AbPsy_Phase2_.pdf

Abnormal Psychology Phase 2: Anxiety, Trauma, OCD, Somatic Symptom, Dissociative Disorders Source: Barlow, Durand & Hofm...

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