Abnormal Psychology - Phase 1: Introduction PDF

Abnormal Psychology Phase 1: Introduction Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR Introduction ▪ To spec...

Abnormal Psychology Phase 1: Introduction Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR Introduction ▪ To specify what makes the disorder different o Psychological Disorder – psychological from normal behavior dysfunction within an individual associated with o Prevalence – How many people in the distress or impairment in functioning and a population as a who have/had the disorder? response that is not typical or culturally o Incidence – how many new cases occurring expected during a given period ▪ Psychological Dysfunction – refers to a o Course – individual pattern of symptoms breakdown in cognitive, emotional, or ▪ Chronic – last a long time behavioral functioning ▪ Episodic – likely to recover a few months ▪ Distress or Impairment – individual is only to suffer re-occurrence extremely upset and cannot function ▪ Time-Limited – disorder will improve properly without treatment in a relatively short ▪ Atypical or Not Culturally Expected – period with little or no risk or recurrence deviates from the average or the norm of the o Onset – beginning of the disorder culture ▪ Acute – sudden o Psychopathology – scientific study of ▪ Insidious – gradually over an extended psychological disorders period of time o Clinical/Counseling Psychologist – received o Prognosis – anticipated course of the disorder Ph.D. and follow a course of graduate-level o Etiology – study of origins, why the disorder study lasting approx. 5 years begins o Psy.D. – focus on clinical training and de- o Ego-Syntonic – behaviors are aligned with your emphasize or eliminates research training personal values and self-image o Ph.D. – integrate clinical and research training o Ego-Dystonic – actions that are inconsistent o Psychiatrists – first earn an M.D. in med school, with your ego then specialize in Psychiatry History o Psychiatric Social Workers – earns master’s in Supernatural social work as they develop expertise in o During the last quarter of the 14th century, collecting information relevant to the social and Roman Catholic Church fought back against evil family situation of the individual in the world that is believed must have been o Scientist-Practitioners – they may keep up with behind these disorders the latest scientific developments in their field o People turned to magic and sorcery to solve and utilize the knowledge in their practice their problems because they also believed that ▪ Evaluate their own assessments and psych disorders were the works of the devil treatment procedures to see whether they and witches are effective o Treatments include exorcisms, shaving the ▪ Conduct research that produces new pattern of a cross in the hair of the victim’s head information about disorders or their and securing sufferers to a wall near the treatments, thus becoming immune to the church fads that plague our field, often at the o Mental depression and anxiety were expense of patients and their families recognized as illness, although symptoms such o Presenting Problem or Present – traditional as despair and lethargy were often identified by shorthand way of indicating why the person the church as a sin of acedia, or sloth came to the clinic o Common treatments was rest, sleep, and o Clinical Description – represents the unique health and happy environment (baths, combination of behaviors, thoughts, and ointments, and happy environment) feelings that make up a specific disorder o Nicholas Oresme – suggested that melancholy ▪ Clinical – refers both to the types of (depression) was the source of some bizarre problems or disorders that you would find in behavior, rather than demons a clinic or hospital and to the activities connected with assessment and treatment  Abnormal Psychology Phase 1: Introduction Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR o Possession is not always connected with sin o Chinese focused on the movement of air or but may be seen as an involuntary and the “wind” throughout the body possessed individuals as blameless ▪ Unexplained mental disorders were caused o In the middle ages, if exorcism failed, some by blockages of wind or the presence of authorities resorted to confinement, beatings, cold, dark wind (yin) as opposed to warm, and other forms of torture as treatment life-sustaining (yang) (hanging people over a pit full of poisonous ▪ Treatment: acupuncture snakes o Advanced Syphilis – sexually transmitted o Mass Hysteria – whole groups of people were disease caused by a bacterial microorganism simultaneously compelled to run out in the entering the brain, include delusions streets, dance, shout, rave, and jump around in o General Paresis – psychotic patients patterns as if they were a particularly wild deteriorated steadily, becoming paralyzed and party (Saint Vitus’s Dance and Tarantism) dying within 5 years of onset o Paracelsus – rejected the notions of o John P. Grey – believed that the causes of possession and suggested that the movement insanity were always physical of moon and starts had profound effects on ▪ Invented rotary fan people’s psychological functioning ▪ Conditions in hospitals greatly improved o Johann Weyer – founder of modern psychiatry; o In the 1930s, the physical interventions of used compassion and pioneering approach in electric shocks and brain surgeries were often treating mental illness in Europe during the used time of witchcraft o Manfred Sakel – used large doses of insulin to Biological convulse and temporarily comatose patients o Hippocrates – Father of Modern Medicine (Insulin Shock Therapy) ▪ Hippocratic Corpus (Hippocratic Oath) o Benjamin Franklin – discovered that mild and ▪ Suggested that psych disorders should be modest electric shock to the head produced treated like any other disease brief convulsion and memory loss but ▪ Psych disorders might also be caused by otherwise did little harm brain pathology or head trauma and could be o Joseph von Meduna – schizophrenia is rarely influenced by heredity observed to individuals with epilepsy ▪ Brain is the seat of wisdom, consciousness, o Emil Kraepelin – founding fathers of modern intelligence, and emotion psychiatry ▪ Also coined the word Hysteria to describe a ▪ Contributed to the diagnosis and concept he learned about from the Egyptians classification of disorders (now Somatic Symptoms Disorders) ▪ Dementia Praecox ▪ Wandering Uterus Psychological o Galen – adopted the ideas of Hippocrates and o Aristotle – emphasized the influence of social developed Humoral Theory of Disorders environment and early learning on later a. Blood – heart; sanguine – cheerful and psychopathology optimistic o Moral Therapy – basic tenets included treated b. Black Bile – liver; melancholic – depressed institutionalized patients as normally as and sentimental possible in a setting that encouraged and c. Yellow Bile – spleen; choleric – apathetic reinforced normal social interaction and chill ▪ Philippe Pinel and Jean-Baptiste Pussin – d. Phlegm – brain; phlegmatic – hot-tempered Moral Therapy in Framce ▪ Two treatments: Bloodletting and induced ▪ William Tuke – Moral Therapy in England vomiting ▪ Benjamin Rush – Moral therapy in US ▪ Robert Burton – recommended eating ▪ Dorothea Dix – mental health movement tobacco and half-boiled cabbage to induced o Franz Anton Mesmer – suggested to his vomiting patients that their problem was caused by an  Abnormal Psychology Phase 1: Introduction Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR undetectable fluid found in all living organisms o Anna Freud – Ego Psychology (defensive called animal magnetism reactions of ego, determines our behavior) o Jean-Martin Charcot – demonstrated some o Heinz Kohut – focused on a theory of formation techniques of mesmerism were effective with a of self-concept and the crucial attributes of the number of psychological disorders, and he did self that allow individual to progress toward much to legitimize the fledgling practice of health (Self-Psychology) hypnosis o Object Relations – study of how children o Freud partnered with Josef Breuer to incorporate the images, the memories, and experiment different hypnotic procedure and sometimes the values of a person who was discovered “Unconscious” mind important to them (introjection) o Catharsis – release of emotional material o Carl Jung – introduced the concept of collective o Structure of Mind: unconscious, which is wisdom accumulated by ▪ Id - pleasure society and culture that is stored deep in ▪ Ego - reality individual memories and passed down from ▪ Superego – morality generation to generation o Defense Mechanisms – unconscious protective o Alfred Adler – created the term Inferiority processes that keep primitive emotions Complex associated with conflicts in check so that the o Free Association – patients are instructed to ego can continue its coordinating function say whatever comes to mind without the usual socially required censoring o Dream Analysis – therapist interprets the content of dreams o Transference – patients come to relate to the therapist much as they did to important figures in their childhood o Countertransference – therapist project some of their own personal issues and feelings, usually positive, onto the patient Humanistic o Self-Actualizing – highest potential, in all areas of functioning o Abraham Maslow – postulated Hierarchy of Needs o Carl Rogers – originated Person-Centered Therapy o Unconditional Positive Regard – the complete and almost unqualified acceptance of most of the client’s feelings and actions o Psychosocial Stages: Oral, Anal, Phallic, o Empathy – sympathetic understanding of the Latency, Genitals individual’s particular view of the world o Fixation – if we did not receive appropriate o Thomas Szasz – societies invented the concept gratification during a specific stage of mental illness so that they can control o Castration Anxiety – fear of losing penis people whose unusual patterns of functioning o Oedipus Complex – battle of lustful impulses upset or threaten social order towards his mother and castration anxiety on o Joseph Wolpe – Systematic Desensitization other o Hans Selye – developed General Adaptation o Electra Complex – young girl wanting to Syndrome (GAS) replace her mother and possess her father ▪ three-stage process that describes the (penis envy) physiological changes the body goes o Neuroses – disorders of the nervous systems through when under stress  Abnormal Psychology Phase 1: Introduction Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR ▪ Stage 1: Alarm – refers to the initial situations they feared so that their fear could symptoms the body experiences when extinguish under stress o Operant Conditioning – behavior changes as a ▪ Stage 2: Resistance – After the initial shock function of what follows the behavior (rewards of a stressful event and having a fight-or- or punishment) flight response, the body begins to repair ▪ B.F. Skinner itself. It releases a lower amount of cortisol, ▪ Edward Thorndike – Law of effect (behavior and your heart rate and blood pressure can be strengthened or weakened) begin to normalize. ▪ Reinforcement – reward ▪ Stage 3: Exhaustion - result of prolonged or ▪ Shaping – process of reinforcing successive chronic stress; no longer have energy to approximations to a final behavior or set of fight stress behaviors Genes o Genes – long molecules of DNA at various locations on chromosomes, within cell nucleus o 46 Chromosomes, 23 Pairs, 22 Pairs of Autosomes, 1 pair Sex Chromosomes o XX – female, XY – male o Dominant and Recessive o Adverse life events can overwhelm the influence of genes o Erik Kandel – speculated that the process of learning affects more than behavior; environment may occasionally turn on certain genes Behavioral o Diathesis-Stress Model – individuals inherit o Classical Conditioning – type of learning in tendencies to express certain traits or which neutral stimulus is paired with response behaviors, which may then be activated under until it elicits that response conditions of stress ▪ Unconditioned Stimulus – natural stimulus ▪ Diathesis – a condition that makes someone ▪ Unconditioned Response – natural or susceptible to developing disorder unlearned response (vulnerability) ▪ Conditioned Stimulus – newly conditioned ▪ The higher vulnerability, the lesser life event introduced stress needed to trigger traits ▪ Conditioned Response – response from the o Gene-Environment Correlation Model – people conditioned stimulus might have genetically determined tendency to ▪ Extinction – without CS showed long create the environment risk factors that trigger enough, the behavior could be eliminated a genetic vulnerability o Stimulus Generalization – strength of the o Epigenetics – study how your behavior and response to similar objects or people is usually environment can cause changes that affect a function of how similar these objects or your genes work people are Neuroscience o Introspection – Edward Titchener; subjects o Neuroscience – how the nervous system and report their inner thoughts and feelings after the brain works towards understanding our experiencing certain stimuli behavior, emotions, and cognitive processes o John B. Watson – founder of behaviorism o Central Nervous System – processes all ▪ Little Albert information received from our sense organs o Systematic Desensitization – patients were and reacts as necessary gradually introduced to the objects or o Neurons – nerve cells that transmit information throughout the NS  Abnormal Psychology Phase 1: Introduction Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR o Dendrites – receive messages from other o Cerebral Cortex – provides us with our nerve cells distinctly human qualities, allowing us to look o Axon – transmit impulses to other neurons to the future and plan, to reason, and to create o Synapses – connections to other neurons ▪ Left Hemisphere – responsible for verbal o Action Potentials – electric impulses where and other cognitive processes information is transmitted ▪ Right Hemisphere – perceiving the world o Terminal button – end of axon around us and creating images o Synaptic Cleft – space between terminal button ▪ Lobes: Frontal, Parietal, Occipital, Temporal of one neuron and the dendrite of another ▪ Prefrontal Cortex – area responsible for o Neurotransmitters – biochemicals that are higher cognitive functions released from the axon of one neuron and ▪ HPA Axis – Hypothalamus, Pituitary Gland, transmit the impulse to the dendrite receptors Adrenal Cortex of another neuron Peripheral Nervous System ▪ Excitatory – increase the likelihood that the o Somatic Nervous System – controls the connecting neuron will fire muscles ▪ Inhibitory – decrease the likelihood that the o Autonomic Nervous System – regulate connecting neurons will fire cardiovascular system and endocrine system o Glial Cells – modulate neurotransmitter activity ▪ Sympathetic – fight or flight responses Brain ▪ Parasympathetic – calms the sympathetic o Brain Stem – lower and more ancient part of nervous system; rest and digest functions the brain; essential for autonomic functioning o Endocrine System – glands produce hormones such as breathing, heartbeat, etc. that is released to the blood streams ▪ Hindbrain – contains the medulla, pons, and ▪ Pituitary – master gland cerebellum; regulates many autonomic ▪ Thyroid – controls metabolism and growth activities such as breathing, heartbeat, and (thyroxine) digestion ▪ Parathyroid – controls the levels of calcium ▪ Cerebellum – controls motor coordination ▪ Adrenal – controls metabolism, blood abnormalities associated with autism pressure, sex development, stress ▪ Midbrain – coordinates movements with (epinephrine) sensory input and contains parts of reticular ▪ Pineal – releases melatonin activating system (contributes to sleep, ▪ Pancreas – creates insulin arousal and tension) ▪ Testes – makes sperm and release ▪ Thalamus and Hypothalamus – involves in testosterone regulating behavior, emotions, and ▪ Ovaries – releases estrogen, progesterone, hormones and testosterone o Limbic System – located around the edge of the Neurotransmitters center of the brain o Agonist – effectively increase the activity of the ▪ Hippocampus, Cingulate Gyrus, Septum, and neurotransmitters Amygdala o Antagonist – decrease or block ▪ Regulate emotional experiences and neurotransmitter expressions and, to some extent, our ability o Inverse Agonists – produces effects opposite to to learn and to control impulses those produced by the neurotransmitters ▪ Also involved with the basic drives of sex, o Reuptake – neurotransmitter is released, aggression, hunger and thirst quickly broken down and brought back to the o Basal Ganglia – base of the forebrain, includes synaptic cleft caudate nucleus o Glutamate – excitatory neurotransmitters that ▪ Damage involved changing our posture or turns on many different neurons leading to twitching or shaking action ▪ High levels is linked to Parkinson’s, Alzheimer’s, and Huntington’s  Abnormal Psychology Phase 1: Introduction Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR ▪ Low levels is linked to learning and memory o Taxonomy – classification of entities for issues scientific purposes o Gamma-Aminobutyric Acid/GABA – inhibitory o Nosology – taxonomy of psychological or neurotransmitter medical phenomena ▪ Inhibit the transmission of information and o Nomenclature – describes the names or labels action potential of the disorders that make up the nosology ▪ Benzodiazepines – make it easier for GABA o 1952: APA first published DSM-I to attach themselves to the receptors of ▪ Includes 106 mental disorders specialized neurons ▪ Distinguished personality disturbance from ▪ Reduces levels of anger, hostility, neurosis aggression, and perhaps even more o 1968: DSM-II positive emotional states ▪ 182 mental disorders ▪ Decreased GABA activity = mood disorders, ▪ Strived toward an “atheoretical” approach anxiety, schizophrenia, ASD ▪ Homosexuality was referred as Scythians o Serotonin – regulates our behavior, moods and Disease thought processes o 1980: DSM-III attempted to take an atheoretical ▪ Low levels = less inhibition and with approach to diagnosis, relying on precise instability, impulsivity and the tendency to descriptions of the disorders as they presented overreact, aggression, suicide, and to clinicians rather than on psychoanalytic or excessive sexual behavior biological theories of etiology ▪ High levels = interact with GABA to ▪ DSM-III also specified and written in detailed counteract glutamate manner the criteria for identifying disorder ▪ Selective-Serotonin Reuptake Inhibitors ▪ Precise descriptive format (SSRIs) – affects serotonin more directly ▪ Multiaxial format (5 Axis) and are used to treat number of ▪ Clear shift from psychodynamic approach psychological disorder ▪ 265 diseases o Norepinephrine – stimulate at least two groups ▪ DSM-III-R – 292 mental disorders of receptors called alpha-adrenergic and beta- o 1994: DSM-IV adrenergic receptors ▪ Distinction between organically based ▪ High levels = high blood pressure, arrythmia, disorders and psychologically based etc. disorders ▪ Low levels = anxiety, depression, ADHD, ▪ 297 disorders headaches, memory problems, etc. ▪ 5 Axes o Dopamine – implicated in the pathophysiology o 2000: DSM-IV-TR of schizophrenia and disorders of addiction ▪ TR = Text Revision ▪ Low levels = less motivated ▪ Corrected minor errors and improved the ▪ High levels = more competitive, aggressive supportive educational material and poor impulse control ▪ Mental retardation (now called IDD) o Endorphin – relieves pain, reduce stress, ▪ Used to have Autism (now ASD), Asperger’s improves well-being Syndrome and Childhood Disintegrative DSM-V Disorder o Idiographic Strategy – tailoring the treatment based on the information of the client o Nomothetic Strategy – determining the general class of problems to which the presenting problem belongs (classifying the problem) o Classification – any effort to construct groups or categories and to assign objects or people to categories on the basis of their shared attributes or relations  Abnormal Psychology Phase 1: Introduction Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR clinician stated the specific reason why it is not met o Unspecified disorders – applied when symptoms do not meet the full criteria and the clinician chose to not specify the reason to make more specific diagnosis o Amok - syndrome or pattern of behavior acknowledged in southeast Asia (Malaysia, Philippines, Indonesia) characterized by sudden outbursts and frenzied violent behaviors after a period of brooding and quiet o Equifinality refers to the observation that in any open system a diversity of pathways may lead Axis I to the same outcome. Disorders usually diagnosed in developmental o Multifinality suggests that any one component age may function differently depending on the Delirium, Dementia, Cognitive Disorders organization of the system in which it operates Mental Disorders due to general medical o Mental Status Exam: condition ▪ Appearance and Behavior – general Substance-related appearance, facial expressions, gestures Schizophrenia ▪ Thought Process – flow of speech, tone and Mood and Anxiety Disorders volume of voice, coherence, content of Somatoform, Factitious Disorders speech, delusions Dissociative ▪ Mood and Affect – Mood is over all state, Sexual and Gender Identity Affect is what we say at a given point Eating and Sleep ▪ Intellectual Functioning – vocabulary, Impulse-Control memory, reasoning Adjustment Disorders ▪ Sensorium – general awareness of the Other conditions surroundings – date, time, and person Axis II Personality Disorders Mental Retardation Axis III General Medical Conditions (Biological) Axis IV Psychosocial Problems Axis V Global Assessment o 2013: DSM-V ▪ Removed the Axial System ▪ Designed to usher in a system of classification wherein mental disorders exist along spectrum ▪ Strives to be evidence-based Cultural Concepts of Distress ▪ Attempt to eliminate the category Not o Ataque de Nervous – syndrome among Otherwise Specified (NOS) individuals of Latino Descent, characterized by o 2022: DSM-V-TR symptoms of intense emotional upset, including ▪ Prolonged Grief Disorder acute anxiety, anger, or grief; screaming; o Other Specified disorders – applied when attacks of crying; trembling; heat in the chest symptoms do not meet the full criteria, but the  Abnormal Psychology Phase 1: Introduction Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR rising into the head; and becoming verbally and physically aggressive o Dhat Syndrome – coined in South Asia characterized by young male patients who attributed their symptoms to semen loss o Koro - acute anxiety and a deep-seated fear of shrinkage of the penis and its ultimate retraction into the abdomen, which will cause death o Khyal Cap – syndrome found among Cambodians characterized by panic attacks o Kufungisisa – overthinking; idiom of distress and cultural explanation among the Shona of Zimbabwe o Maladi Moun – Haiti; sent sickness; interpersonal envy and malice cause people to harm their enemies by “sending illness” o Nervios – among latinos; general state of vulnerability to stressful life experiences and to difficult life circumstances o Shenjing Shuairuo – syndrome composed of weakness, emotions, excitement, nervous pain, and sleep o Susto – distress and misfortune prevalent among some latinos in US, attributed to a frightening event that causes the soul to leave the body and results to unhappiness and sickness, as well as functioning in key social roles o Taijin Kyufusho - an intense fear that one's body parts or functions displease, embarrass or are offensive to others end  Abnormal Psychology Phase 2: Anxiety, Trauma, OCD, Somatic Symptom, Dissociative Disorders Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR Anxiety Disorders ▪ Fight/Flight System (FSS) – produces an o Anxiety – negative mood state characterized by immediate alarm-and-escape response that body symptoms of physical tension and by looks very much like panic in humans apprehension about the future ▪ FFS is activated partly by the deficiencies in ▪ Subjective sense of uneasiness, set of serotonin behaviors or a physiological response o Psychological Contributions: originating in the brain and reflected in ▪ Freud: anxiety was a psychic reaction to elevated heart rate and muscle tension danger surrounding the reactivation of an o Fear – an immediate alarm reaction to danger infantile fearful situation o Panic – sudden overwhelming reaction ▪ Behaviorists: Anxiety was a product of o Panic Attack – defined as an abrupt experience learning (Conditioning, Modeling, or other of intense fear or acute discomfort, forms of learning) accompanied by physical symptoms ▪ In childhood, we may acquire an awareness ▪ Expected (Cued) – if you have a clue of that events are not always in our what/where situations a panic attack could controlꟷthe continuum of this perception occur may range from total confidence in our ▪ Unexpected (Uncued) – if you don’t have a control of all aspects of our lives to deep clue when/where the next attack will occur uncertainty about ourselves ▪ The way parents who interact with their children by responding to their needs contributes to the development of anxiety ▪ Anxiety Sensitivity: appears to be an important personality trait that determines who will and who will not experience problems with anxiety under certain stressful conditions o Social Contributions: ▪ Stressful life events trigger our biological o Intense emotional alarm accompanied by a and psychological vulnerabilities surge of energy in the autonomic nervous ▪ Repeated denials of their true thoughts, system motivates us to flee from danger emotions and behavior make these people o Biological Contributions: extremely anxious ▪ We inherit the tendency to be tense, uptight, ▪ Children who fail to receive unconditional and anxious positive rewards may be over critical of ▪ low GABA levels = increased anxiety themselves and develop harsh self- ▪ low Serotonin = increased anxiety standards ▪ Corticotropin-Releasing Factor (CRF) ▪ Many people are guided by irrational beliefs activates Hypothalamic-Pituitary- that lead them to act in inappropriate ways Adrenocortical (HPA) axis which has a wide- (Basic Irrational Assumptions) ranging effects on areas of the brain ▪ People with GAD constantly hold silent implicated in anxiety assumptions that imply they are in imminent ▪ Limbic System – mediator between the brain danger stem and the cortex that is most often ▪ Metacognitive Theory (Wells): people with associated with anxiety GAD implicitly hold both positive and ▪ Behavioral Inhibition System – activated by negative beliefs about worrying; they believe signals from the brain stem of unexpected that worrying is a useful way of appraising events and coping with threats of life  Abnormal Psychology Phase 2: Anxiety, Trauma, OCD, Somatic Symptom, Dissociative Disorders Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR ▪ Intolerance of Uncertainty Theory: certain o Diagnosis of disorder due to another medical individuals cannot tolerate the knowledge condition should be assigned if the anxiety and that negative events may occur worry, based on history to be physiological ▪ Avoidance Theory: people with GAD have effect of another specific medical condition greater bodily arousal and that worrying o Substance or medication must not be the reduces this arousal etiological cause of anxiety o Triple Vulnerability Theory – (1) Generalized o Worry whether or not they are being Biological Vulnerability; (2) Generalized judged/evaluated Psychological Vulnerability; and (3) Specific o May worry about separation but could also Psychological Vulnerability worry about other things Generalized Anxiety Disorder o If the individual experiences unexpected panic attacks as well and shows persistent concern and worry or behavioral change because of the attacks, then additional diagnosis should be considered o Worry about multiple events, situations, or activities o focus of the worry is about forthcoming problems o may be diagnosed comorbidly if the anxiety/worry is sufficiently severe to warrant clinical attention o women diagnosed with this disorder outnumber men 2 to 1 o children experience some degree as part of growing up and that all use ego defense mechanisms; their defense mechanisms are particularly inadequate o Fear Circuit is excessively active o Improper functioning by various neurons, o Individuals with GAD do not respond as strongly structures, interconnections, or other to stressors as individuals with anxiety neurotransmitters throughout the fear circuit disorders in which panic is prominent o Low cardiac vagal tone, leading to autonomic inflexibility o May have arisen in early stressful experiences where they learned the world is a dangerous place o Intense cognitive processing in the frontal lobs as indicated by EEG activity, particularly in the left hemisphere o Intense worrying may act as avoidance o Treatment: Benzodiazepines (but creates dependence to it) & Cognitive-Behavioral Treatment (beneficial for long-term), Rational- Emotive Therapy o Rarely occur prior to adolescence; may occur early in life but manifested as anxious temperament  Abnormal Psychology Phase 2: Anxiety, Trauma, OCD, Somatic Symptom, Dissociative Disorders Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR Panic Disorder, Agoraphobia, Separation Anxiety o Nocturnal Panic – occur during delta wave or slow wave sleep, which typically occurs several hours after we fall asleep and is the deepest stage of sleep o Agoraphobia develops after a person has unexpected panic attacks o Mean age at onset is 34.7 yrs o Initial Onset: before 35 yrs old, with 21 yrs the o Very rare in childhood mean age o Chronic in adolescence and comorbid with o Persistent and chronic other disorders o If the fear, anxiety is limited to one of the o PD shouldn’t be diagnosed if full-symptom agoraphobic situation, the Specific Phobia must panic attacks was never experienced be diagnosed o PD is not diagnosed with panic attacks are o Although we all typically experience rapid direct physiological consequence of another heartbeat, if you have psychological or medical conditions or substance cognitive vulnerability, you might interpret the o Norepinephrine activity is indeed irregular in response as dangerous and feel a surge of people who suffer from panic attacks anxiety o Susto – disorder that is characterized by o Early object loss and/or separation anxiety sweating, increased heart rate, and insomnia predispose to someone to develop the condition but not by reports of anxiety or fear, even as an adult though a severe fright is the cause o Ataques De Nervios – quite similar to panic attack but with shouting or bursting into tears o Kyol Goeu – wind overload, too much wind or gas in the body which may cause blood vessels to burst  Abnormal Psychology Phase 2: Anxiety, Trauma, OCD, Somatic Symptom, Dissociative Disorders Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR Blood-Injection-Injury Phobia Nosocomephobia – hospitals o Separation Anxiety Disorder predominantly Hemophobia – blood concerns real or imagined separation from Trypanophobia – needles attachment figures Dentophobia – dentists o Onset: early as preschool age and may occur Situational Phobia some time during childhood and adolescence Aerophobia – flying o In SepAnx, threats of separation from close Claustrophobia – tight or crowded spaces attachments may lead to extreme anxiety and Glossophobia – public speaking panic attacks Sociophobia – social judgment o SepAnx is not responsible for school absences Nature Environment Phobia or school avoidance Acrophobia – heights o School refusal in SepAnx may be common but Entomophobia – insects due to fear of being away with attachment Mysophobia – dirt and germs figures Escalophobia - escalators o SepAnx = fear of POSSIBLE separation is the Animal Phobia central thought Zoophobia – animals o SepAnx concern about the proximity and safety Arachnophobia – spiders of key attachment figures Cynophobia – dogs o Treatment: High-Potency Benzodiazepines, Musophobia – mice and rats SSRIs, closely related serotonin- o Acquired through direct experience, norepinephrine reuptake inhibitors, Panic experiencing in false alarm, and observing Control Treatment, Exposure exercises, CBT others Specific Phobia o Usually develops in early childhood o Irrational fear of a specific object or situation o Situational phobias tend to have a later age at that markedly interferes with an individual’s onset ability to function o Women: Men, 2:1 o Treatment: Exposure-based exercises  Abnormal Psychology Phase 2: Anxiety, Trauma, OCD, Somatic Symptom, Dissociative Disorders Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR Social Anxiety Disorder (Social Phobia) and o Should be diagnosed only when a child has an Selective Mutism established capacity to speak in some social situations o SAD may be associated with SM o Holding unrealistically high standards o They learn to perform avoidance and safety behaviors to avoid disasters o Treatment: CBT, D-Cycloserine Trauma- and Stressor-Related Disorders Reactive Attachment Disorder o Human beings are also prepared to fear angry, critical, or rejecting people o Fearful of scrutiny by others o Panic attacks are always cued by social situations and do not occur “out of the blue” o Typically have adequate age-appropriate social relationships and social communication capacity o Disorder manifest in similar fashion between the ages of 9 months and 5 years o Less is known about the clinical presentation of reactive attachment disorder in children, and diagnosis should be made with caution in children older than 5 yrs o Experienced history of severe social neglect o Show social communicative functioning comparable to their overall level of intellectual o Rare childhood disorder characterized by a functioning lack of speech in one or more setting in which o Show lack of preferred attachment despite speaking is socially expected having attained a developmental age of at least o Usually before age 5 yrs 9 months o Many individuals outgrow selective mutism o Restricted to specific social situation  Abnormal Psychology Phase 2: Anxiety, Trauma, OCD, Somatic Symptom, Dissociative Disorders Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR Disinhibited Social Engagement Disorder o Described from the second year of life through adolescence among children raised in institutional settings, and even into young adulthood o Can be distinguished from ADHD by not showing difficulties in attention or hyperactivity Posttraumatic Stress Disorder  Abnormal Psychology Phase 2: Anxiety, Trauma, OCD, Somatic Symptom, Dissociative Disorders Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR o If you have a strong supportive group of people around you, it is much less likely you develop PTSD after trauma o Heightened activity in the HPA axis o Treatment: Catharsis, Imaginal Exposure o In non-western groups, avoidance is less commonly observed, whereas in eastern groups somatic symptoms are more common o An adjustment disorder is also diagnosed when the symptom pattern of PTSD occurs in response to a stressor that does not meet PTSD criterion A o Requires that trauma exposure precede the onset or exacerbation of pertinent symptoms o Disruptions in the individual’s attention and concentration can be attributable to alertness to danger and exaggerated startle responses to reminders of the trauma Acute Stress Disorder o Someone experiences trauma and developed disorder o The greater the vulnerability, the more likely we are to develop PTSD o Higher intelligence predicted decreased exposure to these types of traumatic events  Abnormal Psychology Phase 2: Anxiety, Trauma, OCD, Somatic Symptom, Dissociative Disorders Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR o Begins within 3 months of onset of a stressor o If symptoms persist beyond 6 months after the stressor or its consequences have ceased, the diagnosis will no longer apply o May sometimes be diagnosed instead of bereavement if bereavement is judged to be out of proportion to what would be expected or significantly impairs self-care and interpersonal relations Prolonged Grief Disorder o Cannot be diagnosed until 3 days after a traumatic event o PD will only be diagnosed if panic attacks are unexpected and there is anxiety about the future attacks o If the symptoms persists for more than 1 month and meet the criteria for PTSD, then diagnosis will be changed to PTSD o Psychological Debriefing – form of crisis intervention that has victims of trauma talk extensively about their feelings and reactions within the days of critical incident Adjustment Disorder  Abnormal Psychology Phase 2: Anxiety, Trauma, OCD, Somatic Symptom, Dissociative Disorders Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR b. Forbidden Thoughts or actions (Aggressive/Sexual/Religious) c. Cleaning/Contamination d. Hoarding o It is also common for tic disorder to co-occur in patients with OCD o The tendency to develop anxiety over having additional compulsive thoughts may have generalized biological and psychological precursors as anxiety in general o Onset after the age 35 is unusual but does occur o Obsessions of OCD usually do not involve real- o Focused on feelings of loss and separation life concerns and can include one, irrational, or from a loved one rather than reflecting magical content generalized low mood o In BDD and Trichotillomania, the compulsive o Involves distress from a deceased person behavior is limited to hair pulling in absence of Obsessive Compulsive and Related Disorders obsessions Obsessive-Compulsive Disorder o Hypothesis 1: Early experiences taught them that some thoughts are dangerous and unacceptable because terrible things they ae thinking might happen and they would be responsible o When children come to fear their own id impulses, and use ego defense mechanisms to lessen anxiety o Some children experience intense rage and shame as a result of negative toilet-training experience during the Anal Stage o Have intrusive thoughts more often than other people o Thought-Action Fusion – clients with OCD equate thoughts with specific actions or activity represented by the thoughts ▪ Caused by attitudes of excessive responsibility and resulting guilt developed during childhood, when even a bad thought is associated with evil intent o Etiology: 1. Deficits in Yedasentience – subjective feeling of knowing 2. Behavioral models emphasize operant o Obsessions – intrusive and mostly nonsensical conditioning of compulsions (that thoughts, images, or urges that the individual compulsions are reinforced to reduce tries to resist or eliminate anxiety) o Compulsions – thoughts or actions used to 3. Mistrust of memory suppress the obsessions and provide relief 4. Thought Suppression o 4 Major Types of Obsessions: o Treatment: Exposure and Ritual Prevention, a. Symmetry Psychosurgery  Abnormal Psychology Phase 2: Anxiety, Trauma, OCD, Somatic Symptom, Dissociative Disorders Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR Body Dysmorphic Disorder Hoarding, Trichotillomania, Excoriation o May first emerge around ages 15-19 yrs old, start interfering with the individual’s everyday functioning by mid-20s, and cause clinically significant impairment by the mid-30s o Often chronic o Possible intervention by third parties in children must be considered when making o Preoccupation with some imagined defect in diagnosis appearance by someone who actually look o Prader-Willi Syndrome must be crossed out reasonably normal o Not diagnosed if it is judged to be a direct o “imagined ugliness” consequence of neurodevelopmental or o Formerly known as “Dysmorphophobia” neurocognitive disorders o Most of them goes to medical doctors to correct their deficits o Mean age onset: 16-17 yrs old o Most common age onset: 12-13 yrs old o Excessive appearance related preoccupations and repetitive behaviors that are time- consuming o Eating disorders and BDD can be co-morbid o May be seen in infants, resolved during early development o Onset commonly coincides with or follows the onset of puberty o Should not be diagnosed when hair removal is performed solely for cosmetic reasons o In individuals with OCD that has obsession with symmetry, diagnosis of hair-pulling must not be given  Abnormal Psychology Phase 2: Anxiety, Trauma, OCD, Somatic Symptom, Dissociative Disorders Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR o Requires distressing or impairing somatic symptoms that may or may not be associated with another medical condition but must be accompanied by excessive or disproportionate thoughts, feelings, or behaviors o Anxiety and somatic symptoms are more persistent o The focus is on the distress that particular symptoms cause o Most often has onset during adolescence, o The individual’s belief that somatic symptoms usually begins as with dermatological condition might reflect serious underlying physical o In absence of deception, excoriation disorder illness are not held with delusional intensity can be diagnosed if there are repeated Illness Anxiety Disorder attempts to decrease or stop skin picking Somatic Symptom Related Disorders o Somatic Symptom Disorder – problems preoccupying these people seem to be physical disorders o Formerly known as Briquet’s Syndrome Somatic Symptom Disorder o Chronic, episodic, and relapsing o Rare in children although onset can occur in childhood or adolescence o Peaks in middle age o If a medical condition is present, the health- related anxiety and disease concerns must be disproportionate to its seriousness o SSD requires the presence of somatic o Likely to be chronic and fluctuating and symptoms that are distressing or result in influenced by the number of symptoms, significant disruption, whereas illness anxiety individual’s age, level of impairment, and any disorder, somatic symptoms either are not comorbidity present or, if present, mild in intensity o Factors that distinguish individuals with o People with somatic symptom disorders have somatic symptom disorder from individuals enhanced perceptual sensitivity to illness cues with general medical conditions alone include o They also tend to interpret ambiguous stimuli the ineffectiveness of analgesics, a history of as threatening o These disorders seems to develop in the mental disorders, unclear provocative or context of a stressful life event palliative factors, persistence without cessation, and stress o People who develop these disorders tend to have had a disproportionate incidence of disease in their family when they were children  Abnormal Psychology Phase 2: Anxiety, Trauma, OCD, Somatic Symptom, Dissociative Disorders Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR o Or an important social and interpersonal Psychological Factors affecting Other Medical influence may be involved Conditions o Treatment: Psychodynamic Psychotherapy, CBT Conversion Disorder (Functional Neurological Symptom Disorder) o Particularly in younger children, corroborative o Mean onset of nonepileptic attacks peaks at history from parent or school can assist the ages 20-29 years, and motor symptoms have diagnostic evaluation their mean onset at ages 30-39 years o The psychological or behavioral factors are o Prognosis may be better in younger children judged to affect the course of the medical than in adolescents condition o Unexpected neurological disease cause for the o Psychological factors affecting other medical symptoms is rarely found at follow-up conditions is diagnosed when the psychological o Coexist with recognized neurological disease traits or behaviors do not meet criteria for a and may be part of the prodromal state of some mental diagnosis progressive neurological diseases o Emphasis is on the exacerbation of the medical o Conversion Disorder can be diagnosed along condition with SSD o Anxiety may be a relevant psychological factor o If both Conversion Disorder sand Dissociative affecting medical condition, but the clinical disorder are present, both diagnoses should be concern is the adverse effects on medical made condition Factitious Disorder  Abnormal Psychology Phase 2: Anxiety, Trauma, OCD, Somatic Symptom, Dissociative Disorders Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR o Derealization – your sense of external world is lost; things may seem to change shape or size; people may seem dead or mechanical o Onset: 16 yrs old, although it can start un early or middle childhood o Can vary greatly from brief to prolonged episodes o Rare onset after 40, but in such cases the individual should be examined more closely for o Malingering – refers to producing false medical underlying medical conditions symptoms or exaggerating existing symptoms o Characterized by the presence of constellation in hopes of being rewarded in some way of typical depersonalization/derealization o La Belle Indifference – patients with conversion symptoms and the absence of other reactions had the same quality of indifference manifestations of illness anxiety disorder to the symptoms thought to be present in some o If the depersonalization/derealization clearly people with severe SSD precedes the onset of MDE or clearly continues o One of intermittent episodes after its resolution, the diagnosis applied o Onset: early adulthood, often after o Symptoms that occur only during panic attacks hospitalization must be not diagnosed with D/DD o When imposed on another, the disorder may o In such presentations, the diagnosis of begin after hospitalization of the dependent depersonalization/derealization can be made if o Individual provides false information (1) D/DD component of the presentation is very o Requires illness falsification is not fully prominent from the start; (2) D/DD continues accounted for by external rewards even after PD has remitted or has been o Evidence of deceptive falsification of symptoms successfully treated o Requires induction of injury in association with Dissociative Amnesia deception Dissociative Disorders Depersonalization-Derealization Disorder o Generalized Amnesia – unable to remember anything lifelong or may extend from a period in a more recent past o Depersonalization – your perception alters so o Localized or Selective Amnesia – failure to that you temporarily lose the sense of your own recall specific events, usually traumatic, that reality, as if you are in a dream watching occur during a specific period yourself o Psychogenic Amnesia – memory loss due to psychological cause  Abnormal Psychology Phase 2: Anxiety, Trauma, OCD, Somatic Symptom, Dissociative Disorders Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR o Biogenic Amnesia – due to biological factors o Autohypnotic Model – people who are (tumors, accidents, etc.) suggestible may be able to use dissociation as o Dissociative Fugue – memory loss revolves a defense against extreme trauma around a specific incident, an unexpected trip; ▪ When trauma becomes unbearable, the individuals just take off and later find person’s very identity splits into multiple themselves in a new place, unable to dissociated identities remember why or how they got there o Treatment: helping the patient visualize and o Observed in young children, adults, and relive aspects of the trauma until it simple a geriatric populations terrible memory instead of current event o If a person experiencing PTSD cannot recall o Dissociative disorders are caused by part or all of a specific traumatic event and that repression, the most basic ego defense extends to beyond the immediate time of the mechanism trauma, comorbid diagnosis of DA may be o Absent-mindedness – often fail to register info warranted bec out thoughts are focusing on other things o There must be no true neurocognitive deficits o Déjà vu – strange sensation of recognizing a Dissociative Identity Disorder scene that we happen upon for the first time o Jamais Vu – a situation that part of our daily lives felt unfamiliar o Tip-Of-The-Tongue – unable to recall info but we know we know it end o Host Identity – the person who becomes the patient and asks for treatment; usually developed later o Switch – transition from one personality to another o Most surveys report high rate of childhood trauma in cases of DID o DID seems to have the same etiology as PTSD o Some suggested that DID is an extreme subtype of PTSD o Individuals with DID are at high risk for adult interpersonal trauma o Additional presence of Identity Disruption, characterized by two or more distinct personalities o Hypnotic Trance – tend to be focused on one aspect of their world and they become vulnerable to suggestions by the hypnotist  Abnormal Psychology Phase 3: Mood Disorders and Suicide, Eating and Sleep-Wake Disorders, Physical Disorders, Sexual Dysfunctions Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR Mood Disorders o Unipolar Mood Disorder – individuals who suffers either depression or mania; mood remains at one “pole” of the usual depression- mania continuum o Unipolar Depression – have no history of mania and return to a normal or nearly normal mood when their depression lifts o Bipolar Disorders – have periods of mania that alternate with periods of depression o Most people with Unipolar Mood Disorder develops to Depression o Major Depressive Episode – most commonly diagnosed and most severe depression o Hypomania – less severe version of a manic episode that does not cause marked impairment in social or occupational functioning o Anhedonia – loss of energy and inability to engage in pleasurable activity or have any “fun” o Mania – extreme pleasure in every activity, becoming extraordinarily active, requires little sleep, and may develop grandiose plans, believing they can accomplish anything they desire ▪ Persistently increased goal-directed activity or energy  Abnormal Psychology Phase 3: Mood Disorders and Suicide, Eating and Sleep-Wake Disorders, Physical Disorders, Sexual Dysfunctions Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR Bipolar I, Bipolar II, & Cyclothymic Disorder symptoms over the individual’s baseline in order to justify an additional diagnosis of BP1 o BP1 consists of at least one MANIC episode o Peak age at onset of BP1: between 20 and 30 years, but onset occurs throughout the lifespan o Children should be judged according to his or her own baseline in determining whether a o BP2 – major depressive episodes with particular behavior is normal or evidence of a HYPOMANIC episodes rather than full manic manic episode episodes o First episode is usually depressive and its o Can begin in late adolescence and throughout symptoms are the most frequent symptoms adulthood, slightly later than bipolar disorder experienced across the long-term course of but earlier than MDD BP1, and usually the individual seeks help for o Often begins with depressive episodes depression o Highly recurrent, also have seasonal variation o Factors that could be considered before in mood compared to those with BP1 diagnosing MDD: o The number of lifetime episodes tends to be ✓ If there is a family history of Bipolar higher for BP2 than for MDD or BP1 Disorder o Once the hypomanic episode has occurred, it ✓ Onset of illness in early 20s never reverts back to MDD ✓ Past episodes o Switching from a depressive episode to a manic ✓ Presence of psychotic symptoms or hypomanic may occur, both spontaneously ✓ History of lack of response to and during the treatment for depression antidepressant treatment or the emergence o BP2 is distinguished from cyclothymic disorder of a manic episode during antidepressant by the presence of one or more hypomanic treatment episodes and one or more MDE o The diagnosis is “Bipolar I disorder, with o The diagnosis of BP2 with psychotic features, if psychotic features” if the psychotic symptoms psychotic symptoms have occurred exclusively have occurred EXCLUSIVELY during manic and during major depressive episodes major depressive episodes o The double counting of symptoms toward both o Symptoms of mania in BP1 occur in distinct ADHD and BP2 can be avoided if the clinician episodes and typically begin in late clarifies whether the symptoms represent a adolescence or early adulthood distinct episode and if the noticeable increase o When any child is being assessed for Mania, it over baseline required for the diagnosis of BP2 is essential that the symptoms represent clear is present change from the child’s typical behavior o Mania may be linked to low serotonin activity o Symptoms of mood lability and impulsivity must accompanied by high norepinephrine activity represent a distinct episode of illness, or there o Among bipolar individuals, irregularities of must be a noticeable increase in these these ions may cause neurons to fire too easily  Abnormal Psychology Phase 3: Mood Disorders and Suicide, Eating and Sleep-Wake Disorders, Physical Disorders, Sexual Dysfunctions Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR (mania) or too stubbornly resist firing o Treatment: Lithium, Interpersonal and Social (depression) Rhythm Therapy, CBT Disruptive Mood Disorder, Major Depressive Disorder, Persistent Depressive Disorder, & Premenstrual Dysphoric Disorder o Cyclothymic Disorder – milder but more chronic version of bipolar disorder o Do not meet the complete criteria for depressive symptoms and hypomanic symptoms o Usually begins in adolescence or early adult life and is sometimes considered to reflect a temperamental predisposition to other disorders o Experience onset of mood symptoms before the age of 10 o With Anxious Distress Specifier – at least two of the following symptoms during majority of o Onset must be before age of 10 yrs, with the days of the current manic, hypomanic, or developmental age of younger than 6 yrs MDE: o The diagnosis of DMDD must be made while ✓ Feeling tense considering the presence or absence of ✓ Feeling unusually restless multiple other conditions ✓ Concentration difficulty o DSMM is not episodic conditions, hence, the ✓ Fear that something awful may happen diagnosis cannot be assigned to a child who has ✓ Feeling that the individual might lose control ever experienced a full duration hypomanic or of himself or herself manic episode or who has ever had a manic or o With Mixed Features Specifier hypomanic episode lasting more than 1 day o Rapid Cycling Specifier – presence at least 4 o Presence of severe and frequently recurrent mood episodes in the previous 12 mounts that outbursts and persistent disruption in mood meat the criteria for manic, hypomanic, or MDE between outbursts o With Melancholic Features o Requires severe impairment in at least one o With Atypical Features setting and mild to moderate impairment to o With Psychotic Features – delusions or second settngs hallucinations o can receive comorbid diagnosis of ADHD o With seasonal pattern - at least one type of o children with DMDD may have symptoms that episode also meet criteria for anxiety disorder and can  Abnormal Psychology Phase 3: Mood Disorders and Suicide, Eating and Sleep-Wake Disorders, Physical Disorders, Sexual Dysfunctions Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR receive both diagnoses, but children who months during which they were entirely free of irritability is manifest in the context of depressive symptoms exacerbation of an anxiety disorder diagnosis o Depression with earlier age at onset are more rather than DMDD familial and more likely to involve personality o IED and DMDD should not be made in the same disturbances child o If criteria are met for both MDD and PDD, both o For children with outbursts and intercurrent can be diagnosed persistent irritability, only the diagnosis of o Irritability is confined to the major depressive DMDD should be made episodes o When the depressive symptoms meet full criteria for a MDE, a diagnosis of other specified depressive disorder may be made in addition to the diagnosis of psychotic disorder o Distractibility and low frustration tolerance can occur in both ADHD and MDE; if the criteria are met for both, ADHD may be diagnosed in addition to the mood disorder o May additionally further described as seasonal (if it changes with seasons), catatonic (marked by either mobility of excessive activity), peripartum (during pregnancy or within 4 weeks of giving birth), and melancholic (person is almost totally unaffected by pleasurable events) o May first appear at any age, but the likelihood of onset markedly with puberty o Chronicity of depressive symptoms substantially increases the likelihood of underlying personality, anxiety, and substance use disorders and decreases the likelihood that o Often has an early and insidious onset and, treatment will be followed by full symptom chronic course resolution o Early onset is associated with a higher o Ask individuals presenting with depressive likelihood for comorbid personality disorders symptoms to identify the last of at least 2 and substance-use disorders  Abnormal Psychology Phase 3: Mood Disorders and Suicide, Eating and Sleep-Wake Disorders, Physical Disorders, Sexual Dysfunctions Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR o If full criteria for a major depressive episode c. Mixed Features have been met at some point during the current d. Melancholic Features episode of illness, a diagnosis of MDD would e. Peripartum Onset apply. Otherwise, a diagnosis of other specified f. Seasonal Pattern depressive disorder or unspecified depressive o Seasonal Affective Disorder – episodes must disorder should be given have occurred for at least 2 yrs with no o A separate diagnosis of PDD is not made if the evidence of nonseasonal MDE during that symptoms occur only during the course of the period of time psychotic disorder ▪ Cabin fever o Integrated Grief – acute grief, the finality of death and its consequences are acknowledged and the individual adjusts to the loss o Complicated Grief – this reaction can develop without preexisting depressed state o Bipolar disorder may simply be a more severe variant of mood disorders o These disorders may be inherited separately and therefor be separate disorders at all o Permissive Hypothesis – when serotonin (norepinephrine) levels are low, other neurotransmitters are permitted to range more widely, become dysregulated, and contribute to mood irregularities o Chronic Stress reduces dopamine levels and produces depress-like behavior o People who are depressed, there is a significantly shorter period after falling asleep before REM sleep begins o Depriving depressed patients of sleep, particularly during the second half of the night, causes temporary improvement in their conditions o Stress and trauma are among the striking contributions to the etiology of all the o Onset can occur at any point after menarche psychological disorders o PMS do not require a minimum of five o Introjection – direct all their feelings for the symptoms nor mood-related symptomatology loved one, including sadness and anger, toward and is generally considered to be less severe themselves than Premenstrual Dysphoric Disorder o Symbolic or Imagined Loss – person equates o Double Depression – suffer from both MDE and other kinds of events with the loss of a loved PDD with fewer symptoms one ▪ Few depressive symptoms develop first and o Object relation theorist propose that then one or more MDE occur later only to depression results when people’s relationships revert to underlying pattern of depression – especially their early relationship – leave once the MDE has run its course