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psychological disorder

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a psychological dysfunction within an individual associated with distress or impairment in functioning and an atypical response that is not culturally expected. Must be all three to have disorder.

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psychological dysfunction

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refers to a breakdown in cognitive, emotional, or behavioral functioning. Knowing when to draw the line between normal and abnormal dysfunction is often difficult. Problems are on a continuum.

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phobia

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a psychological disorder characterized by marked and persistent fear of an object or situation

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prototype

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consider how the apparent disorder/disease matches a "typical" profile of a disorder when most or all symptoms are present.

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psychopathology

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the scientific study of psychological disorders.

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clinical and counseling psychologists

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receive the Ph.D degree (or Psy.D or Ed.D) and follow a course of graduate-level study (5 years), and research causes and treatments of disorders and to diagnose and treat them. Clinical psychologists concentrate on more severe psychological disorders. Counseling for more healthy people.

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Interoceptive exposure

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learning not to let the physical sensations of anxiety scare you. Utilized to treat panic disorder and agoraphobia.

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DSM-5 definition of abnormal

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behavioral, emotional, or cognitive dysfunctions that are unexpected in their cultural context and associated with personal distress or substantial impairment in functioning=abnormal

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harmful dysfunction

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is the behavior out of the individual's control

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DSM-5

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widely accepted system used to classify psychological problems and disorders

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psychiatrists

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earn an M.D. degree in medical school and then go on for residency training (total=6-7 years). Emphasize drugs or biological treatments.

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psychiatric social workers

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Earn a master's degree in social work. Treat disorders, concentrating on family problems associated with them.

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psychiatric nurses

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advanced degrees, master's or Ph.D and specialize in the care and treatment of patients with psychological disorders, usually in hospitals.

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mental health counselors

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spend 1-2 years earning a master's degree and are employed to provide clinical services by hospitals or clinics, under supervision of a doctoral-level clinician.

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Scientist-Practitioner

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Many mental health professionals take a scientific approach to their clinical work. They are: 1) consumer of science - enhancing the practice; 2) Evaluator of science - determining the effectiveness of the practice; 3) Creator of science - conducting research that leads to new procedures useful in practice.

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Clinical Description

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Represents the unique combination of behaviors, thought, and feelings that make up a specific disorder. What makes the disorder different from normal behavior, or from other disorders.

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presenting problem

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Why the person came to the clinic

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Prevalence

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how many people in the population have a disorder

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Incidence

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how many new cases occur during a given period of time

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course of disorder

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Chronic = last a long time. Episodic Course = recovery within months. Time-limited = disorder will improve without treatment in a short period.

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onset of disorder

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Acute = begins suddenly. Insidious = develop gradually over an extended period

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Prognosis

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The anticipated course of a disorder. Good = individual will probably recover. Guarded = the probable outcome doesn't look good.

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age of patient

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disorder different in child than in adult. Ex: Depression. Children with depression are irritable; adults with depression are sad.

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developmental psychology

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changes in behavior over time, throughout life-span

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developmental psychopathology

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the study of developmental processes that contribute to or protect against, psychopathology

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Etiology

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study of origins - why a disorder begins, including biological, psychological, and social dimensions

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integrative perspective of "best practice"

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Includes pharmacologic, psychosocial, and/or combined treatments

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vulnerability factors

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genetic factors, biological characteristics, psychological traits, previous learning history, low social support

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Stressors

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economic adversity, environmental trauma, interpersonal stresses or losses, and occupational setbacks or demands

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current vulnerability and current experienced stress =

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psychological disorders

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Three dominant traditions

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supernatural, biological, and psychological

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Supernatural Tradition

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forces outside our bodies influence our behavior (divinities, demons, spirits, moon and stars, magnetic fields, witchcraft). Deviant behavior as a battle of good vs. evil. Mind (soul/psyche) separate from the body. Treatments include exorcism, torture, and beatings. Thought stress and depression caused insanity. Mass hysteria. Thought the moon and stars had to do with it.

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Biological Tradition

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Hippocrates - abnormal behavior is physical disease. He is considered the father of modern medicine. Thought psychological disorders could be treated like any other disease.

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Biological Tradition: Galen

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Created the Humoral theory of mental illness - normal brain functions related to four bodily fluids or humors. Treatments were crude - bloodletting.

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19th Century: Biological Tradition

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1) discovery of the nature and cause of syphilis. 2) Strong support from John P. Grey.

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Syphilis/General Paresis

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symptoms of advanced syphilis (a sexually transmitted disease caused by a bacterial microorganism entering the brain) include believing that everyone is plotting against you, believing you are God, and other bizarre behaviors. Resulted in death. Pasteur discovered the cause. Penicillin as successful treatment.

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John P. Grey, Psychiatrist

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champion of the biological tradition in the U.S. Believed causes of insanity were always physical. Emphasis on rest, diet, and proper room temperature and ventilation. Improved the conditions at hospitals to be more humane, livable institutions. Reduced interest in treatment mental disorders because he thought they were incurable. Hospitalize them instead.

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Consequences of the biological tradition

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mental illness = physical illness. New treatments. 1930s - shock therapy, brain surgery. 1950s - the first effective drugs for severe psychotic disorders were developed. Neuroleptics - controlled agitation and aggression. Benzodiazepines - reduce anxiety.

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Psychological Tradition

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Plato and Aristotle. The Rise of Moral Therapy - humane and responsible care for the psychologically disturbed. Moral = emotional or psychological. Better treatment of those with psychological disorders. Dorothea Dix - led mental hygiene movement. Emergence of competing alternative psychological models.

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Psychoanalytic Tradition

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Freudian Theory - structure and function of the mind: id (pleasure principle), ego (reality principle, keeps the id and superego in check), superego (moral principles)

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Intrapsychic conflicts

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when the id or superego become too strong, psychological disorders will develop

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catharsis

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release of emotional material can be therapeutic.

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defense mechanisms

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unconscious processes that keep primitive emotions associated with conflicts in check so that the ego can continue its coordinating function.

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Neuroses

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disorders resulting from underlying unconscious conflicts, the anxiety resulting from those conflicts, and the implementation of ego defense mechanisms.

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collective unconscious

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Carl Jung introduced this concept. It is a wisdom accumulated by society and culture stored deep in memories.

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Psychoanalysis

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Talk therapy = unearth the hidden intrapsychic conflict. "The real problems." Free Association - patients say whatever comes to mind. Dream analysis - therapist interprets the content of dreams.

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Transference

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patients come to relate to the therapist much as they did to important figures in their childhood.

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Counter-Transference

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therapists project some of their own personal issues and feelings onto the patient.

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Behavioral Model

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Classical conditioning (Pavlov; Watson) - Pairing neutral stimuli and unconditioned stimuli. Operant conditioning (Thorndike; Skinner) - voluntary behavior is controlled by consequences.

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systematic desensitization

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Joseph Wolpe. Individuals gradually introduced to the objects or situations they feared so that their fear could extinguish. (Beginning of behavior therapy)

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Behavior Therapy

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Reactionary movement against psychoanalysis and non-scientific approaches. Early pioneers = Wolpe, Beck, Bandura, Eysenck, Lazarus, Tends to be time-limited, direct, here-and-now focused. Widespread empirical support.

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multidimensional integrative approach

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system of influences that cause and maintain suffering. Uses information from several sources. Abnormal behavior as multiply determined. context is the Biological (genetics, neurological), Psychological, Emotional, Developmental. Also, social, cultural, and interpersonal.

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Gregor Mendel

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Genes - DNA, 23 pairs of chromosomes, dominant vs. recessive genes, the genetic contribution to psychopathology is less than 50%

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The Diathesis-Stress Model

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individuals inherit tendencies to express certain traits or behaviors, which may then be activated under conditions of stress. Each inherited tendency = a diathesis (a condition that makes someone susceptible to developing a disorder). Stress is environmental, but must interact to produce the disorder. Ex: alcoholism and blood-injury-injection phobia

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Gene-Environment Correlation Model

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genetic endowment may increase the probability that an individual will experience stressful life events. They may have a certain personality trait that makes them more likely to be involved in certain events. Ex: depression, divorce, and impulsivity

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Non-Genetic Inheritance of Behavior

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Environmental influences may override genetic influences. Genes are not the whole story.

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Neuroscience

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the role of the nervous system in disease and behavior

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Human Nervous System

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1) Central Nervous System - brain and spinal cord. 2) Peripheral Nervous System - somatic and autonomic branches (links the CNS with sensory receptors, muscles, glands in body)

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Neurons function electrically

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but communicate chemically. Neurotransmitters are the chemical messengers

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Two main parts of brain

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Brainstem - Handles automatic functions, breathing, sleeping, and moving. Forebrain - most advanced region of the brain.

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Three Main Divisions

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Hindbrain = most primitive area (Medulla, pons, cerebellum); Midbrain (coordinates movement, Reticular Formation); Forebrain (cerebral cortex - most sensory, emotional, and cognitive processing)

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Hindbrain

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lowest and most primitive level of the brain. Brain stem: supports vital life functions. Medulla: heart rate and respiration. Pons: regulate sleep, respiration. Cerebellum: muscle movement coordination, learning and memory.

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Thalamus

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At top of brainstem. Brain's sensory "switchboard." Relays center for incoming sensory information. Visual, auditory, and body senses (balance and equilibrium)

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hypothalamus

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At top of brainstem. Motivation and emotion. Regulates basic biological needs: hunger, thirst, temperature control, aggression, and sex. Linked to endocrine system: pituitary gland.

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Limbic System

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At base of forebrain. Memory, emotion, goal-directed behavior, helps coordinate behaviors. Includes hippocampus (involved in forming and retrieving memories) and amygdala (aggression and fear)

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Cerebral Cortex

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the largest part of the forebrain, contains more than 80% of all neurons in the central nervous system. Provides us with our distinct human qualities. Divided into two hemispheres. Left side responsible for verbal and other cognitive processes. Right side better at perceiving the world and creating images. Four lobes: frontal (thinking and reasoning, memory), temporal (sounds and sights and long-term memory), parietal (touch, body positioning), and occipital (vision).

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Peripheral Nervous System

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2 Divisions: Somatic Nervous System (sensory and motor neurons send messages to sense organs and muscles, controls the muscles, voluntary movement, talking) and Autonomic Nervous System (regulates the cardiovascular system and the endocrine system, senses body's internal functions, controls glands).

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Sympathetic Nervous System

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fight or flight. Part of the autonomic nervous system. Increased heart rate, dilates pupils, slows digestive system, increased respiration.

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Parasympathetic Nervous System

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slows down body processes, maintains homeostasis.

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Acetylcholine (Ach)

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neurotransmitter involved in memory and muscle activity. Memory loss - Alzheimer's. Paralysis. Muscle contractions.

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Norepinephrine (NE)

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neurotransmitter involved in learning, memory, wakefulness, and eating. Depression, stress, and panic disorders.

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Serotonin (5HT)

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neurotransmitter involved in mood, sleep, eating, arousal, pleasure, and pain. Depression and sleeping disorders.

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Dopamine (DA)

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neurotransmitter involved in voluntary movement, emotional arousal, learning, memory. Parkinson's disease, Depression, and Schizophrenia.

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GABA

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inhibitory neurotransmitter that reduces anxiety, overall arousal, and tempers emotional responses. Anticonvulsant effects, relaxing muscle groups subject to spasms.

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Implications of neuroscience for psychopathology

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Relations between brain and abnormal behavior (Ex: OCD and schizophrenia). Psychosocial influences can change brain structure and function. Therapy also changes brain structure and function (Ex: Depression).

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The Role of Emotion in Psychopathology

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The nature of emotion is to elicit or evoke ACTION. Different from affect (the momentary emotional tone that accompanies what we say or do) and mood (persistent period of affect). Components of emotion = behavior, physiology, and cognition. Ex: fear.

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Harmful side of emotion dysregulation

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anger, hostility, emotional suppression, and psychopathology

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learned helplessness

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encountering conditions over which we have no control.

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emotion and behavior

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basic patterns of emotional behavior differ in fundamental ways. Ex: anger differs from sadness. It is a means of communication.

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cognitive aspects of emotion

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appraisals, attributions, and other ways of processing the world around you that are fundamental to emotional experience.

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Life-span Development

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experiences during different periods of development may influence our vulnerability to other types of stress or to differing psychological disorders.

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Equifinality

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indicates that we must consider a number of paths to a given outcome. Similar outcomes stem from very different early experiences.

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Developmental Framework

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Development in the Individual Context (biological, moral, cognitive, emotional, gender/sexuality, self development and attachment). Development in the family context, social context, and cultural context.

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Organizational perspective of Developmental Psychopathology

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human is "holistic", an integrated system, all areas of development are in continual interaction with one another.

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Development is "hierarchical"

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psychological growth is a process of increasing complexity; new structures emerge out of those that came before

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Stage salient issues

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tasks at each stage of development that must be mastered, their effects are carried forward to the next stage of development

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Probabilistic vs deterministic

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previous development may shape or constrain future development (increases or decreases the likelihood of psychopathology), but such an effect IS NOT predetermined

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multifinality

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the same risk and protective factors may lead to different outcomes. Various outcomes may stem from similar beginnings.

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Risk factor

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a variable that precedes a negative outcome of interest and increases the chances that the negative outcome like psychopathology will occur (e.g., community violence, parental divorce; chronic adversity)

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Risk Mechanism

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underlie psychopathology. Explains how the risk factors affect us.

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Vulnerability

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increases the likelihood that a PARTICULAR child will succumb to risk. Intensifies the child's response to risk. Ex: gender, temperament, absence of a good relationship with parents, poor planning ability, poor social skills,

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Resilience Factor (Protective Factors)

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a variable that increases one's ability to avoid negative outcomes, despite being at risk for psychopathology; tempers the risk for psychopathology. Promote or maintain healthy development. Ex: average intelligence, affectionate ties to parents, external support system

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Protective Mechanisms

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How do protective factors work? Ex: reduction of risk impact and negative chain reactions, and promotion of self esteem and self-efficacy

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continuity

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children 7 or 8 years old with disruptive behavior are 16 times more likely to develop later conduct problems

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discontinuity

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problem behavior in toddler and preschool period tends not to be good predictor of subsequent disturbances -- around age 7, predictability increases

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Are problems more common in boys or girls?

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boys, but girls are referred for treatment more frequently. Could be biological, genetic, developmental lag, or differential socialization. Most of the adult psychological disorder are more common among women, though.

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Clinical Assessment

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used to determine how and why a person is behaving abnormally and how that person may be helped. The systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder. Includes a clinical interview, a mental status exam, a behavioral observation and assessment, and psychological tests

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Diagnosis

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the process of determining whether the particular problems afflicting the individual meets all of the criteria for a psychological disorder, as set forth by the DSM-5

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Three basic Concepts of assessments

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Reliability = the degree to which a measurement is consistent. Validity = the degree to which a technique measure what it is designed to measure. Standardization = application of certain standards to ensure consistency across different measurements. Standards might apply to the procedures of testing, scoring, and evaluating data.

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What do we assess?

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Behavior, symptoms, cognitive functioning, personality functioning, neuropsychological functioning

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factors to enter in determination of assessment method

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nature of target behavior, characteristics of the patient, referral source, assessment setting, sociocultural milieu, and purpose of your assessment (diagnosis, placement, intervention, treatment, evaluation)

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Phases of the Assessment Process

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1) Review referral information; 2) Obtain background information; 3) Clinical Interview; 4) Behavioral Observations; 5) Select and administer appropriate test battery; 6) Score and interpret test findings; 7) formulate hypotheses; 8) Develop intervention recommendations; 9) Write report; 10) Provide feedback; 11) Follow up; 12) Call the referral source and send report

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Clinical Interview

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determine when the problem began and other events that occurred about the same time. gathers info on current and past behavior, attitudes, and emotions and a detailed history of the individual's life in general and of the presenting problem.

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Mental Status Exam

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Covers 5 categories: 1) Appearance and Behavior; 2) Thought Processes; 3) Mood and affect; 4) Intellectual functioning; 5) Sensorium = awareness of surroundings in terms of self, time, and place = oriented times three

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semistructured interviews

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made up of questions that have been carefully phrased and tested to elicit useful info in a consistent manner so that clinicians can be sure they have inquired the most important aspects of particular disorders. Example: The SCID and ADIS.

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Behavioral Assessment

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ABC's: Antecedent = what came before the behavior. Behavior = what is the resulting behavior. Consequence = what is the consequence of the behavior.

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Physical Assessment

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Some physical conditions may lead to psychological problems. If a current medical condition exists, the clinician must decide whether it represents a coexisting problem or it central to the etiology of the disorder.

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"Go-No-Go" Neuropsychological Test

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ex: "When I hold up 1 finger, you hold up 2" test measures visual skill, shifting sets in mind, cognitive functioning, impulsivity, and attention

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Rey-Osterreith Complex Figure Test

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Neuropsychological test. Reproduce a picture, first by copying it, then by memory.

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Self-Report: Behavior rating scales

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more formal and structured way to observe behavior. Used as assessment tools before treatment and then periodically during treatment to assess changes in the person's behavior.

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Self-Report Measures

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Beck Depression Inventory: measures depressed mood. Anxiety Sensitivity Index: measures anxiety. The Brief Psychiatric Rating Scale : assesses 18 general areas of concern, each symptom rated on a 7-point scale from 0 to 6. Screens for moderate to severe psychotic disorders and includes items such as somatic concern, guilt feelings, and grandiosity.

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Clinical Tests

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1) Intelligence Tests 2) Personality inventories 3) self report questionnaires 4) psychophysiological tests 5) neurological and neuropsychological tests 6) projective tests

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Projective Tests

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Include Rorschach inkblot test, the Thematic Apperception Test (tell a story about the picture), and the sentence-completion method. Intend to assess responses to stimuli (repressed). Not reliable or valid. Subjective element.

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Psychophysiological tests

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measurable change in the nervous system reflecting emotional or psychological events. EEG, Event-related or evoke potentials, measure of heart rate, respiration, skin temp, muscle tension, facial expression. Used in testing sexual dysfunctions and disorders.

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personality inventories

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self-report questionnaires that assess personal traits. Minnesota Multiphasic Personality Inventory (MMPI) - Have to label T/F on over 500 statements. Patterns of responses are reviewed (rather than individual). Myers-Briggs.

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Intelligence testing

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Stanford-Binet and Wechsler tests (for adults, children, and young children) IQ testing, which is an estimate of how much a child's performance in school will deviate from the average performance of others of the same age.

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Neurological testing: Neuroimaging

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Neuroimaging: pictures of the brain - allows examination of brain structure and function.

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Imaging Brain Structure

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1) CAT scan - uses X-rays of brain. Pictures in slices. 2) MRI - better resolution than CAT, operates via magnetic field around head.

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Imaging Brain Function

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Injection of radioactive isotopes. 1) PET scan - show parts of the brain are working and what parts are not. 2) SPECT - not as accurate but less $. 3) fMRI - see the immediate response of the brain to a brief event.

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Neuropsychological Tests

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assess a person's abilities such as: receptive and expressive language, attention and concentration, memory, motor skills, perceptual abilities, learning, reasoning and abstraction, and intellectual and academic functioning

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Assessment Report

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Summary of the clinical interview. Ends with a diagnosis recommendation (for treatment or for other interventions)

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Classification System

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any effort to assign people to categories on the basis of their shared attributes or relations. Classical/Categorical Approach - categories that do not overlap. Dimensional Approach - classification along dimensions (scale). Prototypical approach - both classical and dimension - the DSM-5 uses prototypical

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Two Widely Used Classification Systems

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1) International Classification of Diseases and Health Problems (ICD-10) published by the World Health Organization. 2) Diagnostic and Statistical Manual of Mental Disorder (DSM) published by the American Psychiatric Association.

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Issues with the DSM-5

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Does everything have to fit neatly somewhere? Arbitrary Time Periods in the Definitions of Diagnoses. The Problem of Comorbidity (high rates). Labeling and stigmatization.

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DSM-5 Changes

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Divided into 3 sections. 1) introduces the manual and describes how to use it. 2) presents the disorders. 3) descriptions of disorders or conditions that need further research. No more multiaxial system. Use dimensional ratings for frequency, severity, etc. Provides info for treatment. Cultural Formulation. Most interfering and distressing disorders presented first.

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Stigma

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is a combo of stereotypic negative beliefs, prejudices and attitudes resulting in reduced life opportunities.

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taxonomy

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classification for scientific purposes

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Nosology

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applying a taxonomic system to a psychological problem

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nomenclature

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names or labels of the disorders that make up the nosology (Ex: anxiety or depression)

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Is treatment effective?

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more helpful than placebo or no treatment. People who receive treatment are generally better off than those who don't.

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neurodevelopmental disorders

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neurologically based developmental disorders that often persist as the person grows older. Lifelong problems. Categorized as neurodevelopmental disorders in the DSM-5: include ASD, ID, Specific Learning Disorder, Communication disorder, and ADHD,

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Major areas of development

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motor, social, cognitive (language/verbal), emotional

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need to understand normal development

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to understand when a child's development goes off course. Childhood is associated with a significant developmental change that follows a specific pattern.

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Importance of Attachment

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The effects of maternal-infant separation is long lasting and extend to social behavior in adulthood. Males more vulnerable than females. If separated for more than 6 months, rehabilitation was not possible.

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Psychological Problems in Infants (Birth-18 months)

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genetic disorders autism spectrum disorders attachment disorders

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Psychological Problems in Toddlers (18 months - 3 years)

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disruptive behavior disorders sleep disorders

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Psychological Problems in Preschoolers (3-6 years)

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fears and anxiety disorders (separation anxiety, specific fears) disruptive behavior disorders enuresis and encopresis Selective Mutism sleep disorders attention problems

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Psychological Problems in School aged children

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learning disorders (reading, written, math) disruptive behavior problems anxiety disorders (GAD, SAD, Social Anxiety, Specific fears) mood disorders Tourette's disorder ADHD

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Psychological Problems in Adolescence

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anxiety disorders (panic disorder, social anxiety) conduct disorder substance use disorders eating disorders sexual disorders sleep disorders mood disorders

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Psychological Problems in Late Adolescence

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full range of psychopathology, including personality disorders, psychotic disorders

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Childhood Disorders

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some childhood disorders are also experienced by adults (anxiety and depression). Other childhood disorders (conduct disorder, ADHD, and enuresis or encopresis) either disappear or radically change form by adulthood.

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Reactive attachment disorder

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unstable home environment or institutionalization has prevented the child from forming a normal reciprocal attachment to the caregiver, resulting in abnormal behavior. Inhibited = child is withdrawn and unresponsive. Disinhibited = child approaches and cuddles up indiscriminately to strangers and familiar people. Treatment = parent-child interaction therapy (increase warmth/secure attachment)

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Oppositional Defiant Disorder

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Children that consistently display extreme hostility and defiance. Symptoms = argue repeatedly with adults, lose temper, feel anger and resentment, are disobedient, display negative behaviors. 8% of children have this. More common in boys than girls before puberty. (after puberty - its equal) . Comorbidity with ADHD.

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Conduct Disorder

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MORE SEVERE THAN OPPOSITIONAL DEFIANT DISORDER. Symptoms = violate the basic rights of others, aggressive, may be physically cruel to people or animals, destroy others' property, skip school, may steal, threaten, harm their victims, commit crimes, acts of physical violence. Associated with anti-social personality disorder in adults.

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Causes and Treatment of disruptive behavior disorders

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Biological factors, drug abuse, poverty, traumatic events, exposure to violent peers or community violence, troubled parent-child relationships, inadequate parenting, family conflict, marital conflict and family hostility, children whose parents reject, leave, coerce, or abused them. Treatment = Parent-Child Interaction Therapy (parents taught to interact positively, set appropriate limits); Parent Management Training (parents are taught behavior skills for managing child behavior; how to stop rewarding unwanted behaviors and reward proper ones); Drug therapies include Ritalin.

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Elimination Disorders: Enuresis

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repeated involuntary or intentional bed wetting or wetting clothes; must be 5 years old to receive diagnosis; may be triggered by a stressful event. Prevalence decreases with age. 10% of 5 year old have it. Often a sibling/parent has had disorder. Treatment = classical conditioning pairing bell and pad technique. Also, Dry bed training - children are awakened throughout night, go to bathroom, rewarded.

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Elimination Disorders: Encopresis

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defecating into one's clothing; less common than enuresis and less researched. Seldom occur at night; starts after age 4, affects 1% of 5 year olds. More in boys than girls. causes social problems. May stem from biological factors, stress, improper toilet training, or combination. Physical problems often linked. Treatment = behavioral, medical, and dietary. Family Therapy, too.

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Attention Deficit Hyperactivity Disorder (ADHD)

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one of the most common reasons children are referred for mental health services in the U.S. Symptoms = 1) problems of inattention; 2) hyperactivity and impulsivity - fidgeting, always on the go, and blurting out answers before questions have been completed, trouble waiting turns. Need 6 symptoms of each. Presence of symptoms before the age of 7. Impairment from symptoms in at least two settings. Prevalent in 5% of school children. 90% boys. Less impulsive and hyperactive as they age. Half of children with ADHD have learning or communication problems. Causes = Strong genetic and (some) environmental influences, abnormal activity of dopamine and abnormalities in frontal striatal region, high levels of stress and family dysfunction. Treatment = Ritalin, psychosocial and educational interventions (teaching child to stay seated longer, appropriate play). Combination is best.

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Motor and Vocal Tics

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Tics = sudden, repetitive, stereotyped movements or phonic productions that mimic normal behaviors. Simple or complex. 20% of children show some tic behavior. More tics occur at night, when stressed, and when excited. Tourette's Disorder = involuntary motor movements AND vocalizations (tics). More common in boys, begins at 5-6. By age 18, most are free of symptoms. Rare. Causes = environmental (prenatal and perinatal events, exposure to stimulants, fatigue, stress, excitement, and life events.) Comorbid with OCD and ADHD. 22% have learning disabilities. Treatment = antipsychotics (Haldol) and atypical agents (Risperdal), Habit Reversal Training.

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Selective Mutism

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consistent failure to speak in social situations where there is an expectation of speaking. The disturbance interferes in educational or occupational achievement or with social communication. Failure to speak is not due to lack of knowledge of language.

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Specific Learning Disorder

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Discrepancy between ability and achievement. Characterized by performance that is substantially below what would be expected given the person's age, IQ, and education. Reading disorder, math disorder, written expression disorder. Causes = genetic, neurobiological, and environmental factors. Treatment = educational intervention.

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Communication disorders

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receptive, expressive, or mixed language disorder, phonological disorder, articulation disorder.

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Fear

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natural human emotion; intrinsic to development; a response to a perceived environmental threat involving behavioral avoidance, cognitive distress, and physiological arousal.

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Phobias

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exaggerated fears or fears that are more persistent and disturbing and result in maladaptive, avoidant behavior.

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Anxiety and related disorders

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Definition = distinguished from fear "apprehension without apparent cause." Is FUTURE ORIENTED emotion. Causes: biological (genetic, depleted levels of GABA, overly responsive limbic system), psychological (sense of uncontrollability), environmental (reinforcement from siblings, parents), triple vulnerability theory = the first vulnerability is a generalized biological vulnerability. The second is generalized psychological vulnerability. The third is a specific psychological vulnerability in which you learn from early experience that some situations or objects are fraught with danger Comorbidity - anxiety and depression. Half of the people with anxiety also have depression.

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Autism Spectrum Disorder

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neurodevelopmental disorder 1) impairments in communication and social interaction (problems with social reciprocity, nonverbal communication, and initiating and maintaining social relationships-- all 3 must be present to diagnose ASD), 2) repetitive patterns of behavior, interests, or activities (like things to stay the same) impairments present in early childhood. Includes autistic disorder, Asperger's disorder, childhood disintegrative disorder, and Rett disorder. Levels of severity in DSM-5. More common in males, increase in rates. 38% have intellectual disabilities. Causes = biological and psychosocial, genetic, neurobiological (enlarged amygdala) Treatment = psychosocial, integrating treatments, little success with meds

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Intellectual Disability (ID)

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person must have significantly subaverage intellectual functioning, with a cut-off IQ score of 70, deficits or impairments in adaptive functioning, communication, self-care, home living, social and interpersonal skills, self-direction, and this must all be evident before the age of 18

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panic attack

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an abrupt discomfort, accompanied by physical symptoms that usually include heart palpitations, chest pain, shortness of breath, and dizziness Expected panic attack = ex: fear of heights. More common in specific phobias. Unexpected panic attack = if you don't know when or where the next attack will occur.

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Culture and anxiety

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pervasive across cultures. Specific fears documented in every culture. Gender differences similar across cultures. Expression, course, and interpretation of symptoms vary by culture.

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Gender differences in children's fears

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by age 6, anxiety disorders are twice as prevalent in girls than boys. May be due to report bias. Girls more willing to admit their fears and anxieties. Relates to genetic influences, social roles, and experiences.

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Childhood Anxiety Disorders

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Separation anxiety disorder, specific phobias, social anxiety disorder, generalized anxiety disorder (worrying about many different things), panic disorder (rush of physical symptoms out of the blue) and agoraphobia, and school refusal and test anxiety

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Cognitive Behavioral Treatment for Child Anxiety

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reduce overall frequency and intensity of the anxiety response, decrease maladaptive behaviors/thinking, help child learn new ways of coping with stressful situations and negative emotions,

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Generalized Anxiety Disorder

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at least 6 months of excessive anxiety and worry more days than not. Difficult to turn off or control the worry process. Characterized by muscle tension, mental agitation, fatigue, irritability, and difficulty sleeping. For children, only one physical symptom must be present to be diagnosed. People worry about minor, everyday life events * different from other anxiety disorders. Starts in late teens, more prevalent in minorities and females. 5% of population. Comorbidity: depression, substance abuse, and other anxiety disorders. Treatment = psychoeducation about the nature of anxiety, cognitive restructuring, situational exposure, discourage avoidance.

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Three Component Model of Fear and Anxiety

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Breaking down anxiety to: Thoughts, feelings, behaviors. Treatment addresses each of these components.

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Fear and Avoidance Hierarchy

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breaking fears into smaller steps, building rewards, practice in vivo (classrooms, trains, elevators, malls, etc.) No relaxation techniques during exposure.

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Other anxiety treatments

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Relaxation Training script - progressive muscle relaxation with imagery. Targeting Thoughts: detective thinking - identify thought, look for evidence to support or deny thought, come up with realistic interpretation.

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Obsessive Compulsive

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Its own section in the DSM-5. Consists of obsessions or compulsions or both. Allows distinction for insight (poor, good, absent). Tic-related specifier. obsession - intrusive and mostly nonsensical thoughts, images, or urges that the individual tries to resist or eliminate. Causes them anxiety --> compulsions. compulsions = the thoughts or actions used to suppress the obsessions and provide relief. the obsessions or compulsions cause marked distress, take more than 1 hour/day, or significantly interfere with the person's normal routine, occupational functioning, or social activities or relationships Prevalent in 1.6% of people, more in females. Age of onset = 19, but earlier for males. Checking is prevalent in many college students.

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Treatment for OCD

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Exposure and Response Prevention - reduce aversiveness of feared situations and thoughts via repeated in vivo or imaginal exposure while preventing engagement in compulsions. Superior to meds at follow-up. SSRIs are also used. Mindfulness-based treatment.

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habituation

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the natural drop in anxiety that happens when you stay "exposed" and "prevent the response"

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Body Dysmorphic Disorder

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Classified under OCD. normal looking people that imagine they are so ugly that they are unable to interact with others or function normally for fear that people will laugh at them. Obsessions of defects and repeatedly checking appearance. Either a fixation or avoidance of mirrors. Suicidal ideation and behavior. Ideas of reference for imagined defect. Equal in females and males. Onset - early 20s. Most seek out plastic surgery. Chronic. 50% believe their imagined defect is real. In DSM-5: added "with muscle dysmorphia" specifier. Treatment = Parallels that for OCD, exposure and response prevention, SSRIs, plastic surgery is not helpful,

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Trichotillomania

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hair-pulling disorder. Classified under OCD. Results in hair loss, distress, and significant social impairments. 1% - 5% of college students, females more than males. May be genetic influence. Often co-occur with OCD and BDD. Treatment = Habit Reversal Training - awareness training, development of a competing response, building motivation, and generalization of new skills. SSRIs

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Hoarding Disorder

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Classified under OCD. hoard things, fearing that if they throw something away, then they might urgently need it. 2% of population.

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Excoriation

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(skin-picking disorder) part of OCD and related disorder. Largely female disorder. 1% of population.

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Somatic Symptom and Related Disorders

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DSM-5. Includes disorders in which preoccupation with health or appearance can become so great that it interferes and dominates a person's life. Chronic. Age of onset is adolescence. 17% of population have these disorders.

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Illness anxiety disorder

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Somatic Symptom Disorder: Severe anxiety about possibility of having or developing a disease; physical symptoms may be mild or nonexistent. Comorbid with anxiety and mood disorders; especially panic disorder; runs in families; almost any physical sensation may become the basis for concern; disease conviction is a core feature; Reassurances only have short-term effect. Causes = Vicious cycle of focused attention on sensations, making them more intense, increasing anxiety, and thus causing additional physical symptoms. Disorders of cognition or perception with strong emotional contributions. Biological and psychological vulnerabilities to anxiety. Family history of illness. Linked to antisocial personality disorder. Treatment = CBT - identify and challenge illness-related misinterpretations, provide substantial reassurance. Explanatory therapy - explain the disorder, results in reduction of fears.

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Somatic symptom disorder

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excessive focus on physical symptoms, severe somatic complaints, no medical basis for complaints, severe impairment, persistent for more than 6 months. Continually feel weak and ill. More common in females, unmarried, low SES, age of onset = adolescence. Psychological or behavioral factor, particularly anxiety or distress, are compounding the severity and impairment associated with the physical symptoms.

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Dissociative disorders

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when people assume a new identity because they feel they have lost theirs or they lose their memory or sense of reality and are unable to function. Often due to severe stress, trauma, or abuse. More likely to happen when sleep deprived.

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Psychological factors affecting other medical conditions

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Somatic Symptom Disorder. Example: the anxiety in panic disorder might worsen a person's asthma. Example 2: being in denial of medical condition and neglecting treating it.

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Conversion Disorder

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Somatic Symptom Disorder. Physical malfunctioning - going blind when all visual processes are normal; experiencing paralysis when there is no neurological damage. Lack physical pathology. Malfunctioning often involved sensory-motor areas. Includes total mutism, loss of sense of touch, seizures, lump in throat. Often unaware of their actual abilities. Precipitated by marked stress. Tough to distinguish between conversion disorder and malingerers. Comorbid anxiety and mood disorder. Primarily in females. Develops during adolescence. Children have better long term outcome than adults. Causes: individual experiences a traumatic event, represses the conflict, anxiety continues to increase, and the person converts into physical symptoms(Primary gain of reinforcing event). Social and cultural influences. Biological vulnerability. Treatment = Attending to the trauma and addressing the primary gain. Remove sources of secondary gain. Reduce talk about symptoms. Catharsis - reliving the event.

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Factitious disorder

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falsification of symptoms, symptoms are under voluntary control, but there is no obvious reason for voluntarily producing the symptoms except, possibly to assume the sick role and receive increased attention. The deceptive behavior is evident even in the absence of obvious external rewards. The behavior is not better explained by another mental disorder.

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Munchausen Syndrome by proxy/ Factitious disorder by proxy

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An adult may purposely make her child sick for the attention and pity then given to the mother who is causing the symptoms but it is really an atypical form of child abuse; mother becomes overly involved in care of the child; medical staff may at first perceive parent as remarkably caring; great lengths to keep child looking "ill" for the attention

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Changes in the DSM of Somatic Symptom Disorders

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1) excessive thoughts, feelings, or behaviors related. 2) 6 months of being symptomatic. 3) one or more somatic symptoms are distressing resulting in significant disruption of daily life.

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Dpersonalization-Derealization Disorder

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Depersonalization = Distortion in perception of your own reality. Derealization = losing a sense of the reality of the external world; things seen to change shape or size; you dissociate from reality. *When feelings of unreality are so severe and frightening that they dominate an individual's life and prevent normal functioning. Comorbidity with anxiety and mood disorders. Onset = 16. Chronic course. Causes = cognitive deficits in attention, short-term memory, spatial reasoning. Easily distracted. Treatment = little is known.

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Dissociative Amnesia/Dissociative Fugue

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Generalized type = inability to recall anything, including identity Localized or selective - failure to recall specific (usuallt traumatic) events Dissociative fugue = amnesia is accompanied with leaving or wandering away from home. Confused travel, take off to a new place, unable to remember the past, unable to remember how they arrived at a new location. Often assume new identity. Usually occurs in adulthood. Rapid onset and dissipation. Mostly seen in females. Most people get better without treatment and remember what they forgot.

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Dissociative Identity Disorder

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Dissociation of personality. Adopt several new identities (as many as 100) but average is 15. Identities show unique behaviors, voice, and posture. Alters - the different identities Host - the identity that keeps other identities together Switch - quick transition from one personality to another. Caution* people try to fake DID to get away with crimes. Ratio of females to males is 9:1. Onset in childhood. 1.5% of population. High comorbidity rate, with a lifelong chronic course. Causes = most have histories of abuse. Most are highly suggestible. Closely related to PTSD. Biological vulnerability, environmental, smaller amygdala. Treatment = focus is on reintegration of identities. Identify and neutralize cues/trigger that provoke memories of trauma.

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