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Lecture 5

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Psychology 2030A/B
David Vollick

 Posttraumatic Stress Disorder (PTSD): An Overview  Facts and Statistics o About 7.8% of the general population meet the criteria for PTSD o Combat and sexual assault are the most common traumas o Few in air-raid bunkers developed PRSD- few experienced death, etc.  Posttraumatic Stress Disorder (PTSD): Causes and Associated Features  Subtypes and Associated Features of PTSD o Acute PTSD- May be diagnosed 1-3 months post trauma (don’t diagnose right away because it may not develop into PTSD) o Chronic PTSD- Diagnosed after 3 months post trauma o Delayed onset PTSD- Onset of symptoms 6 months or more post-trauma o Acute stress disorder- Diagnosis of PTSD immediately post-trauma  Causes of PTSD o Intensity of the trauma and one’s reaction to it (true alarm) o Uncontrollability and unpredictability (avalanche) o Extent, or lack, of social/emotional support, post-trauma (if you have good emotional support you are at a lower rick of PTSD-either way you are better off with it) o Direct conditioning and observational learning  Researchers are suggesting that depression way actually be PTSD o Biological & psychological predispositions, personalities, and genetics affect PTSD o CRF activation (endocrine), hippocampus damage (memory), brain stem (emotional)  Posttraumatic Stress Disorder (PTSD): Treatment  Psychological Treatment of PTSD o Cognitive-behavioral treatment (CBT) involves gradual re-exposure (imaginational exposure in a hierarchy of intensity) o Increase positive coping skills and social support o CBTs are highly effective o Meichenbaum- modification of exposure- therapist helps individual reconstruct the story and change the meaning behind it and help to adapt positive coping skills o Eye-movement desensitization and reprocessing- therapist will move fingers and clients eyes will follow finger while thinking about trauma; it is supposed to somehow rewire the brain; not much supporting evidence o SSRI’s can help  Hierarchy: table 5.10 Fear and Avoidance Hierarchy for Marcie  DSM table 5.7: Diagnostic Criteria for OCD  Obsessive-Compulsive Disorder (OCD): An Overview  Overview and Defining Features o Obsessions- intrusive and nonsensical thoughts, images, or urges that one tries to resist or eliminate (aggression, sexual) o Compulsions- thoughts or actions to suppress the thoughts and provide relief o Most persons with OCD display multiple obsessions (contamination, somatic concerns, symmetry, sexual, aggressive impulses) o Most persons with OCD present with cleaning and washing or checking rituals  Summerfeldt- Four Associations o Aggressive and sexual obsessions- seem to lead to checking rituals o Symmetry obsessions- lead to ordering and arranging rituals o Contamination- results in cleaning rituals o Hoarding rituals- fearing if they throw things away, they might urgently need it eventually  Obsessive Compulsive Disorder (OCD): Causes and Associated Features  Facts and Statistics o About 2.6% of the general population meet criteria for OCD in their lifetime o Most people with OCD are female o OCD tends to be chronic o Onset is typically in early adolescence or young adulthood  Causes of OCD o Parallel to the other anxiety disorders o Early life experiences and learning that some thoughts are dangerous/unacceptable o Thought-action fusion-tendency to view the thought as similar to the action  Obsessive Compulsive Disorder (OCD): Treatment  Medication Treatment of OCD o SSRIs seem to benefit up to 60% of patients o Relapse is common with medication discontinuation  Psychological Treatment o Cognitive-behavioral therapy (involving exposure and ritual prevention) is effective with OCD- no harm o Medication+CBT does not work as well as CBT alone o McLean (UBC)- Exposure and ritual prevention vs. CBT-ERP slightly better than CBT- both improved thoughts o ERP, with or without clomiprimine, gave superior results than the drug alone  Summary of Anxiety-Related Disorders  Anxiety disorders are the largest domain of psychopathology  From a normal to a disordered experience of anxiety and fear o Requires consideration of biological, psychological, experimental and social factors (diathesis- stress) o Fear and anxiety persist to bodily or environmental non-dangerous cues o Symptoms and avoidance cause significant distress and impairs functioning (DSM-IV-has to be distressful and impair function to be a disorder) Chapter 6- Somatoform and Dissociative Disorders  An Overview of Somatoform Disorders  Soma- meaning body o Overly preoccupied with their health of body appearance o No identifiable medical condition causing the physical complaints  DSM-IV-TR  DSM table 6.1- Diagnostic Criteria for Hypochondriasis  Hypochondriasis: An Overview  Problem is anxiety  Chronic onset  Hypochondriasis vs. panic disorder o Similarities  Both focus on bodily symptoms o Differences  Hypochondriasis focuses on long-term process of illness; constant concern; constantly seeking medical treatment; wider range of symptoms (vary from heart problems to muscle problems)  Panic disorder is in the moment  Overview and Defining Features o Physical complaints without a clear cause  Severe anxiety focused on the possibility of having a serious long-term disease vs. panic disorder  Strong disease conviction (almost like they want to have disease)  Medical reassurance does not help o Facts and Statistics  Good prevalence data lacking- onset at any age  Culture specific  Hypochondriasis: Causes and Treatment  Causes o Cognitive perceptual distortions  Sensitivity to illness (interpret it at threatening)  Ambiguous bodily stimuli are threatening  *Munchhausen-create illness consciously  Stressful life, family disease when young o Familial history of illness  Treatment (CBT- most effective) o CBT better than SSRIs o Challenge illness-related misinterpretations o Provide more substantial and sensitive reassurance o Stress management and coping strategies  DSM-IV- DSM table 6.2- Diagnostic Criteria for Somatization Disorder  Somatization Disorder: An Overview  Overview and Defining Features o Extended history of physical complaints before 30 o Substantial impairment in social or occupational functioning o Concerned over the symptoms themselves, not what they might mean (vs. hypochondriacs) o Symptoms become the persons identity  Facts and Statistics o Rare condition o Onset usually in early adolescence o Mostly affects unmarried, low social economic status woman o Runs a chronic course  Somatization Disorder: Causes and Treatment  Causes o Over attend to physical sensations o Familial history of illness o Linked with antisocial personality disorder o Weal behavioral inhibition system, not control behavioral activation system  Treatment o No treatment exists with demonstrated effectiveness o Reduce tendency to visit numerous medical specialists by assigning “gatekeeper” physician o Reduce supportive consequences of talk about physical symptoms  DSM-IV-TR: DSM table 6.3- Diagnostic Criteria for Conversion Disorder  Conversion Disorder: An Overview  Overview and Defining Features o Physical malfunctioning without any physical or organic pathology o Freud’s primary and secondary (I do this in order to get something) gain o Malfunctioning often involves sensory-motor areas; blindness, aphonia, paralysis (like a neurological disease) o Difficult to discern between malingering, real physical disorders and conversion disorder o CD shows la belle indifference (I cant see
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