alzheimer s with early onset individuals are under the age of 65 progresses more quickly 0 Alzheimer s with late onset when the Alzheimer s begins these individuals are over 65 years old 0 Signs of dementia of the Alzheimer s type 0 Early signs Deficits in memory 0 Later signs Confusion Disorientation Restlessness Agitation Poor judgment Personality changes Increased irritability o In later stages individuals may develop motor disturbances and eventually become mute and bedridden E Diagnosis 0 Difficult to diagnose 0 Can be done with certainty only after death by doing an autopsy and analyzing brain tissue families often don t want to do an autopsy F Treatment 0 No cure for Alzheimer s has been discovered 0 Drugs to improve memory and behavior are being tested There is some suggestion that anti inflammatory drugs can help reduce the progression of Alzheimer s 0 Test on Monday 0 Large majority comes from class notes 0 Figure out how everything is relatedbig picture 0 Truefalse Read textbook Sequence questions 45 multiple choice Matching 1 vocab word from the textbook 0 Left side disorders 0 Right side symptoms or something associated w the disorder Lots of stuff on Disorders of Childhood and Adolescence Know the similaritiesdifferences between different disorders anorexia V bulimia different types etc Know the criteria for each disorder Understand the difference between delirium dementia etc Know the etiology for all cognitive disorders are medical condition or use of a substance Know terms aphasia apraxia etc Read the book part on anorexiabulimia Personality Disorders 11112011 11100 PM I On Personality Disorders A Personality pattern of characteristic traits coping styles and ways of interacting with the social environment Personality disorder an enduring pattern of traits coping styles and ways of interacting that is so inflexible and maladaptive that the individual39s ability to function adaptively and in compliance with society39s norms is significantly impaired o Onset is not laterthan early adulthood may not come to clinical attention until relatively later in life 0 Classified on Axis II I Individuals with a personality disorder coded on Axis II will often have a clinical syndrome that is coded on Axisl o Etiology I Comorbidity B Diagnostic Criteria pg 59 o The enduring pattern is manifested in two or more of the following areas I Cognition Affectivity Interpersonal functioning I Impulse control 0 Personality disorder is not dependent on the situation it cuts across all situation defines who the individual is as a person 0 Leads to clinically significant distress or impairment in functioning o The pattern is stable and of long duration and its onset can be traced back at least to adolescence or early adulthood II Three Clusters of Personality Disorders A Cluster A odd and eccentric o Schizotypal I More common in men Peculiar thought patterns Oddities of perception and speech I Most strongly related to schizophrenia o Schizoid Loner I More common in men I Impaired social relationships I Inability to form attachments to others 0 Paranoid pg 60 I Think others are quotout to getthemquot I Have difficulty building relationships and getting along with others I Bears grudges I Preoccupied w unjustified doubts about the loyalty or trustworthiness of friends I Has recurrent suspicions regarding fidelity of spouse or sexual partner B Cluster B dramatic emotional and erratic o Histrionic I Equally common among genders I Selfdramatization I Overconcern with attractiveness I Tend to be irritable and may have tempertantrums if they feel they are not receiving enough attention I Selfcentered o Antisocial I More common in men I Underdeveloped morals and ethics I Shameless manipulation of others I Conduct problems in childhood I Experience no guiltregretremorse for the bad things they saydo o Borderline I More common in women I Impulsiveness and inappropriate anger I Drastic mood shifts I Attempts at selfmutilation or suicide I Has the most attention in treatment I Overly emotional I Dramatic I Criteria on pg 61 must have at least 5 I Grandiosity sense of selfimportance I Selfesteem is not as stable is it appears I Long to be successful I Narcissism as a personality trait is not uncommon but have it as a fullblown disorder is less common I More common in men than women C Cluster C anxious and fearful o Avoidant I Equallycommon in malesandfemales I Hypersensitivity to rejection I Shyness I Insecurity in initiating relationships I Would like to have relationships it isjust difficult for them 0 Dependent I Equallycommon in malesandfemales I Difficulty in separating in relationships I Discomfort at being alone I Subordination of needs to maintain a relationship 0 ObsessiveCompulsive pg 62does not have true obsessions or compulsions but do have a personalitythat is obsessive compulsive in nature I 4 of 8 symptoms I Distinguishable from the trait of being organized etc I Hoarding In extreme cases more often associated with the anxiety disorder ratherthan personality disorder I You can get diagnosed with both Anxiety disorder from Axis 1 and Personality Disorder on Axis II III Differential Diagnosis Distinguishing between a personality disorder and an Axis 1 mental disorder 0 A person has an Axis 2 personality disorder when the defining characteristics 0 Appear before early adulthood o Are typical ofthe individual39s long term functioning general behavior in most all situations 0 Do not occur exclusively during an episode of an Axis I disorder Distinguishing between the ten personality disorders 0 Diagnostic criteria are not as sharply defined 0 People often show characteristics of more tan one personality disorder 0 High level of comorbidity amongst the personality disorders Distinguishing between a personality disorder and a personalitytrait 0 Personality Disorder Not Otherwise Specified NOS 0 Disorder of personality functioning that does not meet criteria for any specific personality disorder 0 Only becomes a personality disorder when it39s maladaptive definition on top of page 54 IV Categorical Versus Dimensional Model for Personality Disorders Categorical Perspective Each of the personality disorders are qualitatively distinct with their own set of defining criteria 0 Dimensional Model Suggests that personality disorders represent maladaptive variants of normal personality traits o Occurs on a continuum Normal to Maladaptive Mildly or Severely V Course and Treatment 0 Once diagnosed usually fairly stable Some disorders are more likely to remit with age Borderline personality amp Antisocial OCD amp Schizotypal are least likely to remit Treatment 0 Very difficult 0 Have relatively enduring pervasive and inflexible patterns of behavior and inner experience 0 Do not believe that they need to change and so are reluctant to entertherapy 0 Medication doesn39t usually help much increased rates of suicide 0 Cluster C disorders seem to respond the best to treatment The ones based on anxiety amp fear 0 Cluster A disorders seem to be most resistant to change 0 Not much research relative newcomerto the DSM 0 Cognitive Therapy works well for people with avoidant disorder of Cluster C the individual who is shy and reluctant to initiate and maintain relationships Borderline personality disorder has received the most attention because of its high risk of suicide Schizophrenia and Other Psychotic Disorders 11112011 11100 PM I On Schizophrenia Psychotic Disorder 0 Inability to distinguish reality from fantasy 0 Prototypical of abnormality 0 Effects ourthinking what we feel and how we express it our behavior and our perceptual ability 0 quotBest example of abnormal behaviorquot 0 Occurs in every culture in people from all walks of life 0 1 out of 100 individual will experience a schizophrenic episode O 1 is significant due to the severity of the illness 0 Age of Onset o Onset is typically in late adolescence and early adulthood I Men 25 I Women 29 Rarely occurs in childhood 0 Gender Differences 0 Men earlier onset a little more severe in nature slightly higher prevalence worse longterm functioning Poor Insight 0 At the beginning may notice something is not quite right but once fully psychotic they do not realize they are wrong 0 Myth 0 Violence is associated with Schizophrenia 0 Most individuals with schizophrenia are not going to be violent DSMlVTR Criteria forthe Diagnosis of Schizophrenia A Characteristic Symptoms p 63 o Delusion Erroneous beliefsthat are fixed and firmly held despite contradictory evidence 90 of schizophrenics will be delusional at some point Persecutory delusion person believes he or she is being tormented followed tricked spied on or ridiculed most common type of delusion Referential delusion person believes that certain gestures comments newspapers or other environmental cues are specifically directed at him or her Grandiose delusion false beliefs of greatness person believes they have a unique relationship with God or they have an exaggerated idea of selfimportance Nonbizarre delusion plausible Bizarre delusion implausible wouldn39t actually happen a Thought withdrawa thoughts have been taken away by some outside force Thought insertion alien thoughts have been put into their mind D Thought broadcasting private thoughts are being broadcast indiscriminately to others 0 Hallucination a sensory experience that occurs in the absence of an external perceptual stimulus Auditory most common hearing something that does not exist about 75 of schizophrenics will have an auditory hallucinations at some point hearing two or more voices conversing with each other is enough to fulfill Criterion A Visual seeing something that does not exist Olfactory smelling something Tactile feeling something ex feeling a snake crawling inside your body 0 Disorganized speech because we cannot see or hear exactly what is inside someone39s head we make assumptions about what theirthought form is based on what they say Derailment or loosening of associations individual moves from one topic to another subjects are loosely associated to one another Tangentiality person answers a question and the answer is either slightly or very unrelated to the question that was asked Incoherence word salad speech is so severely disturbed or disorganized that it is almost incomprehensible Poverty of content the person is saying a lot of stuff but there is not much content Neologisms the person makes up new words ortakes parts of two different words and put them together 0 Disorganized or catatonic behavior variable inappropriate childlike or silly behavior marked decrease in reactivity to environment can involve a problem with engaging in purposeful behavior 0 Negative symptoms involve an absence or a deficit of normal behavior opposite of positive symptoms reflect an excess or distortion in normal behaviors and experiences includes delusions and hallucinations Affective flattening flat or blunted emotional expressiveness Alogiavery little speech Avolition no ability to initiate or persist in goaldirected activities When there are a lot of negative symptoms it suggests a poor courseprognosis for the disorder and the individual B Social andor occupational dysfunction 0 Level of functioning must be remarkably lowerthan a previous level of functioning D Duration entire disturbance needs to last for at least six months 0 Prodromal illness is beginning to develop individual is not yet experiencing a fullblown case of it 0 Active actively psychotic must last at least 1 month in order to be diagnosed with schizophrenia assuming the individual is not on medication 0 Residual symptom begin to fade out positive symptoms are more mild few negative symptoms are present Iquot Subtypes of Schizophrenia pg 64 A Paranoid type preoccupation with one or more delusions or frequent auditory hallucinations very suspicious individuals severe difficulty interacting with others and maintaining relationships 0 Persecutory delusions and delusions of grandeur are the most common types of delusions for paranoid individuals 0 Paranoid schizophrenics tends to function at a higher level overall than other schizophrenics have the most intact cognitive skills out of all schizophrenics best prognosis most likely to get better B Disorganized type involves disorganized speech disorganized behavior and flat or inappropriate affect 0 Has a more gradual insidious onset than other forms of schizophrenia worst prognosis ofall types of schizophrenia infantile childlike behavior individuals will generally be emotionally indifferent C Catatonic type involves abnormal motor behavior ranging from immobility lack of movement to excessive or agitated motor activity individuals may bounce back and forth between catalepsy and agitation may be accompanied by some violent behavior becoming less common in North America and other industrial parts of the world 0 Catalepsy a state of sustained unresponsiveness in which a fixed body posture is maintained over a long period of time waxy flexibility O Echolalia pathological parrotlike or apparently senseless repetition of a word or phrasejust spoken by another person potential symptom of both catatonic schizophrenia and autism O Echopraxia repetitive imitation of the movements of another person 0 Undifferentiated symptomsthat meet the defining criteria for schizophrenia are present but additional criteria are not met for the Paranoid Disorganized or Catatonic Type quotcatch allquot for schizophrenia 0 Residual absence of prominent delusions hallucinations disorganized speech and grossly disorganized or catatonic behavior but continuing evidence ofthis disturbance is present in a milderform IV Etiological Factors for Schizophrenia Environmental factors In many cases disorders are caused by multiple disorders that work together Strong genetic component 0 Family studies odds of being schizophrenic I 1100 if you are a member of a random group of 100 people 110 if you have an afflicted firstdegree biological relative V2 if you have an afflicted monozygotic twin 0 Twin studies have shown that the 39 rate for is higherfor 39 LWiil than dizygotic twins Not entirely geneticjust genetically influenced individual can inherit a genetic predisposition forthe disorder Genetic predisposition for developing schizophrenia I Multiple genes works together to make an individualsusceptible to schizophrenia The more schizophrenia genes inherited 9 more likely to develop schizophrenia o Prenatal virus factors 0 Early nutritional deficiencies 0 Birth complications Neurodevelopmental disorder disorder that stems from a brain lesion that occurs very early in development perhaps before birth Schizophrenogenic mother cold and aloof mother who causes schizophrenia part of a false hypothesis about the cause of schizophrenia V Outcome and Treatment for Schizophrenia A Outcome 0 16 of schizophrenics will recover fully o 38 will have a favorable outcome given that they stay on medication or continue treatment of some kind they will probably be able to function pretty well 0 33 will have continued signs of the illness despite the continuation of medication and treatment 0 12 will need longterm institutionalization 0 We are getting much better at recognizing symptoms diagnosing it early and treatment it B Pharmacologicaltreatment 0 1950s first generation of antipsychotic medications many bad side effects 0 1980s second generation of antipsychotics much fewer side effects alleviate the positive and negative symptoms of schizophrenia utilize dopamine I Schizophrenia and dopamine D Receptor cells supersensitive to dopamine 9 excess of dopamine in schizophrenics D Antipsychotic drugs act to block some of the dopamine receptors thus reducing the amount of dopamine 0 Recently discovered that estrogen has some clinical benefits women with schizophrenia can be given estrogen to minimize schizophrenic symptoms Sexual and Gender Identity Disorders 11112011 11100 PM I On Sexual and Gender Identity Disorders ll SameSex Orientation A What is sexual orientation 0 Erotic or romantic attraction one or both sexes B Prevalence of Sexual Orientations Same Sex Orientation o 5 of adult men 0 3 of adult women Believed to be an underestimation Bisexuality believed to be rare however it is difficult to measure so may be more common than we think C Historical Changes in our Understanding and Treatment of SameSex Orientation 1 Homosexuality as a crime a sin or a sickness o 3 Way Venn Diagram Crime Sin Sickness with a little overlap each way 0 Individuals who committed this crime were often incarcerated or killed 2 Kinsey on homosexuality 1940s1950s o Conducted large national survey about sexual attitudes and behaviors 0 Found that homosexual behavior was more common than previously believed o Started challenging existing beliefs about homosexuality 0 Many believe that the 1950s was when the gay rights movement really began but didn39t catch momentum until the 60s 3 The 1960s and the Stonewall Riot o Stonewall Riot protest by gay men in response to police raid of Stonewall Inn solidifyingthe beginning of the gay rights movement in the US 4 Removal from the DSMll bythe APA 1974 o APA voted to take homosexuality out of what wasthen the DSM part in response to pressure from gay rights movement part in response to more empirical evidence that it was not a mental disorder 5 Research on adjustment of homosexual individuals 0 Gay men have higher rate of I Anxiety I Depression I Suicidal Ideation o Lesbians have higher rate of substance abuse 0 Most gay men and lesbians do not have a mental disorder 6 Changes in the law 2000s a Can samesex couples legally engage in sexual relations b Can samesex couples marry Sodomy imprecise legal term applied to sexual behavior otherthan heterosexual penilevaginal intercourse 0 Usually refers to oral sex and intercourse between samesex partners and in some state also between opposite sex partners o In South Carolina defined as oral and anal sex between both samesex and oppositesex partners and until the summer of 2003 was a felony Bowers v Hardwick 1986 US Supreme Court case which upheld Georgia antisodomy law ruling that the Constitution did not protect the right of homosexuals to have sex in their own home 0 Lawrence amp Garner v Texas 2003 US Supreme Court case which struck down Texas antisodomy law ruling that the Constitution did protect the right of individuals to engage in sexual relations with someone of the same sex 0 American public on homosexual sex polls show that 6 out of 10 Americans believe that homosexual sex between consenting adults should be legal D Where gay marriage is legal 1 District of Columbia 2 Massachusetts 3 Connecticut 4 Iowa 5 Vermont 6 New Hampshire 7 New York E Sexual orientation and the DSM 1 Normal sexual variant samesex orientation is not considered a psychological disorder as defined by the DSM but instead a nonpathological or normal sexual variant 2 Sexual disorder not otherwise specified NOS includes sexual disturbancesthat do not meet the criteria for a specific sexual disorder ex persistent and marked distress about sexual orientation F s sexual orientation a matter of choice Socioenvironmentalpsychologicalbiological 3way Venn diagram with overlapping in the middle 0 Americans who believe sexual orientation is at least partially biological are more likely to support gay and lesbian civil rights than those who believes it is determined primarily by the environment G Sexual orientation and current issues 0 Don39t Ask Don39t Tell Don39t Pursue 1993 prohibits asking recruits about sexual orientation but views disclosure of same sex orientation as misconduct worthy of discharge 0 Don39t Ask Don39t Tell Repeal Act 2010 ultimately repealsthe 1993 law that prevented openly gay people from serving in the US Armed Forces 0 Gay parents commonly lose visitationcustody rights based on the belief that their sexual orientation will harm their child39s development 0 Few if any differences found in children depending on parents39 sexual orientation 0 Does not effect selfesteem gender roles sexual orientation development school problems wellbeing Gender Identity Disorders A Biological sex vs gender 1 refers to thequot g39 r 39 diff r n of the sex 39 of the sex 39 m4 sex organs of males and females 0 Sex chromosomes 0 Internal genitalia 0 External genitalia 2 Physical Intersex Condition a disconnect between the componentsthat define your biological sex 0 True Hermaphrodite typically XX 1 ovary and 1 testis external genitalia ambiguous o Pseudohermaphrodite XY with testes and femaleambiguous genitalia XX with ovaries and maleambiguous genitalia 3 Gender refers to the psychosocial condition of being masculine or feminine o Assumed to be approximate for a given sex by members of a society behaviors traits interests 0 Gender identity one39s view of oneself as a male orfemale 4 Transexualism a disconnect between one39s biological sex and one39s gender or gender identity 0 Transsexual an individual who views himself or herself as beingthe sex opposite his or her biological sex can be male or female cross dress because it fits their gender identity B Gender Identity Disorder DSMIVTR diagnosis for transsexuals who report significant distress over their condition C Gender Identity Disorder NOSthis alternative diagnosis is for disorders n gender identitythat do not meet all the criteria for Gender Identity Disorder D Transvestism Transvestic Fetishism paraphilia in which a heterosexual male achieves sexual arousal by wearing women39s clothing Transvestites are only heterosexual males IV Normal Sexual Response Cycle A Female sexual response cycle 1 Excitement o Vasocongestion engorgement of blood vessels 0 Transudation vaginal lubrication o Tenting effect lengthening and expansion of vagina elevation of uterus o Fibrillations rapid irregular contractions of the uterus 0 Sex flush reddening or darkening of the skin often in the facial region 0 Myotonia increase in muscle tension 0 Increase heart rate blood pressure and respiration 5 Plateau o Orgasmic platform engorged tissue at outer portion of vagina results in narrowing of vaginal opening 0 Seminal pool small pocket at back of vagina seminal fluid collects here 0 Orgasm rapid and rhythmic contractions of the uterus and anal sphincter muscle that surroundsthe anal opening 6 Resolution period during which the female39s body returns to a prearoused state B Male sexual response cycle 1 Excitement o Vasocongestion o Penile tumescence erection o Widening of urethral opening 0 Thickening of scrotal sac and elevation of testes 0 Sex flush o Myotonia 0 Increase in heart rate blood pressure and respiration 2 Plateau o Erection maintained 0 Continued vasocongestion sex flush and myotonia o Darkening of penis o Droplets of fluid from Cowper39s gland appear on tip of penis 3 Orgasm o Orgasm Stage 1 Emission stage of e39aculation I Seminal fluid collects in urethral bulb I Bladder sphincter closes I Subjective feeling of ejaculatory inevitability o Orgasm Stage 2 Expulsion stage of e39aculation I Contractions of urethral bulb and urethra I Semen expelled through urethra 4 Resolution 0 Period during which the male s body returns to a prearoused state 0 Also referred to as the refractory period V Sexual Dysfunctions A Sexual dysfunctions pg 69 recurrent sexual problemsthat interfere with normal sexual performance and cause distress forthe individual andor cause interpersonal difficulty Axis 1 0 Lifetime prevalence of sexual dysfunctions o 43 of women 0 31 of men Higher educational level 9 lower chance of sexual dysfunction Classifying sexual dysfunctions 1 Primary has been a lifelong problem 2 Secondary Develops after a period of normal functioning 3 Generalized causes problems in any and all sexual situations 4 Situational causes problems in some sexual situations 0 Fantasy model of sex Zilbergeld unrealistic model promoting common misconceptions concerning sexthat create sexual pressure contributing to sexual difficulties 0 Sexual myths 9 sexual pressure 9 sexual difficulties B Types of sexual dysfunctions DSM criteria on pg 70 must meet criterions A different for each B the disturbance causes marked distress or interpersonal difficulty and C dysfunction is not due exclusively to a medical condition orthe use of a substance 1 Sexual desire disorders 0 Abnormally low of absent interest in sexual activity 0 Age increase 9 testosterone decrease 9 sexual desire disorders increase a Hypoactive sexual desire disorder individual who doesn39t fantasize about sexual encounters doesn39t desire sexual activity most common sexual dysfunction in females b Sexual aversion disorder individual has an extreme aversion to sexual activity thought that hypoactive sexual desire and sexual aversion occur on a continuum 2 Sexual arousal disorders lines up with excitement and plateau phases 0 Characterized by problems with the process of sexual arousal o Often causes difficult with vaginal lubrication for women or difficulty obtaining or sustaining an erection for men I Both interfere with sexual performance 3 Orgasmic disorders a Female orgasmic disorder pg70 I Anorgasmia I 1015 experience this lifelong nonorgasm Inhibited female orgasm Frigidity Most women need sexual stimulation in order to achieve orgasm women need stimulation during orgasm b Male orgasmic disorder I Cannot ejaculate during intercourse but typically can during masturbation I OR if it takes along than avg time to ejaculate typically 2 min after penetrating vagina c Premature ejaculation I Has orgasm before ready to I 13 of all men have it I Most common dysfunction 4 Sexual pain disorders a Dyspareunia male orfemale I Physical component I Physical pain during sexual intercourse I Almost always associated w medical condition for men ex UTI I Pain for women that is different than pain she experiences for not having lubrication b Vaginismus women only I Pain and spasms of vaginal muscles during intercourse I A lot more common I Prevent penetration of penis tampon or masturbation I Though stimulation can receive orgasm but not intercourse I Typically victims of rape and others experience timidity towards this 5 Sexual dysfunctions due to a general medical condition 0 Ex male erectile disorder due to diabetes 0 Criteria I Marked distress or interpersonal difficulty I Fully explained by direct physiological effects of a general medical condition 6 Substance induced sexual dysfunction 0 Criteria I Marked distress or interpersonal difficulty I Fully explained by substance abuse C General causes of sexual dysfunction 1 Medications and illicit drugs 0 Alcohol 9 take away or defer sexual desire I Interferes with male erection I Interferes with orgasm and time to develop one I Decrease intensity in women I Antidepressants 9 same side effects as alcohol 0 Psychological factors I Anxiety I Depression I Guilt or shame I Past sexualdrama rape 0 Relationship problems I Control issues I Resentment I Fear of intimacy D Treatment of sexual dysfunctions 1 Trends 0 Assess medical and psychological 0 Assess relationship as a whole 0 Only see one therapist for both partners 0 Relapse prevention 2 Medical treatments 0 Surgical implants I Men with erectile dysfunction get penile replacement 0 Oral medications I Viagra can cause headaches and blurred vision 0 Sextherapy I Go to counselortogether I Stress mutual responsibility I Emphasized education I Modify attitudes and expectations u Eliminate performance anxiety I Address impersonal factors VI Paraphilias A About deviant sexual behavior 1 Historical development of atypical sexual behavior 0 Law Religion amp Medical Science have all shaped the definition 0 Changes in our of Sexuallv Deviant Behavior Revisions of the DSM I DSM 1950s included category of disorders called sexual deviations I DSM 1970s Removed homosexuality as a deviant disorder I DSM IV 1990s Refers to sexual deviations as paraphilias 2 Distinctionsinterminology o Freud caled them perversions that39s why we call people perverts a Atypical or uncommon sexual behavior 0 Uncommon and not practiced by the majority of individuals ex same sex orientation b Sexually deviant or abnormal behavior paraphilia o Involves a pathological component that is distressingto the person or causes problems in his or her life c Atypical vs sexually deviant practices 0 Deviant practices are atypical but atypical behavior is not necessarily deviant B DSMIVTR criteria for paraphilia 1 Recurrent intense sexually arousing fantasies sexual urges or behaviors generally involving a Nonhuman objects b The suffering of humiliation of oneself or one39s partner c Children or other nonconsenting persons 2 Occur over a period of at least six months 0 Not uncommon for more than one 0 Usually begins in adolescence or puberty o More common in men C Noncoercive paraphilias pg 71 1 Fetishism individual does not feel compelled to wearthe object theyjust want it to be part of their sexual experience fetish objects are not limited to articles of female clothing used in crossdressing or devices designed forthe purpose of tactile genital stimulation 0 Rare in women 0 A small number of men develop true fetishes Partialism intense arousal to a nonsexual body part 2 Transvestic fetishism compared to transexualism over a period of at least six months a heterosexual male has recurrent intense sexually arousing fantasies sexual urges or behaviors o Transvestic individuals do not typically stand out from other heterosexual men 0 Tend to be a little more shy and maybe keep to themselves 0 Transvestites crossdress because it sexual excites them transsexuals crossdress because it fits their gender ident y 3 Sexual sadism recurrent intense sexually arousing fantasies sexual urges or behaviors involving acts in which the psychological or physical suffering including humiliation of the victim is sexually exciting to the other person 0 Most common practices include beating bonding and humiliation 4 Masochism recurrent intense sexually arousing fantasies sexual urges or behaviors involvingthe act of being humiliated beaten bound or otherwise made to suffer o The only paraphilia found among women with any degree of frequency but it is still more common in men Sadomasochistic sexual interactions 0 Typically consensual in nature 0 Typically mutually gratifying 0 Individuals who engage in sadomasochistic fantasies urges or behavior and I DO NOT experience distress or dysfunction 9 not diagnosed with a sexual disorder I DO experience distress or dysfunction 9 diagnosed with a sexual disorder Sadomasochism Rape and antisocial personality disorder 9 threeway Venn diagram 0 Individual may have a disorder but typically the sadomasochists is seeking a consenting partner D Coercive paraphilias no consent from the other individual involved 1 Exhibitionism involves the exposure of one39s genitals to an unsuspecting stranger 0 Legally referred to as quotindecent exposurequot 0 Mostly men 0 One of the few paraphilias that seems to decrease in frequency as the individual gets older 0 Exhibitionists tend to have interpersonal difficulty 0 Starts by fantasizing about the behavior then they go to their quotfavorite placequot hangout for a while rehearse the behavior in their mind expose their genitals and then return home to masturbate about the experience 2 Voyeurism individual observes an unsuspecting person who is undressing disrobed or engaging in sexual activity of some kind 0 Fairly uncommon sexual disorder Troilism paraphilia in which a man watches his wife or regular partner engaging in sexual activity with another person on purpose most often a noncoercive paraphilia 3 Frotterurism rubbing and touching one39s genitals against a nonconsenting person 0 Usually associated with younger individuals 0 Almost always male Toucherism paraphilia which involvesthe fondling of a nonconsenting person an involves the active use of the hands 4 Pedophilia involves sexual activity with a prepubertal child 0 Must be at least 16 years old in orderto receive this diagnosis Person they are engaging with must be at least five years younger than the individual 0 Literally means quotlove of childrenquot 0 0 Almost always male 0 Usually only engages in sexual activity with little girls OR little boys one orthe other 0 Child abuser vs pedophilia 9 twoway Venn diagram child abusers and pedophiles may overlap but not necessarily Can receive the pedophile diagnosis even ifthe individual hasn39t acted on their fantasies but a child abuser can only receive that diagnoses if they have acted on the idea E Paraphilias Not Otherwise Specified NOS 0 Telephone scatologia deriving sexual pleasure form making obscene phone calls Necrophilia deriving sexual pleasure from sexual activity with corpses Zoophilia bestiality deriving sexual pleasure from sexual activity with animals F Etiological factors Biopsychosocial model multiple factors contribute Biologicalfactors 0 Little is actually known but research is being explored Psychosocial factors 0 Dysfunctional family 0 Physical or sexual abuse 0 Exposure to sexually deviant behavior or material G Treatment of problematic sexual behavior Difficult to treatment individuals who engage in sexually deviant behavior Pharmacological approach 0 Eliminate sex drive 0 Eliminate ability to act out deviant behavior Cognitivebehavioralapproach 0 Social skills training 0 Assertiveness training 0 Sex education Relapse prevention training 0 Identify and avoid situationsthat present high risk for offending