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Psychology 1000 - March 20.docx

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Western University
Psychology 1000
Laura Fazakas- De Hoog

Psychology 1000 Thursday March 20 Lecture 10 Chapter 16 – Disorders & Chapter 17 Announcements: • If you want to talk to the TAs about your exam, you need to print off your answers and take them with you. • Your research credits are due by April 8 • If your grade says ‘0’ for research participation, that means you’re losing 0 marks (that’s what you want to see) Practice Exam Question: With schizophrenia, which of the following is not a “negative” symptom? a) Alogia b) Blunted affect c) Avolition d) Delusions e) Anhedonia Answer: D - delusions Practice Exam Question: According to the DSM-IV, a diagnosis of diabetes belongs on which axis? a) Axis I b) Axis II c) Axis III d) Axis IV e) Axis V Answer: C – Axis III Outline: (continued from next class) I. Mood Disorders a. Typology II. Anxiety Disorders a. Phobias b. Panic Disorder c. Obsessive Compulsive Disorder d. Post-Traumatic Stress Disorder III. Psychotic Disorders IV. Somatoform Disorders a. Conversion Disorder & Hypochondriasis V. Dissociative Disorders VI. Personality Disorders Anxiety Disorders Obsessive-Compulsive Disorder • Prevalence of 2-3% • Involves recurrent obsessions or compulsions that are serious enough to adversely affect a person’s life • eg. hand washing compulsion, turning on and off the lights a certain number of times • Obsessions: Persistent and anxiety-evoking ideas, thoughts, impulses, or images o *They are ego-dystonic (the person sees them as something outside of themselves) • Compulsions: Repetitive behaviours or mental acts to prevent or reduce anxiety or distress o eg. hoarding compulsion (comes from a fear of throwing things away) • Most common: o Obsessions:  Contamination or fear of germs, imagining harming self or others, imagining losing control of aggressive urges, intrusive sexual thoughts or urges, excessive religious or moral doubt, forbidden thoughts o Compulsions:  Repetitive washing, repeating things a certain number of times, checking, touching, counting, ordering/arranging, hoarding/saving, praying  Compulsions are engaged in to reduce anxieties caused by obsessions • Causes? o Biological Factors:  Genetics (for anxiety in general)  Higher than normal activity in the frontal lobe (involved in impulse control)  Low serotonin  Smaller caudate nucleus (difficulty suppressing incoming impulses) o Psychodynamic Theory  Caused by sexual and aggressive impulses breaking from the unconscious to conscious mind and causing anxiety  The id is out of control, and the superego is too weak to contain the id’s impulses o Learning Theory  Learned an inappropriate and now vicious cycle of reinforcement that is difficult to break  The person engages in compulsions which lowers anxiety, and therefore they are maintained over time (negative reinforcement) Generalized Anxiety Disorder (GAD) • Prevalence: 4% male, 7% female • Excessive worry and anxiety dominates a patient’s life • There is a sense of “free floating anxiety” • Symptoms: Tense, on edge, irritable, sleep difficulties, exhausted, difficulty concentrating/making decisions • Causes? o Biological  There is a genetic vulnerability (identical twins have a higher concordance than fraternal twins)  It is thought to be due to insufficient GABA or GABA receptors (GABA is an inhibitory transmitter that shuts down activity in the nervous system) o Cognitive  Selectively focus on threats  The person overestimates the chance of the threat Post-Traumatic Stress Disorder • Prevalence: 1-2% (but the percentage is closer to 30% if the person has experienced a trauma, such as Iraq war veterans, sexual assault victims) • Follows exposure to a severe trauma and is characterized by: o Re-experiencing the event through intrusive thoughts, flashbacks, nightmares and dreams o Avoidance of stimuli associated with the trauma (avoid people/places associated with the event) o Increased physiological arousal (difficulties falling/staying asleep, irritability, outbursts of anger) • Causes? o Biological  Physiological hyperreactivity (the person’s nervous system overreacts to trauma and stress) o Family Systems  A history of family instability and childhood trauma increases likelihood of PTSD (hardwires the brain) o Cognitive  PTSD shatters our schemas and assumptions (they need to be re- built) o Other Factors  Pre-existing distress  Coping style (if someone uses avoidance or dissociation, they are at greater risk of developing PTSD)  Good social support protects against PTSD Somatoform Disorders • Bodily symptoms that suggest a physical defect or dysfunction when none is present o It is assumed that emotions lead to physical symptoms • It is different from malingering where someone makes up a disorder for a gain, or a factitious disorder where the person makes up a disorder for no apparent gain Conversion Disorder • First noted by Freud • Motor or sensory symptoms suggesting a neurological impairment when there is none • Conversion refers to unconscious conflicts being converted into physical symptoms o The person is able to discharge anxiety without actually experiencing it • About 30% of people who are exposed to a severe trauma will develop conversion disorder • Symptoms: o Motor deficits o Sensory deficits o Seizure-like symptoms • Causes: o Triggered by a stressful or traumatic event o Primary gain (internal): eg. if a patient feels guilty about not being able to perform some task – being ill provides a justifiable excuse so there is no more guilt o Secondary gain (external): eg. miss work or avoid jail • Treatment: o Need to address initial stressful event and remove reinforcers Pain Disorder • Predominant complaint is pain and psychological factors have an important role in the onset, severity, exacerbation, or maintenance of the pain • Types: o Acute (less than 6 months) o Chronic (the pain has lasted for more than 6 months) • Causes: o Psychodynamic – unconscious conflicts are expressed as physical rather than emotional pain o Behavioural – are there positive consequences for the symptoms? How is the behaviour reinforced? • Treatment: o Supportive psychotherapy to address the underlying cause of the pain o Pain management strategies o Relaxation strategies o Since the physical pain is real, we may use analgesics Hypochondriasis • Unduly alarmed by any physical symptom they detect and/or they are convinced that they have a serious illness despite evidence to the contrary o Despite the doctor reassuring them, they still believe they have the disease • Causes: o Biological – it runs in families o Learning – the behaviours are rewarded, and are therefore reinforced o Psychodynamic – underlying conflicts cause anxiety which present as physical symptoms or pain o Environmental – there is excessive illness in the family growing up (they learn a sick role)  It is more frequent in societies where emotional expression is not encouraged • Treatment: o Rule out any physical causes o Behavioural:  Focus on stress reduction/relaxation  Reduce the help-seeking behaviour • They often put a “gate-keeping physician” in place so the patient will only go through that one doctor  Eliminate reinforcers (gains) o Psychodynamic  Resolve the underlying conflict  Emotional expression Dissociative Disorders • A breakdown of the awareness and integrated memory processes Psychogenic Amnesia • Person responds to a stressful life event with selective memory loss • May forget past events, places, or people • *But their cognitive processes remain intact Psychogenic Fugue • More profound dissociative disorder • Usually triggered by extreme stress • Loss of all sense of personal identity • *Lasts from a few hours to a few years o Sometimes people forget about their lives and get remarried, only to discover that they remember they had a family before Dissociative Identity Disorder • AKA “Multiple Personality Disorder” • It is the MOST profound dissociative disorder • Trauma-Dissociation Theory: o Usually extreme trauma in childhood o Fragmentation of personal identity and memory o Alternate personalities (it is obvious when they change personalities, they can sound like different people altogether) • Research Findings: o *This is somewhat controversial o People can sometimes fake different traits and mannerisms, but they can’t fake illnesses, allergies, visual acuity, different voice patterns, different hemisphere dominance & EEG patterns Personality Disorders • Cause distress (both to the individual and others) • A failure of the normal or complete development of the personality • There are stable, inflexible, and maladaptive traits or patterns of behaviour • eg. if a child is being sexually abused by a family member and has no support, they disassociate and eventually this becomes a perpetual pattern of behaviour Odd/Eccentric Personality Disorders • Paranoid Personality Disorder: The person is mistrustful and suspicious of others o They are reluctant to confide in others o They read demeaning meanings into innocent remarks • Schizoid Personality Disorder: An absence of close interpersonal relationships o Take little pleasure in activities o Appear indifferent to praise or criticism • Schizotypal Personality Disorder o Uncomfortable in close relationships o Cognitive and perceptual distortions o Eccentric behaviour o While schizophrenia comes and goes in phases, this personality disorder is chronic Anxious/Fearful Personality Disorders • Avoidant Personality Disorder o The person feels inhibited and socially inadequate • Obsessive Compulsive Personality Disorder o Preoccupation with cleanliness and orderliness o Distinct from obsessive/compulsive disorder • Dependent Personality Disorder o Excessive need to be cared for o Have trouble making simple decisions without advice Dramatic/Emotional/Erratic Personality Disorders • Borderline Personality Disorder o Instability in moods, relationships, and self-image
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