Chapters 16, 711, 1215
Abnormal Behavior PSYO 2220
Exam 1 Feb 5th (25%) (Chapters 16)
Exam 2 March 17th (25%) (Chapters 711)
Exam 3 Exam Period (40%) (cumulative and chapters 1215)
Random Quizzes (5%)
Online Participation (5%) (posting articles, commenting on articles/ guest lectures, etc)
Bonus Credits (3 points) Research Participation
Chapter 1: Abnormal Behavior in Historical Context
What is abnormal behavior? Abnormal thats not functional for people. The field devoted to the
scientific study of abnormal behavior to describe, predict, explain, and change abnormal patterns of
functioning. Clinical scientists, practitioners treat it. Abnormality usually determined by several
characteristics at one time such as:
- Statistical infrequency
- Violation of norms
- Personal distress
- Disability or Dysfunction
Statistical Infrequency: A behavior that occurs rarely or infrequently. Can be positive though, like elite
athletic and intellectual abilities.
Violation of Norms: Goes against social norms, it either threatens or make anxious those observing it.
Anti social behavior of a psychopath violates social norms, threatening to others. Needs to be considered
in reference to prevailing cultural norms (prostitution good or bad?)
Cultural Relativism: No universal standards or rules for labeling a behavior as abnormal. Behaviors can
only be abnormal relative to cultural norms. Ex. Cow = food, or cow = respected animal, not food,
depending on who you ask.
Gender Role Expectations: How are men/women expected to act? Different for different cultures.
3 Criteria for Psychological Disorders Context and Culture:
1. Cultural Norms shift over time
- Drapetomania slaves wanting to escape.
- Homosexuality removed from DSM in 1973
2. Consider what is culturally acceptable and what is not in our society
3. Distress of person, how it affects their ability to function normally
Personal Distress: Behavior creates personal suffering, distress or torment in a person. Some disorders
don’t involve distress. Some things like hunger and childbirth cause distress but are not abnormal.
Disability or Dysfunction: A behavior that causes impairment in some important area of life, work,
personal relationships, recreational activities. Transvestism only a mental disorder if it causes distress for
Unexpectedness: A surprising or out of proportion response to environmental stressors can be considered
abnormal. Ex. Laughing after being sexually assaulted.
Szasz argues that because of the influence of culture the whole concept of mental illness is invalid, a
myth of sorts. More like problems of living. Societies invent concept of mental illness to better control or
change people who threaten social order.
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Psychopathology DSM 5: Has to be clinically significant, outside of what we think is normal, some form
of distress, and damaging and deviant in a way to someone.
Chapter 2: Integrative Approach to Psychopathology
Models of Abnormality
Perspectives used to explain events known as models or paradigms. Each spells out basic assumptions,
gives order to field under study, guidelines. Models influence what investigators observe, Q’s they ask,
info they seek, how they interpret info.
43% of people believe that people bring mental health disorders upon themselves
30% consider mental health disorders caused by sinful behavior
Brain and SC. Memory, consciousness, perception and voluntary action. Who we are.
Sensory somatic NS connects the brain to the world via senses muscles.
Autonomic NS unconscious functions. Heart beating, breathing, etc.
Sympathetic NS revs you up. Speeds up heart, dilates pupils.
- Parasympathetic NS settles you down. Slows heart, contracts pupils.
Chemical substances released into blood, change our physiology, behavior. Cortisol is hormone linked to
depression and stress.
Genetics of Psychopathology
Watson and Crick identified genes. Segments of DNA control proteins. Genotype, genes, phenotype,
observable traits. Inheritance of traits, genes.
Variability of characteristics in a pop arises from genetic vs environmental factors. Genetics causing a
mental disorder? Role of environment? Combination.
How much nature how much nurture? Heritability of Generalized Anxiety Disorder (GAD) is 0.32 in
persons from western countries.
Identical, same genes. Grow up in different environments, can measure environmental impact. Fraternal
twins grow up in same environment with different genes.
Drug therapy. 1950s. 4 major drug groups.
Respect in field. Produces valuable new info. Brings relief. Can limit our understanding. Too simple.
Evidence incomplete/ inconclusive. Treatments produce significant undesirable () effects.
Actions are determined largely by our experiences in life. Concentrate on behaviors and environment.
Bases explanations and treatments based on learning. Can be tested in lab, research support. Limited.
- Joseph Wolpe. Systematic desensitization.
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- Albert Bandura. Social learning or cognitive behavior therapy.
- Arnold Lazarus. Multimodal behavior therapy.
- Hans Eysenck. Conditioning therapy.
- Aaron Beck. Cognitive therapy.
- Stanley Ratchman. One of original founders of behavior therapy approach.
- Skinner. Positive and negative reinforcement. Operant conditioning.
Use operant conditioning, modeling and classical conditioning.
Pairing an unconditioned stimulus with a sound. Eventually learn to identify this stimulus when you hear
the sound. Ex. Easy button and gun.
Know if you do something you get a positive reward, you do it more. Know if you do something it takes
away something bad, do it more.
Studies mental processes starting from the analogy of info processing by a computer. Behaviorally based
methods to track hidden mental processes. Understanding of psychological disorders. Maladaptive
thinking is the cause of maladaptive behavior. Faulty assumptions and attitudes. Illogical thinking
Develop a new way of thinking to prevent maladaptive behavior. Very broad appeal. Clinically useful and
effective. Uniquely human process, not all countries use it. Therapies effective in treating disorders.
Precise role of cognition in abnormality has yet to be determined (why do we think maladaptively).
Limited effectiveness. Overemphasis on the present.
Abnormal behavior is best understood in the light of that social and cultural forces that influence an
individual. Norms and roles in society. Focus on social labels and roles. Look at family structure and
communication. Abnormal functioning within a family leads to abnormal behavior. Shared and non
shared environments. Product of our environment. Important to consider upbringing and lives people live.
Clinically successful when other treatments failed. Research difficult to interpret. Model unable to predict
abnormality in specific individuals.
Attachment. Establishing and maintaining an emotional bond with parents or other significant individuals.
612 months of age. Evolving caregiver child relationship helps child regulate behavior.
Freud. Based on belief that a persons behavior is determined largely by underlying dynamic
psychological forces they are not consciously aware of. Abnormal symptoms are result of conflict among
these forces. Consciousness and unconscious in conflict. For ex, intellectualization. Person represses
emotional reactions in favor of overly logical response to a problem. Other defense mechanisms.
Time limited, active therapist involvement, concrete goals, development of coping skills, current life
experiences, etc. Techniques, free association, therapist interpretation, catharsis, working through, etc.
First to recognize importance of psychological theories and treatment. First to apply theory and
techniques systemically to treatment. Unsupported ideas, non observable, etc.
Relationships with people and things important to us.
Humanistic Existential Paradigms
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Insight focused. Assumes human nature is something in need of restraint. Emphasis on free will. Seldom
focus on cause of problems. Exercising one’s freedom of choice take courage and can generate pain and
Mental processes are mechanistic driven by sexuality and our needs. Certain needs we need to have to be
happy. Maslow’s theory is like a checklist. Not how it works.
Client centered therapy. Thought people understood their world they would be happy. Need to engage
people in order to feel that they are good, cared about, etc. Features unconditional positive regard and
Chapter 3: Clinical Assessment & Diagnosis
How do clinical psychologists actually do an assessment? Address why the patient behaves abnormally,
and how they can be helped. Focus is idiographic (on individual person). Also used to evaluate treatment
progress. eg, people on parol, etc. Tools clinicians use based on their theoretical orientation. Fall into 3
categories, clinical observations, tests and interviews.
Funnel. Broad and then narrows in on the problem.
Get info from the client. Usually first contact between clinician and patient. Can be unstructured or
structured. Unstructured ask broad opened questions, get the patient to share information willingly. May
lack validity, only based on clinicians opinion. In a structured interview clinicians ask prepared questions.
3 concepts determine value of assessment
- reliability consistent
Assessing Psychological Factors
- Patient history. Some can’t say a lot about history (dementia).
- Malingering. Intentionally providing a false report of symptoms or exaggerating existing symptoms.
Either for material gain or to avoid unwanted events.
- Factitious disorder. Falsely reporting or inducing medical or psychological symptoms.
Hundreds of them.
1. Projective tests. Clients interpret vague and ambiguous stimuli or follow open ended instruction. Used
by psychodynamic practitioners. ex. Inkblot test. ex. Thematic Apperception test (tell me the story
behind this image). ex. Sentence completion test. ex. Drawings (draw a person DAP test). Helpful for
providing supplementary info. Rarely demonstrated anything reliable and valid. Not ethnically diverse.
2. Personality inventories. Measure broad personality characteristics. Focus on beliefs, personality and
how they see the world. ex. MMPI2. Consists of 550 self statements that can be answered true or false
or cannot say. Anything above a T cell of 70, means symptoms might be in the pathological state.
Comprised of 10 clinical scales. Don’t account for culture. Objectively scored and standardized.
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3. Response Inventories. Based on self reported responses. Focus on one specific area of functioning.
ex. Beck Depression Inventory. Rate various things (suicidal thoughts. work inhibition, loss of libido,
etc). Have strong face validity.
4. Psychophysiological tests. Hook them up to machines. Measure heart rate, blood pressure, brain
activity, etc, to various psychological factors. Most popular is polygraph. Require expensive equipment
that must be tuned and maintained. Can be inaccurate and unreliable. Tests don’t work that well.
Implicit Association Test (did it in psych 1000). Finds out your biases.
5. Neurological and Neuropsychological Tests. Directly assess brain functioning directly. CAT, PET,
EEG, MRI etc. Neuropsychological tests assess brain function by assessing cognitive, perceptual, and
motor functioning. Ex. Bender Visual Motor Gestalt Test. Tests can be very accurate, administer a
number of them. Tell you if the person is impaired, doesn’t say much about personality.
6. Intelligence Tests. Indirectly measures intellectual ability. Series of tests assessing verbal and non
verbal skills. Score is IQ. Popular is WAIS. Hard question, how can you really measure intelligence?
Doesn’t account for culture. Are among the most carefully produced of all clinical tests. High
reliability and validity.
Systemic Observations of Behavior
Focuses on antecedents, behavior and consequences.
- Naturalistic. Focus on interactions. Observations generally made by participant observers and reported
to clinician. Reliability is a concern, is it how they actually function? Validity concern.
- Analog. Fake naturalistic. In a lab.
- Selfmonitoring. Look at how you behave. People are poor observers of their own behavior, can justify
certain bad behaviors. We have a lot of biases.
- Family Assessment. Based on family systems. Useful to understand dynamics. Only valuable in the
hands in people trained to use them.
Brain imaging (CT scan), high resolution. Magnetic resonance (MRI). fMRI, see BOLD response, so
what area of brain causes addiction, etc. PET scan. More expensive, looking for radioactive isotopes.
fMRI better than PET because no radiation, short. Not good because its noisy, patient has to lie still, etc.
Challenges in assessment
Resistance and inability to provide info. With children, difficulties in communication and reporting.
Across cultures, language barrier, can’t relate as much, etc.
Increase sensitivity to cultural issues. Insure participants understanding. Establish rapport. Distinguish
cultural response to cultural stereotypes.
Provides the ability to describe a condition in a few words. Group certain abnormal behaviors and
experiences together, convey etiology, course and indications for treatment, study cases, course and
effects for treatment. Help individuals identify with others, live a normal life.
Systematic error in diagnosis. May cause certain groups to receive a particular diagnosis
disproportionately. Clinician may misinterpret certain behaviors as pathological.
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Diagnosis is a stigmatizing label, Influences how others view and treat that person. May change how the
patient behaves and feels about their self. Some may blame themselves or not seek treatment. NAMI
combats incorrect diagnosis.
Many people get better on their own. Treatment may make peoples symptoms worse. Have to understand
there is a huge overlap. 75% of untreated patients look like treated patients. Certain types of treatment
work better for certain disorders. Big stigma about seeking therapy.
The Nature and Form of Classification Systems. Classical (or pure) categorical approach strict
categories. Dimensional approach classification along dimension. Prototypical approach combines
classical and dimensional views. DSM 5 (NA) or ICD10 (Europe).
Presence/ absence of a disorder. Have it or you don’t.
Rank on a continuous quantitative dimension. How much you have it.
18 year old female, occasional binge eating, (1 x per week), food restriction when stressed (2x per week),
alcohol binge drinking (1x week) which leads to thoughts of suicide and hallucinations, daily cannabis
use (1gm, day), feels life is like a dream. Disorder? Or just a young adult. Class vote 50/50.
Multiaxial, 5 branches. People usually receive diagnosis on Axis 1 or 2 but may be both.
53.6% no disorders
18.7% one disorder
10.4% 2 disorders
17.3% 3 or more disorders
Most diagnosed disorders. Include, anxiety, mood, eating, sleep, factitious disorders, dementia, sexual
Personality disorders and mental retardation. Long standing problems.
Relevant general medical conditions. Ex. Aids, become deaf, amputies, etc.
Psychosocial and environmental problems. Ex. relationships, starting school, etc.
Global assessment of psychological, social and occupational functioning (GAF). Got rid of this Axis in
DSM V. 0100 scale of how good you are doing.
Ethnic/ Cultural Considerations
DSMV is a little better at this. DSM IV includes 25 culture bound syndromes. ex. Amok. Acting
irrationally, temperamental, etc, to express anxiety. Culture can influence a person very directly. Risk
factor, types of symptoms experienced, willingness to seek help, availability of treatments, etc.
Dis not take on a dimensional approach to diagnoses. Removed axial criteria. Axis 1 and 2 categories are
arbitrary. Designed to be harmonized with ICD 11. Nototherwisespecified disorders were replaced with
Other specified disorder (meet some but not all of the symptoms for a disorder, but are obviously
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clinically distressed) and Unspecified disorder (Clinician doesn’t want to say what type of disorder the
patient has right away. Because of the state the patient is in don’t want to tell them right away).
Yes and no. Lots of categories within a disorder.
Treatments that target neurological factors
Is the new treatment more effective than no treatment?
Effective because of whats in it or patient expectations?
More effective than other treatments?
Are side effects worth it?
Therapy worth it? Make patients into a worse state than when they came in.
Positive effect of a medically inert substance or procedure. Can be strengthened or weakened by outward
qualities of the placebo and how it is administered. Taking more placebo pills has a greater effect.
Provider is more interested and supportive. Patients told placebo is more expensive. Patients may not
truly be blinded in double blind studies. May need to use an active placebo. Mimics the side effects of an
actual medication, but does not affect the symptoms.
Chapter 4: Research Methods
When participants leave a study. On average more than half of those who begin a treatment in a study do
not complete it. Can affect results. Decision can yield either (+) or () findings.
Helpful aspects of therapy. Shared by all types of psychotherapy. Opportunities to express problems.
Some explanation and understanding of the problems. Opportunity to obtain support, feedback and
advice. Encouragement to take appropriate risks and achieve a sense of mastery. Hope and a positive
relationship. Give patients Working Alliance Inventories to fill out at the end of sessions, studies, etc.
Characteristics of a particular treatment or technique that lead it to have unique benefits. Above and
beyond those of common factors.
Is therapy better than no treatment? Have people in treatment or no treatment group. Measure baseline
symptoms. Assess same variables again after the treatment period. Compare results of two groups.
Manual Based Treatment
Book that is put out that outlines the course of treatment. Ensures therapists the same distinct form of
Studies conducted by investigators who prefer a particular theoretical orientation tend to obtain data that
supports that orientation.
Well designed and well conducted research study shows a particular treatment or technique for a given
disorder has had a beneficial effect. Works for most people, keeps therapy short. Protects therapists from
Evidence Based practice
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Choosing a treatment or set of techniques that research has shown to be effective for a particular patient.
Takes elements of ESP and other factors into account.
70% of people with major depression use these. 60% of these are helped by them. Relapse rates are high
(>50%), if they are stopped within 4 months after an episode of major depression. From 19812000, use
of antidepressants grew from 3.2 to 14 million. People who have moderate minor depression, cognitive
Consent, assent (child needs to agree to participate), voluntary research participation (subtle pressure and
coercion okay). People need to know what they are signing up for. Underaged people, or mentally
challenged people need legal guardian consent.
Disclosed info must be kept confidential. Individuals must be advised about any exceptions to
confidentiality. Disclosures of child abuse are common problem in child research and may compromise
confidentiality, depending on circumstances of disclosure and reporting requirements of states or
province. No research procedures may be used that harm the person physically or psychologically.
How the Q is asked affects the A
People will respond differently if it is a written, or online questionnaire, vs being asked by an interviewer.
Tendency to respond in a particular way regardless of what is being asked. Acquiescence agreeing
frequently regardless of item content.
Wanting people to see ourselves in a certain way.
Experimenter expectancy effect
Intentionally or unintentionally treating participants in ways that encourage particular types of responses.
Double blind design. Neither participant nor researcher know which group participant is in, results of
Things people do, changes in their behavior, when they are aware they are being observed.
Chapter 5: Anxiety Disorders
Breathing Space Meditation
Becoming aware of your breath, your body, your thoughts, your surroundings, etc. Can ignore things and
push them away, or through this method except what you’re feeling.
Anxiety is a state of alarm in response to a vague sense of threat or danger. Similar to fear, except fear is
immediate alarm in response to serious threat, etc. Anxiety/ fear response works when fight or flight is
protective, however when it is inappropriate to the situation can be disabling. Six disorders:
- Generalized anxiety disorder (GAD)
- Panic Disorder. Fear of having a panic attack.
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- Obsessive compulsive disorder (OCD). Has obsessions and feels a compulsion to do a certain behavior.
Can’t help themselves.
- Acute stress disorder. PTSD within a month, short term.
- Posttraumatic stress disorder (PTSD). Long term and may not surface immediately after traumatic
event takes place.
GAD (Generalized Anxiety Disorder)
Characterized by excessive worry and anxiety in at least two life domains (often about everyday
activities). Has often been called freefloating anxiety. Symptoms include feeling restless, keyed up, or on
edge, fatigue, difficulty concentrating, muscle tension and/or sleep problems. Symptoms must last at least
six months. Even if not at the clinical level, treatments can still apply for mild cases.
GAD cognitive perspective
Proponents suggest that psychological problems caused by dysfunctional ways of thinking. Perceive
things as threats. Aaron Beck, argued that those with GAD constantly hold silent assumptions that imply
imminent danger. A situation/ person is unsafe until proven safe. Assume the worst not the best,
particularly about dangerousness. Think if they worry about it, it will make things a little better.
Wells, suggests that the most problematic assumptions in GAD are the individuals worry about worrying.
Intolerance of uncertainty theory
Dugas. Believe that any possibility of a negative event ocurring means that the event is likely to occur.
Borkovec, worrying gives them control over their bodily sensations.
Psychological methods aim to increase sense of control over thoughts and worries. Decrease muscle
tension. Learn how to breath properly. Reduce behaviors associated with worry.
Persistent and unreasonable fears of particular objects, activities or situations. People with a phobia often
avoid the object or thoughts about it. More intense and persistent fear, greater desire to avoid the feared
object or situation, distress that interferes with functioning. Most phobias categorized as specific and
others are social phobias and agoraphobia.
Persistent fears of specific objects or situations. When exposed to the object or situation, sufferers
experience immediate fear. Most common phobias are of specific animals/ insects, heights, enclosed
spaces, thunderstorms and blood.
Some people are genetically predisposed. Phobias develop through conditioning. Once fears are acquired
the individuals avoid dreaded object.
Treating Specific Phobias
Through graded exposure. Interact with the graded object slowly over time, until you can face dreaded
object and feel comfortable. Dcycloserine (antibiotic) may facilitate the neural bases of fear extinction.
Severe, persistent and unreasonable fears of social or performance situations in which embarrassment
may occur. May be narrow talking, performing, eating or writing in public. May be broad general fear
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of functioning poorly in front of others. In both forms people rate themselves as performing less
adequately than they actually do.
Treating Social Phobia
Drugs. Exposure can help. Habituate to their anxiety symptoms. Cognitive behavioral group therapy uses
exposure and cognitive restructuring in a group setting to promote interactions with people. Self help
public organizations for public speaking.
Anxiety disorders. 29% develop one of the disorders at some point in their lives. Only 1/5 seek treatment.
Most individuals with one disorder often have a second one. Anxiety and depression go together.
About 50% of people with an anxiety disorder are also depressed. Have high levels of emotions, low level
of positive emotions and physiological hyperarousal. Need to drink at parties to calm down (1025% with
anxiety disorders abuse or are dependent on alcohol). Self medicate. Substance abuse and personality
disorders blend with anxiety disorders. Medical coronary heart disease, makes anxiety ramp up. Anxiety
seems to occur more in women, more socially acceptable? Generally more dependent, more needy, make
less/ etc compared to men. More women seek medical help as well.
Panic Disorder (PD)
With or without agoraphobia. An extreme anxiety reaction can result when a real threat suddenly emerges.
The experience of panic attacks however are different. Periodic, short bouts of panic that occur suddenly,
reach a peak and pass. (10 mins). Often feel they will die, go crazy or lose control. Attacks happen in the
absence of a real threat. Quite heritable. Comes from a miss interpretation of physiological sensations,
causes person to think “what is it”, over catastrophize situation. Worry about having more panic attacks.
When person associates certain situations with panic and avoids these and similar situations have panic
disorder with agoraphobia. Intensity may fluctuate.
The cognitive perspective of PD
In their view, full panic reactions are experienced only by people who misinterpret bodily events. Not all
biological. Cognitive treatment is aimed at correcting such misinterpretations. Snow ball effect of
symptoms getting worse and worse until they peak at about 10 minutes. Panic prone people may be very
sensitive to certain bodily sensations and may misinterpret them as signs of a medical catastrophe; this
leads to panic. Experience more frequent or intense bodily sensations. Poor coping skills, lack of social
support, unpredictable childhoods, overly protective parents.
About one third to one half of people diagnosed with panic disorder develop agoraphobia. Fear places
where they might have trouble escaping or getting help if they become anxious or suffer a panic attack.
Often fear they will embarrass themselves if others see their symptoms or efforts to escape during an
Obsessive Compulsive Disorder
Made of two components. Obsessions, persistent thoughts, ideas, impulses or images that seem to invade
a persons consciousness. Compulsions, repetitive and rigid behaviors or mental acts that people feel they
must perform to prevent or reduce anxiety. Common forms; cleaning, checking, order or balance,
touching, verbal and or counting. The thoughts that are obsessive you want to get rid of, but they’re
always there. Do the compulsions to reduce the obsessive thoughts. Has to affect multiple areas of their
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life. Most people with OCD have both obsessions and compulsions. Many with OCD are concerned that
they will act on their obsessions (ex, killing someone in their family). Terrified of these thoughts.
Egodistonic (obsessions), egosistonic (compulsions).
Behavioral Perspective OCD
Learning by chance. People happen upon compulsions randomly. When the threats, obsessions lift, they
associate the improvement with the random act. After repeated succession, believe compulsion is
Cognitive perspective OCD
Everyone has repetitive, unwanted and intrusive thoughts. People with OCD blame themselves for normal
(although repetitive and intrusive) thoughts and expect that terrible things will happen as a result.
Neutralizing thoughts/ actions with things.
Thought action fusion
Evan. I hope Evan dies in a car accident today. Do you believe thinking/ writing it will come true?
Erasing it/ not doing it would make it not happen, get rid of the thought of it happening.
For anxiety disorders need to have a person experience them, anxiety arousing situations. Exposure. Let
them know that these situations are okay.
Post Traumatic Stress Disorder (PTSD)
Tends to be chronic. People with PTSD are not easy to be around, annoying, aggressive, etc. Most people
are compassionate towards the person though, unless you’ve been around them for a long time, they can
come across as winey.
1. Reexperiencing the traumatic event; Nightmares, intrusive thoughts or images
2. Avoidance of stimuli; numbing, decreased interest in others, distant or estranged from others, unable to
experience positive emotions.
3. Increased arousal; Insomnia, irritability, hypervigilance, exaggerated startle response.
Extreme response to severe stressor. Anxiety, avoidance of stimuli associated with trauma,
emotional numbing. Exposure to a traumatic event that involves actual or threatened death or injury (war,
rape, natural disaster). Can also be from someone else’s trauma (losing someone in the Twin Tower’s
terrorist attack for ex). Trauma leads to intense fear or helplessness. Symptoms present for more than a
Women and PTSD rape most common type of trauma. Men violence more common.
Stress vs Traumatic Stress
Stressor is considered traumatic when both of the following were present: a) Event or events
involved actual or threatened death or serious injury, or threat to the physical integrity of self or others. b)
Response involved intense fear, helplessness or horror.
Traumatic events are relatively common. Up to 30% of all people will experience some type of
disaster in their lifetime and 25% have experienced a serious car accident. Several factors can affect
whether a stress disorder will develop following a traumatic event; the kind of trauma, the severity of the
traumatic event, its duration and its proximity.
Traumatic events challenge the basic assumptions that most people have about the world. Change
their opinions. The belief in a fair and just world; The belief that it is possible to trust others and be safe;
The belief that is is possible to be effective in the world; The sense that life has purpose and meaning.
People react differently to stressors and traumatic events based on previous experiences, appraisal of the
stressor and coping style.
Types of Traumatic Events
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Large scale traumatic events with multiple victims disasters, war, mass violence, etc.
Unintended acts involving fewer people motor vehicle accidents, life threatening illness, etc.
Intended personal violence rape, physical assault, torture, stalking, child abuse (1/4 females, 1/6 males
prevalence), etc. People that commit violence (kill someone, accidentally, or intended) can experience
7.8% of pop meet criteria for PTSD
Combat and sexual assault are most common traumas
2/3 of children experience traumatic event by 16, most don’t get PTSD
Six month prevalence for ages 1217 was 3.7% for boys, 6.3% for girls
Depression and/or substance abuse comorbidity
Onset may be delayed for months/years
Cognitivebehavioral therapy helpful
Children more resistant to trauma then adults can be
What is the feared stimulus in PTSD? The memory of the event.
Pretrauma psychological factors affect likelihood of developing PTSD. Existing depression/other psych
disorders, belief one is unable to control stressors/ world is a dangerous place (helpless spin on things),
lower IQ > increase risk. Operant/classical conditioning after traumatic event can help explain avoidance
symptoms. Self medicating as negative reinforcement (alcohol).
Targeting psychological and social factors. Combination of behavioral and cognitive methods: exposure
(going back to place trauma happened), relaxation, breathing to reduce arousal and anxiety.
Psychoeducation educate patient on their condition. Cognitive methods help resolve misattributions.
DSM IV Criticisms
PTSD introduced in 1980 to DSM . Distress and suffering experienced moths after a traumatic event are
not necessarily pathological. Many symptoms overlap with depression and anxiety. Used to just be
extreme traumatic events, now includes more common ones. Altered for “second hand victimization”.
Has become a way to seek status for financial, legal or psych reasons.
Acute Stress Disorder (ASD)
Symptoms similar to PTSD. PTSD, but very short term, goes away. Duration varies, shortterm reaction.
Symptoms occur between 2 days and 1 month after trauma. As many as 90% of rape victims experience
ASD. More than 2/3 of those with ASD develop PTSD within 2 years.
Description of anxiety disorders in childhood: Normal fears, anxieties, worries and rituals.
Normal anxieties are common during childhood and adolescence. The most common are separation
anxieties (most common), test anxiety, excessive concern about competence, excessive need for
reassurance and anxiety about harm to a parent. Girls display more anxiety than boys (more acceptable
for girls to act this way, boys should “toughen up”) but symptoms are similar. Some specific anxieties
decrease with age but nervous and anxious symptoms often do not and may remain stable over time.
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Moderate worry can help children prepare for the future. Children with anxiety disorders worry
more often and more intensely than children without anxiety disorders. Ritualistic and repetitive activity
is common, helps child gain control and mastery of environment. Doing things “just right”. Same
mechanisms that underly OCD are same mechanisms that underly rituals kids do.
Separation Anxiety Disorder (SAD)
Separation anxiety is important for a young child’s survival. Worry parents will be hurt/die when
they’re away from their parents. It is normal from about 7 months through preschool years. Age
inappropriate excessive disabling anxiety about being away from parents or away from home. Refusal to
attend class or difficulty remaining in school for an entire day. Equally common in boys and girls. Occurs
more often between ages 511, first occurring during preschool, kindergarten or first grade, peaking in
second grade. Fear of school may be fear of leaving parents. Serious long term consequences if remains
Stress related diagnosis. Often in kids, but can be in adults too. Consists of emotional and
behavioral symptoms (depressive symptoms, anxiety symptoms and/or antisocial behaviors). Arise within
3 months of the experience of a stressor. The stressor that lead to adjustment disorder can be of any
Chapter 6: Somatoform & Factitious Disorders
Somatoform disorders are problems that appear to be medical but are due to psychosocial factors. They
are psychological disorders masquerading as physical problems. In common they both may occur in
response to severe stress, have traditionally been viewed as forms of escape from stress, and a number of
individuals suffer from both a somatoform and a dissociative disorder (commorbidity).
When a physical ailment has no apparent medical cause, physicians may suspect a somatoform disorder.
People with this disorder do not want or purposely produce their symptoms (they believe problems are
genuinely medical). Psychological problem is the cause to physical ailments. Two main types of disorder
are i) Hysterical somatoform disorders and ii) Preoccupation somatoform disorders.
Hysterical Somatoform Disorders (HSD)
Suffer actual changes in their physical functioning. Hard to distinguish from genuine medical problems. It
is always possible that a diagnosis of HSD is a mistake and that the problems have organic causes. DSM
IV lists three HSDs. Most people are resistant to this diagnosis, won’t believe it could all be in their head.
1. Conversion disorder: A psychosocial conflict (stress going on in someones life) or need is
converted into dramatic physical symptoms that affect voluntary or sensory functioning
(paralysis, blindness, loss of feeling). ex. Hand going numb from writing tests/assignments, etc.
Most begin between late childhood and young adulthood. Diagnosed in women 2x as often as
men. Appear suddenly, rare.
Case study: Female, mid 50s, off work, unresolved grief, fainting spells when discussing family matters,
avoidant/dependent personality, unable to voice negative attitudes and views. Checked out medically,
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nothing wrong with her. When talking with psychiatrist, would start to faint, etc. Really wanted people to
think of her positively, needed positive reassurance. Psychiatrist tried to make her mad, wouldn’t get mad,
2. Somatization disorder: Have many long lasting physical ailments that have little or no organic
basis (AKA Briquet’s syndrome). For diagnosis must have range of ailments including several
pain symptoms, gastrointestinal symptoms, sexual symptom and a neurological symptom.
Patients go from Dr to Dr in search of relief. Lasts longer than conversion disorder, many years.
Symptoms may fluctuate but never disappear. Rarer. Ex. Chronic fatigue. Can have physical
origins, but maybe psychological symptoms. Staying in bed makes you not have to do other
things, so you feel tired all the time to avoid those things.
3. Pain disorder with psychological factors: Psychosocial factors play a central role in the onset,
severity or continuation of pain. Appears to be fairly common. Often develops after an accident
or illness that has caused genuine pain. Any age, and more women than men experience it.
Perception of pain is greater than it should be. Pain is normal, but they experience it longer/
more intensely. Use psychological methods to try and get rid of pain, instead of drugs.
Hysterical vs Medical symptoms
Hard to distinguish. As many as 1/5 of people from around the world who seek medical care may actually
suffer from somatoform disorder. Rely on oddities in patients medical picture to distinguish the two (ex.
Hysterical vs Factitious Symptoms
HSDs are different from patterns in which individuals are purposefully producing or faking medical
symptoms. Patients may be malingering (lying) intentionally faking illness to achieve external gain
(financial, legal, compensation, etc). May just wish to be a patient.
Go to extremes to create appearance of illness. Many take medications to produce symptoms.
Patients often research their supposed ailments and are impressively knowledgeable about medicine. Most
common in people who as children received extensive medical treatment for a true physical disorder,
experienced family disruptions, physical/emotional abuse, grudge against medical profession (screw over
doctors), were nurses, lab technicians or medical aides, underlying personality problem such as extreme
dependence. Attention seekers.
Munchausen syndrome is the extreme and long term form of factitious disorder. In Munchausen
syndrome by proxy, a related disorder, parents make up or produce physical illnesses in their children.
Happened in NS. Women intentionally made her baby very sick, to the point of near death, just to get
medical attention from nurses/doctors. Very void personality. Ex. Poisoning children, request invasive
surgeries for them. Very believable.
Preoccupation somatoform disorders
Include hypochondriasis and body dysmorphic disorder. People with these problems misinterpret and
overreact to bodily symptoms and features. Cause great distress but differ from hysterical disorders.
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Unrealistically interpret bodily symptoms as signs of serious illness. Often symptoms are merely normal
bodily changes such as coughing, sores or sweating. Some recognize their concerns are excessive, many
do not. Patients present picture very similar to somatization disorder. Anxiety great and bodily symptoms
minor > hypochondriasis. If symptoms overshadow anxiety > somatization disorder.
Case Study: Older gentleman, married, prostatitis, previous heart attack, moderatesevere major
depression and being treated with antidepressant medication, convicted for sexual assault against adult
female and in treatment for same, walks with cane, etc. Would always want to bring up what was going
on with his medical history. Kept thinking he was going to die (put off all his Drs appointments. Would
walk with a cane, except at break time, would run etc. Would walk with a cane around psychiatrists, for
Body dysmorphic disorder (BDD)
AKA dysmorphophobia. Become deeply concerned over imaged or minor defect in their appearance.
Focus on wrinkles, spots, facial hair, swelling or misshapen facial features (nose, jaw or eyebrows). Most
begin in adolescence but not revealed until adulthood. Up to 5% of people in US have BDD, equally
common among men and women. Often these are the people who get plastic surgery, and even after
surgery things aren’t quite right so they go again. Ex. Guys think they can never be big enough, girls can
never be thin enough, and when this interferes with life, BDD.
Are psychological. The key to one’s identity the sense of who we are and where we fit in our
environment is memory. People with this disorder experience a major disruption of their memory,
identity or consciousness. When such changes in memory lack a clear physical cause they are called
dissociative disorders. Usually a stress cause. Several kinds:
- Dissociative amnesia
- Dissociative fugue
- Dissociative identity disorder (multiple personality disorder).
- Depersonalization disorder (DSM IV)
Found in cases of acute or posttraumatic stress disorders.
Unable to recall important information, usually of an upsetting nature about their lives. Loss of memory
more extensive than normal forgetting and is not caused by organic factors. Often an episode of amnesia
is directly triggered by a specific upsetting event. Only symptom/criteria for this disorder is memory loss.
Amnesia interferes primarily with episodic memory. Semantic memory memory for abstract or
encyclopedic info usually remains intact. Dissociative amnesia is a defense mechanism, to separate
traumatic/stressful events from their self concept. Protect them, so they can go on functioning (survival).
Forget memories you don’t want to remember.
Not only forget their personal identities and details of their past, but also flee to an entirely different
location. For some, fugue is brief (hours/days). Can have it for years too. May travel far from home, take
a new name and establish new life. Don’t do this on purpose, don’t know what they’re doing. “Restart”
their brain. Survival mechanism when stress gets so high you consider suicide, so your brain just restarts
so you can forget all the stress and go on? Fugue tends to resolve itself.
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Dissociative Identity Disorder (DID)
A person can have 2 or more true personalities. Each with a unique set of memories, behaviors, thoughts
and emotions. Sometimes they don’t realize that they have other people living inside them. Some have
amnesia from episodes they have. Some people have different accents, need different sets of corrective
lenses, etc. Research supports that people can have multiple personalities. If the personalities are
developed as a defense mechanism, and than later on during treatment, do the personalities drop off? No
longer need the defense mechanisms.
Can’t control when they switch between personalities. Try to have conversations between them to
control it, but often not successful. At any one given time one of the subpersonalities dominates the
person’s functioning. Kind of looks like they’re spacing off/having a seizure when they switch. Most
cases are diagnosed in late adolescence or early adulthood. More common in women than men.
Subpersonalities often display dramatically different characteristics including physiological
symptoms. Some researchers even argue that many or all cases are iatrogenic, that is unintentionally
produced by practitioners. Supported by the fact that many cases of DID first come to attention only after
a person is already in treatment (not true for all cases). Leading the person on to remember old memories
(sexual assault, abuse). Diagnoses are increasing. Contributed because a growing number of clinicians
believe that DID exists are are willing to diagnose it.
Central symptom is persistent and recurrent episodes of depersonalization, which is a change in one’s
experience of the self in which one’s mental functioning or body feels unreal or foreign. Body and the
world does not seem real, but you are still functioning in it. Feel they are observing themselves from the
Pulled an all nighter, changed cities, experienced overwhelming joy? Feels surreal, you feel
different. ex. Getting high on drugs. Transient depersonalization reactions are fairly common. The
symptoms of the disorder are persistent or recurrent, cause considerable distress and interfere with social
relationships and job performance. Pretty bad at treating dissociative disorders. Talking through it with a
therapist, no drugs. Target reducing the stressors in their life.
Chapter 7: Mood Disorders
Extremes in normal mood. Nature of depression, mania and hypomania. Types of DSM IV depressive
- Major Depressive disorder
- Dysthymic disorder
- Double depression
Types of DSM IV Bipolar disorders:
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- Bipolar I disorder
- Bipolar II disorder
- Cyclothymic disorder
Major Depressive Disorder
Major depressive episode: extremely depressed mood state lasting at least 2 weeks. Have to be very
down, or can’t get back up. Cognitive symptoms (feeling worthless, indecisive). Vegetative (low activity,
sleep a lot, eat little/ a lot) or somatic symptoms central to the disorder. Anhedonia loss of
pleasure/interest in usual activities. Things aren’t fun, don’t want to go out, pointless. Single episode is
highly unusual. Recurrent episodes are more common. Mood disorders usually come in waves.
- Cognitive: Poor concentration, indecisiveness, poor self esteem, hopelessness (I can’t get any better),
suicidal thoughts, delusions, psychosis.
- Physiological/Behavioral: Sleep or appetite disturbance, psychomotor problems, catatonia, fatigue, loss
- Emotional: Sadness, depressed mood, anhedonia, irritability.
Unipolar depression = just depression. Sometimes people become reclusive, angry, etc. Get into
arguments with people for no good reason. Acting out depressive feelings instead of internalizing them.
Depression can last years.
Defined by persistently depressed mood that continues for at least 2 years. Controversial disorder just
feeling kind of down, nothings really great, always have a low mood. Can be pessimistic (things are never
gonna be better), doesn’t have to be. Looks to be a personality construct, lasts a long time, and doesn’t go
away. Treatments usually none, people can usually live with it. Minorly dysfunctional.
Symptoms of dysthymia are milder than major depressive. Symptoms can persist unchanged over
long periods (20+ years). Late onset typically in the early 20’s. Early onset before age 20, greater
chronicity, poorer prognosis. In a 10 year study, 95% of patients with dysthymic disorder developed
Person experiences major depressive episodes and dysthymic disorder. Always have a low mood, and
then they have episodes where they’re really bad. Dysthymic disorder often develops first. Quite
common, associated with severe psychopathology, associated with a problematic future course.
Bipolar I Disorder
Alternations between full manic episodes and depressive episodes. Average age onset is 18 years, but can
begin in childhood. Tends to be chronic. Suicide is a common consequence. Some say it is more
debilitating then psychosis. Left treated or untreated, its a life long disorder. Chaotic life, hard way to live.
Many people through medication and therapy do quite well. People like their manic episodes. A lot of
very productive people have bipolar disorder. Manic episodes are exhausting to people around them. Anti
depressants can induce bipolar like symptoms for a short while. Need a mood stabilizer lithium. Genetic
link. Stress usually starts off mood disorders. Nothing triggers the episodes, mood just changes. Manic
states usually last daysweeks. Can last as long as months. Cannot have just a manic disorder.
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Bipolar II Disorder
Alternations between major depressive episodes and hypomania episodes. Don’t go up as high on their
manic episodes. Average onset is 22, but can begin in childhood. Tends to be chronic. Only 1013% of
cases progress to full bipolar disorder. More manageable disorder. Often manic episodes are shorter, but
they don’t have to be.
Symptoms of mania
Experience dramatic and inappropriate rises in mood. Intense emotions. 5 main areas of functioning can
1. Emotional symptoms: active, powerful emotions in search of outlet.
2. Motivational symptoms: Need for constant excitement, involvement, companionship.
3. Behavioral: Very active, move quickly, talk loudly or rapidly. Flamboyance is not uncommon.
4. Cognitive symptoms: Show poor judgment or planning. Especially prone to poor (or no planning).
Maxing out credit cards, shop a lot. Lack of sleep not a concern.
5. Physical Symptoms: High energy level. Often in the presence of little or no rest.
Symptoms similar to those people who use cocaine.
More chronic version of bipolar disorder. Manic and major depressive episodes are less severe. Manic or
depressive mood states persist for long periods. Pattern must last for at least 2 years (1 year for children
and adolescents). Average age onset is 1214 years. Tends to be chronic and life long, most common in
females. High risk for developing bipolar I or II disorder. Lithium works quite well as treatment, may
prevent them from developing further bipolar disorders.
Additional Criteria for mood disorders
Atypical oversleep, overeat, gain weight and are anxious
Melancholic severe somatic symptoms, more severe depression
Chronic major depression only, lasting 2 years
Catatonic very serious condition, absence of movement
Psychotic mood congruent/incongruent
Past history and recovery from depression/mania
Seasonal pattern weather episodes are more likely during a certain season
Women are twice as likely to have a mood disorder than men.
Depression is something that appears in a lot of other disorders; medical, eating, anxiety, substance,
personality disorders, etc. Often comorbid. If nothing else, often have symptoms.
Learned Helplessness Theory
Of depression. Person learns over time that they have no control over the outcomes that happen to them.
Internal. Their fault always, applies to everything. Believe negative events will disrupt many life
activities. Related to lack of perceived control over life events.
Cognitive Theory of Depression
Aaron Beck. The way you think, the way you behave and your emotions make you who you are. Have
schemas of how you see the world. Ex. Argument with husband. Schema that you are unlovable. Thinking
your a bad wife and husbands going to leave. Spends all day in bed. Feel depressed and guilty. Mood is
influenced by way she thinks and how she behaves. No reason to not feel crappy. Help change their
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Mix of comprehensive and straight memorization type questions
ex. What medication for panic disorder?
ex. Symptoms, what do they have?
Depression Quest Game
Full of seemingly unimportant decisions, that can actually have a major impact on our life. Learned about
all the road blocks experienced. Even though the options are there, it doesn’t feel like you have any
options at all.
According to Isaac Sakinofsky (1998) of the center for addiction and mental health in Toronto, suicide
rates in Canada are highest in Alberta, Quebec and the Northwest Territories and lowest in Newfoundland
and Labrador. Overwhelmingly a white and Native American phenomenon. Suicide rate of aboriginal
people is extremely high with great variability existing across specific groups. Might be from lower SES,
huge cultural loss, lifestyle on reservations, no access to fresh water. Racism against aboriginals in
Canada. A lot more hopelessness.
Suicide rates are increasing, particularly in the young. More common after age 14, about 1 in 12
adolescents attempt suicide. Gender differences, males are more successful at committing suicide than
females. Females attempt suicide more often than males. Differences in how they commit suicide? Males
use more lethal methods (firearms, hanging (most common)). Females use pills, cutting, less successful.
Not all suicide attempts have the intention of dying, for attention. Certain personality disorders are
vindictive of this. Make parasuicidal attempts for attention, still in distress when they’re doing this.
Suicide in the family increases risk. Low serotonin levels increase risk. A psychological disorder
increases risk. Alcohol use and abuse. Past suicidal behavior increases subsequent risk. Experience of a
shameful/humiliating stressor increases risk (has to be shameful/humiliating to that person). Publicity
about suicide and media coverage increase risk. Never pictures (not even of the family mourning), and
you try not to mention it in the media. Biological/psychosocial underpinnings. More people that are
anorexic are more likely to die from suicide than from anorexia.
Giving away possessions. Saying goodbye to friends or family. Talking about death or suicide generally,
or talking about plans. Making threats of suicide. Rehearsing a plan for suicide. Not everyone displays
warning signs. Sometimes environment/ people in it, make it had to share thoughts.
IS PATH WARM
S Substance Abuse
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M Mood change
What should I say?
Ask them if they’re okay, if they’re suicidal. If they’re willing to talk, just want an out, haven’t committed
to killing themselves. Call a help line. Don’t leave them alone. Get them to commit to doing something.
Okay to talk about suicide.
Treatment of Mood Disorders
Widely used (Trofanil, Elavil). Block reuptake of Norepinephrine and other neurotransmitters. Takes 28
weeks for the effects to be known. Negative side effects are common. May be lethal in excessive doses.
Enzyme that breaks down serotonin and norepinephrine. MAO inhibitors block monoamine oxidase.
MAO inhibitors are slightly more effective than tricyclics. Must avoid foods containing tyramine (beer,
red wine, cheese).
Selective Serotonergic Reuptake Inhibitors (SSRIs)
Specifically block reuptake of serotonin. Fluoxetine (Prozac) is the most common. SSRIs pose no unique
risk of suicide or violence. Negative side effects are common.
Treatments for Bipolar Disorder: Lithium and Other Mood Stabilizers
The use of lithium (a metallic element occurring as mineral salt) and other moodstabilizers has
dramatically changed this picture. Helps reduce the manic episodes as well as the depressive episodes.
Lithium is extraordinarily effective in treating bipolar disorders and mania. Determining the correct
dosage for a given patient is a delicate process. Too low = no effect. Too high = lithium intoxication
All manner of research has attested to the effectiveness of lithium and other mood stabilizers in treating
manic episodes. More than 60% of patients with mania improve on these medications. Experience fewer
new episodes while on the drug.
ECT Electroconvulsive Therapy
Involves applying brief electrical current to the brain. Results in temporary seizures. Usually 6 to 10
treatments are required. ECT is effective for cases of severe depression. Side effects are few and include
shortterm memory loss. Uncertain why ECT works and relapse is common.
Cognitive Therapy Addresses cognitive errors in thinking. Also includes behavioral components. Help
people see the world differently.
Behavioral Activation Involves helping depressed persons make increased contact with reinforcing
events. Train a human to act a certain way. Increase people’s behavior that is good for them, helps them
challenge their cognitions.
Interpersonal Psychotherapy Focuses on problematic interpersonal relationships. We see the world
through our relationships. Happy with your relationships should be happy.
Outcomes with psychological treatments are comparable to medications, some times. Psychological
treatments reduce rate for relapse.
Family Therapy for bipolar disorders. If people are treated with a mood stabilizer and family therapy they
fair better than just drugs alone.
Beck’s Cognitive Therapy
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Beck viewed unipolar depression as resulting from a pattern of negative thinking that may be triggered by
current upsetting situations. Maladaptive attitudes lead people to the cognitive triad. Negative viewing
oneself, the world, and the future. These biased views combine with illogical thinking to produce
Beck’s cognitive therapy which includes a number of behavior techniques is designed to help clients
recognize and change their negative cognitive processes. This approach follows four phases and usually
lasts fewer than 20 sessions.
1. Increasing activities and elevating mood
2. Challenging automatic thoughts
3. Identifying negative thinking and biases
4. Changing primary attitudes
The way we think, the way we behave and how we feel are all tied together. Lets challenge those thoughts
and change the way we feel.
CBT. Case formulation and treatment planning. Behavioral activation. Activity scheduling. Challenging
automatic thoughts. Thought records. Use of ambiguous pictures. Challenge typical cognitive delusions.
Schema therapy. Be a scientist evidence for and against a negative schema.
Challenging automatic thoughts homework for the client. Write things down about events, thoughts,
Ambiguous Images tells you about a persons thought content. Everybody interprets them differently. Get
the client talking.
Common Cognitive Distortions
Minimization and maximization
Chapter 8: Eating Disorders
Two major types of DSM IV Eating Disorders
- Anorexia nervosa and bulimia nervosa
- Both involve severe disruptions in eating behavior
- Both involve extreme fear and apprehension about gaining weight
- Both have strong sociocultural origins Westernized views, white upper class phenomenon
Other subtypes of DSM IV eating disorders
- Bingeeating disorder
- Rumination disorder
- Pica eat things not suppose to
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- Feeding disorder
Binge eating Hallmark of Bulimia. Bingeeating excess amounts of food. Eating is perceived as
uncontrollable. Compensatory behaviors. Purging self induced vomiting, diuretics, laxatives. Some
exercise excessively, whereas others fast. DSM IV subtypes of Bulimia
- Purging subtype most common subtype (vomiting, laxatives, enemas)
- Nonpurging subtype about 1/3 of bulimics (excess exercise, fasting)
Associated features: Most within 10% of target body weight. Most are over concerned with body shape,
fear gaining weight. Most are comorbid for other psychological disorders. Purging methods can result in
severe medical problems dental, finger, toes erosion, electrolyte imbalance. Can’t tell they’re bulimic,
look normal/slightly above normal weight. Rates of bulimia increasing since the 60’s, peaking now.
Successful weight loss hallmark of anorexia. Defined as 15% below expected weight. Intense fear of
obesity and losing control over eating. Anorexics show a relentless pursuit of thinness, often beginning
with dieting. DSM IV subtypes of anorexia
- Restricting subtype limit caloric intake via diet and fasting
- Binge eating purging subtype about 50% of anorexics
Associated features: Most show marked disturbances in body image. Most are comorbid for other
psychological disorders, and drug abuse. Methods of weight loss can have severe life threatening medical
consequences. Many die by suicide. Organ function falls off brain, heart, ovaries (losing period), etc.
Vicious cycle of anorexia Fear of obesity and distorted body image leads to starvation, preoccupation
with food, increased anxiety and depression. Leads to medical problems (physical/psychiatric) > greater
feelings of fear and loss of control, harder attempts at thinness, cycle starts over.
Meth/cocaine effective for losing weight, because you don’t eat and you don’t sleep, attacks body fat.
Anorexic people have a lack of interest/pleasure from life. Reward center in brain not stimulated.
DSM IV: experimental diagnostic category, engage in food binges, but do not engage in compensatory
behaviors. Associated features: many persons with bingeeating disorder are obese. Most are older than
bulimics and anorexics. Show more psychopathology than obese people who do not binge. Share similar
concerns as anorexics and bulimics regarding shape and weight. Western phenomenon. Not a quantitative
value for what constitutes a binge but normally a days worth of calories.
Facts and Stats
- Majority are female, with onset around 1619 years of age.
- Lifetime prevalence is about 1.1% for females, 0.1% for males
- 68% of college women suffer from bulimia
- Tends to be chronic if left untreated
- People with bulimia are “throwing up their emotions”
- Majority are female and white, from middle to upper middle class families
- Usually develop around age 13 or early adolescence
- Tends to be more chronic and resistant to treatment than bulimia because of cognitive beliefs
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- People with anorexia are trying to blunt out their emotions
Both bulimia and anorexia are found in westernized cultures.
Causes of Bulimia and Anorexia
Media and cultural considerations. Being thin = success, happiness.. really? Cultural imperative for
thinness translates into dieting. Standards of ideal body size change as much as clothes. With improved
nutrition, media standards of the ideal are difficult to achieve. Developmental considerations. What is
normal growth and development around puberty? Psychological ad behavioral considerations food
restrictions often leads to preoccupation with food. Low sense of personal control and self confidence. An
integrative model of eating disorders.
Treatment of Bulimia
- Antidepressants can help reduce binging and purging behavior
- Antidepressants are not efficacious in the long term
- Be careful of doses, low body weight, purging medication
- Cognitive behavior therapy (CBT) is the treatment of choice
- Interpersonal psychotherapy results in long term gains similar to CBT
Treatment of Anorexia
- There are none with demonstrated efficacy
- Weight restoration first and easiest goal to meet
- Treatment involves education, behavioral, and cognitive interventions
- Treatment often involves the family
- Long term prognosis for anorexia is poorer than for bulimia
Sleep & Sleep Disorders: Amanda LeRoux
Sleep is the intermediate state between wakefulness and death The philosophy of sleep, 1834.
Unique brain patterns compared to awake brain. 5 distinct stages. NREM (Stages 14) and REM (stage 5).
Sleep timing controlled by circadian clock (suprachiasmatic nucleus, SCN).
Physiological & Psychological
Bidirectional relationship. Clear physiological basis of sleep. Sleep problems interact in important ways
with psychological factors. Sleep loss and poor sleep impact social, family, work life. Schizophrenia,
bipolar disorders, anxiety related disorders, depression. Elevated mood in depressed patients. Sleepiness
can impair driving performance as much or more so than alcohol. Being awake for 2125 hours is like
having a BAC of 0.08.
Two major types of DSM IV sleep disorders
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- Dyssomnias: difficulties in getting enough sleep, problems in the timing of sleep, and complaints about
the quality of sleep.
- Parasomnias: abnormal behavioral and physiological events during sleep
Sleep related complaints not being able to fall asleep, sleep movement, excessive daytime sleepiness,
inability to sleep in desired time.
Assessment of disordered sleep: Polysomnographic (PSG) Evaluation:
- Electroencephalograph (EEG) leg movements and brain wave activity
- Electrooculograph (EOG) eye movements
- Electromyography (EMG) muscle movements
- Includes detailed history, assessment of sleep hygiene and sleep efficiency (SE)
- Multiple Sleep Latency Test (MSLT)
International Classification of Sleep Disorders. 85 sleep disorders:
- Sleeprelated breathing disorders
- Hypersomnias not due to breathing
- Circadian rhythms sleep disorders
- Sleeprelated movement disorders
- Isolated symptoms, apparently normal variants and unresolved issues
- Other sleep disorders
The Dyssomnias & Defining features of Insomnia
Insomnia and primary insomnia
- One of the most common sleep disorders (3050%)
- Difficulties initiating sleep, maintaining sleep, and/or nonrestorative sleep
- Primary insomnia means insomnia unrelated to any other condition (rare)
Females reported insomnia twice as often as males. Insomnia is often with medical and/or psychological
conditions. Many have unrealistic expectations about sleep. Many believe lack of sleep will be more
disruptive than it usually is.
Defining features of Hypersomnia
Hypersomnia and primary hypersomnia
- Problems related to sleeping too much or excessive sleep
- Person experiences excessive sleepiness as a problem
- Primary hypersomnia means hypersomnia unrelated to any other condition (rare)
About 39% have a family history of hypersomnia. Hypersomnia is often associated with medical and/or
psychological conditions. Complain of sleepiness throughout the day, but do sleep through the night.
Daytime sleepiness and cataplexy. Cataplexic attacks REM sleep, precipitated by strong emotion.
Narcolepsy is rare, affects about 0.030.16% of the population. Equally distributed between males and
females. Onset during adolescence, and typically improves over time. Cataplexy, sleep paralysis, and
hypnagogic hallucinations improve over time. Daytime sleepiness does not remit without treatment.
BreathingRelated Sleep Disorders
Breathing related sleep disorders.
- Sleepiness during the day and/or disrupted sleep at night.
- Sleep apnea: restricted air flow and/or brief cessations of breathing.
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Subtypes of sleep apnea
- Obstructive sleep apnea (OSA): Airflow stops, but respiratory system works
- Central sleep apnea (CSA): Respiratory system stops for brief periods
- Mixed sleep apnea: combinations of OSA and CSA.
More common in males, occurs in 12% of the population. Equally distributed between males and
females. Persons are usually minimally aware of apnea problem. Often snore, sweat during sleep, wake
frequently and have morning headaches. May experience episodes of falling asleep during the day.
Circadian Rhythm Disorders
Circadian rhythm disorders
- Disturbed sleep (either insomnia or excessive sleepiness during the day)
- Problem is due to brain’s inability to synchronize day to night
Circadian rhythms follow a 24 hour clock. Suprachiasmatic nucleus, the brain’s biological clock,
stimulates melatonin. Jet lag type sleep problems related to crossing time zones. Shift work type sleep
problems related to changing work schedules
Medical Interventions for Dyssomnias
- Benzodiazepines and over the counter sleep medications
- Prolonged use can rebound insomnia, dependence
- Best as shortterm solution
Hypersomnia and Narcolepsy
- Stimulants (Ritalin)
- Cataplexy is usually treated with antidepressants
Breathing related sleep disorders
- May include medications, weight loss, or mechanical devices
Circadian Rhythm Sleep disorders
- Phase delays moving bedtime later (best approach)
- Phase advances moving bedtime earlier (more difficult)
- Use of very bright light trick the brain’s biological clock
Relaxation and stress reduction
- Reduces stress and assists with sleep
- Modify unrealistic expectations about sleep
Stimulus control procedures
- Improved sleep hygiene bedroom is a place for sleep and sex only
- For children setting a regular bedtime routine
- Insomnia short term medication plus psychotherapy is best
- Lack evidence for the efficacy of combined treatments with other dyssomnias
The problem is not with sleep itself. Problem is abnormal events during sleep, or shortly after waking.
Two types of parasomnias: Those that occur during REM (dream) sleep and those that occur during non
REM (nondream) sleep.
Parasomnias Nightmare disorder
- Occurs during REM sleep
- Involves distressful and disturbing dreams
25 A B N O R M A L B E H A V I O R Abnormal Behavior
Chapters 16, 711, 1215
- Such dreams interfere with daily life functioning and interrupt sleep
Dreams often awaken the sleeper. Problem is more common in children than adults. May invol