Abnormal Psych- Chapt. 4 – Flashcards

-Most common disorder in the US -In any given year 18% of the adult population suffer from one or another of the anxiety disorders in the DSM-5 -Close to 29% of all people develop one of the disorders at some point -1/5 of these individuals seek treatment

-*Generalized anxiety disorder*: A disorder marked by persistent and excessive feelings of anxiety and worry about numerous events and activities. -The problem is sometimes described as *free-floating anxiety* -they typically feel restless, keyed up, or on edge; tire easily; have difficulty concentrating; suffer from muscle tension; and have sleep problems -The symptoms last at least three months -Surverys suggest that as many as 4% of the US population have the symptoms of this disorder in any given year -Close to 6% of all people develop generalized anxiety disorder sometime during their lives -Usually emerges in childhood or adolescence -Women out number men with this disorder 2:1

-According to sociocultural theorists, generalized anxiety disorder is most likely to develop in people who are faced with ongoing societal conditions that are dangerous. -Studies have found that people in highly threatening environments are indeed more likely to develop the general feelings of tension, anxiety, and fatigue and the sleep disturbances found in this disorder -One of the most powerful forms of societal stress is poverty. --pplwithout financial means are likely to live in rundown communities with high crime rates, have fewer educational and job opportunities, and run a greater risk for health problems --As sociocultural theorists would predict, such people also have a higher rate of generalized anxiety disorder --In the United States, the rate is almost twice as high among people with low incomes as among those with higher incomes -Race is closely tied to stress in the US --In any given year African Americans are 30% more likely than white Americans to suffer from this disorder.

-Sigmund Freud: Believed that all children experience some degree of anxiety as part of growing up and that all use ego defense mechanisms to help control such anxiety ---Children experience realistic anxiety when they face actual danger; neurotic anxiety when they are repeatedly prevented, by parents or by circumstances, from expressing their id impulses; and moral anxiety when they are punished or threatened for expressing their id impulses *Psychodynamic Explanations*- -According to Freud, when a child is overrun by neurotic or moral anxiety, the stage is set for generalized anxiety disorder. Early developmental experiences may produce an unusually high level of anxiety in such a child. -Today's psychodynamic theorists often disagree with specific aspects of Freud's explanation for generalized anxiety disorder. --Most continue to believe, however, that the disorder can be traced to inadequacies in the early relationships between children and their parents --In one strategy, they have tried to show that people with generalized anxiety disorder are particularly likely to use defense mechanisms. -*Therapies*- -Psychodynamic therapists use the same general techniques to treat all psychological problems: free association and the therapist's interpretations of transference, resistance, and dreams. -Freudian psychodynamic therapists use these methods to help clients with generalized anxiety disorder become less afraid of their id impulses and more successful in controlling them. -Other psychodynamic therapists, particularly object relations therapists, use them to help anxious patients identify and settle the childhood relationship problems that continue to produce anxiety in adulthood -Controlled studies have typically found psychodynamic treatments to be of only modest help to persons with generalized anxiety disorder - An exception to this trend is short-term psychodynamic therapy which has in some cases significantly reduced the levels of anxiety, worry, and social difficulty of patients with this disorder

-Humanistic theorists propose that generalized anxiety disorder, like other psychological disorders, arises when people stop looking at themselves honestly and acceptingly -Repeated denials of their true thoughts, emotions, and behavior make these people extremely anxious and unable to fulfill their potential as human beings. -Carl Rogers explains Humanistic View --believed that children who fail to receive unconditional positive regard from others may become overly critical of themselves and develop harsh self-standards, what Rogers called conditions of worth. --They try to meet these standards by repeatedly distorting and denying their true thoughts and experiences. --Despite such efforts,threatening self-judgments keep breaking through and causing them intense anxiety. --Practitioners of Rogers' treatment approach use client-centered therapy try to show unconditional positive regard for their clients and to empathize with them --The therapists hope that an atmosphere of genuine acceptance and caring will help clients feel secure enough to recognize their true needs, thoughts, and emotions. -research suggests that client-centered therapy is only sometimes superior to placebo therapy -researchers have found, at best, only limited support for Rogers' explanation of generalized anxiety disorder and other forms of abnormal behavior.

-Followers of the cognitive model suggest that psychological problems are often caused by dysfunctional ways of thinking -*Maladaptive assumptions*- -Initially, cognitive theorists suggested that generalized anxiety disorder is primarily caused by maladaptive assumptions, a notion that continues to be influential. -*Basic irrational assumptions:* The inaccurate and inappropriate beliefs held by people with various psychological problems, according to Albert Ellis. -When people who make these assumptions are faced with a stressful event, such as an exam or a first date, they are likely to interpret it as dangerous, to overreact, and to experience fear. As they apply the assumptions to more and more events, they may begin to develop generalized anxiety disorder. -*New Wave Cognitive Explanations*- -The metacognitive theory, developed by the researcher Adrian Wells (2011, 2010, 2005), suggests that people with generalized anxiety disorder implicitly hold both positive and negative beliefs about worrying. -At the same time, Wells argues, individuals with generalized anxiety disorder also hold negative beliefs about worrying, and these negative attitudes are the ones that open the door to the disorder. -This explanation has received considerable research support. Studies indicate, for example, that individuals who generally hold both positive and negative beliefs about worrying are particularly prone to developing generalized anxiety disorder and that repeated metaworrying is a powerful predictor of developing the disorder -ANother new explanation- *Intolerance of uncertainty theory*- This explanation has received considerable research support. Studies indicate, for example, that individuals who generally hold both positive and negative beliefs about worrying are particularly prone to developing generalized anxiety disorder and that repeated metaworrying is a powerful predictor of developing the disorder -Proponents of this theory further believe that people with generalized anxiety disorder keep worrying and worrying in efforts to find "correct" solutions for the various situations in their lives -Studies have found, for example, that people with generalized anxiety disorder display greater levels of intolerance of uncertainty than people with normal degrees of anxiety -A third and final explanation- *avoidance theory*- developed by researcher Thomas Borkovec, suggests that people with this disorder have greater bodily arousal (higher heart rate, perspiration, respiration) than other people and that worrying actually serves to reduce this arousal, perhaps by distracting the individuals from their unpleasant physical feelings --the avoidance theory holds that people with generalized anxiety disorder worry repeatedly in order to avoid or reduce uncomfortable states of bodily arousal --Research reveals that people with generalized anxiety disorder experience particularly fast and intense bodily reactions, find such reactions overwhelming, worry more than other people upon becoming aroused, and successfully reduce their arousal whenever they worry *Cognitive Therapies*- -2 kinds -first kind: CHANGING MALADAPTIVE ASSUMPTIONS --*Rational-emotive therapy*: A cognitive therapy developed by Albert Ellis that helps clients identify and change the irrational assumptions and thinking that help cause their psychological disorder. --Studies suggest that this approach and similar cognitive approaches bring at least modest relief to persons suffering from generalized anxiety -Second kind: BREAKING DOWN WORRYING --some of today's new-wave cognitive therapists specifically guide clients with generalized anxiety disorder to recognize and change their dysfunctional use of worrying --they begin by educating the clients about the role of worrying in their disorder and have them observe their bodily arousal and cognitive responses across various life situations. --In turn, the clients come to appreciate the triggers of their worrying, their mistaken ideas about worrying, and their misguided efforts to control their lives by worrying -Treating individuals with generalized anxiety disorder by helping them to recognize their inclination to worry is similar to another cognitive approach that has gained popularity in recent years. -The approach, mindfulness-based cognitive therapy, was developed by psychologist Steven Hayes and his colleagues as part of their broader treatment called Acceptance and Commitment Therapy (ACT) --Here therapists help clients to become aware of their streams of thoughts, including their worries, as they are occurring and to accept such thoughts as mere events of the mind. -Mindfulness-based cognitive therapy has also been applied to a range of other psychological problems, such as depression, posttraumatic stress disorder, personality disorders, and substance abuse, often with promising results

-Biological theorists believe that generalized anxiety disorder is caused chiefly by biological factors -this claim was supported primarily by *family pedigree studies*,-A research design in which investigators determine how many and which relatives of a person with a disorder have the same disorder. -Approximately 15% of the relatives of people with the disorder display it themselves—much more than the prevalence rate found in the general population. -*Biological Explanations:GABA inactivity:* -Benzodiazepines: The most common group of antianxiety drugs, which includes Valium and Xanax. pparently certain neurons have receptors that receive the benzodiazepines, just as a lock receives a key. --*GABA*: The neurotransmitter gamma-aminobutyric acid, whose low activity has been linked to generalized anxiety disorder --There is the notion that in normal fear reactions, key neurons throughout the brain fire more rapidly, triggering the firing of still more neurons and creating a general state of excitability throughout the brain and body. --Normally, when body starts to feel fear/anxiety, GABA is release and attaches to some neurons that calms them down and the anxiety/fear subsides. --But researchers have concluded that a malfunction in this feedback system can cause fear or anxiety to go unchecked --First, according to recent biological discoveries, other neurotransmitters may also play important roles in anxiety and generalized anxiety disorder, either acting alone or in conjunction with GABA --econd, biological theorists are faced with the problem of establishing a causal relationship. The abnormal GABA responses of anxious persons may be the result, rather than the cause, of their anxiety disorders. Perhaps long-term anxiety eventually leads to poorer GABA reception -emotional reactions of various kinds are tied to brain circuits—networks of brain structures that work together, triggering each other into action with the help of neurotransmitters and producing a particular kind of emotional reaction --It turns out that the circuit that produces anxiety reactions includes the prefrontal cortex, anterior cingulate cortex, and amygdala, a small almond-shaped brain structure that usually starts the emotional ball rolling *Biological Treatments* -leading treatment is drug therapy -Other interventions are relaxation training and biofeedback -Antianxiety Drug Therapy- -*Sedative-hypnotic drug*: A drug used in low doses to reduce anxiety and in higher doses to help people sleep. Also called anxiolytic drug. -when benzodiazepines bind to these neuron receptor sites, particularly those receptors known as GABA-A receptors, they increase the ability of GABA to bind to them as well, and so improve GABA's ability to stop neuron firing and reduce anxiety -it has been discovered that a number of antidepressant medications, drugs that are usually used to lift the moods of depressed persons, and antipsychotic medications, drugs commonly given to people who lose touch with reality, are also helpful to many people with generalized anxiety disorder -Relaxation Training- -*Relaxation training*: A treatment procedure that teaches clients to relax at will so they can calm themselves in stressful situations. -In one version, therapists teach clients to identify individual muscle groups, tense them, release the tension, and ultimately relax the whole body. -Research indicates that relaxation training is more effective than no treatment or placebo treatment in cases of generalized anxiety disorder. -Relaxation training is of greatest help to people with generalized anxiety disorder when it is combined with cognitive therapy or with biofeedback -Biofeedback- -*Biofeedback:* A technique in which a client is given information about physiological reactions as they occur and learns to control the reactions voluntarily. -*Electromyograph (EMG):* A device that provides feedback about the level of muscular tension in the body -lients "see" or "hear" when their muscles are becoming more or less tense. Through repeated trial and error, the individuals become skilled at voluntarily reducing muscle tension and, theoretically, at reducing tension and anxiety in everyday stressful situations.

-*Phobia*- A persistent and unreasonable fear of a particular object, activity, or situation. -People with a phobia become fearful if they even think about the object or situation they dread, but they usually remain comfortable as long as they avoid it or thoughts about it. -DSM-5 indicates that a phobia is more intense and persistent and the desire to avoid the object or situation is greater -Most phobias technically fall under the category of specific phobias, DSM-5's label for an intense and persistent fear of a specific object or situation. -agoraphobia, a fear of venturing into public places or situations where escape might be difficult if one were to become panicky or incapacitated.

-*Specific phobia*: A severe and persistent fear of a specific object or situation (other than agoraphobia and social phobia). -Common specific phobias are intense fears of specific animals or insects, heights, thunderstorms, and blood. -Each year close to 9% of all people in the US have the symptoms of a specific phobia -More than 12% of individuals develop such phobias at some point during their lives, and many people have more than one at a time. -Women with the disorder outnumber men 2:1 -the prevalence of specific phobias also differs among racial and ethnic minority groups -In some studies, African Americans and Hispanic Americans report having at least 50% more specific phobias than do white Americans, even when economic factors, education, and age are held steady across the groups - People whose phobias center on dogs, insects, or water will keep encountering the objects they dread. -Most people with a specific phobia do not seek treatment. They try instead to avoid the objects they fear.

-*Agoraphobia*: An anxiety disorder in which a person is afraid to be in public places or situations from which escape might be difficult (or embarrassing) or help unavailable if panic-like symptoms were to occur. -In any given year 2.2% of the adult population experience this problem, women twice as frequently as men -2x as common among poor people as wealthy people -1/5 of ppl w/ agoraphobia are currently in treatment -People usually develop agoraphobia in their 20's or 30's -It is typical of people with agoraphobia to avoid entering crowded streets or stores, driving in parking lots or on bridges, and traveling on public transportation or in airplanes. -In many cases the intensity of the agoraphobia fluctuates -In severe cases, people become virtual prisoners in their own homes. - Persons with agoraphobia may also become depressed, sometimes as a result of the severe limitations that their disorder places on their lives. -Many people with agoraphobia are prone to experience extreme and sudden explosions of fear, called panic attacks, when they enter public places -In such cases, they may receive two diagnoses—agoraphobia and panic disorder,

-Evidence tends to support behavioral explanations *Behavioral Explanations* -Behaviorists propose classical conditioning as a common way of acquiring phobias, particularly specific phobias. -n classical conditioning, two events that occur close together in time become closely associated in a person's mind, and the person then reacts similarly to both of them. If one event triggers a fear response, the other may also. -ANother way of acquiring a fear reaction is through modeling (A process of learning in which an individual acquires responses by observing and imitating others.) --A person may observe that others are afraid of certain objects or events and develop fears of the same things. -Behaviorists believe that after acquiring a fear response, people try to avoid what they fear. -Behaviorists also propose that learned fears of this kind will blossom into a generalized anxiety disorder when a person acquires a large number of them. --*Stimulus generalization: A phenomenon in which responses to one stimulus are also produced by similar stimuli -*Behavioral Explanations in research*- -some laboratory studies have found that animals and humans can indeed be taught to fear objects through classical conditioning -Research has also supported the behavioral position that fears can be acquired through modeling. -Several laboratory studies with children and adults have failed to condition fear reactions. -although it appears that such a phobia can be acquired by classical conditioning or modeling, researchers have not established that the disorder is ordinarily acquired in this way. *Behavorial-Evolutionary explanation( -Theorists often account for these differences by proposing that human beings, as a species, have a predisposition to develop certain fears -*Preparedness*: A predisposition to develop certain fears. -The predispositions have been transmitted genetically through an evolutionary process.

-The major behavioral approaches to treating them are desensitization, flooding, and modeling. --*Exposure treatments*: Behavioral treatments in which persons are exposed to the objects or situations they dread. --*Systematic desensitization:* A behavioral treatment that uses relaxation training and a fear hierarchy to help clients with phobias react calmly to the objects or situations they dread. --Desensitization therapists first offer relaxation training to clients, teaching them how to bring on a state of deep muscle relaxation at will --The therapists help clients create a fear hierarchy, a list of feared objects or situations, ordered from mildly to extremely upsetting. --Vivo-desensitization: the therapist has the client face the event at the bottom of his or her hierarchy. This may be an actual confrontation --Covert desensitization: the confrontation may be imagined --*Flooding*: A treatment for phobias in which clients are exposed repeatedly and intensively to a feared object and made to see that it is actually harmless. --Flooding therapists believe that people will stop fearing things when they are exposed to them repeatedly and made to see that they are actually quite harmless --The flooding procedure, like desensitization, can be either in vivo or covert. -*Modeling*- Therapists acts out the fear of their clients --participant modeling-the client is actively encouraged to join in with the therapist. -Clinical researchers have repeatedly found that each of the exposure treatments helps people with specific phobias -The key to greater success in all of these therapies appears to be actual contact with the feared object or situation. -In vivo desensitization is more effective than covert desensitization, in vivo flooding more effective than covert flooding, and participant modeling more helpful than strictly observational modeling *Treatment for agoraphobia*- -Therapists typically help clients to venture farther and farther from their homes and to gradually enter outside places, one step at a time. -Sometimes the therapists use support, reasoning, and coaxing to get clients to confront the outside world. -Exposure therapy for people with agoraphobia often includes additional features, particularly the use of support groups and home-based self-help programs, to motivate clients to work hard at their treatment. -Between 60%-80% of agoraphobic clients who receive exposure treatment find it easier to enter public places, and the improvement persists for years after the beginning of treatment -Unfortunately, these improvements are often partial rather than complete -Those whose agoraphobia is accompanied by a panic disorder seem to benefit less than others from exposure therapy alone.

-*Social anxiety disorder*: A severe and persistent fear of social or performance situations in which embarrassment may occur. -The social anxiety may be narrow, such as a fear of talking in public or eating in front of others, or it may be broad, such as a general fear of functioning poorly in front of others. -It is because of its wide-ranging scope that this disorder is now called social anxiety disorder rather than social phobia, the label it had in past editions of the DSM. -Social anxiety disorder can interfere greatly with one's life -7.1% of ppl in the US experience social anxiety disorder in any given year -Around 12% develop this disorder at some point in their lives -It tends to begin in late childhood or adolescence and may continue into adulthood. -1/4 of ppl with the disorder are in treatment -Research finds that poor people are 50% more likely than wealthier people to experience social anxiety disorder -in several studies African Americans and Asian Americans, but not Hispanic Americans, have scored higher than white Americans on surveys of social anxiety

-The leading explanation for social anxiety disorder has been proposed by cognitive theorists and researchers 1. They hold unrealistically high social standards and so believe that they must perform perfectly in social situations. 2. They view themselves as unattractive social beings 3. They view themselves as socially unskilled and inadequate. 4. They believe they are always in danger of behaving incompetently in social situations. 5.They believe that inept behaviors in social situations will inevitably lead to terrible consequences. 6. They believe that they have no control over feelings of anxiety that emerge during social situations. -Cognitive theorists hold that, because of these beliefs, people with social anxiety disorder keep anticipating that social disasters will occur, and they repeatedly perform "avoidance" and "safety" behaviors to help prevent or reduce such disasters -Beset by such beliefs and expectations, people with social anxiety disorder find that their anxiety levels increase as soon as they enter into a social situation -after the social event has occurred, the individuals repeatedly review the details of the event -Researchers have indeed found that people with social anxiety disorder manifest the beliefs, expectations, interpretations, and feelings listed here -At the same time, cognitive theorists often differ on why some individuals have such cognitions and others do not. -Various factors have been uncovered by researchers, including genetic predispositions, trait tendencies, biological abnormalities, traumatic childhood experiences, and overprotective parent-child interactions during childhood

-There are 2 things that feed off each other that cause the disorder. 1. sufferers have overwhelming social fears and 2. they often lack skill at starting conversations, stating their needs or meeting the needs of others *How can social fears be reduced?* -Social fears are often reduced through medication -Somewhat surprisingly, it is antidepressant medications that seem to be the drugs of most help for this disorder, often more helpful than benzodiazepines or other kinds of antianxiety medications. -*Psychological approaches* --exposure therapy-the behavioral intervention so effective with phobias --Exposure therapists encourage clients with social fears to expose themselves to the dreaded social situations and to remain until their fears subside --In addition, group therapy offers an ideal setting for exposure treatments by allowing people to face social situations in an atmosphere of support and caring -Cognitive therapies have also been widely used to treat social fears, often in combination with behavioral techniques -studies show that rational-emotive therapy and other cognitive approaches do indeed help reduce social fears -*How can social skills be improved?* -*Social skills training*: A therapy approach that helps people learn or improve social skills and assertiveness through role playing and rehearsing of desirable behaviors. -Therapists usually model appropriate behavior and then role play with the client -Reinforcement from other people with similar social difficulties is often more powerful than reinforcement from a therapist alone. -According to research, social skills training, both individual and group formats, has helped many people perform better in social situations

-Sometimes an anxiety reaction takes the form of a smothering, nightmarish panic in which people lose control of their behavior and, in fact, are practically unaware of what they are doing. Anyone can react with panic when a real threat looms up suddenly. -*Panic attacks*- Periodic, short bouts of panic that occur suddenly, reach a peak within minutes, and gradually pass. -The attacks feature at least four of the following symptoms of panic: palpitations of the heart, tingling in the hands or feet, shortness of breath, sweating, hot and cold flashes, trembling, chest pains, choking sensations, faintness, dizziness, nausea, a feeling of unreality, fear of losing control, and fear of dying -More than 1/4 of all people have one or more panic attacks at some point in their lives -*Panic disorder*: An anxiety disorder marked by recurrent and unpredictable panic attacks. - In addition to the panic attacks, people who are diagnosed with panic disorder display maladaptive thinking or behavior as a result of the attacks -2.8% of all ppl in the US suffer from panic disorder in a given year -5% develop it at some point in their lives -The disorder tends to develop in late adolescence or early adulthood and is at least twice as common among women as among men -Poor people are 50% more likely than rich people to experience panic disorders -The prevalence of this disorder is the same across various cultural and racial groups in the United States, although the features of panic attacks may differ somewhat from group to group -At least 1/3 of individuals with the disorder in the US are in treatment

-*What biological factors contribute to panic disorder* -Several studies produced evidence that norepinephrine activity is indeed irregular in people who suffer from panic attacks. -*Locus ceruleus*: A small area of the brain that seems to be active in the regulation of emotions. Many of its neurons use norepinephrine. -Similarly, in another line of research, scientists were able to produce panic attacks in human beings by injecting them with chemicals known to increase the activity of norepinephrine -research conducted in recent years suggests that the root of panic attacks is probably more complicated than a single neurotransmitter or a single brain area. -It turns out that panic reactions are produced in part by a brain circuit consisting of areas such as the amygdala, ventromedial nucleus of the hypothalamus, central gray matter, and locus ceruleus -Most of today's researchers believe that this brain circuit—including the neurotransmitters at work throughout the circuit—probably functions improperly in people who experience panic disorder -One possibility is that a predisposition to develop such abnormalities is inherited -*Drug Therapies*- -It appears that all antidepressant drugs that restore proper activity of norepinephrine in the locus ceruleus and other parts of the panic brain circuit are able to help prevent or reduce panic symptoms -Such drugs bring at least some improvement to 80 percent of patients who have panic disorder, and the improvement can last indefinitely, as long as the drugs are continued -Apparently, the benzodiazepines help individuals with this disorder by indirectly affecting the activity of norepinephrine throughout the brain.

-In their view, full panic reactions are experienced only by people who further misinterpret the physiological events that are occurring within their bodies. Cognitive treatments are aimed at correcting such misinterpretations. -*Cognitive explanation*- -Cognitive theorists believe that panic-prone people may be very sensitive to certain bodily sensations; when they unexpectedly experience such sensations, they misinterpret them as signs of a medical catastrophe -*Biological challenge tes*t: A procedure used to produce panic in participants or clients by having them exercise vigorously or perform some other potentially panic-inducing task in the presence of a researcher or therapist. --participants with panic disorder experience greater upset during these tests than participants without the disorder, particularly when they believe that their bodily sensations are dangerous or out of control -One possibility is that panic-prone individuals generally experience, through no fault of their own, more frequent or more intense bodily sensations than other people do -In fact, the kinds of sensations that are most often misinterpreted in panic disorders seem to be carbon dioxide increases in the blood, shifts in blood pressure, and rises in heart rate—bodily events that are controlled in part by the locus ceruleus and other regions of the panic brain circuit. -Another possibility, supported by some research, is that people prone to bodily misinterpretations have experienced more trauma-filled events over the course of their lives than other persons -*Anxiety sensitivity*: A tendency to focus on one's bodily sensations, assess them illogically, and interpret them as harmful. -Studies have found that people who score high on anxiety sensitivity surveys are up to five times more likely than other people to develop panic disorder -Other studies have found that individuals with panic disorder typically earn higher anxiety sensitivity scores than other persons do -*Cognitive Therapy*- -Cognitive therapists try to correct people's misinterpretations of their body sensations -Therapists may also teach clients to cope better with anxiety—for example, by applying relaxation and breathing techniques -In addition, cognitive therapists may use biological challenge procedures to induce panic sensations, so that clients can apply their new skills under watchful supervision -According to research, cognitive treatments often help people with panic disorder -In studies across the world, around 80% of participants given these treatments have become free of panic, compared to only 13% of control participants. Cognitive therapy has proved to be at least as helpful as antidepressant drugs or alprazolam in the treatment of panic disorder, sometimes even more so -Unclear how effective combining biological and cognitive treatments are

-*Obsessions*- A persistent thought, idea, impulse, or image that is experienced repeatedly, feels intrusive, and causes anxiety. -*Compulsions*- A repetitive and rigid behavior or mental act that persons feel they must perform in order to prevent or reduce anxiety. -*OCD*-: A disorder characterized by recurrent and unwanted thoughts and/or a need to perform rigidly repetitive physical or mental actions. -Research indicates that several additional disorders are closely related to obsessive-compulsive disorder in their features, causes, and treatment responsiveness, and so DSM-5 has grouped them together with obsessive-compulsive disorder -Between 1-2% of ppl in the US and around the world have OCD -As many as 3% of ppl develop the disorder at some point in their life -Equally common in men and women and among ppl of different races and ethnic groups -usually begins by young adulthood and typically persists for many years, although its symptoms and their severity may fluctuate over time -40% of ppl with ocd seek treatment

-Obsessive thoughts feel both intrusive and foreign to the people who experience them. Attempts to ignore or resist these thoughts may arouse even more anxiety, and before long they come back more strongly than ever. People with obsessions typically are quite aware that their thoughts are excessive. --Cleaning is a common obsession -Compulsions are similar to obsessions in many ways. Most of these individuals recognize that their behaviors are unreasonable, but they believe at the same time something terrible will happen if they don't perform the compulsions -After performing a compulsive act, they usually feel less anxious for a short while -Although some people with obsessive-compulsive disorder experience obsessions only or compulsions only, most of them experience both -In fact, compulsive acts are often a response to obsessive thoughts One study found that in most cases, compulsions seemed to represent a yielding to obsessive doubts, ideas, or urges

-As you have seen, psychodynamic theorists believe that anxiety disorders develop when children come to fear their own id impulses and use ego defense mechanisms to lessen the resulting anxiety. - What distinguishes obsessive-compulsive disorder from the anxiety disorders, in their view, is that here the battle between anxiety-provoking id impulses and anxiety-reducing defense mechanisms is not buried in the unconscious but is played out in overt thoughts and actions. -Sigmund Freud traced obsessive-compulsive disorder to the anal stage of development (occurring at about 2 years of age). -He proposed that during this stage some children experience intense rage and shame as a result of negative toilet-training experiences. -Other psychodynamic theorists have argued instead that such early rage reactions are rooted in feelings of insecurity -Either way, these children repeatedly feel the need to express their strong aggressive id impulses while at the same time knowing they should try to restrain and control the impulses. If this conflict between the id and ego continues, it may eventually blossom into obsessive-compulsive disorder. -Overall, research has not clearly supported the psychodynamic explanation -When treating patients with obsessive-compulsive disorder, psychodynamic therapists try to help the individuals uncover and overcome their underlying conflicts and defenses, using the customary techniques of free association and therapist interpretation. -Research has offered little evidence, however, that a traditional psychodynamic approach is of much help

-Behaviorists have concentrated on explaining and treating compulsions rather than obsessions. They propose that people happen upon their compulsions quite randomly. -The famous clinical scientist Stanley Rachman and his associates have shown that compulsions do appear to be rewarded by a reduction in anxiety. -*Exposure and response prevention*: A behavioral treatment for obsessive-compulsive disorder that exposes a client to anxiety-arousing thoughts or situations and then prevents the client from performing his or her compulsive acts. Also called exposure and ritual prevention. -Many behavioral therapists now use exposure and response prevention in both individual and group therapy formats. -Between 55% and 85%clients with obsessive-compulsive disorder have been found to improve considerably with exposure and response prevention, improvements that often continue indefinitely

-Cognitive theorists begin their explanation of obsessive-compulsive disorder by pointing out that everyone has repetitive, unwanted, and intrusive thoughts. -Those who develop this disorder, however, typically blame themselves for such thoughts and expect that somehow terrible things will happen as a result of the thoughts -*Neutralizing*: Attempting to eliminate thoughts that one finds unacceptable by thinking or behaving in ways that make up for those thoughts and so put matters right internally. -Neutralizing acts might include requesting special reassurance from others, deliberately thinking "good" thoughts, washing one's hands, or checking for possible sources of danger. -When a neutralizing effort brings about a temporary reduction in discomfort, it is reinforced and will likely be repeated. Eventually the neutralizing thought or act is used so often that it becomes, by definition, an obsession or compulsion. -In support of this explanation, studies have found that people with obsessive-compulsive disorder experience intrusive thoughts more often than other people, resort to more elaborate neutralizing strategies, and experience reductions in anxiety after using neutralizing techniques -Although everyone sometimes has undesired thoughts, only some people develop obsessive-compulsive disorder. Why?? --1. to have exceptionally high standards of conduct and morality --2. to believe that their intrusive negative thoughts are equivalent to actions and capable of causing harm --3. to believe generally that they should have perfect control over all of their thoughts and behaviors -Cognitive therapists help clients focus on the cognitive processes involved in their obsessive-compulsive disorder. -Initially, they educate the clients, pointing out how misinterpretations of unwanted thoughts, an excessive sense of responsibility, and neutralizing acts help produce and maintain their symptoms. -The therapists then guide the clients to identify, challenge, and change their distorted cognitions. -It appears that cognitive techniques of this kind often help reduce the number and impact of obsessions and compulsions -While the behavioral approach (exposure and response prevention) and the cognitive approach have each been of help to clients with obsessive-compulsive disorder, some research suggests that a combination of the two approaches (cognitive-behavioral therapy) is often more effective than either intervention alone

-researchers points to (1) abnormally low activity of the neurotransmitter serotonin and (2) abnormal functioning in key regions of the brain. -*Serotonin:* A neurotransmitter whose abnormal activity is linked to depression, obsessive-compulsive disorder, and eating disorders. -a surprising finding by clinical researchers—this time that two antidepressant drugs, clomipramine and fluoxetine (Anafranil and Prozac), reduce obsessive and compulsive symptoms (Stein & Fineberg, 2007). Since these particular drugs increase serotonin activity, some researchers concluded that the disorder might be caused by low serotonin activity. -Still other studies have recently suggested that other neurotransmitters, particularly glutamate, GABA, and dopamine, may also play important roles in the development of obsessive-compulsive disorder -Another line of research has linked obsessive-compulsive disorder to abnormal functioning by specific regions of the brain, particularly the orbitofrontal cortex (just above each eye) and the caudate nuclei (structures located within the brain region known as the basal ganglia). -hese regions are part of a brain circuit that usually converts sensory information into thoughts and actions -The circuit begins in the orbitofrontal cortex, where sexual, violent, and other primitive impulses normally arise. -These impulses next move on to the caudate nuclei, which act as filters that send only the most powerful impulses on to the thalamus, the next stop on the circuit -If impulses reach the thalamus, the person is driven to think further about them and perhaps to act. -Many theorists now believe that either the orbitofrontal cortex or the caudate nuclei of some people are too active, leading to a constant eruption of troublesome thoughts and actions -Additional parts of this brain circuit have also been identified in recent years, including the cingulate cortex and, once again, the amygdala -In support of this brain circuit explanation, medical scientists have observed for years that obsessive-compulsive symptoms do sometimes arise or subside after the orbitofrontal cortex, caudate nuclei, or other regions in the circuit are damaged by accident or illness -The serotonin and brain circuit explanations may themselves be linked. It turns out that serotonin—along with the neurotransmitters glutamate, GABA, and dopamine—plays a key role in the operation of the orbitofrontal cortex, caudate nuclei, and other parts of the brain circuit -Ever since researchers first discovered that certain antidepressant drugs help to reduce obsessions and compulsions, these drugs have been used to treat obsessive-compulsive disorder -We now know that the drugs not only increase brain serotonin activity but also help produce more normal activity in the orbitofrontal cortex and caudate nuclei -Studies have found that these antidepressant drugs bring improvement to between 50%and 80% of those with obsessive-compulsive disorder -The obsessions and compulsions do not usually disappear totally, but on average they are cut almost in half within eight weeks of treatment -People who are treated with antidepressant drugs alone, however, tend to relapse if their medication is stopped. -more and more individuals with obsessive-compulsive disorder are now being treated by a combination of behavioral, cognitive, and drug therapies -In fact, some studies suggest that the behavioral, cognitive, and biological approaches may ultimately have the same effect on the brain.

*Obsessive-compulsive disorder:* A disorder characterized by recurrent and unwanted thoughts and/or a need to perform rigidly repetitive physical or mental actions. -Assigned four of these patterns to that group: hoarding disorder, hair-pulling disorder, excoriation (skin-picking) disorder, and body dysmorphic disorder. -*Hair-pulling*-individuals with hair-pulling disorder, also known as trichotillomania, repeatedly pull out hair from their scalp, eyebrows, eyelashes, or other parts of the body --it is common for anxiety or stress to trigger or accompany the hair-pulling behavior. --Because of the distress, impairment, or embarrassment caused by this behavior, the individuals often try to reduce or stop the hair-pulling. -*excoriation (skin picking*)- -keep picking at their skin, resulting in significant sores or wounds --Like those with hair-pulling disorder, they often try to reduce or stop the behavior --Other common areas of focus include the arms, legs, lips, scalp, chest, and extremities such as fingernails and cuticles. The behavior is typically triggered or accompanied by anxiety or stress. -*Body dysmorphic disorder*: A disorder marked by excessive worry that some aspect of one's physical appearance is defective. Also known as dysmorphophobia -- the perceived defect or flaw is imagined or greatly exaggerated in the person's mind --individuals with the problem experience significant distress or impairment. --Body dysmorphic disorder is the obsessive-compulsive-related disorder that has received the most study to date. --Researchers have found that, most often, individuals with this problem focus on wrinkles; spots on the skin; excessive facial hair; swelling of the face; or a misshapen nose, mouth, jaw, or eyebrow --as many as half of people with the disorder seek plastic surgery or dermatology treatment, and often they feel worse rather than better afterward --theorists typically account for body dysmorphic disorder by using the same kinds of explanations, both psychological and biological, that have been applied to obsessive-compulsive disorder --Similarly, clinicians typically treat clients with this disorder by applying the kinds of treatment used with obsessive-compulsive disorder, particularly antidepressant drugs, exposure and response prevention, and cognitive therapy --Now that the body dysmorphic, hoarding, hair-pulling, and skin-picking disorders are being grouped together in DSM-5 along with obsessive-compulsive disorder,