Abnormal Psychology – Exam 2 (Chapters 7, 8, 10, 11, 12) – Flashcards
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Depressive disorders
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Depressive disorders are unipolar mood disorders, separate from bipolar Depression is the most common presenting disorder 15% of people with depression commit suicide Most effective treatment is a combination of medication and CBT Types: -Major depressive disorder -Persistent depressive disorder -Seasonal affective disorder -Postpartum depression (PPD) -Premenstrual dysphoric disorder (PMDD)
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Major depressive disorder
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Must have experienced most if not all of the depressive symptoms (over a period of at least 2 weeks) at least once, with no mania Major depressive episodes can last a year or more in severe cases Can be just as debilitating as a physical illness - may have poor appetite, poor sleeping habits, inability to get out of bed, lose or gain substantial weight May be accompanied by psychotic symptoms (delusions and hallucinations) More common in women Most common type of mood disorder Most people who experience one episode will continue to have recurring episodes - genetic influence, causal factors like low SES and separation / divorce
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Persistent depressive disorder
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Symptoms are fewer and less severe - person is functioning, but not fully Lasts 2 or more years (more chronic) More common in women
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Bipolar disorders
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Both depression and mania - a form of psychosis where the person is excitable, delusional, reckless, talkative, overconfident May experience mixed states, with depression and mania switching back and forth "Rapid cycling" refers to experiencing two or more full cycles of depression and mania within a year Types: -Bipolar I disorder -Bipolar II disorder -Ciclothymia
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Bipolar I disorder
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Major depression with periods of mania - even a single manic episode qualifies a person for bipolar I If a person with bipolar I has not had a manic episode yet, they may be treated with an antidepressant, causing them to become manic - must include mood stabilizer when treating with antidepressants May have periods of normalcy without symptoms Definitely biological, but not everyone with a predisposition develops it (diathesis stress model) Equal rates in men and women - however, men usually begin with a manic episode, while women usually begin with a depressive episode
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Bipolar II disorder
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Major depressive disorder with hypomania (a less severe form of mania- doesn't meet the criteria for diagnosis of mania) Some bipolar II patients go on to develop bipolar I
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Ciclothymia
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Persistent depressive disorder with hypomania (a less severe form of mania) for 4+ days Least intense type of bipolar - milder mood swings lasting at least 2 years Most common type of bipolar, but underdiagnosed
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Psychodynamic causal factors in depressive disorders
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The person experiences loss, neglect, or abandonment - they feel anger (pathological mourning - powerful ambivalent feelings) Repress feelings and turn the anger against themselves (introjection) - self-hatred Earlier experience of loss = greater predisposition for depression Bipolar disorder - shifting dominance between ego (mania) and superego (depression)
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Behavioral / learning causal factors in depressive disorders
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Seligman's experiment with dogs and learned helplessness (electric shocks) - comparison with depression, sense of hopelessness / helplessness For people, learned helplessness can result from repeated failures - lack of positive reinforcement
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Cognitive causal factors in depressive disorders
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Attributional style: how you explain your own behavior - a depressed person has an internal / stable / global attributional style (it's my fault, it will never change) and also tend to catastrophize Beck also describes the cognitive triad of depression: -negative view of self -negative view of environment -negative view of future Cognitive distortions (Burns) - all-or-nothing thinking, overgeneralization, mental filter, etc.
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Biological causal factors in depressive disorders
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Genetic factors (regulation of serotonin) - major depression runs in families, twin studies Life stressors have a greater effect on those with genetic predisposition to depression Imbalance of neurotransmitters (serotonin and norepenephrine) - not just a lack of neurotransmitters, but lack of receptors or sensitivity Even stronger genetic factors in bipolar disorder - possible sperm defects in older men
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Psychodynamic treatments for mood disorders
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Treat by exposing underlying anger / ambivalent feelings and allowing the person to grieve their loss - turn anger outward and verbally express feelings
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Cognitive behavioral treatments for mood disorders
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14-16 weeks of CBT - treat with cognitive restructuring to change attributional style, change automatic thought into rational response Treat learned helplessness by creating a sense of accomplishment / empowerment
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Biomedical treatments for mood disorders
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Treat neurotransmitter imbalance with medication - antidepressants for depression, lithium for bipolar Some side effects may exacerbate depression, but newer drugs (SSRIs) tend to have fewer side effects and work more holistically Another possible treatment is ECT (last resort) or magnetic stimulation therapy (not yet FDA-approved)
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Personality disorders
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Ego syntonic - people with PDs view their behavior as normal, because the disorder is deeply ingrained in their personality Not easy to treat (restructuring personality), not likely to seek help, generally do not learn from their mistakes or believe that their behavior is disruptive PDs are lifelong (from childhood) but are not diagnosed before age 18 Diathesis stress model - may be triggered by environmental stress, childhood abuse / neglect / abandonment - may also be raised by a parent with PD People with PDs tend to have dysfunctional relationships - seen as "difficult people" - blame others for their problems They may choose careers that validate their personality and allow for / encourage abnormal behavior (eg, actors with narcissism) Often accompanied by mood disorders Cluster model - goes from highest to lowest level of functioning (lowest to highest level of severity) Cluster A - paranoid, schizoid, schizotypal Cluster B - histrionic, narcissistic, antisocial, borderline Cluster C - avoidant, dependent, obsessive-compulsive
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Cluster A personality disorders
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These disorders tend to be associated with odd / eccentric behavior, beliefs, speech, and appearance Types: -Paranoid -Schizoid -Schizotypal
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Cluster B personality disorders
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These disorders tend to be associated with erratic / volatile behavior, and involve overcompensation for weak ego / self-esteem but may appear to be the opposite Types: -Histrionic -Narcissistic -Antisocial -Borderline
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Cluster C personality disorders
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These disorders tend to be associated with high levels of fear and anxiety Types: -Avoidant -Dependent -Obsessive-compulsive
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Psychodynamic perspective on personality disorders
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Early stage fixations (oral, anal, etc.) for each type of disorder Problems in early development (up to 3 years) while establishing a sense of self - lack of parental empathy and support, inability to form cohesive images of self and others or separate self (separation-individuation)
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Cognitive-behavioral perspective on personality disorders
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Learning perspective focuses on maladaptive behaviors rather than diagnoses Connection to childhood experiences, learned behaviors, modeling of parents and society
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Substance dependence
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Physical dependence: physical changes occur in the body due to substance abuse - tolerance, withdrawal, and habituation Psychological dependence: feeling of mentally and emotionally depending on a substance to cope with life
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Substance-induced disorders
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Patterns of abnormal behavior that occur due to substance abuse - delirium, intoxication, sleep disorders, dementia, memory loss (Korsakoff's syndrome), etc.
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Tolerance
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A state of physical habituation to a substance - needing greater quantities of a substance to get the same level of intoxication Withdrawal will occur if the substance is not ingested - may suffer delusions and hallucinations, effects vary based on the type of substance
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Pathways to addiction
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1. Experimentation phase - occasional use most users stop here 2. Routine use - recreational, increasing frequency, some level of denial 3. Psychological dependence - 4. Physical dependence
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Depressants
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Depressants slow the nervous system and cause a drowsy feeling Also reduce tension and anxiety, slow movement, and can arrest vital functions if overused Alcohol, opioids, benzodiazepines, barbiturates (sedatives)
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Stimulants
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Stimulants speed up the nervous system and cause increased heart rate, loss of appetite, nausea, and erratic behavior (amphetamine psychosis) High doses cause a euphoric rush - coming down can lead to depression and suicide Amphetamines, cocaine, nicotine, MDMA, caffeine
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Hallucinogens
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Psychedelic effects, intense sensory experiences, changes in perception of time / color / sound No evidence of physical addictiveness, but tolerance / cravings may occur PCP, LSD, marijuana, mescaline (peyote), psilocybin (shrooms)
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Biological perspective on substance-related and addictive disorders
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Substance use increases dopamine, activating reward centers - can decrease the brain's own production of dopamine over time, increasing dependency May also involve other neurotransmitters (serotonin and endorphins) Environmental factors linked to early experimentation - genetic factors linked to continued use throughout life Genetic predisposition may involve structure of dopamine receptors
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Learning perspective on substance-related and addictive disorders
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Operant conditioning - social influence / observation (observational learning) leads to drug use, then drugs become associated with euphoria and anxiety reduction Alcohol use - tension-reduction theory (more use = more dependence), and self-medication for psychological pain Negative reinforcement - relieving pain, withdrawal symptoms Classical conditioning - any reminder of the substance (sight, smell, certain people or locations) becomes a trigger for cravings
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Cognitive perspective on substance-related and addictive disorders
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Having positive expectations about the outcome of drug use (eg popularity) increases the likelihood of use - affected by peer attitudes Beliefs about alcohol boosting self-efficacy, ability to interact with others Self-fulfilling prophecy / absolutist effect - alcoholics believe that even a single drink leads to complete loss of control, so it does
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Psychodynamic perspective on substance-related and addictive disorders
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Oral-dependent personality - alcoholism typically paired with other oral traits such as dependence and depression, also smoking habit
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Biological treatment of substance use disorders
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Begin treatment with detoxification - must get through withdrawal symptoms safely (antianxiety drugs can help) Drugs - disulfiram (causes nausea when combined with alcohol), antidepressants (may reduce cravings), naltrexone (prevents high from drug use) Nicotine replacement therapy - gum, patches Methadone maintenance programs - synthetic opiate, more regulated and less dangerous than heroin - other synthetic opiates include buprenorphine and levomethadyl
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Residential / non-residential treatment of substance use disorders
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Non-residential: AA, NA, and other non-professional self-help groups - AA maintains that addiction is a disease that cannot be cured Residential: hospitalization recommended for those who behave self-destructively and can't exercise self-control - usually involve a 28-day detox period
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Behavioral treatment of substance use disorders
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Focus on modifying abusive and dependent behavior patterns Self-control training - control the three ABC's: antecedent, behavior, consequences Contingency management programs - monetary rewards for staying clean Aversive conditioning - associating drug use with unpleasant stimuli such as nausea Social skills training - develop effective responses in situations where drug use is promoted Controlled drinking - moderation can be a first step toward complete abstinence
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Relapse prevention treatment of substance use disorders
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Designed to help substance users identify high-risk situations and learn effective coping skills Prevent individual lapses from turning into full-blown relapses
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Gender dysphoria
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Experiencing significant personal distress or impaired functioning as a result of a conflict between anatomical sex and gender identity
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Gender identity
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The psychological sense of being male or female
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Sexual orientation
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Strongly biological - there are some brain structure differences (gay men have a smaller hypothalamus) - also, there is a higher than expected percentage of gay and lesbian people in some families (especially related on the mother's side)
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Paraphilic disorders
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Targets of sexual attraction (including objects, activities, etc.) are outside the norm To diagnose - must be present for 6 months or longer, and cause personal distress / impairment / harm to others Rarely diagnosed in women Some types are relatively harmless and victimless Types: fetishism, transvestism, exhibitionism, voyeurism, frotteurism, pedophilia, sexual masochism, sexual sadism
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Fetishism
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Sexual gratification can only be attained with a specific article of clothing, behavior, etc. - cannot get aroused without it! Usually occurs in men May arise from a childhood experience
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Transvestism
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Straight men getting sexual gratification from wearing women's clothing
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Exhibitionism
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Sexual gratification from exposing oneself inappropriately - they get off on the shock factor, not usually interested in actual sexual contact
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Voyeurism
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Sexual gratification from watching others naked or having sex when they don't know they're being watched
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Frotteurism
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Sexual gratification from rubbing up against or inappropriately touching strangers in a crowd
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Pedophilia
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Sexual attraction to children - a pedophile must be at least 16 years old, and at least 5 years older than the victim -true pedophiles don't go for children post-puberty Some people are attracted only to children, others to both children and adults - not all child molesters are pedophiles (attraction to children must be stronger) Most pedophiles have a history themselves of being abused - tend to have a history of fewer relationships, feel threatened by other adults
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Sexual masochism
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Sexual gratification from having pain inflicted on you - one example is hypoxyphilia (autoerotic asphyxiation) More common in men, but may occur in women Connects with sadists
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Sexual sadism
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Sexual gratification from inflicting pain on others Connects with masochists - a small minority become sadistic rapists
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Psychological perspective on paraphilic disorders
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Lovemap (Money) - childhood experiences determine the types of stimuli and activities that become associated with sexual gratification later on, may be "tarnished" by trauma
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Biological perspective on paraphilic disorders
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Sex drives of those with paraphilias tend to be higher than average - more fantasies, shorter refractory period Differences in brain wave patterns on fMRI, especially with pedophiles
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Psychoanalytic treatment of paraphilic disorders
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Paraphilias are a defense against leftover castration anxiety from the phallic period of psychosexual development Sexual masochism and other disorders may represent an escape from the ordinary self
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Cognitive-behavioral treatment of paraphilic disorders
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Generally aversion therapy is used to reduce pleasurable associations by pairing them with electric shocks Also masturbatory reassociation to create pairings with healthier stimuli
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Biomedical treatment of paraphilic disorders
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There are drugs that can reduce testosterone levels (antiandrogens) to help control urges - antidepressants may help by reducing libido Some men volunteer for castration, although it may not stop the urges
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Sexual dysfunctions
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Lifelong vs. acquired Situational vs. generalized 1. Disorders of interest and arousal -Male hypoactive sexual desire disorder -Female sexual interest / arousal disorder -Erectile disorder 2. Orgasm disorders -Female orgasmic disorder -Delayed ejaculation -Premature ejaculation 3. Genito-pelvic pain / penetration disorder
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Male hypoactive sexual desire disorder
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Full physical functionality but low libido (compared to the average male 8-25% of men, more common in older men
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Female sexual interest / arousal disorder
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Lack of sexual interest, or not responsive to stimulation 10-55% of women, more common in older women
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Erectile disorder
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Inability to get or maintain an erection More likely to occur when men are older - 20-40% of men in their 60s, increasing more with age Can also be caused by alcohol intake May have physical cause, but Masters and Johnson found that the origin is often psychological
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Female orgasmic disorder
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Responsive to stimuli, but difficulty achieving orgasm from any source of stimulation 10-42% of women
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Premature ejaculation
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Ejaculation that occurs before it is desired by the man - often within about one minute of penetration - only problematic when it is persistent More common in younger men - 30% or more Start-stop technique - stopping sexual activity before orgasm occurs - trains the guy to read his own body better and slow down if too excited Squeeze technique - squeezing gently under the penis to reduce arousal
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Genito-pelvic pain / penetration disorder
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Pain during sexual intercourse or attempts at penetration May involved vaginismus, involuntary vaginal contraction during penetration may be caused by an STD or history of sexual abuse About 15% of women in North America
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Psychological perspective on sexual dysfunctions
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Emphasizes the role of anxiety (eg performance anxiety), lack of sexual skills, irrational beliefs (Ellis), perceived causes of events, and relationship problems Sexual abuse victims can become afraid of sex, or hypersexualized - may also have depression, guilt, and identity issues
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Biological perspective on sexual dysfunctions
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Low testosterone levels may be connected, but most people with sexual dysfunctions have normal hormone levels Disease (eg diabetes, cardiovascular problems) may manifest in disorders like erectile dysfunction Can also be caused by some medications
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Sociocultural perspective on sexual dysfunctions
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Women have historically believed that sex is for the pleasure of men only May also be linked to sociocultural beliefs and taboos such as sex before marriage
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Biological treatment of sexual dysfunctions
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Exercise and weight loss, reduce intake of alcohol and nicotine Drugs such as Viagra, testosterone treatment Surgery in rare cases for blocked blood vessels
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Behavioral treatment of sexual dysfunctions
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Behavioral treatment model (Masters and Johnson) involves sensate focus, similar to systematic desensitization, to relieve anxiety Sex therapists can also refer clients to sexual surrogates, if the client does not have a partner - surrogates are trained in sensate focus techniques Couples therapy to resolve relationship problems
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Sensate focus treatment of sexual dysfunctions
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Sex therapists must be licensed psychiatrists, psychologists, MSW or LMFT who are then trained in sensate focus - they mostly work with couples and assign homework Phases of sensate focus (lasts 8-12 weeks overall): *Sensate focus I* - no sexual activity allowed, including masturbation and sexual touching - partners can take turns giving and receiving non-sexual touching, such as massage, for 3x/week at 15 minutes per person *Sensate focus II* - genital touching is allowed, but not orgasm - partners are encouraged to stay present and focused - this lasts 2-3 weeks *Sensate focus III* - orgasms are allowed, but no sexual intercourse - may use techniques to correct premature ejaculation: *Vaginal containment* - intercourse is allowed, but no orgasm from sex, must stop before it occurs
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Schizophrenia spectrum disorders
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Types: -Type 1 schizophrenia -Type 2 schizophrenia -Brief psychotic disorder -Schizophrenoform disorder -Schizoaffective disorder -Delusional disorders
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Phases of schizophrenia
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Prodromal phase - gradual onset of symptoms, may occur even in acute cases Active / acute phase - full blown symptoms, significant impairment Residual phase - may occur after treatment, mostly stabilized but still experiencing some symptoms
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Features of schizophrenia
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Delusions Hallucinations Disorganized speech Disorganized or catatonic behavior Positive symptoms Negative symptoms
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Delusions
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Improbable or impossible beliefs Delusions of persecution - paranoid about being spied on or targeted Delusions of control - believing that some person / group / etc. controls your thoughts, feelings, and behavior Delusions of reference - believing that you're actually involved in events unrelated to you Delusions of sin and guilt - incorrectly believing you did something wrong Hypochondriacal delusions - believing you suffer from some improbable or impossible condition Nihilistic delusions - belief in an impending apocalypse Delusions of grandeur - believing you have special powers or status
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Disorganized speech and thoughts
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Thought broadcasting - believing that your thoughts are being broadcast to others Thought insertion - believing that others are putting thoughts into your heard Loose associations - tangential, rambling speech Word salad - using real words in an order that doesn't make sense Neologisms - inventing new words
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Disorganized or catatonic behavior
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Stupor / inactivity Mania Extreme rigidity or flexibility of limbs
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Positive symptoms
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Delusions Hallucinations Disorganized speech Disorganized or catatonic behavior
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Negative symptoms
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Absence of normal behaviors May be shut down, withdrawn, mute and unresponsive
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Biological / genetic perspective on schizophrenia spectrum disorders
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Family studies suggest strong genetic influence, more prevalent among shared genes than shared environment Dopamine hypothesis - antipsychotic effects of neuroleptics and amphetamines Abnormal brain structure and function - damage may have occurred during development, birth trauma May be linked to older fathers, viral infections
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Learning-based perspective on schizophrenia spectrum disorders
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Bizarre behaviors become more reinforced than normal behaviors (conditioning / observational learning) Modeling may occur within the setting of residential treatment
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Family perspective on schizophrenia spectrum disorders
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Theory of the schizophrenogenic mother - the belief that having a cold, domineering mother could cause a child to develop schizophrenia No evidence for this!
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Sociocultural perspective on schizophrenia spectrum disorders
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Schizophrenia is more common in low SES areas (less access to healthcare for early intervention
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Biomedical treatment of schizophrenia spectrum disorders
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Antipsychotic drugs - one type is phenothiazines, which block dopamine receptors - may cause Parkinsons-like effects such as dysthonia (twitching), akathesia (restlessness), and tardive dyskinesia (tic-like behavior) Must be stabilized with antipsychotics before any other kind of treatment can be applied - once stabilized, the patient may benefit from behavior therapy, group therapy, family therapy, and/or psychosocial rehabilitation
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Learning-based treatment of schizophrenia spectrum disorders
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Behavior therapy and group therapy to learn more appropriate behavior Selective reinforcement, token economy (rewards), social skills training
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Psychosocial rehabilitation treatment of schizophrenia spectrum disorders
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Outpatient facilities, group homes, etc. - some "clubhouses" provide multiple services such as finding housing, employment, etc. Depends on level of functionality - the goal is to reintegrate into society Cognitive rehabilitation training to improve attention and memory
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Brief psychotic disorder
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Schizophrenia symptoms lasting less than one month May be linked to stressful life events - sometimes experienced by women after childbirth
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Schizoaffective disorder
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Schizophrenia symptoms combined with major depression - at some point, delusions or hallucinations must have occurred without the presence of a major mood disorder Like schizophrenia, tends to follow a chronic course and may respond to antipsychotic medication Appears to share a genetic link with schizophrenia
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Delusional disorders
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Relatively normal functioning and clear thinking in most areas of life, but with one particular area of delusion - may be completely bizarre, or actually within the realm of possibility (such as a cheating spouse) About 25% of those with delusional disorder will develop full-blown schizophrenia - about 50% with fully recover with treatment (antipsychotic medication) Types: -Erotomanic -Grandiose -Jealous -Persecutory -Somatic -Mixed type
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Erotomanic delusional disorder
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Believing incorrectly that you have a relationship with someone you admire, often a celebrity
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Grandiose delusional disorder
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Believing that you are a significant figure or are communicating with one (eg God)
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Jealous delusional disorder
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Believing that you're being cheated on by your SO - unable to be convinced otherwise
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Persecutory delusional disorder
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Paranoia, believing that you're being spied on or targeted
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Somatic delusional disorder
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Believing that you have some improbable or impossible health condition
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Mixed type delusional disorder
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Combined symptoms with no predominant type of delusion
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Type 1 schizophrenia
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Positive symptoms - presence of schizophrenia-related symptoms Conforms to dopamine hypothesis - antipsychotic drugs block dopamine receptors to reduce symptoms, but may cause Parkinsons-like symptoms Better prognosis
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Type 2 schizophrenia
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Negative symptoms - absence of normal behaviors May be shut down, withdrawn, mute and unresponsive Caused by enlarged ventricles (the areas between brain matter Since the problem is with brain structure, drugs don't help - worse prognosis
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Schizophrenoform disorder
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Schizophrenia symptoms lasting between one and six months Some cases resolve with full functioning, others persist and become reclassified as schizophrenia
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Paranoid personality disorder
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Cluster A personality disorder Suspicious - don't trust others, expect to be hurt, questions other people's loyalty and intentions - do not have outright delusions as with paranoid schizophrenia Easily offended, hold grudges for perceived slights - may initiate multiple lawsuits Erikson - stuck at trust vs. mistrust stage Tend to avoid intimate relationships - don't often confide in others - generally can maintain employment
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Schizoid personality disorder
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Cluster A personality disorder Total indifference to social interaction - no close relationships Flat affect - indifferent to praise or criticism, don't show emotion - internal experience may be completely different, deep sensitivity Tends to have solitary jobs and hobbies, men with schizoid PD rarely date or marry Trust issues prevent them from seeking treatment
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Schizotypal personality disorder
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Cluster A personality disorder Very odd behavior, appearance, and speech Paranoia and odd beliefs - delusions, magical thinking Schizotypal = low end of the schizophrenia spectrum Highly genetic - likely to have relatives with schizophrenia and schizotypal PD Digressive and rambling speech, inappropriate affect Severe social anxiety
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Histrionic personality disorder
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Cluster B personality disorder Excessive emotional reactions, dramatic, always seeking attention and approval Emotions seem superficial, not genuine, and are expressed inappropriately May be hypersexual and obsessed with feeling attractive
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Narcissistic personality disorder
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Cluster B personality disorder See themselves aa God's gift to mankind - entitled, expect special treatment Fantasies of unlimited power and success Hypersensitive to criticism - arrogance is a cover for fragile ego Exploit and manipulate others Have trouble maintaining relationships
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Antisocial personality disorder
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Cluster B personality disorder Lacking both empathy and remorse Generally have conduct disorder in childhood - history of bullying, fighting, cruelty to people and animals Disregard for the truth Often reckless and impulsive, likely to end up in jail - makes it easier to research APD Psychodynamic perspective - no superego Tends to run in families Very resistant to treatment
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Borderline personality disorder
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Cluster B personality disorder Pervasive unstable mood, fragile self-image, pattern of intense and unstable relationships (love or hate) Have trouble interpreting emotions (their own and those of other people) Fear of abandonment leads to impulsive, self-destructive behavior - manipulation of others, no boundaries Poor prognosis, often referred out to other therapists
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Avoidant personality disorder
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Cluster C personality disorder Pervasive social discontent, fear, and anxiety - avoid social interaction Fear of rejection and embarrassment, easily hurt by criticism and disapproval No close relationships
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Dependent personality disorder
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Cluster C personality disorder Need constant reassurance and approval - fear of abandonment and criticism Can't be alone, jump from one relationship to another - not self-sufficient Indecisive - have trouble initiating things Psychoanalytic interpretation: stuck in the oral stage May seek partners with narcissistic personality disorder
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Obsessive-compulsive personality disorder
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Cluster C personality disorder Perfectionist, rigid thinking - afraid to make the wrong decision - not in touch with their emotions Judgment of self and others makes them hypersensitive to criticism May withhold attention or money when upset with others Psychoanalytic interpretation: stuck in the anal stage May seek partners with histrionic personality disorder