EPPP - Abnormal Psychology DSM-IV (OLD) Part 2

(Anxiety D/O) Dx criteria: * Recurrent obsessions &/or compulsions that are severe enough to cause significant distress & are time consuming or interfere w/a indiv. Fx * Obsessions: persistent thoughts, impulses or images the person expreiences as senseless/intrusive (ex: repeated thoughts about contamination) * Complulsions: repititious,deliberate mental acts or behaviors that the person feels driven to perform in response to an obsession or rigid set of rules (ex: repeated hand washing bc think contaminated) In adults, must recognize at some point that the Sx's are excessive/unwarranted In adults, D/O is about equally common in males and females In children & adolescents, it is more prevalent in males Low levels of serotonin, over active caudated nucleus Tx: In vivo exposure w/response prevention for compulsions & often combined w/participant modeling the antidepressant tricyclic clomipramine or an SSRI that increase serotonin levels (block serotonin reuptake) have good short-term benefits in conjunction w/exposure. The purpose of a complusion is to reduce distress or to prevent a feared situation/consequence from occuring & the alternative is excessive or illogical

Dx criteria (TRAUMA): Characteristic Sx's for more than 1 month following exposure to an extreme trauma that Elicits an immediate reaction of intense fear, helplessness, or horror causing the indiv. to be unable to Fx; * followed by characteristic Sx that fall into 3 categories after exposure to a: * Traumatic event that entails actual or threatened death or serious injury to self or others. * Re-experiencing of the trauma (Dreams/flashbacks) * Avoidance; Persistent avoidance of stimuli associated w/the trauma that causes recollection of trauma, feel detached from others, restricted range of enotions * Unable to Fx * Month or more of Sx’s * Arousal Increased (Persistent Sx of increased arousal; Diff falling asleep, hypervigilance, exaggerated startle response, outbursts of anger) 3 Specifiers: Acute (Duration less than 3 mos.) Chrpnic (Duration 3 mos. +) Delayed Onset (Onset of Sx's 6 mos. after stressor) Tx: Most effective is comprehensive multicomponent cognitive-behavioral approach that incorporates exposure, cognitive re-structuring and anxiety management. PTSD only one is caused by direct result to exposure to trauma & Lowest comorbidity with panic D/O w/agorophobia Effectiveness of EMDR appears to be due to exposure rather than to eye movements

Dx Criteria: Similar to PTSD (exposure to a trauma) except that Sx must have an: onset w/in 4 weeks of the trauma & must last for at least 2 days but no longer than 4 weeks. The person has 3 or more dissociative symptoms including: sense of numbing or emotional detachment, derealization, depersonilazation, dissociative amnesia in addition to Persistent reexperiencing of the trauma, Marked avoidance of stimuli that cause recollections of the trauma, and * Marked anxiety or increased arousal

1. Acute Stress D/O (2 dys to 4 weeks) 2. Post-Traumatic Stress D/O (PTSD) 1+ months w/3 specifiers: Acute (less than 3 mos) Chronic (3 mos. +) Delayed Onset (Sx onset 6 mos. after stressor) 3. Generalized Anxiety D/O (GAD) * At least 6 months

Dx criteria includes (WATCHERS 6): Excessive anxiety & worry about multiple events/activities on most days for at least *6 months** * Worry (Excessive constant worry about multiple events/activites) * Anxiety (Anxiety/worry difficult to control & disproportinate to feared event or potential impact: Anxiety/worry entail 3 Sx's:) * Tension in Muscles for most of day * Concentration Difficulty * Hyperarousal (Irritability) * Easily fatigue * Restlesness * Sleep Disturbances * 6 Months (Sx's last at least 6 Mos.) Tx: Most effective comprehensive cognitive-behavioral intervention (CBT) that incorporate applied relaxation, exposure & cog. restructuring. A combo of CBT & Pharmacotherapy w/SSRI's or SNRI's Fluoxetine (currently a 1st line drug) for best long-term outcomes GAD must be distinguished from nonpathological anxiety, which is easier to control, has a shorter duration, is in proportion to feared events & less likely to be accompanied by physical symptoms such as excessive fatigue & restlessness.

Dx Criteria: At least 1 Sx of impaired sensory/voluntary motor Fx that suggests a serious neurological or other serious medical condition (e.g. paralysis, blindness, loss of pain sensation), but for which no medical explanation can be found Believed to be related to psychological factors often exposure to a severe conflict/stressor * 2 psychological mechanisms cause or mainatin the Sx's: * Primary gain - Sx reduces anxiety by keeping a trauma out of the conscious awaerness. * Secondary gain - Sx help the individual avoid an unplesant activity, gain support or obtain some other external benefit. * These Sx are not voluntarily produced & are usually alleviated under hypnosis or in an amytal interview

Characterized by:

At least 8 recurring physical Sx's that began prior to 30 & have occured for several years

Must include at least

4 pain Sx's,

2 gastrointestinal Sx's,

1 sexual Sx & 1 psudoneurological Sx.

The Sx's are not being intentionally produced or feigned & medical attention has been sough but no physical explanation has been found .

Medical exams & tests have not found a physical explanation & no evidence of faking

Dx Criteria:

1 or more physical Sx's for less than 6 months

Dx assigned when the person has somatoform Sx that do not meet the criteria for a specific Somatoform D/O (e.g. for a woman with symptoms of pseudocyesis - i.e. believes she is pregnant and has physical signs of pregnancy but is not pregnant)

Dx Criteria:

1 or more physical Sx's for at least 6 mos.

That can not be explained by a medical condition or substance

Not intenitanally produced/feigned

Do not meet criteria for another mental D/O

Dx Criteria:

1 or more pain Sx's only

Not intentionally produced/feinged

Can't be explained by another D/O

Appear to be related to psychological factors

Characterized by:

Presence of physical or psychological Sx that are intentionally produced or faked apparently for the purpose of fulfilling an intrapsychic need to adopt the sick role.

Have extensive medical knowledge & have undergone multiple painful medical procedures &

When the causes of Sx are not found they respond with denial or seek medical 2nd opinion.

No Tx ID, but good theraputic rel and consistent care best way to manage Sx

aka Munchausen's Syndrome by Proxy - involves the intentional production of physical symptoms in an individual by a caregiver

Ex: Mom deliberatly produces Sx's in thier child

(In DSM under other conditions that may be a focus of clinical attention)

Involve an intentional production or feigning of physical or psychological Sx's

For the purpose of obtaining an obvious external reward such as avoiding work, receiving financial compensation, or obtaining drugs (Avoid undesireable activity)

(Mower's) For Specific Phobias are the result of avoidance conditioning, which involves a combo of classical & operant conditioning:

1st ppl learn to fear a neutral (conditioned) stimulus because its pairing w/an intrinsically anxiety-arousing (unconditioned) stimulus, &

Thier avoidance response is then negativly reinforced because it keeps them from experiencing anxiety.

Since ppl consistently avoid the conditioned stimulus, they never have an opportunity to extinguish the conditioned fear.

Interfere w/normal human sexual response cycle or

Assoc. w/pain during sexual intercourse

Types:

Lifelong or acquired

Generalized or situational

Due to psychological or physiological facotrs or to combined factors

Due to general medical condition or substance induced

Dx when persisitent & casues marked distress or causes interpersonal difficulty

Affects both Males & females

Indiv. is unable to experience orgasm following adequate sexual excitement & stimulation or

Persistent delay in experienceing orgasm

characterized by involuntary contractions of the outer 3rd of the vagina that interfere with sexual intercourse when penetration is attempted

its onset is often preceded by exposure to a sexual trauma

More common in younger women & women who have negative attitudes toward sex

Involves a persistent or recurrent inability to attain or maintain an adequate erection until completion of sexual activity

Presence of erection during sleep can help rule out a physiological cause

Dx only when can not be explained by a medical condition or substance use

Physical factors that have been linked to this disorder include diabetes mellitus, liver and kidney disease, multiple sclerosis, and antipsychotic antidepressant, and hypertensive drugs

Dx when orgasm & ejaculation occur w/minimal sexual stimulation, before, on, or shortly after penetration & before the person desires it

Linked to low serotonin levels and may be effectively treated with an SSRI

Male/female who exp. persistent genital pain during sexual intercourse

Been found most effective for Premature Ejaculation & Vaginismus

Techniques include:

Sensate focus (a series of graded exercises that begin with nongenital pleasuring and gradually build to genital stimulation with a ban on orgasm and intercourse) and

The start-stop & squeeze techniques (which are used to increase a man's control over his ejaculatory reflex)

Use SSRI's to sucessfully treat as has been linked to low serotonin levels.

Characterized by:

Intense recurrent sexual urges, fantasies, or behaviors involing either nonhuman objects,

the suffering or humiliation of oneself or one's partner, or children or other nonconsenting partners

Tx:

In-vivo aversion therapy has short-term effects & has been repalced w/:

Orgasmic reconditioning - Involves having the indiv. replace a deviant sexual fantasy w/a more appropriate one while masturbating

Satiation Therapy - Involves having the person masturbate while imagining the object or activity until it no lopnger produces sexual arousal

Covert sensitization

Involves having the indiv. replace a unacceptable (deviant) sexual fantasy w/a more acceptable one while masturbating

Tx for paraphilia

Dx assigned only when involves cross-dressing for the purpose of sexual arousal & causes significant distress or impairment

Dx Criteria:

Intense sexually arousing fantasies, sexual urges or behaviors involving cross dressing

Basic pref. for men w/D/O is heterosexual, but may have occasionally engaged in homosexual acts.

Characterized by:

Intense sexually arousing fantasies, sexual urges, or behaviors that involve touching or rubbing against a nonconsenting person

Begins in early adolescence

Sx's usually decline after age 25

(Transsexualism is an Alt. term for Gender ID D/O)

Dx Criteria:

Strong, persistent cross-gender identification & sense of inappropriateness or discomfort w/the gender role assoc. w/one's bio. sex

Dx assigned only when the indiv. cross-gender ID represents a profound disturbance in his/her identity

Children: Typically perfer wearing clothes & participating in activities assoc. w/the opposite sex & state a desire to be the opposite sex

Adults: Often preoccupied w/desire to live as a member of the opposite sex & to acquire the physical charteristics of the opposite sex & believe they were born the wrong sex.

Prognosis: Most children display less overt cross-gender behavior over time & most boys no longer meet criteria by late adolesc. or early adulthood & report a bisexual or homosexual orientation.

a. the majority of patients no longer expressed gender dysphoria following surgery - CORRECT Smith and colleagues found that the 162 adults in their study reported that they no longer experienced gender dysphoria following sex reassignment surgery, and the majority were functioning well psychologically, socially and sexually. The outcomes of this study are consistent with the findings of other recent research.

characterized by (Weight Fears Bother Anorexics):

Weight (a refusal to maintain a minimally normal body weight; below 85% ideal)

Fears (an intense fear of gaining weight)

Bother (Body image distortion - a significant disturbance in the perception of the shape or size of one's body), and

Anorexics (in women, amenorrhea)

There are 2 types:

Restricting Type - Dx when weight loss thru dieting/restricting, fasting or excessive exercise & absence of binging & purging

Binge-Eating/Purging Type - Dx when engage in episodes of binge eating &/or purging

Onset of D/O is most often in mid-to-late adolescence & is often associated w/exposure to a stressful life event

Assoc. w/higher than norm serotonin levels & food restriction lowers serotonin levels

CBT Tx (Garner & Bemis, 1982):

1st priority give the CT graded task assignments designed to increase food intake

Foster doubt about her belief that she is accomplishing something by staying thin.

Addressing the validity of the CT's beliefs regarding the consequences of becoming fat & the conviction that thinness is a primary determinant of self-worth & personal value.

Dx Criteria (Bulimics Over Consume Pastries):

Binge & Purge (compensatory behavior) average at least 2 time a week for 3 mos.

Bulimics (Binging -recurrent episodes of binge eating that are accompanied by…

Over (Out of control - a sense of lack of control)

Consume (Inappropriate Compensatory behavior to prevent weight gain such as…)

Pastries (Purging - self-induced vomitting, excessive exercise, or laxative or diuretic use);

Self-evaluation that is unduly influenced by body shape and weight

Onset is usually in late adolescence or early adulthood & often occurs during or after a period of dieting; 90% female

Assoc. w/low levels of serotonin & norephinepherine

Tx: includes nutritional counseling, cognitive-behavioral therapy, family therapy, and in some cases, antidepressants

Involves disturbances in the amount, quality, and timing of sleep

Characterized by irresistible attacks of restorative sleep accompanied by either cataplexy or an intrusion of REM sleep during the transition between sleep & wakefulness

Cataplexy is usually triggered by a anger, suprise, laughter or a strong emotion (occurs at onset of sleep attack)

Due to abnormal breathing during sleep & characterized by a disruption in sleep that leads to insomnia & excessive sleepiness

Most common type is obstructive sleep apnea

Vivid dream like images that occur at the begining of sleep

Involve behavioral or physiological abnormalities during sleep or in the sleep-wakefulness transition

Characterized by repeated episodes of abrupt awakening from sleep, usually beginning with a panicky scream or cry and accompanied by intense autonomic arousal and behavioral signs of fear

Repeated episodes of complex motor behaviors during sleep that include getting out of bed & walking around the room, walking up or down stairs, etc.

Characteristics:

Involve a stable, enduring patter of behavior that:

deviates from the expectations of the person's culture

pervasive & inflexible

onset in adolesc. or early adulthood

causes significant distress or impairment

10 Personality D/O's grouped into 3 clusters based on primary characteristics:

Cluster A (Odd/Eccentric Behaviors)

Cluster B (Dramatic/emotional or erratic)

Cluster C (Anxiety & fearfulness)

To assign the Dx to anyone under 18 years old the Sx's must be present for at least 1 yr except for antisocial which can not be Dx until 18

Essential feature is a pervasive pattern of distrust & suspiciousness that entails interpreting the motives of others as hostile or malicious. 4 charatersistic sx's:

Spousal infidelity suspectd

Unforgiving (bears grudges)

Suspicious (pre-occupied w/unjust doubt about trust worthness of others)

Percieves attacks (reacts quickly)

Enemy or friend? (suspects associate or friends are exploiting, harming or decieving them)

Confiding in others is feared

Threats percieved in benign events (reads into harmless events or comments)

Irrational suspiciousness & mistrust of others

A pervasive pattern of indifference to interpersonal relationships (lack of interesst in social rel) & a restricted range of emotional expression in social situations. At least 4 Sx's: (DISTANT)

Detached or flattened affect (exhibits emotional coldness/detachment)

Indifferent to criticism or praise

Sexual Expereiences of little interest

Tasks done solitarily (almost alwyas chooses solitary activities)

Absence of close friends

Neither desire nor enjoy close relationships

Takes pleasure in few activities

Ppl w/this D/O say they lack close relationships but say they niether enjoy or desire them

Pervasive social & interpersonal deficits & eccentircities in cognition, perception & behavior (odd behavior or thinking; not your typical)

Dx in the presence of 5 Sx's: (ME PECULIAR)

Magical Thinking (odd beliefs)

Expericnces unusual perceptions (bodily illusions or other unusual perceptions)

Paranoid Ideation

Eccentirc Behavior or appearance (peculiar)

Constricted or inappropriate affect

Unusual thinking or speech 9dd)

Lacks close firends

Ideas of reference

Anxiety in social situations

Rule out psychotic or pervasive devel. D/O

Characterized by a pattern of disregard for and violation of the laws/rights of others since 15.

Dx Criteria: (CORRUPT)

Indiv. must be at least 18 yrs old,

Hx of Conduct Disorder before the age of 15,

Exhibit at least 3 Sx's since age 15:

Can’t conform to Law (failure to conform to social norms w/respect to lawful behavior)

Obligations ignored (consistent irresponsibility)

Reckless disregard for safety (of self & others)

Remorseless

Underhanded (decietful)

Planning Insufficient (impulsive)

Temper (irritable/aggressive)

Assoc. Sx's inflated sense of self, superfical charm & lack of empathy.

Although it is chronic, its symptoms often become less evident and pervasive in the fourth decade of life

A pervasive pattern of instability in interpersonal relationships, self-image, affect, and marked impulsivity. 5 Sx's present: (IMPULSIVE)

Impulsive (in at least 2 areas self-damaging/unsafe sex, reckless driving, financial irresponsibility & Sub. abuse)

Moodiness (affective instability)

Paranoia or dissociation under stress

Unstable self-image (or sende of self, manifests as frequent changes in career goals & sexual ID)

Liable intense relationships (patterns of unstable, intense interpersonal rel. marked by fluctuating btwn idealization & devaluation)

Suicidal jestures (recurrent threats)

Inappropriate anger

Vulnerability to abandonment (frantic efforts to avoid abandonment & engage in impulsive & extreme behaviors to keep others w/them)

Emptiness (chronic feelings of)

Most commonly Dx in individuals aged 19-34, and its symptoms are typically most chronic and severe during young adulthood. By 40+ years old up to 75% of indiv. dont meet all criteria

Linehan's (1987) DBT was designed as a treatment for BPD and incorporates 3 strategies:

Group skills training to help clients regulate their emotions & improve their social & coping skills;

Individual outpatient therapy to strengthen clients' motivation & newly-acquired skills; and

Telephone consultations to provide additional support & between-sessions "coaching" which combines CBT w/rogerian therapy and that the assumption of acceptance of the CT necessary for change to occur.

Research has confirmed that DBT reduces premature termination from therapy, psychiatric hospitalizations, & parasuicidal behaviors

Characterized by a pervasive pattern of excessive emotionality, expression of emotion, need for admiration and attention-seeking behaviors in a variety of contexts. Requires 5 Sx's: (ACTRESS)

Appeararance used to draw attention to self

Center of attention (discomfort when not the center of attention)

Theatrical Relationship (believed to be more intimate than are)

Easily influenced (by others/overly trusting)

Seductive behaviors (inapprop. or provacative)

Shallow emotions (Rapidly shifting)

Speech (impressionistic or vauge)

Pervasive pattern of grandiosity, need for admiration & Lack of empathy. 5 Sx's: (GRANDIOSE)

Grandiose (sense of self-importance)

Requires attenition(Req. excessive admiration)

Arrogant (believes s/he is unique)

Need to be special

Dreams of success & power (pre-occupied w/fantasies of unlimited sucess, power, beauty, love)

Interpersonally explotative

Others (unable to recognize feelings/needs of others; lack of empathy)

Sense of Entitlement

Envious

Pervasive pattern of social inhibition, feelings of inadequacy & hypersensitivity to negative evaluations. 4 Sx's: (CRINGES)

Criticism or rejection pre-occupy thoughts in social situations

Restraint in relationships due to fears of shame (Desires close rel. but avoids them bc of feeling inadequate, rejection & hypersensitive to criticism)

Inhibited in new relationships

Needs to be sure of being liked before engaging socially (In intimate rel. demand constant re-assurance they are desired & loved)

Get's around/avoids jobs that require interpersonal contact

Embarrasment prevents new activities or taking personal risks

Self-viewed as unappealing or inferior

Pervasive & excessive need to be taken care of (psychological dpendence on others) which leads to submissive, clinging behavior & fear of separation. At least 5 Sx's: (RELIANCE)

Reassurance required (difficulty making decisions w/out advice & reassurance from others)

Expressing disgreement difficult (Fears dissagrements bc fears might lose suppport)

Life responsibilites assumed by others

Initiating projects difficult

Alone (feels helpless & uncomfortable when alone)

Nurturance (goes to excessive lengths to obtain)

Companionship sought urgently when a relationship ends

Exaggerated fears of being left to care for self

Involves a persistent preoccupation with orderliness, perfectionism, & mental & interpersonal control, which have the effect of severely limiting flexibility, openness, & efficiency. At least 4 Sx's: (SCRIMPER)

Stubborn

Can't Discard worthless objects (or worn-out objects)

Rule obsessed (peroccupied w/details, rules, etc. to where point of activity lost)

Inflexible (overcontientious & inflexible about morals, ethics & values)

Miserable

Perfectionism (interferes w/task completion)

Excludes leisure due to devotion to work (& friendship)

Reluctance to delegate to others (unless willing to do his/her way)

OCPD does NOT involve true obsessions & compulsions

Spens an excessive amt of time paying attention to rules/procedures & trivial details when working on a task, unrealistic high standards for thier perfection.

A misperception or misinterpretation of a real external stimulus

Ex: trickling of water as voices

Belief that events, objects or other ppl have special or unusual significance for oneself.

Disruption in the usually integrated Fx's of consciousness, memory, ID or perception of environment

An alteration in the perception or experience of the self so that one feels detached from & as if one is an outside observer of ones mental processes or body.

Feeling that one is an outside oberver of ones own mental processes or body

Predicts the same inital circumstance may lead to different outcomes

Inital Same = Different (multiple) outcomes

Same to different

Predicts that different circumstances may lead to same outcomes

Inital different = Same (Equal) outcomes

Different to same

Multi-modal Cognitive Behavioral Therapy (CBT):

Primary Sx Chronic Arousal use Stress Innoculation

Primary Dissociative Sx's use Prolonged Exposure

All Sx's Present use both:

Stress Innoculation: Help CT cope w/stress & other adversive states by enhancing coping strategies w/3 overlapping stages:

Cognitive Preparation - Help Ct understand behavior & cog.responses.

Skill acquisition & Rehersal of coping skills

Application & follow thru apply what learned to imagined, filmed or in-vivo situations

***Prolonged Exposure (PE): ***Help CT process traumatic event & reduce Sx's includes:

In-vivo exposure

Imaginal exposure

Refers to speech that is indirect & delayed in getting to the point bc of unnecessary, tedious details & parenthetical remarks.

(AKA Derailment) A complete lack of connectedness btwn utterances & the loss of the original point.

A fabrication of facts or events to compensate for memory loss.

Inability to recall or remember names of familiar objects, words or ppl

Sx of Delirium

Inability to write

Sx of delirium

Language D/O

Inability to express onself thru speech (produce language) & understand language written or spoken.

Sx of Dementia

Inability to carry out voluntary purposeful movements not due to motor deficits or lack of understanding

Sx of Dementia

Inability to recognize familiar

objects

sounds

tastes

other sensations

Sx of Dementia

Lack of voluntary coordination of muscle movement

Characterized by unpleasant feelings of physical restlessness (Motor restlessness) & need to move in the arms & legs.

(Extrapyramidal side effect of neuroleptic drugs & Sx's of Parkinson's disease)

Difficulty swallowing or eating

Speech D/O that involves probs. related to articualtion resulting from muscle waekness or a loss of muscle control involving the muscles of the mouth, tongue, jaw, larynx, & vocal cords.

Speech is slow, garbled & difficult to understand

(Stroke)

Inability to perform skilled movements.

Disturbance in the stress, pitch, melody, cadence & rhythm of speech