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Abnormal Psychology – Midterm 2 Review.docx

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PSYC 241
Shannon Zaitsoff

PSYC 241 Fall Semester 2013 Abnormal Psychology – Midterm # 2 Review Dissociative, Somatic Symptom and Related Disorders Dissociative Disorders - Severe maladaptive disruptions or alterations of identity, memory, and consciousness that are experienced beyond one’s control.  Defining symptom of these disorders is:  Dissociation: The lack of normal integration of thoughts, feelings and experiences in consciousness and memory. Types of Dissociative Disorders - Depersonalization-Derealization Disorder  Individual is affected by persistent or reoccurring feelings of depersonalization and/or derealization.  Depersonalization: An experience in which individuals feel a sense of unreality and detachment from themselves.  Derealization: An experience of detachment and altered relationship to the surrounding world, the individual perceives other people and objects in the environment as unreal, distorted and dream-like. - Dissociative Amnesia  The inability to recall significant personal information in the absence of organic impairment following a traumatic event.  Localized: (Most common type) Failure to recall information from a very specific time period.  Selective: Loss of memory for only some parts of the trauma and other parts are remembered.  Generalized: Loss of all personal information from individual’s past.  Continuous: (Rare) Forgetting information from a specific date until the present. - Dissociative Fugue  An extremely rare and unusual condition  Individual travels suddenly and unexpectedly away from home, accompanied by a loss for one’s past and personal identity.  It is brief (a matter of hours/days) and ends suddenly  Can be very severe – people may travel far from home: - Establish a new home - Establish new relationships - New line of work - Display new personality characteristics PSYC 241 Fall Semester 2013 - Dissociative Identity Disorder “Multiple Personality Disorder” (DID)  Characterized by the presence of 2 or more unique personality states that regularly take control of the individual’s behavior.  One of the most controversial and fascinating disorders recognized by in clinical psychology.  One personality is identified as the “host”, whereas the others are known as “alters”  Each of the personalities has their own distinct features, memories, personal histories and mannerisms.  Three Kinds of Relationships between the Alters (Sub personalities): - Mutually Amnesic Relationships: Sub personalities have no awareness of one another. - Mutually Cognizant Patterns: Each sub personality is well aware of the rest. - One-Way Amnesic Relationships: (Most Common Pattern) Some personalities are aware of others but awareness is not mutual. Those who are aware are known as “co-conscious sub personalities” and are “quiet observers”  Switching: The process of changing from one personality to another. Often occurs in response to a stressful situation. Etiology of Dissociative Identity Disorder (DID) - Trauma Model  A diathesis-stress formulation  Results from severe trauma in childhood (sexual, physical and emotional abuse) paired with personality traits that predispose the individual to use dissociation as a defence mechanism/coping strategy.  No longer adaptive when used regularly as a coping method throughout childhood. - Socio-Cognitive Model  Represents a different etiological position from mental health professionals that do not accept DID as a legitimate disorder.  Views “multiple personalities” = role-playing, where individuals begin to act in a way that is consistent with their own and their therapists’ beliefs about the disorder. Treatment of Dissociative Identity Disorder (DID) - Psychotherapy:  Three Stages of Psychotherapy PSYC 241 Fall Semester 2013 1. Building therapeutic alliance (establishing a “safe” and trusting environment for the individual to discuss emotionally charged memories of past traumas) 2. Developing coping skills to provide patient with tools to deal with traumatic history 3. Integration of personalities (merging all alters into one personality) - Hypnosis:  Popular method used to confirm the diagnosis, to contact alters, and to uncover memories of traumatic childhood abuse.  Criticism: Hypnosis has the potential of retrieving confabulated memories and personalities. - Medication:  Not really useful when directly treating dissociative disorders, however psychopharmacology can be helpful at treating comorbid disorders (depression and anxiety).  “Truth Serum” (Sodium Amytal), a barbiturate that causes drowsiness can sometimes be used to recall previously forgotten memories or identify additional alters. How Do Theorists Explain Dissociative Disorders? - The Psychodynamic View:  Support from case histories (Childhood Experiences)  Theorists believe that dissociative disorders are caused by repression, the most basic ego defence mechanism.  Repression: Fighting off anxiety by unconsciously preventing painful memories, thoughts, or impulses from reaching awareness. (Dissociative amnesia and fugue are single episodes of massive repression).  DID = Lifetime of Excessive Repression + Traumatic Childhood Events - The Behavioral View:  Relies of case histories to support view.  Dissociation grows from normal memory processes and is a response learned through operant conditioning  Dissociation = “Escape Behavior”  Momentary forgetting of trauma  Leads to a drop in anxiety (Negative Reinforcement) increasing the likelihood of future forgetting. PSYC 241 Fall Semester 2013 Somatoform Disorders (DSM-IV-TR)  Somatic Symptom Disorders (DSM-V) - Individuals report physical symptoms that cannot be supported by medical exams, but have reason to believe they reflect psychological factors.  Malingering Disorder: Individual adopts the sick role and complains of symptoms to achieve some objective (insurance money, evading military service or avoiding an exam).  Factitious Disorder (Munchausen Syndrome): Individual deliberately fakes or generates the symptoms of an illness to gain medical attention (sympathy, care and attention). Types of Somatic Symptom Disorders - Conversion Disorder  Loss of functioning in a part of the body that appears to be due to a neurological or other medical cause, but without any underlying medical abnormality to explain it.  Most dramatic somatic symptom disorder  Motor Deficits: - Paralysis - Localized Weakness - Impaired Coordination/Balance - Inability to Speak - Difficulty Swallowing/Lump in Throat - Urinary Retention  Sensory Deficits: - Loss of Touch/Pain Sensation - Double Vision - Blindness - Deafness  Glove Anesthesia: The loss of all sensation (touch, temperature and pain) throughout the hand, with the loss sharply limited at the wrist, rather than following a pattern consistent with the sensory innervation (nerves) of the hand and forearm.  La Belle Différence: Lack of concern about the nature and implications of one’s symptoms. - Somatization Disorder (DSM-IV-TR)  Somatic Symptom Disorder (DSM-V)  Somatization Disorder (DSM-IV-TR)  Individuals report multiple recurring complaints of physical ailments that not appear to have an organic basis. - Must Report (Somatic Symptoms):  Pain  Gastrointestinal Symptoms PSYC 241 Fall Semester 2013  Sexual/Reproductive Symptoms  Symptoms that suggest a Neurological Condition  Somatic Symptom Disorder (DSM-V)  1 or more somatic symptoms that are maladaptive and distressing  Excessive thoughts, feelings and behaviors related to somatic symptoms or health concerns. - Individual is anxious about the bodily symptoms that they are experiencing - Causes of Conversion and Somatic Symptom Disorders  In the past, Conversion + Somatic Symptom Disorders  Were know as “Hysterical Disorders”  Hysterical Disorders: Excessive and uncontrolled emotions underlie the bodily symptoms  Today’s leading explanations:  The Psychodynamic View 1. Sigmund Freud  Hysterical disorders represent a conversion of underlying emotional conflicts into physical symptoms (E.g. Electra Complex) 2. Today’s Psychodynamic View  Sufferers of the disorders have unconscious conflicts carried from childhood. a. Primary Gain: Bodily symptoms keep internal conflicts out of conscious awareness. b. Secondary Gain: Bodily symptoms further enable people to avoid unpleasant activities or receive sympathy from others.  The Cognitive View - Hysterical disorders are a form of conversion and somatic symptom disorder that provides means for people to express difficult emotions. - Emotions  Converted into Physical Symptoms  The Multicultural View - Western Clinicians  Hold bias that sees somatic symptom disorder as an inferior way to dealing with emotions - Personal Distress  Transforms into Somatic Complaints (Bodily and Psychological reactions to life events are influenced by one’s culture) PSYC 241 Fall Semester 2013 - Illness Anxiety Disorder (Hypochondriasis)  Long-standing fears, suspicions, or convictions about having a serious disease, despite medical reassurance that the disease is not present.  Misinterprets bodily symptoms or bodily functions.  Theorist’s Explanation:  Behaviorists: Classical Conditioning or Modeling  Cognitive Theorists: Oversensitivity to bodily cues.  Treatments:  Antidepressants  Exposure and Response Prevention (ERP)  Cognitive-Behavioral Therapies (CBT) - Somatic Symptom Disorder “Predominant Pain” (Pain Disorder)  Must have complaints of pain in one or more body sites sufficiently serious to warrant clinical attention.  Pain must be severe enough to cause significant distress or to disrupt the individual’s daily life, possibly leading to an inability to work, attend school, or socialize with others.  Symptoms must be chronic with a duration lasting more than six months.  “Somatization” Pattern vs. Predominant Pain Pattern  Somatization Pattern: Long-lasting physical ailments that have little or no organic basis. - Pain Symptoms - Gastrointestinal Symptoms - Sexual/Reproductive Symptoms - Neurological Symptoms  Predominant Pain Pattern: Primary feature of somatic symptom disorder is pain. - Pattern develops after an accident or illness that has caused genuine pain - Pattern may begin at any age. - Pain Assessment:  Patient History  Diagnosed when psychological factors are in the onset, exacerbation, severity or maintenance of pain symptoms. (High risk of addiction to pain medications) PSYC 241 Fall Semester 2013 - Body Dysmorphic Disorder (BDD)  Excessive preoccupation with an imagined or exaggerated body disfigurement, sometimes to the point of delusion  Significant distress or impairs functioning  Believes everyone notices this “defect” - People often seek plastic surgery or dermatological treatment, but often feel worse rather than better afterwards.  Theorist’s Explanation:  Physical and psychological explanations that have been applied to anxiety and OCD disorders are also used to explain BDD.  Clinicians:  Treat clients by applying same methods of treatment for OCD - Antidepressants - Exposure and Response Prevention (ERP) - Cognitive-Behavior Therapy (CBT) PSYC 241 Fall Semester 2013 Substance-Related Disorders - Overlaps with Eating Disorders, in terms of treatment and how patients are not really open to seeking help. DSM-IV-TR  DSM-V - DSM-IV-TR: Intoxication vs. Abuse vs. Dependence - DSM-V: Eliminated boundary between Abuse and Dependence  Intoxication vs. Substance Use Disorder Substance Intoxication - A reversible and temporary condition due to the recent ingestion of (or exposure to) a substance. - Must demonstrate clinically significant maladaptive behavioral or cognitive changes and impaired thought processes or motor behavior. Substance Use Disorder - The recurrent substance use that results in significant adverse consequences in social or occupational functioning.  Symptoms Related to Impaired Control (Psychological Dependence): 1. Ingestion of large amounts (Impairment of Control) of the substance or over a long period than was originally intended. 2. Desire to cut down with or without unsuccessful efforts to reduce or discontinue. 3. Great deal of time spent obtaining, using or recovering from a use of a substance. 4. Cravings (Habituation): Desires triggered by different cues “Obsession”.  Symptoms Related to Social Impairment: 5. Failure to fulfill major roles, obligations at work, school or home. 6. Continued use despite social and interpersonal problems drawn from the effects of the substance. 7. Loss of social, occupational, or recreational activities because of substance abuse.  Symptoms Related to Risky Abuse: 8. Recurrent substance use in situations in which it is physically hazardous (E.g. Driving). 9. Continued use despite knowledge of having recurrent/persistent physical or psychological problems that is likely to be caused by substance (E.g. Kidney Failure  Still Drinking Alcohol) PSYC 241 Fall Semester 2013  Pharmacological (Physiological Dependence) Criteria: 10.Tolerance: Increased amounts of a substance needed to achieve the same effects. 11.Withdrawal: An unpleasant and sometimes dangerous symptom as the addictive substance is removed from the body.  Lethargy  Nausea  Headaches Polysubstance Abuse - “The rule not the exception” - The simultaneous misuse or dependence upon two or more substances.  Risks  Physically dangerous  Mixture  Results in worse conditions (combination is greater than the sum of the parts)  Associated with greater comorbidity of other psychological disorders.  Treatment Challenges:  Which drug present the more immediate threat to health?  Which one is to be treated first? Alcohol Abuse - “The World’s Number One Psychoactive Substance” - The recurring use of alcoholic beverages despite its negative consequences. - University Students Statistics  86% of students reports having consumed alcohol in the past 12 months  18.5% report to binge drinking  Binge Drinking: 5 or more drinks per month or more.  51% report to having blackouts  Blackouts: An interval of time for which the person cannot recall key details or entire events. (Passing out and not being able to remember anything) - Associated to Changes in the Brain  Damaging Etiology of Alcohol Abuse - Genetic Factors  Higher in males  concordance rate for developing alcohol abuse.  Twin Studies  Significant effect for males MZ twins than females MZ twins - Male MZ twins 26-77% concordance rate. PSYC 241 Fall Semester 2013  Many offsprings of alcoholics  do not become alcoholics, and many alcoholics are born to non-alcoholic parents (Hodgins & Mackay, 2010) - Physiological Factors  Strong placebo effects  Alcohol Expectancy Theory: Individual’s drinking is determined by the reinforcements they expect to obtain from it.  Positive Reinforcements (The power of alcohol within people’s own perceptions): - More Fun - More Social - More Relaxed - Behavioral Disinhibition  People with alcohol problems tend to have greater difficulty controlling impulsive behavior  “Risk-Takers” are more prone (Risk Factor & Predictor) Abstinence vs. Moderation (Defining Treatment Goals) - Abstinence: Helping the individual to stop drinking completely.  Based on the Disease Model = Minnesota Model  Cannot control drinking in a controlled way  Alcoholism = “Disease”  Participants are required to attend AA meetings to encourage to keep going after treatment and to address the danger of relapse. - Moderation: Taking the substance in limited small amounts “gradual decrease”. Motivational Interviewing & The Transtheoretical Model of Change - Motivational Interviewing  An approach that can be used with clients who present with varying levels of readiness to change their behaviors.  Lasting change is not likely to occur until individuals can resolve their ambivalence.  OARS Strategy - Open-Ended Questions: Get individuals talking and make it difficult for them to say one-word replies or short answer replies  Elicits “Change Talk” - Affirmations (Express empathy): Statements and facts that are used to discourage doubts (doubts hinder progress in MI)  Affirmations/Reinforcements: PSYC 241 Fall Semester 2013 o Resourcefulness o Previous change attempts o Qualities of individuals that may facilitate change. - Reflective Listening (Ambivalence is Normal): Saying statements back with inferred meaning (tone of voice, highlight something important), statements – not questions. - Summarizing: “Action Process”  complex reflection, selective and directive, includes both sides of ambivalence.  When to use “Change Talk” o Pros associated with change o Cons associated with present behavior o Intentions to change o Discrepancy between where individual ideally wants to be and their current tasks o Transitioning between tasks at the end of assessment or session (Certain specific time points) - The Transtheoretical Model of Change  A theoretical framework for understanding the process of behavioral change.  A theory that can be applied to everything  Stages of Change:  Precontemplation: Not ready for change, individuals feel that they don’t have a problem, cons > pros with change.  Contemplation: Thinking about changing behaviors, but not committed to change  ambivalent. Weighing pros and cons.  Preparation: Decided to change and developing a plan for change with therapist, changing environment.  Action: Actively working at changing their problem behavior, thought records, actively doing in order to reduce behavior.  Maintenance: Working to maintain changes and prevent relapse.  “Spiral Method”, not linear: Movement can occur forwards or backwards in treatment.  People can enter at any stage  Relapse is common (normal), often a maintenance issue.  Interventions to “match” individuals’ stage of change  Matching and moving up the spiral  Miss-matches  behavi
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