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PHYS 102: Exam 2
Somatic Symptom Disorder
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-one or more somatic symptoms with abnormal/excessive thoughts, feelings, and behaviors
-somatic=physical
-high anxiety
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Conversion Disorder
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-client only presents pseudo neurological complaints
-sensory or motor problems
-symptoms not compatible with recognized neurological/medical conditions
-Dramatic symptoms
-paralysis or blindness
Three main types:
1. motor symptoms/deficits
2. Non-seizures and convulsions
3. sensory deficits
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Illness Anxiety Disorder
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-preoccupation with having/acquiring a serious illness
-mild to no somatic symptoms
-used to be called hypochondriasis
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Somatic Symptom Disorders: Epidemiology
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-14-20% of people in general community report symptoms with no physical basis
-actual somatic disorders are rare
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Somatic Symptom Disorders and Functional Impairment
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-unemployment
-overuse of health services
-physical disability
-social isolation
-illness anxiety disorder usually severe and chronic
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Somatic Symptom and Related Disorders: Etiology
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-psychoanalytic
-people who are less aware of their emotions may be more likely to think they have a medical problem
-behavioral
-hyper vigilance for body signals of illness
-reinforcement for being sick as child
-cognitive
-inaccurate beliefs about prevalence of sickness and meaning of bodily symptoms
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Treatment of Somatic Symptom and Related Disorders
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-antidepressants (SSRI's)
-Cognitive-behavioral therapy
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Factitious Disorders
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-physical or psychological symptoms are intentionally produced
-examples: faking temperature, chest or abdominal pain, tampering with lab results
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Etiology of Somatic Disorders
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-behavioral--positive reinforcement (of illness behaviors of others)
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Malingering
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-physical symptoms are intentionally produced in order to gain incentives or avoid unwanted situations
-example: faking an injury to get lawsuit money
-Different from factitious disorders because person produces symptoms for external reward
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Amnesia
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-inability ro recall important information
-medical, not psychological, cause
-not reversible
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Dissociative Amnesia
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-inability to recall important personal information
-usually follows stressful/traumatic event
-psychological, not medical, cause
-reversible
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Types of Dissociative Amnesia
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-localized (can't remember events during certain period of time)
-generalized (can't remember any aspect of one's life)
-selective (can't remember some elements of traumatic experience)
-with dissociative fugue (forget old life completely and go to a different city with no ID or anything about your old life)
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Depersonalization/Derealization Disorder
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-feelings of being detached from one's body or mind (depersonalization)
-feelings of unfamiliarity/unreality about one's physical environment or interpersonal environment (derealization)
-occurs during times of heightened emotionality or stress or altered physical states (panic attack)
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Dissociative Identity Disorder
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-two or more distinct personality states (alters) within one person
-at least two identities repeatedly take control of person's behavior
-identity has to control behavior
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DID:Etiology
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-psychsocial: early traumatic experiences
-dissociation is a way to block painful memories (such as child abuse)
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DID and child abuse
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-post traumatic model
-person compartmentalizes reaction to trauma in for form of alternate personalities
-sociocultural model
-childhood abuse not shown to cause DID
-person uses cures from therapist, media, and others to create alters and "remember" abuse
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Iatrogenesis
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-therapist creates disorder
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Accurate vs. Repressed/Recovered Memories
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-memory is constantly reconstructed
-recall can change based on the questions asked (eye-witness)
-bad idea to bring back repressed memories
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Treatment of Dissociative Disorders
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-dissociative amnesia usually resolves without treatment
-no controlled pharmacological trials but antidepressants help
-CBT may be helpful for some disorders
-reintegration--dont do this anymore
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5 types of dissociative experiences
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1. Depersonalization-feel detached from body/self
2. Derealization-unfamiliarity or unreality of world, dreamlike
3. Amnesia-inability to recall information
4. Identity confusion-unclear about who you are
5. Identity Alteration-behaviors show someone has assumed another identity
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Difference between Amnesia and Dissociative Amnesia
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-Amnesia--medical
-Dissociated Amnesia--psychological
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Iatrogenic Disorders
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-a lot of people think therapists create the disorder
-increase in media attention, increase in DID diagnosis
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Difference between factitious disorder and malingering
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people with malingering produce symptoms to get external reward, not simply to be in sick role
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Dysphora
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persistant sad or low mood
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Anhedonia
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severe enough depression to impair persons interest in/ability to engage in normally enjoyable activites
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Symptoms of Major Depressive Disorder
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-emotional symptoms (sadness, anhedonia)
-physical symptoms (insomnia, weight loss/gain, fatigue/restlessness, psychomotor retardation/agitation)
-cognitive symtoms (trouble concentrating, irritability, thoughts about worthlessness and helplessness)
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Major Depressive Disorder: Peripartum Onset
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-formerly postpartum depression
-6-13% of all new mothers
-may negatively impact the child (temperamental, social, emotional, cognitive and behavioral difficulties)
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Bereavement
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grieving the loss of a loved one
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Persistant Depressive Disorder (Dysthymia)
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-chronic state of low mood
-social isolation, high suicide risk
-double depression
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Disruptive Mood Dysregulation (DMDD)
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-severe and recurrent temper outburst that are grossly out of proportion
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Premenstrual Dysphoric Disorder (PMDD)
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-mood swings, sensitivity to rejection
-irritability/anger or increased interpersonal conflict
-depressed mood, anxiety
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PMS vs. PMDD
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-bloating, headaches and crankiness
-20-40% of women experience before menstrual period begins
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Bipolar Disorder
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-episodic depressed mood and episodic mania
-dramatic shifts in mood, energy and ability to function
-bipolar 1 vs. bipolar 2
-hypomania (mild mania)
-doesn't impair functioning
-lack of impulsitivity/lapses in judgement
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Symptoms of a Manic State
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-inflated self esteem or grandiosity
-decreased need for sleep
-greater talkativeness
-flight of ideas
-increased goal-directed behavior
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Cyclothymic Disorder
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-fluctuations between hypomanic and dysthymic symptoms
-symptoms present for at least two years
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Rapid Cycling Bipolar Disorder
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-4 or more episodes in one year
-mixed state
-requires lifelong treatment and clinical management
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Epidemiology of Bipolar and Depressive Disorders
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-almost twice as many women suffer from depression than men
-some evidence that bipolar 1 more common in women
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Etiology and Treatment of Mood Disorders: Psychodynamic
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psychodynamic
-"Anger turned inward" self-accusatory
-actually directed at loved ones/ misdirected at self
-Melancholia-AKA major depression
-Bipolar/hypomania: defenses against depression
-exaggerated self-esteem and grandiosity protective factors
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Etiology and treatment of Mood Disorders: Biological
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-strong familial link for major depression
-twin studies: 37% heritability rate
-Bipolar disorder (strong familial and genetic component)
-serotonin abnormalities
-Abnormalities in the limbic system
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Etiology and treatment of Mood Disorders: Behavioral Theory
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-withdrawal of reinforcement
-learned helplessness
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Etiology and treatment of Mood Disorders: Cognitive Theory
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-negative cognitive schemas (automatic thoughts)
-lead to self-fulfilling prophecies
-negative cognitive triad
-examples of cognitive distortions
-overgeneralizing (I got a C on one paper, psychology isn't right for me)
-selective thinking or discounting the positive
-catastrophizing (I got a flat tire, this is the worst day of my life)
-Personalizing
-Personal ineffectiveness (assuming you can do nothing to change your situation)
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Treatment of Major Depression
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psychological
-Cognitive Behavioral Therapy (give new, positive thoughts)
Behavioral Activation
-increasing positive life events and establishing life goals
Interpersonal Psychotherapy (IPT)
-train people how to have successful relationships
Biological
-tricyclic antidepressants (too many side effects)
-MAOIs (physical risk, but prescribed more than tricyclic)
-SSRIs (inhibit repute of serotonin, milder side effects)
Electroconvulsive Therapy
-if nothing else helps
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Treatment of Depressive Symptoms
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seasonal affective disorder
-subtype of major depression
-episodes vary by season (usually winter)
-excess melatonin production
-don't get as much sunlight
light therapy
-exposure to artificial light, same time each day, last 30-90 minutes
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Treatment of Bipolar Disorder
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Cognitive Behavioral Therapy
-family-based treatment
-effective for depressive symptoms/episodes (does nothing for mania)
Interpersonal and Social Rhythm Therapy (IPRST)
-adherence to regular routines
-reasonable and consistent social events
Biological
-lithium, anti convulsants, SSRIs
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Differentiate depression from sadness
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depression is severe enough impair persons interest in/ability to engage in normally enjoyable activities. You also have episodic tendencies.
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Suicide
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10th leading cause of death in the US
3 stages:
1. suicidal ideation-thoughts of death (passive vs. active)
2. suicide attempts
3. completed suicide
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Risk factors for suicide
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Family history
-but, can't always disentangle genetics from environment
Psychiatric illness
-approximately 90% of suicides, 89% of attempts is depression
Biological factors
-low levels of serotonin
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Suicide Prevention
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-crisis intervention (suicide hotline)
-societal level prevention (education, eliminate access to weapons)
-preventing suicidal contagion (media portrayal)
-focus on high risk groups (early detection/treatment of mood disorders)
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Anorexia Nervosa
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-restriction of energy resulting in significantly lower body weight
-have to be at least 15% below healthy body weight and be actively trying to loose weight
-intense fear of gaining weight or persistent behavior that interferes with weight gain
two subtypes:
1. restricting--not eating, caloric intake is very low
2. Binge eating/purging--only 800 or 1,000 cals is a binge
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Binge Eating
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-eating unusually large amount of food at one time
-loss of control
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Purging
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-self inducing vomiting, laxatives, diuretics
-reverse effects of binge
-produce weight loss
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Associated symptoms of AN
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-amenorrhea--irregular menstrual cycle
-dehydration
-lanugo hair--develop thin layer of fuzzy hair on their body
-dry brittle hair, low body temp, BP, HR, growth retardation, bloating and constipation, perfectionism, anxiety/depression (very likely)
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Personality and AN
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-perfectionism (high standards in all areas)
-obsessionality (going over things in your mind)
-neuroticism (constant worry/hard to shake things off)
-high comorbidity with anxiety (75%) and depression (80%)
-common among white females (typically do well in school)
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Bulimia Nervosa
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-recurrent episodes of binge eating
-lack of control
-followed by compensatory behavior
-normal weight or overweight
-more common than anorexia
-eat as much as 20,000 calories a day
-Purging and non purging behaviors
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Associated Features of BN
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-fatigue/lethargy, bloating, GI problems, erosion of dental enamel, calluses on backs of hands, impulsive behaviors
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Binge Eating Disorder (BED)
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-regular binge eating behavior but no compensatory behavior
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Obesity and BED
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-associated with obesity but not every obese person has it
Differences:
-obesity and dieting behaviors start earlier
-weight yo-yos
-more psychological features of eating disorders
-a lot of psychological baggage
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Other Specified Feeding and Eating Disorders (OSFED)
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OSFED categories
-atypical AN
-subthreshold BN
-Subthreshold BED
-Purging disorder
-night eating syndrome
-anything disorder type that doesn't quite meet criteria for the 3 classified disorders are diagnosed as this
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Pica
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-persistant eating on non-nutritive or non-food substances
-common in children with developmental delays
-causes--biological (lacking nutrient), environmental, developmental, psychological
-lower SES may be lacking a certain nutrient so they crave it in another way (dirt is high in iron)
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Remuneration Disorder
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-recently eaten food is regurgitated, then re-chewed, then re-swallowed and/or spit out
-extremely rare
-symptoms--bad breath, chapped lips, stomachache, weight loss
-causes--physical illness, severe stress, neglect/abuse
-one theory is children who have been neglected do this to savor their food
-to treat remuneration disorder, you use habit reversal. You teach them to do something else like deep breathing instead of regurgitating
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Avoidant-Restrictive Food intake disorder (ARFID)
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-any eating/feeding disturbance that leads to persistent failure to meet nutritional needs
-severe picky eater syndrome
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Etiology of Eating Disorders: biological
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-biological animal models (hypothalamus controls apetite regualtion)
-biological brain studies (serotonin and dopamine abnormalities)
-bulimia--deficiencies in serotonin may lead body to crave carbs
-biological family and genetic studies--moderate genetic component
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Etiology of Eating Disorders: psychodynamic
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-AN: defend against anxiety regarding development of sexuality by starving to "prepubertal state"
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Etiology of Eating Disorders: behavioral
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negative reinforcement
-binge serves as negative reinforcer
positive reinforcement
-restricting leads to "in control" feeling
more likely to restrict when not feeling in control (nursing home behavior)
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Etiology of Eating Disorders: cognitive-behavioral
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-distorted cognitions around body shape, weight, eating, personal control
-distorted thoughts--feelings behaviors that maintain unhealthy weight-related behaviors
-perceive yourself differently that you actually are
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Etiology of Eating Disorders: socio-cultural model
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-preoccupation with thinness as beauty
-westernized ideal, but genetic predisposition may play a role
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Gender Dysphoria
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-marked incongruence between assigned and experienced gender
-you are male but feel female or vice versa
-children are disgusted by genitals
-adults are less disgusted but still want to change
-transgender behavior
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Etiology of GD
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-biological (transexual men and women have similar brain structures)
-hormonal production (congenital adrenal hyperplasia)
-psychosocial (parental rejection, reinforcement of masculine or feminine behaviors)
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Treatment of GD
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Sex Reassignment Surgery
1. live in new gender for at least 2 years
2. hormone therapy
3. sex reassignment surgery
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Male hypoactive sexual desire disorder
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deficient/absent sexual thoughts or desires
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Male erectile disorder
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most responsive to medication as treatment
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Female sexual interest/arousal disorder
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-lack of/reduced sexual interest or arousal
-subjective sexual arousal disorder (physiologically its there, lubed up but no pleasure)
-genital sexual arousal disorder (pleasure and desire is there but no lube)
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Female Orgasmic Disorder
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delay or absence of orgasm
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two categories of paraphilic disorders
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1. based on anomalous target preferences
2. based on anomalous activity preferences
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Fetishistic Disorder
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sexual arousal that involves nonliving objects or non genital body areas
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Transvestic Disorder
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-no desire to be opposite gender
-typically males in stable heterosexual relationship
-cross-dresser
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Pedophilic Disorder
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-sexual urges, fantasies, behavior directed toward a prepubescent child (under 13 years)
-or a 16 year old perpetrator that is 5 years older than child
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ExhibitionisticDisorder
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flasher
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Frotteuristic Disorder
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groper
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Voyeuristic Disorder
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peeping tom
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sexual masochism
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like getting hurt or humiliated
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sexual sadist
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inflicting pain
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Epidemiology of Sexual disorder
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-most are male
-typically don't seek treatment, but only receive treatment because they get in trouble
-average age on onset: 16 years old
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Etiology of Sexual Disorders
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Behavioral
-person engages in paraphilic behavior-->achieves sexual release -->reinforcement
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Treatment of Paraphilic Disorders
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-requires significant distress or impairment
-not motivated to change due to sexual pleasure
-people will lie and say they are treated to avoid more legal trouble
-Plethysmography: method to measure sexual arousal in men and women
-biological--surgical castration (past), SSRIs, and anti androgen medications (reduce sex drive)
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