Abnormal Psychology: Looking at Abnormality PDF

LOOKING AT ABNORMALITY The continuum model of abnormality - what behaviors are considered normal of abnormal Study of abnormality - studying psychopathology Mental illness ○ Assuming behaviors that are viewed as pathological are the product of a mental illness...

LOOKING AT ABNORMALITY The continuum model of abnormality - what behaviors are considered normal of abnormal Study of abnormality - studying psychopathology Mental illness ○ Assuming behaviors that are viewed as pathological are the product of a mental illness ○ But we do not have one biological test to help us to diagnose any of the types of abnormality - we can only say the reasoning, feelings and behavior of a person are in line with what we associate with a certain disease The context or circumstances surrounding a behavior influences whether the behavior is viewed as abnormal ○ Cultural relativism - a view that there are no universal standards for labeling a behavior abnormal (some things are normal in different parts of the world that would be abnormal here, etc) ○ But problem when we use cultural norms to dictate what is normal and use that to justify controlling and silencing others (Holocaust, slavery) ○ Culture and gender have an effect on how an individual expresses their symptoms ○ Also influences people's willingness to admit to certain behaviors/feelings + the treatment deemed acceptable for people exhibiting abnormal behaviors Evaluating behavior in four Ds ○ Deviance The degree to which the behaviors a person engages in and their ideas are considered unacceptable or uncommon in society ○ Distress Negative feelings a person has because of their disorder or the negative feelings of other people ○ Dysfunction Maladaptive behavior that interferes with a person being able to successfully carry out everyday functions ○ Danger Dangerous or violent behavior directed at other people or oneself Historical perspectives on abnormality ○ Biological theories Similar to physical diseases - some breakdown of systems in the body Cure - restoring bodily health ○ Supernatural theories Result of divine intervention, curses, sin, possessions Cure - religious rituals, confessions, exorcism  Trephination - drilling holes into skulls to allow the evil spirits to go away ○ Psychologicla theories Result of trauma and chronic stress Cure - rest, relaxation, change of environment ○ Have an effect on how people are regarded in society ○ Ancient china - imbalance between yin and yang Human emotions are controlled by internal organs Later - evil winds and ghosts are bewitching people ○ Ancient Egypt, Greece and Rome Diseases only in woman because of a wandering uterus (tf) Abnormal behavior because of affliction of gods, imbalance in substances in the body (Hippocrates - four categories of abnormal behavior: epilepsy, mania, melancholia, brain fever) People declared insane lost rights ○ Witchcraft Women usually experienced melancholy and senility - but the church didn't like that so you were speaking with the devil, bitch ○ Psychic epidemics Phenomenon in which large numbers of people engage in unusual behaviors that appear to have psychological origin Dance frenzies Tarantism - suddenly developing an acute pain they attributed to the bite of a tarantula ○ Asylums Started as nothing more than a prison ○ Moral treatments 18th and 19th century Prescribing relaxation, praying, treating patients with dignity Dorothea Dix - responsible for the passage of laws and appropriations to fund the cleanup of mental hospitals and the training of mental health proffesionals Eventually, too many patients in asylums and not enough caretakers + imigration and prejudice against patients from different cultures -> decline in funding ○ Modern perspectives Increasement of knowledge about anatomy, neurology, etc. - beliefs that all psychological disorders can be explained in terms of brain pathology First attempts at classifying symptoms for specific diseases Discovering general paresis - disease leading do paralysis, insanity and death Syphilis as the cause of insanity Psychoanalytic perspective  Mesmarism - a method that worked thanks to trancelike state that Mesmar (mainly treated hysteria) seemed to induce -> hypnosis Freud and psychoanalysis Behaviorism Everything comes from conditioning Even complex behaviors stem from the impact of reinforcements and punishments Cognitive psychology Attention, interpretations of events, beliefs can also affect ones mental heatlh Albert Bandura Self-efficacy beliefs Albert Ellis - challenging patients irrational belief systems Drug therapies Deinstitutonalization Patents' right movement - 1960's Building community mental health centers Halfway houses - structured environments to live in, as patienst try to fix their lives Day treatment centers Managed care A collection of methods for coordinating care that ranges from simple monitoring to total control over what care can be provided and paid for Goal is to prevent future medical problems Takes away the need of an individual/their family to find appropriate needs - it's up to the primary provides (like a general practicioner) THEORIES AND TREATEMENT OF ABNORMALITY Sociocultural approach - disorders are the result of environmental conditions and cultural norms ○ Disorders are labels society puts on people who's behavior differs from social norms - using a continuum perspective of abnormality ○ Socioeconomic disadvantages, wars, natural disasters, social norms and policies, implicit and explicit rules about which abnormal behaviors are acceptable ○ Different approaches in therapy that take into account the culture of an individual (e.g. collectivist individuals need smt different than traditional western populations) Some cultures value restraint and repression  Some cultures emphasize respect for authority and the client doesn't want to take the initiative in therapy Biological approach - disorders are the result of abnormal genes or neurobiological dysfunction ○ Disorders are either present or absent ○ Recently - disorders as collections of deficits in fundamental neurobiological processes ○ Focuses on: Brain dysfunction Brain can be divided into three parts - hindbrain (basic life functions , midbrain (responses to rewards, control movement) and forebrain Forebrain - outer part called the cerebral cortex (advanced thinking processes), subcortical structures (thalamus, hypothalamus, limbic system, amygdala, hippocampus) Biochemical imbalances Neutrotransmitters - the amount of them in synapses is associated with types of psychopathology Can be affected by the reuptake (initial neuron reabsorbs the nt -> decreases the amount left in the synapse) or degradation (receiving/sending neuron releases an enzyme that breaks down the nt into other biochemicals) Also problems when there are too few/too many receptors on the dendrites The endocrine system - some disorders rise from the dysregulation and malfunctioning of a system called the hypothalamic-pituitary-adrenal axis (HPA axis) -> abnormalities in this system make it difficult to cope with stress and result in symptoms of anxiety and depression Genetic abnormalities To what extenct are behaviors or behavioral tendencies inherited and which processes are affected by genes? Genetic factors work to influence the kinds of environments we choose + the environment may act as a catalyst for a genetic tendency ○ Drug therapies Antipsychotic drugs Phenothiazines - negative side effects Mood drugs SRI's, SNRI's Anticonvulsants - treatement of mania Benzadiazepamine - anxiety disorders  ○ Brain stimulations, psychosurgeries Psychological approach - disorders are the result of thinking processes, personality styles and conditioning ○ Cognition, learning and emotional control also fall along a continuum - based on where we fall on the spectrum, we are considered as dysfunctional ○ People on the less severe end give us insight into the behavior of those on the more severe end ○ Social learning theory - Bandura Modeling - new behaviors from imitation of important people in their lives, usually an authority figure Observational learning - observing rewards and punishments that other people receive for a behavior ○ Behavioral therapies - behavioral assessment of client's problem, what are the specific circumstances that elicit the unwanted behavior Works by the method of systematic desensitization - starting with things causing low anxiety and builiding up to the big stuff ○ Cognitive therapies Causal attribution - the answer to the question of why something happened to us Global assumptions - broad beliefs about ourselves, our relationships and our world When they are maldaptive, they cause problems But do maldaptove cognitions precede and cause the disorders, or are they rather symptoms and consequences? ○ Psychodynamic theories Ego psychology - importance of the individual's ability to regulate defenses Object relations - early relationships create unconscious mental images of ourselves and others Self psychology + relational psychoanalysis - unconscious relationships with others Interpersonal therapy (ITP) - client's pattern of relationships with important people in their life More structured than normal psychodynamic therapies, offers interpretation, how to change the relationships ○ Humanistic therapies Reflection - a therapist tries to understand what the client is experiencing ○ Family systems theories The hierarchy and rules of a family govern family members' behavior A mental illness of a family member indicares of a dysfunctional family system  Inflexible family - no self autonomy, controlling Disengaged family - isolation, avoidance Behavioral family system therapy - targets family communication and problem solving ○ Third wave approaches View poor regulation of emotions as a transdiagnostic risk factos Combining behavioral and cognitive therapy with meditation practices Dialectical behavior therapy - focuses on difficulties in managing negative emotions and in controlling impulsive behaviors Aims to increase problem-solving and managing negative emotions Acceptance and commitment therapy - experiential avoidance of painful thought, memories and feelings cause problems Biopsychological approach ○ Integrating all three approaches together ○ Dealing with the nature-nurture question - says psychological symptoms stem from a combination of risk factors Biological - genetic predispositions Psychological - difficulty remaining calm in stressful situations Sociocultural - growing up in a racist area while being a poc Transdiagnostic risk factors - increase risk of multiple types of psych problems ○ A risk factor is not enough - we need a trigger as well to develop psychopathology -> DIASTHESIS-STRESS model Prevention programs ○ Stopping the development before it even starts - primary prevention (reducing drug abuse - changing neighborhoods) ○ Detecting a disorder at the earliest stages - secondary prevention  ○Preventing relapce and reducing the impact of the disorder - tertiary prevention What do all therapies have in common? ○ Positive relationship with the therapist ○ Providing an explanation or interpretation of why the patient is suffering ○ Recommendations for how to operate under symptoms ○ Confronting painful emotions - systematic desensitization ASSESING AND DIAGNOSING ABNORMALITY A continuum approach vs a categorical approach (strict thresholds and cutoffs for identifying disorders) Assesment = process of gathering information about people's symptoms and possible causes of them, information is gathered from various sources Diagnosis = set of symptoms that often occur together ○ Sets of symptoms - syndrome ○ Classification system - set of syndromes and the rules for determininh whether an individual's symptoms are part of one of these syndromes ○ DSM Modern classification systém - developed by Emil Kraepelin First very vague criteria, based on psychoanalysis Later, increased reliability and concrete descriptions of disorders Show how long a person must show symptoms of the disorder to be given a diagnosis Symptoms must interfene with occupational or social functioning Problems with reliability - many mood disorders have subjective experiences that the client must report to have and how severe they are Increasing reliability - conducting field trials to determine whether siagnostic criteria can be applied reliably and whether they fit individuals' experiences Nonaxional approach to diagnosing Normally - one axis for clinical disorders, second one for personality disorders and intellectual disabilities + axis about other factors like childhood to improve the overall clinical picture But DSM-5 - using the International Classification of Diseases The goal is to consider the individual's functional status seperately from their diagnosis or symptom status Problems with DSM These diagnoses were made up, they are technically social constructions based on society's current views  Even the newest version is still mostly categorical and provides a dimension view only on a couple of disorders (e.g. autism)… but are dimensions even practical? Comorbidity - the overlap of criteria for different disorders Cultural issues - some diseases seem to be culturally bound Modern tools used of assessment used to diagnose and help understand problems ○ Provide informatuon about the characterictics of a person, cognitive deficits, emotional well-being, etc. ○ All tools must be valid, reliable and standartized Standard method of administering tests prevents extraneous factors from affecting a person's response We should standardize both the administration and the interpretation of tests ○ Clinical interview Initial interview with the client Mental status exams How does the individual act and appear? What are their thought processes? Are they coherent? What's their mood and affect? How is their intellectual functioning, do they speak well? Are they approprieatly oriented to place, time and person? Structured interview - series of questions about symptoms ○ Symptom questionnaires Cover a wide variety of symptoms of several different disorders E.g. the BDI exam to test the level of depression ○ Personality inventories Questionnaires meant to assess people's typical ways of thinking, feeling, and behaving E.g. the Minnedota Multiphasic Personality Inventory - presenting clients with sentences describing moral and social attitudes, behaviors, psychological states and phusocal conditions (scores in different dimensions are then compared to a normal population) ○ Behavioral observation and self-monitoring Assessing deficits in the client's skills or ways of handling a situation Helping to understand why we act a certain way, how we can change our approach But individuals might alter their behavior because they are being watched, different observers might interpret things differently,  not always possible -> clients keep track of how often they partook in a behavior in a day themselves + under which conditions it occurred ○ Intelligence tests But they do not measure social skills and other talents that are still needed for an individual to be succesfull Biased to favor WEIRD populations ○ Neuropsychological tests Detecting specific cognitive deficits (e.g. memory) E.g. Bender-Gestalt Test - sensotimotor skills determined by reproducing sets of drawings (we know that there is smt wrong but don't know what) Halstead-Retain test + Luria-Nebraska test - contain more parts ○ Brain-Imaging techniqies CT = computerized tomography Amount of radiation absorbed by beams passing through the brain are measured -> computer generates an image PET = positron-emission tomography Harmless radioactive isotrope injected - parts of the brain that need glucose that’s present in it - as it decays, it releases positrons that collide with electrons and cause the making of two photons -> PET scanner sees tose and generates an image based on most active areas SPECT - same as PET but a different substance MRI - creates magnetic field around the brain that causes realignment of hydrogen atoms in the brain Turning magnetic field on and off causes atoms to emit magnetic signals ○ Psychophysiological tests EEG + ERP Measure emotional responses to a specific type of stimuli ○ Projective tests Based on the assumption that when presented with an ambiguous stimulus, people will interpret it in line with their current concerns and feelings Unconscious motives and desires Rorschach Inkblot Test Looking at themes in the responses, how they focus on small details/bigger picture Thematic Apperception Test Client is asked to make up a story about what is happening ○ Challenges in assessment Resistance to providing information  Trying to affect how the specialist sees us, refusing treatment Evaluating children Cannot describe their feelings well, showing distress only in non verbal ways Specialists have to rely on other people to gain insight - but that's not reliable Implementing own problems onto the child to try to seek treatement for themselves Cause the problems in the first place - do not want to acknowledge or seek help for the child's difficulties Cultural norms differ Teachers are usually the first to recognize a child has a problem - more valid, the child is not in the comfort of their own home Evaluating individuals across cultures Language barrier - both under and overdiagnosing Cultural biases Some cultures do not view the mind and the body as separate, they might report physical symptoms even when it's related to the mental health MOOD DISORDERS AND SUICIDE Depressive disorders ○ Symptoms of depression take over a whole person's life ○ Depressed mood out of proportion to any cause ○ Anhedonia - the loss of interest in everything ○ Psychomotor retardation - slowed down behavior ○ Psychomotor agitaton - cannot sit still, fidgeting ○ Sometimes even include delusions and hallucinations ○ Major depressive disorder (single episode/ recurrent episode - two or more episodes seperated by at least 2 months) ○ Persistent depressive disorder Depressed mood for most of the day for at least 2 years Two or more of the following symptoms Poor apetite, insomnia/hypersomnia, low energy, low self esteem, hopelessness, poor concentration Must be present at all times, max 2 months without ○ Comorbid with substance abuse, anxiety disorders and eating sidorders ○ Subtypes Anxious distress - prominent anxiety symptoms with depressive symptoms  Mixed features - depression + three symptoms of mania (but not fully diagnosed with mania) Melancholic features - extra depressed Psychotic features - delusions and hallucinations Catatonic features - strange behaviors ranging from lack of movement to excited agitation Atypical features - odd assortment of random common symptoms Seasonal affective disorder - history of two years of experiencing and fully recovering from major depressive episodes Peripartun onset - major depressice episode occurs during pregnancy or in the 4 weeks following childbirth ○ Premenstrual dysphoric disorder - separate disorder, not a subtype Bipolar disorders ○ Mania symptoms Elated mood mixed with irritation and agitation Grandiose self esteem Impulsive behavior One must show these symptoms plus thers for at least one week ○ Bipolar I disorder - manic episodes and depressive episodes, does not have to have diagnosed depression ○ Bipolar II disorder - hypomania (milder), do not intervene with daily functioning, major depressive episodes required ○ Cyclothymic disorder - some hypomania symptoms and some depressive symptoms Does not meet the full diagnosis just yet ○ Rapid cycling bipolar disorder - four or more mood episodes that meet criteria for manic, hypomanic, or major depressive episode within 1 year ○ Disruptive mood dysregulation disorder - for children age 6 and older Severe temper outbursts inconsistent with the developmental level At least three temper outbursts per week for 12 months in two settings Theories of depression ○ Biological theories Genetics First degree relatoves of people with major depressive disorder are two or three times more likely to also have depression  Depression that begins early in life - stronger genetic base Avnormalities on the seretonin transporter gene - more prone to depression when experiencing a stressfull life event Neurotransmitters Norepinephrine, seretonin, dopamine Abnormalities in synthesis of these neurotransmitters? Release process of the neurotransmitters into the cleft - abnormal? Less sensitive receptors? Structural and functional brain abnormalities Prefrontal cortex, anterior cingulate, hippocampus and amygdala Reduction of gray matter in the prefronal cortex, lower brain acitivity specifically in the left part (area involved in motivation and goal orientation) Anterior cingulate - emotional expression and social behavior Hippocampis - smaller volume and lower metabolic activity Many receptors for cortisol -> influencing the development of new neurons Amygdala - increased activity Neuroendocrine factors The HPA axis (hypothalamus + pituary + adrenal cortex Chronic hyperactivity in the HPA axis - increased fight or flight Hormones released by the HPA inhibit the receptors for the happy neurotransmitters Changes in ovarian hormones affect seretonin and norepinephrine ○ Psychological theories Behavioral Depression as a reaction to a stressful negative event Life stress lead to depression - reduces the positive reinforcers in a person's life Person strats to wuthdrawal -> even less reinforcers Depressive behaviors are reinforced by the sympathy and attention from others Learned helplesseness - the stressful event most likelu to lead to depression is an uncontrollable negative event -> people start believig they are helpless to control important outcomes in the environment  Loss of motivation, passivity Cognitive Negative cognitive triad - negative views of themselves, the world and the future Ignoring good events and exaggarating negative events Reformulated learned helplessness theory - people explain negative events by causes that are internal, stable and global Hopelessness depression - pessimistic attrivutions for the most important events in their lives and percieve they have no way to cope with consequences Ruminative response styles theory - focusing on the bad things Storing and recalling memories in a general fashion as a way of coping with traumatic past Intrapersonal Chornic conclicts with loved ones Deficits in social and communication skills Rejection sensitivity, esxessive reassurance seeking -> people get annoyed -> individual panics and wants even more reassurance -> whitdrawal of close ones How our parents act towards us Sociocultural Cohort effects - when people's differences depend on the era when they live Historical and culutral changes of recent years -> higher risk of depression Rapid changes in social values, disintegration of he family unit Younger generations have higher expectations Gender differences Women are more likely to ruminate about ther feelings + are more interpersonally oriented More prejudice and discrimination Ethnicity/race differences Stress about social status - more prone to anxiety disorders Theories about bipolar disorder ○ Biological theories Genetic First degree relayoves - five to ten time higher rates of also having it Same genes that contribute to schizophrenia Structural and functional brain abnormalities  Amygdala + prefrontak cortex + (hippocampus) - processing of emotions, control,… Striatum - processing of environmental cues of reward Abnormal hyperacitivity -> more sensitive for rewarding cues Curcuit connected to the p.c and amygdala - knowing when you should drop one strategy in favor off another in order to get a reward Abnormalities in functioning -> inflexible responses (mania - excessive seeking of reward, depression - insensivity to reward) Youth with bipolar disorder - abnormalities in white matter -> difficulty communicating, organized emotions and normal behaviors Neurotransmitters Dysregulation in the dopamine system - again with the rewards ○ Psychosocial contributors Reward sensitivity - degree to which people experience emotional, behavioral and biological responses to positive events they experience or anticipate Gets obsessed with rewarding or receiving punishment - pushes them on one side of the disorder's spectrum Stress - goal striving situations trigger high reward sensitivity Changes in bodily rhythms or usual routines Treatment ○ Biological treatments Drugs or ECT, sometimes TMS or deep brain stimulation First, believed that drugs affect the receptors of the happy neurotransmitters, now a theory about the slow-emerging effects on intracellular processes + the action of genes that regulate them, the limbic system and the stress response Selective seretonin reuptake inhibitors Safer Effects on a wide range of symptoms - even stuff like anxiety, eating disorders, … Nausea, diarrhea, tremor, no sex drive, no orgasm Bipolar people might develop more manic symptoms Might increase suicidal thought in adolescents Selective serotonin-norepinephrine reuptake inhibitors Better at preventing relapse More side effects Norepinephrine-dopamine reuptkae inhubitor  Bupropion For people suddering with psychomotor retardation, hypersomnia, inattention, helps to stop cravings Doesn't support sexual dysfunction like the other drugs Tricyclic antidepressants Numerous side effects - low blood pressure, cardiac arrhythmia Affect acetylcholine Fatal overdose Monoamine oxidase inhibitors Dangerous side effects - consuming some stuff on them can result in fatal rises in blood pressure Liver damage, weight gain Interacts poorly with other meds Mood stabilizers Lithium Improve the functioning of the intracellular processes that are abnormal in mood disorders Small difference between what is good and what is toxic - patients must be monitored closely Lots of dangerous side effects - diabetes, kidney disfunction Over half of people develop a resistance to it anywyays Anticonvulsant and atypical antipsychotic medications Antiepyleptic mendications also help to stabilize mood Valporate, Lamotrigine Cause birth defects when taken during pregnancy Do not tackle suicidal tendencies like lithium does Drugs like olanzapine, ariprizole, quetiapine, risperidone - normally for schizophrenia, but also works for mania ECT Usually used unilaterally - right hemisphere so it doesn't affect the memory and language High relapse rate Reduces metabolic action in frontal cortex and other parts rTMS Repeated high-intensity magnetic pulses Vagus nerve stimulation  Stimulation of the vagus by an electronic device -> increased activity in hypothalamus and amygdala Light therapy Mostly for SAD (their moods improve in summer) Helps to reset circadian rhythms Decreases levels of melatonin -> increase levels of seretonin and norepinephrine ○ Psychological treatments Behavioral therapy - changing patterns of interaction with the environment Cognitive-behavioral therapy - changing negative paths of thinking and solve problems with new skills Interpersonal therapy Helps clients face losses of important relationships Role disputes - when people do not agree to the roles in a relationship Developing more effective ways of communication Role transitions (college to work, etc.) Skill deficits Interpersonal and social rhythm therapy Specifically for people with bipolar disorder - helps with regular patterns of activity and routines Family focused therapy Suicide ○ = death from an injury, poisoning, or suffocation where there is evidence that the njury was self-inflicted and the decedent intended to kill themselves ○ Completed suicide, suicide attempts, suicide ideation ○ Differences between gender and racial groups ○ Rates have steadily declined since 1994, spiked after 2004 ○ Emile Durkheim - different types of suicide Egoistic suicide - who feel aliented from others, alone in an uncsupportive world Anomic suicide - severe disorientation because of a major change in a relationship to society Altruistic suicide - believe they are benefitting society Suggests social ties and integratuon into a society will help tp prevent suicide - but not when it supports it ○ Mood disorders - most closely associated with suicide (but also anorexia, bpd, substance abuse) ○ Sexual abuse, loss of a loved one, economic hardship (esspecially in African American men) ○ Physical illness  ○ Suicide clusters - when one suicide promotes another one, people relate, see it as more acceptable -> two or more suicide attempts bunched together in a short time Close friends, media exposure to celebrities Suicide contagion ○ Impulsivity - risk factor in combination with a mental health disorder ○ Hopelessness - feelings about being a burden to others and never belonging ○ Rumination, perfectionism, poor problem solving,… ○ Biological factors Genetic predisposition and neurotransmitter dysfunction Low levels of seretonin + abnormalities in genes that regulate seretonin ○ Intervention programs - for people at immidieate risk of suicide (hotlines, dialectical behavior therapy) Crisis intervention programs - short term help Aims to reduce the imminent suicide attempt Dialectical behavior therapy - for people with BPD who frequently attemp Focus on managing negative emotions and controlling impulsive behaviors ○ Prevention programs - for public in general, goal is to educate ○ Lithium + SSRI - reduces suicide risk ANXIETY DISORDERS ○ Fight or flight - modulated by the autonomic nervous system + adrenal-cortical system (HPA axis) Both mediated by the hypothalamus Corticotropis release facto signals to the pituary to secrete ACTH -> stimulating adrenal glands and releasing cortisol Emotional response - terror and dread Cognitive response - looking for danger Behavioral response - confront or escape Normal responses subside when the threat subsides - in anxiety and related disorders presumes even without any ca use ○ PTSD + acute stress disorder Consequences of experiencing extreme stressors = traumas To be diagnosed, the trauma has to be exposed or threatened death, serious injury or sexual violation that was either directly experienced, witnessed, of someone they are close to or experience details repeatedly (so called A criteria) Symptoms of PTSD: Reexperiencing of the traumatic event (nightmares, flashbacks) Persistent avoidance of situations, thoughts or memories associated with the trauma Negative changes in thought and mood associated with the event - unrealistic blame, survivor guilt, loss of memories, emotional numbness Hypervigilance and chronic arousal - always on guard for more traumatic stuff to happen Sometimes dissociation Acute stress disroder - related to traumatic events but symptoms arise within one month and last no longer than four weeks Similar symptoms, more dissociation, reduced awareness of surroundings, derealization, depersonalization Adjustment diroder Emotional and behavioral symtoms that arise within 3 months of the experience of a stressor When people do not fit in with all the symtoms of PTSD or acute stress disorder Traumas: natural disasters, human made disastrers, sexual assaults Theories of PTSD (aka what affects the development of this disorder?)  Environmental and social factors Severity and duration of the event + an individual's proximity to it The availability of social support Psychological factors People already experiencing symptoms of anxiety or depression before the trauma Styles of coping - self destructive/avoidant/dissociative coping strategies are worse Gender and cross-cultural differences Women are more prone African americans, hispanics and asian americans Culture has a strong influence on the manifestation of anxiety Ataque de nervios, nervios in Latin communities Biological factors Genetic predispositions Neuroimaging Amygdala responds more actively Medial prefrontal cortex - less activity (normally modulates the reactivity of the amygdala) Shrinkage of the hyppocampus - overexposure to stress hormones Biochemical findings Resting levels of cortisol are lower than normal -> prolonged activity of the sympathetic nervous system after stress Genetics - abnormally low cortisol levels might be heriteable Treatment Exposure to what they fear, challenging distorted cognitions that contribute to symtoms, helping to reduce overall stress Cognitive behavioral therapy Systematic desensitization Prolonged exposure therapy - repeated exposure to trauma reminders Cognitive processing therapy - reinterpretation of the traima  Stress-inoculation therapy - when clients cannot tolerate the exposure to traumatic memories Teaching how to overcome problems in life that increase their overall stress Biological therapies SSRIs + benzodiazepines - for sleep problems, irritability, nightmares Specific phobias and agoraphobia Specific phobias Irrational fears of specific objects or situations Animal type, natural environment type, situational tupe, blood injection type, others Avoiding the object, enduring disproportionate fear and anxiety towards the object Symtoms must last six months, cause clinical distress and cannot be attributed to another mental or physical disorder Agoraphobia Half of the people have a history of panic attacks that preceded the development of agoraphobia Theories Freud - phobias result from unconscious anxiety that is displaced onto a neutral or symbolic object Classical conditioning leads to the fear (aquisition), operant conditioning helps to maintain it (maintenance) Mower's two-stage theory Observational learning - seeing someone else afraid of an object makes you afraid Prepared classical conditioning - fearing objects that could cause harm to our ancestors Genetics - especially for situational and animal phobias Treatment Behavioral treatment Using exposure to extinguish the person's fear Systematic desensitization Applied tension technique - for people with blood injection injury phobias (tensing the musceles in arms and legs so you do not faint)  Modeling - the therapist does each thing in the fear hiearchy in front of the patient before asking them to do it as well - observational learning Flooding - just straight to the main thing (hold a snake, etc.) Biological treatment Benzodiazepine, valium - only help with the fear at the moment, do not help to cure the phobia Social anxiety disorder Anxiety in social situations, fears of being rejected, judged, humiliated Develops in early preschool or adolescence Most people have humiliating experiences in their earlier lives Theories Genetic basis - people are more prone to anxiety disorders in general Cognitive perspectives are the most often used Excessively high standards for their social performance, focusing on negative aspects of social interactions Noticing social cues and interpreting them as bad Overprotective and controlling parents that are often negative Parents' modeling of social anxious behavior Treatments SSRIs + SNRIs Cognitive behavioral therapy - exposure to stressful situation, relaxation techniques, role playing, removing safety behaviors (avoiding eye contact) Mindfulness based interventions - teaching how to be less judgemental about their own thoughts Group therapies - more natural ways o engage patients in social situations Panic disorder Common occurrence of panic attacks which are unprovoked by any particular situations Patient worries about having them, changes behaviors as a result  Often fear that they have a life-threatening illness, or dying because of a seizure, heartattack, etc. Theories Heritability is around 40 % Poorly regulated fight or flight response Poor regulations of norepinephrine, seretoning, GABA, CCK Hyperventilation, caffeine -> trigerring panic attacks Differences in the amygdala, hypothalamus, hippocampus Locus ceruleus - poor regulation leads to lowering the treshold for the activation of diffuse and chronic anxiety Fluctuations in progesteron Paying close attention to bodily sensations, misinterpreting sensations in a negative way, engaging in snowballing thinking, exaggerating symtoms and consequences Anxiety sensitivity - unfounded belief that bodily symptoms will have harmful consequences Interoceptive awareness - heightened awareness of bodily cues that may signal a coming panic attack Interoceptive conditioning - bodily cues that have occurred at the beginning of some past attacks become a conditioned stimuli Conditioned avoidacne response - associated places with a panic attack leads to them avoiding it -> reducement of anxious symptoms Often leads to developing agoraphobia Treatments SSRIs, SNRIs and tricyclic antidepressants Benzodiazepines - suppressing the central nervous system and influencing functioning in the GABA, norepinephrine and seretonine systems Cognitive behavioral therapy Confronting situations that arouse anxiety Teaching relaxation and breathing exercises Identifying the carastrophizing cognitions they have about bodily sensations Experiencing panic symtoms during a session and practicing breathing exercises Challenging the catasthropic thoughts Systematic desensitization  Generalized anxiety disorder Anxiety at all times in all situations Spending a lot of time an energy preparing for feared situations, avoiding situations and seeking reassurance Chornic muscle tension and sleep loss Increases risk for cardiovascular diseases Theories Emotional and cognitive factors Highly reactive to negative events, experience more intense negative emotions Feeling like emotions are not controllable and manageable Hightened reacivity in the amygdala Elevated acitivity in the sympathetic nervous system and hyperreactivity to threathening stimuli Maldaptive assumptions -> responding to situations with automatic thoughts that stir up anxiety Theory about hypervigilance Stressors or traumas which were uncontrollable and came without warning Unpredistable and uncontrollable life experiences (abusive parent) Overly controlling and demanding parents Preffering the constant level of anxiety than leaving themselves open to a sharp increase in negative emotion Worrying about all the possible outcomes actually helps to reduce the actual reactivity to unavoidable negative events Biological factors Deficiency in GABA receptors -> excessive firing of neurons in the limbic system Treatments Cognitive behavioral treatments Confronting issues they worry about the most Challenging catastrophizing thoughts Develop coping strategies  Emotional awereness and regulation therapy CBT Biological treatments Benyodiazepine - short term relief Tricyclic antidperessant imipramine + SSRI parocetine + Venlafaxin - better results However - psychologically, phisiologically addictive + side effects Seperation anxiety disorder Associated with childhood Shy, sensitive and demaning of adults - never got rid of the fear of being seperated from their parents Worrying smt bad will happen to their caregivers, fears of accidents, kidnappings Symptoms must persist for at least 4 weeks Physical symptoms when seperated - nausea, stomach aches Theories Biological Family histories of anxiety and depressive disorders Inherited tendency trait - behavioral inhibition More shy, irritable as toddlers, introverted, cautious and quiet Psychological and sociocultural More controlling and critically negative parents Not being able to control one's surroundings -> anxiety Treatments Cognitive behavioral therapies - relaxation techniques, changing the cognitions that feed the anxiety, prolonging periods of seperation Biological - antihistamines, stimulants, SSRIs ○ Obsessive compulsive disorder Obsessions - persistent thought, ideas, images or urges, that uncontrollably intrude the consciousness Compulsions - repetitive behaviors or mental acts that an individual feels they must perform  Individuals know that their thoughts and behaviors are irrational but cannot control them Begins at a young age, children usually hide the symptoms Most common obsessions Aggression (hurting smn) Sexuality (pornographic images) Religion (shouting obscenities in a house of worship) Symmetry and ordering Contamination Closely related disorder that is classified seperately - hoarding Experiencing thoughts about their possesions - more natural than unwanted Distress and anger when pressured to get rid of their hoarded possessions Also in a category with hair pulling disorder, skin picking disorder and body dysmorphia - repetition Theories Biological Circuit involving the frontal cortex, basal ganglia and thalamus Alterations in structure and activity level Body dysmorphia also present in the differences in processing visual stimuli Inability to turn off primitive urges or the execution of the stereotyped behaviors Greater reduction in the rate of activity - can be affected by serotonin Rare cases - strep infection Autoimmune processes then affect some areas of basal ganglia Genetics Cognitive behavioral theories More prone to it when distressed - inability to turn off these negative and intrusive thoughts Tendency towards rigid and moralistic thinking - judge their intrusive thoughts more harshly than normal people -> more anxious about having them Belief one should be able to control all their thoughts Compulsions develop from operant conditioning - negative reinforcement Hoarding - exaggerated sense of responsibility - feeling guilty about wasting things Treatments  Biological SSRIs or antipsychotics Cognitive behavioral Exposure and response prevention therapy Focusing on the obsession and preventing the compulsive responses Homework Changing moralistic thoughts Habit reversal training - becoming more aware ot behaviors HEALTH PSYCHOLOGY ○ = Behavioral medicine ○ How biological, psychological and social factors interact to influence physical health ○ Biological factors Genetics, age, sex - influence on our susceptibility to disease ○ Social and environmental factors - directly impact health Stress, culture ○ Psychological factors Certain behaviors enhance our health or promote disease Resilient people bounce right back from a stressful experience Fragile people - easily influenced More pessimistic style of interpreting events Causes chronic arousal of the body's fight ot flight Leads to more unhealthy behavior Coping strategies Avoidance - bad for health, denying that you are ill Talking about negative emptions and issues - encourages health Understanding and finding meaning in events happening in our lives -> reducing negative emotions Social support - reduces emotional reactivity and in turn reduces physiological reactivity to stress Women tend to seek support and comfort from others - stress releases oxytocin promoting affilitation Married people - less physical illness (but only if it’s a healthy marriage) Women are more physiologically reactive to marital conflict, more emotionally attuned  Asians tend to find comfort in social support in a more subtle way, they rarely reveal their issues Religious people are more positive, and cope better Psychological disorders More disorders leads to worse overall health Psychopathology and medical illness may share a common genetic cause (e.g. cardiocascular disease and depression are both tied to dysfunction in serotonin systems) Social and psychological stress of having a serious medical illness can cause depression and anciety Eating disorders, substance abuse -> worse health More pessimism and worse coping skills Specific diseases and psychosocial factors Immune system Innate immune system - reacts quickly and nonspecifically to any toxin that enters the body Specific immune system - slower but has a tailored response Chronic stress decreases ummune functioning - biochemicals released as part of the fight or flight response suppress the immune system if a stressor persists for long periods Especially prominent is stressors are uncontrollable Negative interpersonal events - arguing married couples, recently divorced people, Cancer Pessimistic patients are more likely to die Healthy coping strategies result in lower mortality If nothing, support can reduce depressive symtoms and improve quality of life HIV Experiencing chronic stressors affects the progession of HIV Gay men still in the closet had a faster progerssion of disease  Stressful events of people close to us - also make the progression faster History of trauma - also makes it faster Pessimism, unhealthy coping,… Coronary heart disease and hypertension When bloodbessels that suppy the hart muscles are narrowed down or closed thanks to the build up of plaque and inflammation of the vessel walls = atherosclerosis Angina pectoris - pain before the heart attack People with a family history - more prone to CHD High stress and low control jobs promote CHD Unstable social conditions - new people in our surroundings we cannot cope with Hypertension - high blood pressure Fight or flight increases blood pressure Stressul circumstances Esspecially visible in low-income African Americans History of hypertension - spike in blood pressure in more situations (hightened physiological reactivity to stress) Personality Type A behavior pattern Sense of time urgency Esaily aroused hostility Competitive striving for achievement Cynical form of hositlity characterized by suspiciousness, resentment, frequent anger, antagonism, distrust of others Hyperactivity of the sympathetic nervous system, slower return to baseline  Greater secretion of catecholamines -> frequent changes in blood pressure -> reducing resiliance of blood vessels Also tend to engage in other risk factors - smoking, high cholesterol, hypertension Have to learn how to express themselves without exploding, reevaluate certain beliefs Depression Blocked arteries also lead to reduced oxygen in he brain -> mood changes Deficiency in omega-3 fats Depression associated with reduced heart rate variability - indication of poorer functioning of the autonomic nervous sysem More likely to engage in harmful behaviors - not enough exercise, bad diet ○ How to improve health related behaviors? People know what we should do but rarely follow advice We also need motivation to change, believe that we can change and have the skills to do so Guided mastery techniques Provide people with explicit informatuon about how to engage in positive health related behaviors Goal is to increase self-efficacy beliefs that they CAN change Things like using condoms to prevent HIV, avoiding excessive drinking, expercising Role playing to prepare for real life situations Adapted for cultural differences to avoid the resistance of some people to engage in changing their behavior Internet based health interventions Easy access + cheaper ○ Sleep and health Lack of sleep weakens the immune system Impais memory, learning, logical reasoning,… Irritability, emotional instability, hallucinations  Polysomnigraphic or actigraph - to asses individual's sleep pattern Sleep disorders Often result from the physiological effects of a medical condition (Parkinsons, strokes, encefalitida,…) Illicit drugs, alcohol or prescription drugs affected sleep -> substance induced sleep disorder Insomnia - chronic difficulty initiating os maintaining sleep or sleep that does not restore energy and alertness Episodic insomnia - tied to a specific stressor, lasts only a couple of days Diagnosis - three nights per week for at least three months Sleep is affected by our body temperature - ditruptions in this rhythm interfene with ability to fall asleep of not wake up during the night Worrying about being able to sleep -> arousal Hypervigilance for things that might keep them awake (bodily aches, noises) Believe they get less sleep than they do and attribute daytime problems to insomnia -> anxiety Counteroriductive behaviors to try to fall asleep Cognitive behavioral interventions - changing the patterns of thought, only using the bed for sleep and sex, not napping Sleep restriction - restricting the amount of time insomniacs try to sleep Medications - antidepressants, antihistamines, melatonin, benzadiazepines Hypersomnolence disorders Exessive sleepiness, chronically sleepy and sleep for long periods of time Narcolepsy - reccurent attacks of an irrepressible need to sleep Moving very quickly into REM sleep Cataplexy - sudden oss of muscle tone triggered by laughter or joking Dropping objects, buckling of the knees Still aware Sleep paralysis Lacking cells in the hypothalamus that secrete hypocretin (promotes wakefullness) or low levels of hypocretin  Low levels of histamine also contribute Genes linked to autoimmune functioning Using stimulants (modafinil, methamphetamine,…) Sleep related breathing disorders Central sleep apnea - complete cessation of respiratory activity for brief periods of time but do not have frequent awakenings and do not feel tired Occurs when the brain does not signal to breathe Caused by central nervous system disorders, head injuries, heart disease and opioid use Sleep related hypoventilation Episodes of decreased breathing associated with high carbon dioxide levels Lung diseases of diseases of the chest wall Obstructive sleep apnea/hypopnea syndrome episodes or abnormally shallow breathing or low respiratory rate Snoring loudly, stopping breathing for several seconds at a time, gasping for air When the airflow is stopped due to narrow airway or an obstruction in the airway Can be treated by a CPAP machine Drugs affecting the serotonin system, stimulants Surgery - not as effective Circadian rhythm sleep wake disorders Biological rhythms driven by mechanisms in the brain that keep people in sync with the regular patterns of light and dark Located in the superchiasmatic nucleus Delayed sleep phase type - persisstent pattern of delayed sleep onset and anabiluty to go to sleep or wake up earlier if desired Advanced sleep phase type - sleep onset and awekanenings more than two hours earlier than desired Irregular sleep-wake type - no pattern Non-24-hour type - cycle that is not calibrated with the light and dark cycle of the day (vampires)  Shift work type - working totating shifts or irregular hours Disorders of arousal Reccirent episodes of incomplete awakening from sleep that mix elements of wakefulness and NREM sleep Sleep terror disorder - bad dreams that occur during the NREM phase Screaming and sweating, not being able to awake and do not remember Sleepwalking disorder - not acting out a dream Confusional arousals - incomplete awekanenings that do not involve terror or sleepwalking Slow speech, disoritentation Rapid eye movement sleep behavior disorder Complex and violent behavior while asleep More at risk to develop Parkinson's Abnormalities in dopamine functioning Clonazepam, melatonin, antidepressants Nightmare disorder Frequent enough to cause significant distress or imapirment in functoning Medication prazosin Restless legs syndrome Uncomfortable feeling when laying down that makes the person want to move around Abnormalities in the dopamine system, iron deficiencies PSYCHOANALYTIC APPROACH TO PSYCHOLOGY ○ All human activity is motivated by psychic energy Operates according to the law pf conservation of energy - the amount stays constant throughout ones lifetime Personality change = redirection of a person's psychic energy The source of it are instincts (sexual and an aggressive one) Libido - life instinct, thanatos - death instinct ○ Thoughts, feelings, and urges can take on a life on their own - motivated unconscious They are dynamic and can produce behavior that can later resurface in some way:  In dreams Slips of tongue Physical symtom Transferance Inexplicable anxiety ○ Id operates with primary process thinking - no logical rules of conscious thought or an anchor in reality Using the strategy of wish fulfillment - when I desire something unavailable, I make up a fantasy that satisfies this urge Only temporarily satisfies the id ○ Ego operates with the reality principle - understand urges of the id and how they are in a conflict with social and physical reality Secondary process thinking - strategies for solving problems and obtaining satisfaction ○ The false consensus effect Tendency to assume others are similar to us ○ The projective hypotheses What a person sees in an ambiguous figure reflects their personality Using inkblots or having the patient draw something SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS Five domains of symptoms that define psychotic disorders ○ Positive symptoms Overt expressions of unusual perceptions, thoughts, and behaviors Delusions Individual belifs that are highly unlikely or impossible Individuals are preoccupied with them, they look for evidence to support their delusions Highly resistant to arguments or compelling facts that contradict the delusions Persecutory delusions (we are being watched and tormented by both known people and institutions) Delusion of reference - random events or comments by others are directed at them grandiose delusions - one posseses special powers Delusions of thought insertion - my thoughts are not my own delusion of being controlled,… Different across cultures Primary delusions - not knowing the source, secondary delusions - knowing the source Hallucinations Unreal perceptual experiences  Complex, frequent and consistent Most common - auditory hallucinations (hearing voices, music,…) Either coming from inside, or outside Usually negative, critisizing Visual hallucinations - seeing something Tactile hall. - something is happening to the outside of the body (e.g. bugs crawling) Somatic hall. - something is happening inside of the body Disorganized thought and speech Formal thought disorder - disprganized thinking of people with schizophrenia Loose associations/derailment - switching from one topic to another completely unrelated one Making up neologisms, speech becoming so incoherent it's reffered to as a "word salad" Tangentiality - excessive focus on details and never getting to the main point Disorganized or catatonic behavior Unpredictiable and untriggered agitation Engaging in socially unacceptable behavior, troubles to have a normal daily routine Catatonia - unresponsiveness to the environment Negativism - lack of response to instructions Rigid, bizzare posture Complete lack of motor or verbal responses Catatonic excitement - purposeless and excessive motor activity for no reason ○ Negative symptoms Include a loss of certain qualities of the person More persistent and difficult to treat Less prominent in other psychotic disorders Restricted affect Severe reduction or absense of emotional expression Flat tone of voice, no eye contact, less gestures and facial expressions Anhedonia - loss of pleasure But they still experience intense emotions, they just cannot express it Problems predicting future emotional experiences -> loss of motivation and decision making Avolition/asociality  Inability to initiate or persist at common, goal oriented activities Physically slowed down, unmotivated Inabilty to take care of oneself - no grooming, eating, bathing Social isolation ○ + Cognitive deficits - not part of the diagnosis Declines in functioning of memory, attention and processing speed Make it difficult to pay attention to relevant information and suppress unwanted info Information and stimulation constantly flood their consciousness and they are unable to filter Delusions and hallucinations as a ay to make sense of the thoughts and perceptions Diagnosis ○ First diagnosed in the early 1800s and called the dementia praecox - my boy Kreapelin ○ An individual must show two or more symptoms of psychosis (one has to be delusions, hallucinations or disorganized speech) = A symptoms ○ B symptoms = social and/or occupational dysfunctioning ○ C symptoms = Symtoms present for at least a month - acute phase of the disorder + some symptoms for at least 6 months to a degree that impairs social or occupational functioning ○ D symptoms = no mood disorder ○ E symptoms = not due to somatic condition ○ Prodromal symptoms (before the acute phase) and residual symptoms (after the acute phase) - showing predominantely negative symtoms and milder positive symtopms ○ It is both chronic and episodic Prognosis ○ Most people who get hospitalized once in their life will get hospitilized again ○ Life expectancy - 10 to 20 years shorter ○ Most stabilize within 5 to 10 years aftwe their first episode ○ Women tend to do better than men Better history - disease develops later in life than for men Less cohnitive deficits Estrogen may affect dopamine Brain development during the prenatal period is slower for men - more risk for abnormalities ○ Prognosis improves with age - learn to cope, better understanding of friends and family, reduction of dopamine in the brain due to aging  ○ Social environment in developing countries is better for treating schizophrenia than developed countries \ Other psychotic disorders ○ Schizoaffective disorder Mix of schizophrenia and mood disorder Psychotic symptoms + major depression/manic epidosde At least two weeks of hallucinatons or delusions without mood symtoms (to differentiate from mood disorders with psychotic features) ○ Schizophreniform disorder Symtoms last only 1 to 6 months Do not experience the flat affect, more confused ○ Brief psychotic disorder Sudden onset of positive symptoms Last only for one day to one month ○ Delusional disorder Delusions lasting at least one months regarding situations that occur in real life (being followed, poisoned, having a disease,…) Do not show any other symtopms ○ Schizotypal personality disorder Lifelong pattern of significant oddities in their self-concept and ways of thinking and behavior Trouble setting realistic or clear goals Restricted emtional response or odd for the circumstances Socially anxious, percieve other people as hostile Deficits in working memory, learning and recall Just overall weird Biological theories ○ Genetic contributions to schizophrenia Different genes that are responisble for different symptoms of the disorder First degree relative who shares about 50 % of genes with the sick person - 10 % chance of also hacing it Monozygotic twins - concordance rate aroun 46% ○ Structural and functional brain abnormalities Gross reduction in gray matter in the cortex - medial, temporal, prefrontal and superior temporal parts Prefrontal cortex - language, emotional expression, planning Connected to the limbic system - emotions and cognition Connected to the basal ganglia - motor movement Abnormalities in the development of the prefrontal cortex during adolescence Abnormal huppocampal activation or in the volume and shape of the brain part  Reductions in white matter - working memory areas Present even before they develop any symptoms Enlargement of ventricles -> atrophy, deterioration Social, emotional and behavioral deficits long before they develop any other symptoms Birth complications - oxygen deprivation at births Prenatal viral exposure - mothers exposed to viral diseases (mainly during the second trimester - development of the central nervous system) Thee immune system of mothers becomes more active -> negative impact on the brain cells and dopamine systems of the fetus ○ Neurotransmitters Old dopamine theory - abnormal levels of dopamine in the prefrontal cortex and limbic system Using phenothiazines or neuroleptics to block the reuptake of dopamine Drugs that increase the functional level of dopamine increased the incidence of positive symtopms Neuroimaging studies suggest the presence of more receptors for dopamine in some areas But some people never responded to phenothiazines, showed only decline in the positive symptoms Levels of dopamine change relatively quickly but the changes in symptoms take a long time New theory - different levels of dopamine in various areas can account for the symptoms Mesolimbic pathway - excess dopamine activity Involved in the processing of salience and reward Using the atypical antipsychotics Prefrontal area - low dopamine activity Negative symptoms Also binding seretonin receptors - involved in regulation of the dopamine receptors Abnormalities in glutamate and GABA - deficiencies result in cognitive and emotional symptoms (+ when glutamate blocked -> hallucinations and delusions) Psychosocial theories ○ Social drift - because people are unable to finish their education and keep their job, they drift downward in social class compared to their family of origin ○ People who are born in a large city are more likely to develop the disease Due to overcrowding - pregnancy and infections  ○ Stress might not cause the development, but can trigger new episodes in people with the disease A lot of symptoms in immigrants ○ Early theories about the effect schizophrenia causing mothers = THE SCHIZOPHRENOGENIC THEORY High expressed emotion - a lot of criticism and controlling Cognitive perspectives ○ Fundamental difficulties in attention, inhibition and adgerence to the rules of communication -> promotes people with schizophrenia to try to conserve their limited cognitive resources ○ Using biases and thinking styles to try to understand the world around them Explaining something strange -> delusion Hypersensitivity to perceptual input -> "someone is trying to talk to me" -> hallucinations Societal pressure -> negative symptoms Treatment ○ Biological Typical antipsychotics Phenothiazines - block receptors for dopamine Awful side effects - akinesia, something similar to parkinsons, depression, tardive dyskinesia Atypical antipsychotics Binds specific dopamine receptors and influences other neutotransmitters Clozapin - but dangerous side effects Psychological and social treatments Drugs help with positive symptoms, but what about motivation and social interactions? Best approach - use behavioral, cognitive and social treatments Helping to change demoralizing attitudes they may have towards their illness Social learning theory - operant conditioning and modeling to teach persons with schizophrenia skills like maintaining conversations Self help support groups - increasing human contact, sharing personal experiences Teaching problem solving skills apllicavle to common social situations Family therapy Training family members to be less expressive in emotions, how to cope with innapropriate behavior  Teaching family members about the causes and symptoms Behavioral techniques to encourage desired behavior Better results with drug therapy than the previously mentioned ones But - culturally sensitive (sometimes it backfires) Assertive community treatment programs Provide comprehensive services for people who cannot rely on their families Meet patient's 24 hour needs Occupational training, assistence in receiving financial resources, social skills training, emotional support,… Traditional healers Developing countries Based on the structural model - there are levels of experience, including the body, the emotion and the cognition When the integration of these levels is lost -> problems Social support model - symptoms from conflictual social relationships -> encouraging family members to support Persuasive model - rituals can transform the meaning of symptoms and help with pain Clinical model - the faith the patient has for the healer is good enough to help PERSONALITY DISORDERS Individual's personality patern must deviate markedluy from the expectations of their culture Personality pattern must be inflexible across situations and stable over time Diagnosis before the age of 18 - must be present for at least a year (except antisocial p.d. - not possible to diagnose before adulthood) = enduring pattern of behavior, thoughts, emotions that impairs a person's sense of self, goals, and capacity for empathy and intimacy, and is associated with significant stress and disability Three clusters: ○ Cluster A: = Odd personality disorders 1. Similar to schizophrenia but they still have a grasp of reality, they are not really psychotic 2. Paranoid  Deeply distrustful of other people, suspicious of their motives Consider every event as highly meaningful, misinterpreting Not so off base to be considered delusional More common in the families of people with schizophrenia African americans have higher rates - social and economical risks Often do not feel the need to treat their paranoia + do not trust the therapist Therapist cannot rationally confront their beliefs 3. Schizoid Display little in the way of emotion, avoid social relationships Experience little pleasure, see relationships as unrewarding More often in men Do not fear others, generally just prefer to be alone Self centered Unmotivated for treatment Social skills training, role-playing 4. Schizotypal Extreme discomfort in social situations, bizzare patterns of thinking and perceiving Hypersensitive to criticism Behavioral eccentricities Anxious and distrustful of others Seeing significance in unrelated ecents Magical thinking Slight instances of hallucinations Poor attentional focus Transmitted genetically - gene regulating the NMDA receptor system Dysregulation in dopamine Treatment with antipsychotics ○ Cluster B: = Dramatic personality disorders 1. Lack of concern for others, violent and hostile behavior 2. Antisocial Constantly violate and disregard the rights of others = psychopaths Frequently lie, lack moral conscience, behave impulsivelu Poor emotional regulation 3. Borderline  Instability, extreme mood swings Fundamental deficits in idenitity and and in interpersonal relationships Dramatic changes in identity, goals, friends, sexual orintation Impulsive, reckless behavior Fear of abandonment Parasuicidal gestures They may have never learned how to differentiate between their view of themselves from the view of others Black and white thinking about oneself and others -> splitting (the ever changing views they have, when you are nice - you are amazing, when you upset me - you are the worst person ever) Smaller amygdala and hippocampus Abnormalities in the prefrontal cortex Dialectical behavior therapy Gain more realitsic and positive sense of self, learn adaptive skills for solving problem Learn to control impulsive behavior STEPPS - group intervention Challenging irrational cognitions and adressing self-management Transference focused therapy Relationship between the therapist and the patient used to better understand relationships overall and oneself Mentalization based treatment - helping to understand their own mental states Learn how to appreciate alternatives to their own views 4. Histrionic Overly trusting of others Always want to be the center of attention Self-centered, exaggerated moods and emotions Seek approval of others, concerned with how others evaluate them Feigning physical illness 5. Narcissistic Self centered, seek admiration from tohers Lack empathy Overconfidence in their own talents and characteristics Seem arrogant, lack of interest in other people  More prevelant in young adults - society and economy support the extreme versions of self-focused individualism Symptoms are maladaptive strategies for managing emotions and self-views Defense against rejection or unmet basic emotional needs by important people Grandiose narcissism - view themselves as superior and unique, arrogancy, manipulation, aggressive when distressed Vulnerable narcissist - cope with difficulties by engaging in grandiose fantasies to quell intense shame (not getting a job - I was too good) Difficult treatment - any problems are due to others ○ Cluster C = Anxious personality disorders 1. Avoidant Exessively shy Uncomfortable and inhibited in social situations Dread of criticism Avoiding social contact because of fear of rejection More prone to perssistant depressive disorder, major depression and anxiety More severe and generalized anxiety about social situations than social anxiety Genetically determined, beliefs about being worthless as a result of rejectuon by important people early in life 2. Dependent Extreme need to be cared for Clingy, fear of seperatuon from significant people in their lives Fear upsetting their partners, very obedient, permitting others to make important decisions for them History of seperation anxiety disorder or chornic physical illness Desire to please the therapist - actually helps them Encouraging patients to make their own decision, starting small and building up - homework 3. Obsessive-compulsive Preoccupied with order and control Inflexible, resistant to change Higjly focused on details, often fail to understand the point of an activity Exessive standarts Difficuly expressing affection  Rigidly bound to rules Act towards other based on status Alternative DSM-5 model for personality disorders ○ Not meant for clinical use ○ Characterizes disorders in terms of impairments in personality functioning and pathological personality traits ○ Process 1. Determine individual's level of functioning in terms of their identity or their relationship to other based on a scale 2. Determine whether the individual has any pathological personality traits How well are people able to handle stress - negative affectivity (similar to Big 5 neuroticism) How outgoing and trusting you are towards other people - detachments How concerned for others are you, how honest - antagonism How responsible and organized you are - disinhibition Eccentric beliefs and unusual beliefs - psychoticism 3. Determine whether individuals meet the criteria for any of these specific disorders Only includes: antisocial, avoidant, borderline, narcissistic, obsessive compulsive and schizotypal If it doesn’t really fit -> personality disorder-trait specified DISSOCIATIVE DISORDERS Problems integrating the active consciousness with the receptive consciousness Different aspects of consciousness remain split and operate independently DID ○ More than one distinct identity with different qualities - alters ○ The host - the original one ○ Child alters - to deal with trauma ○ Persecutor alter - inflict pain on other personalities by engaging in self-mutilation ○ Protector - offer advice and perform in actions the host is unable to do themselves ○ Comorbid with PTSD ○ Issues with diagnosis Rarely diagnosed before the 1980's Often misdiagnosed with schizophrenia because of hallucinations The experience has to be like a possesion, unwanted, uncontrollable, distressing and involuntary  Problems with amnesia - has to be with everyday events, not just supressed traumas Is it underdiagnosed or overdiagnosed? ○ Theories Result of coping strategries used by people who faced intolerable trauma Theory that patients are highly suggestible and hypnotizable, may use self hypnosis to dissociate Cognitive model - it is an adaptation to use and an explanation that fits their lives Patients are playing out a role to helo them live their live ○ Treatment Goal is to intergrate all alters into one cogerent personality Helping the identities to become aware of one another Dissociative amnesia ○ Large gaps of memory but no distinct personalities ○ Organic amnesia - caused by brain injury -> anterograde amnesia, inability to remember new info ○ Psychogenic amnesia - not dependent on a brain injury ○ Retrogade amnesia - both organic or psychogenic Organic - forget everything about the past, but have a sense of their own identity Psychogenic - lose their identity, but have some general knowled