psych 300 in class notes

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hypochondriasis: 1. preoccuation with the idea that one has a serious diease
2. preoccupation persits despite apporatire medical evaluation and ressearance
3. beleif is not delusional and nont about appearnace.
4. durationg at least 6 months.
hypocondraisis, clinical picture: trypically contiric
waxes and wanes with lfie stress
associte with
uncessary medical procidures
can expeince complications from these procidures due to the amoung of them they might had
doctor shoroping
social reasltionships are setraiend becuase hypochondraisc is exhausitng to be around.
BDD: 1) preoccupation with an imagined deficit in appearnce ,
2) impiarment and dress
- checking and grooming behvoirs- spend a lot of time trying to disguise thier perceived flaw and applying makeup
social avoidance
unessary medical, dental procidures - constant cosmetic surgery
they both the perople aorund them by consatly asking or reascance even though ti doenst help them wehn it is given to them.
can lead to hosptialization or suicide attemps
clinical picture bdd: little known about prevlance
course tend to be chronic
associted with OCD
physioligcal contributions bdd to all somatoform disroders: somtitisation d: family memeber at risk for SD and antisocial personality, may reflect underlyibg dysfucntion of behovoiral activation system
conversion disorder: family and twin studies point to possible hertiable component
pain disorder: family studies indicate greate risk for depression, alchol dependance and pain histories
cognative behvoiral perspectrive somatorform disoder s: learned resrnces
1) learning history
2) devlop concerns abeleifs about illness with lead to heighted vigilance ot phsyical sensations
leads to anxcous aresoual
focus on body sesnations exaserabtes thsoe seations
interepted as evience fo illnes.
comaplins of sick behvoirs lead to reinrocemnt
treatment for somatoform disroders: medication (SRI)
NSRI
psychodynamic bring conflcits into awarness
cognative behvoiral
identify the correct innacurate beleifs and exccsive focus on symptoms try to get themto sfhit thier attention to other parts of life
identify and manage stress generaty problems.
dissocaitve fugure: sudden unexpectred travel with inability to recall ones past
confusion about personal idenity or assumption of new idenity
confusion about personal idenity or assumption fo new identiti8y
not due ot dissocaitive identity disroder.
effects of substance abuse or medical condition.

thigns we need to rule otu in dissocative fugure
-
things we need to rule out in dissociative fugue: orgnaic brain disroder
- temporal lobe epielsody
psychotic disroer - associted with flight tednency
malingering
clear evidence of grain
depersonalization disorder: persistent experince of feeling detached from ones mental proceses or body
sense of unreality
change of percpetion of self
sense of not being in contorl of ones actions (like somone else contoring thier movments
observer of oneself
like a dream
things dont quite seem real
Dissocitive idenity disroder: two or more distinct identiies or personaly tates in one person
each idenity has its own enduring pattern fo perceiuving relating to and thinking about the envorment and self
the main personality is not aware of alternate oens
at least two of these identieis recurrntkyt ake contorl fo the eporsons behvoir
inability to recall important personal ifnarmtion
m ore extesive than ordinary forgtrefulkl.
person tends to switch personalites during times of stress, thsi may become a automaic as time goes by
demographic and clinical pricture of DID: prevelance uncertain
history of chldhood traujma
suggestible, highly hypnotisabkle
puzzling feature sof DID: sharp rise in the rate of DID in recent years, betwen 1945-1981 ther were 80 cases since then hundress
increased aswareness vereses socially ocnstruted disroder
could be becuase profesional are more aware and able to daignos it others ay tis been publcized dby teh media dn we are creating it.
greographical aggregation fo did, most reproed in US
extent of overlap with outehr disroers -: ptsd 90
outher mood disroders 97
BPD
SD
panic disorder: recurrent, unexpected panic attacks
- sudden intense rush of fear or discomfored that peaks within minutes
-
symptoms of panic disorder: papliations
pounding heart
accelerated heart rate
chains pain or discomfored
sensations of shortness of breath or smothering
feeling dizzy unstead lightheaded or faint
nasua or abnnimnal disotress
trembing or shaking
sweating
drealizsation, feelings of unreality
chills or hot flashes
paresthsias
have to ahve at least 5 of the symptoms
diagnostic features of panic attack: before: anticaptory anxiety- fear of future attacks
after: worry about the consequence of the attack "i am giong crazy:

signigiant behvoir changes
-
daignostic features of panic attack: Diagnostic Features
â€¢ Before: anticipatory anxiety â€“ fear of future attacks
â€¢ After: worry about the consequences of the attack
o â€œIâ€™m going crazyâ€
o â€œIâ€™m having a heart attackâ€
o â€œIâ€™m going to humiliate myselfâ€
â€¢ Significant behaviour change
o Situational avoidance (ex: malls, crowds, enclosed spaces)
o Avoidance of internal sensations (ex: caffeine, thrilling movies, exercise) - People with panic attacks get very in tune with their body sensations, they will avoid many things that cause their heart increase in pounding â€“ some wonâ€™t take showers because the steam slows breathing and they avoid that sensation because it might bring on a panic attack. Some avoid sex because of the physiological sensations of sexual arousal bring on increased heart rate.
o Safety behaviours (ex: cell phones, pill bottles, â€œsafe personâ€) â€“ carrying medication, cell phone to call someone who can help them, someone who can help them in the event of a panic attack
biological challenge studies: aministration of c02 to people with PD will often provoke panic attack where as this does not happen to teh general population
biological theories interpeed these fidings to suggests that PD is a neurochemical imbalance
neurotransmitter theories to PD: poor regualtion of norepinephrine, sertononi and perhaps Gaba and CCK (choecystokinin) in the locus cerulues kindle hte limbic system
Kindling model PD: poor regulation of locus cerulues kindles the limbic sytem lowering the threshold for stimulation of anxiety.
Suffocation False alarm theory pd: the brains of people with panic disorer are hypersensitive to carbon dioxide. these people either have chemoceptors or they are more active htan normal peopels brains
if you give somone a chemoceptors co2 it ill trigger panic in those people, not outhers.
cognitive behvoiral theories: cognative theorists use the evdience tos uggest that catastrophic misinterpreation of ones phsyical sensations, is a core freature of PD

trigger- perceive d threat, apprehension- bodily sensiotns, catastrphic minsterpetions.
Behvoroial cognative therapy for PAnic disroer: education on the phsioloogy of body and panic attacks.
introceptive expsoure, exposing them to the physical symptoms that they are afraid of increasing hear rate, straw breathing the central nevosu system realize it can surive with reduce oxitions
in vivo expsoure situatiosn tha tproduce mpanic attacks.
introceptive exposure: part of cbt, expspign them to the physical sensations associted with what they beleive to be a panic attack shwoiugn that thier harmless increased heart rate.
in vivo expsoure: situations that produce panic attacks , spinning them in a chair and shit
agorophobia: anxiety about being in palces sitations were escape migth be difficult or embarrsring

these sitations are
-
agorophia: Agoraphobia
- Anxiety about being in places/situations where escape might be difficult (or embarrassing) or where help may not be available in the event of having a panic attack
- These situations are either
o Avoided completely
o Entered only with a safe person
o Entered only with marked escape routes
agora phobia: cbt is first line treatmnet
education
in vivo expsoure
relaxationa dn breathign instruction
social phobia: marked by persistent fear of one or mroe soical of performance siatuations
fears of diong somting humulating or embarrsing elicti engative reactionf from other people
- Types: generalized vs. performance
o Generalized â€“ occurs in most situations
o Performance â€“ only in specific performance situations (Ex: stage actors, musicians, public speaking)
behvoiral inhibition: innate hypersenstivity to enviromental change
timid children dispaly elevated heart rate and resiarotoon rate to strangers
increaes risk for eotuerh anxeity disroderes such as panic or GAD
cog beh fac sp: belifs i am stupid peopel are critiical
prediction people are not giogn to like mike jokes ,i will say somethign stupdi
selective attension

leads to incrased anxiety, baises in their judgments and memory
pd: Cognitive behavioural factors
- Negative past social experiences lead to the development of negative beliefs about
o The self (â€œI am inadequateâ€ â€œI am unlikableâ€)
o Other people (â€œPeople are criticalâ€)
- Negative beliefs lead to negative social predictions in current social situations
o â€œI will say something stupid, do something embarrassing, I will be rejected...â€
- Negative predictions lead to selective attention of negative...
o Self-related cues (oneâ€™s own anxiety
- This leads to
o Increased anxiety
o Biases in their judgements and memory
ï‚§ Judgmental bias

In-situation safety behaviours
- Examples: minimize self-disclosure, avoid eye contact, rehearse sentences, conceal anxiety
- Intended to prevent negative social outcomes
- However, these behaviours...
o Increase anxiety
o Prevent disconfirmation of fears
o Increase the likelihood of negative social outcomes
cycllical social phobia from a cognitions perspective.: Negative predictions  selective attention  safety behaviour  biased judgment
treatment fo SP: meds, SSRI obvously

CBT
- education, help the person undersatnd waht keeps the phobia giong
behvoiral expeiremnt
attention grainitng (not to focus on certian cues
interperosnal features experiments to let them know that reducing thier seftey behvoir peopel will like them more,
OCD: persistent thoughts impluses and urges for more than a hour a day
experinced as intrusive, innaproparite and foreing
reconized as a pbyprodct of ones own mind
attempts ot rsiesi or elminate
agressvive impluses, most common is violence agaisnt somone esle seldom carried out.
ocd compusions: repeditive actions
intneded to reduce anxiety or distresss
washing, follows contamination fear
repeated routine activvities
counties
why does OCD develop biological theories: family and twin studies suggest that there is a heritaible ocmponent, dysregualtion fo brain circutis spands
orbital cortex, Caudate nucleas, thalamus
inability to turn off implus
possible to due sertonin defcieicnes
brain scans shwo more activity in thsi ciurit
improvmenht associted with less activity
OCD cognative behvoiral factors: most peopel experince instruve thoughts, the apprasial fo the intrusvie thought is what is important, for example the meaning attached to the though, if it is interpeted as threatneing it will , icnrease anxiety compell the indivual do do somehting about it
if it is not perceived as a threat arouse little to no axniety ti will pas.
faulty appriasals OCD: through action fusision
-
faulty apprasals in OCD: TAF, througha action fusuion
thinkign about it increases is more likley to happen (wrong)
Moral TAF - thinking about somehing i morally equivelent to carrying out that action.

inflated responibility i am responcible if somthing bad happens
treatments of OCD: biological
sri
cognative behvoiral
exposure and responce prevention
expose to obesison, but prevent from compulsing

followed by cognative restructuring
GAD: excessive owrry about a number of events adn activites
worry a collection of thoughts images and doubts realted to future negative events which are accompanied by anxiety
difficulties controlling the worry
biological theories of GAD: heritable component, modelled by parents
underactivie GABA benziodezpine system
cognative behvoiral theories: maintain factors, intolerance of uncertantly, leads to saftey behvoir use to increase certainty, ressurance seeking chekcing exsessive information skeeking.
erronious beleifs aobut worry, worry serves a s ausefull function such as if you didnt worry you would be late all the time
proo problem oreinattion, dont liek to make deicsions so they let them drag on
coganative avoidance, worry wihtout images.
ptsd diagnostic criteria: 1) the event invovles acutal or threatened death or serious injry to self or others
2) persons responce invvoled in tensense fear and helpless enss
ptsd symptoms: 1) re experincing symptoms
2) avoidance - emtional numbing
3) hyper arousal
- hyper vigialance "is that the black truck:
ptsd duration critiera: PTSD Duration > 1 month
⬢ Acute distress disorder: 1-3 months after trauma occurred
⬢ Chronic: >3 months
Acute stress disorder
⬢ Diagnosed within first month following
PTSD vulnerabilites factors: inherited biological vulnerability
prevuous tramatic epxeince
severity fo stressor
proxmity of stress
pre existing emtiona and behvoir problsm
lack fo social support.
two key cognative processes in PTSD: apprasals of traumatic event itself - ie overgenralized negative apprasials based on the event, event generalized to everyting else
appraisal of trauma sequllae
tendency to interpet ones sysmpotms as evdicne that they have perimentely changes.d
maladaptive behvoiral strategies for PTSD: throgh suppresion and cogantive avoidance
hyperviglance to threat cues
avoidance fo stautions ana nd cues
saftey behvoirs
alcholol and medication abuse,
PTSD treatment: prolongede exposure to traumatic memories, doen by qualified person, try to get them to releive the event and talk about it, reactivate memory, go ove rit in safe cirmances, reconsodiatlion of memory.
converrsion disrod er: 1) one or more pseudonerobiolgocial systems
2) associted with psycholgical factors
2) not fully explaiend by meidcla conditons
3) rule out facitous disroder and malingering
pain disorder: pain is predominant focus
2) causes signifigant distress or imapriment
3) psycholigcial factors play a major role in onset severity or maitnnece of pain
4) not due to factitous disroder or malingereing.
clinical picture of pain disroder: primarily psycholgicl facotrs
primarily to a general medication codnition
hypocondraiss: 1) preoccupation with idea that one has a serous dieases
2) preoccuaption persists despite apporate medical evalaution and reassurance
3) beleif is not delusional and non about appearnce
4) duration at least 6 motnsh
hypocondraisis clincial pictyur e: waxes and wayens with life stres
associted with unessary medical procidurres
doctor shopping
social relations strainted
might miss real conditions
BDD: preoccuation with imagined defect in appearnce
impariment or distress
chekcing behvoirs
socail avoidance
uncesary medical dental procidures
drive the peope aware from them
suicdie attemps
a cognative model of hypochonrasis: pateint develes learned concern with a serous slowly developing dieasse
they adapot saftey behoirs that perpeature their concers
self assesment stratiges patients hwo bleive they ahd thyeriod cancaner would concsntalty slowllow.
seeking medicaltioantjions always being expsoed ot illnes and eath

misinterpetion of
ambigous phsyical symptoms
medical reasearhcen
biochemical models of depresion: current theroy permissive models

indicates realtionhship between monoamine system, low sertonin resutl in swings in norepinerphein dopamien
changes in nuerotransmitters are state depenend ( tsee thse chagnes whey they are depressed and dotn when ther not.
Neuroendrcrine models: hpa dysreguation
cortisol stress homorne secred by adrenal galnd
chronically elevated HPA elevation in depressed

cortisol levels effect norepinephrine, dopamine
patients with endocrine problems become derpessed.

stressfull life event associted with onset of mood disorders system never returns to normal

early traumatic stres affect HPA increase risk of depression, ongiong changes
strucutrla brain abnormalities mood disroeres: preforntal
- depressed patients, less metabolic activity in the forntal lobe , antidepressenta reverse
hippocampus - integrates sensory information
smaller volume low activity found in depresse,d at risk for ptsd, negatively baised memory

Anterior Cingutlate coretx, dopamien reward, underactive in deprssed

overacative threat interpetion in amygalda , not sepcific to depression
Dynamic interpersonal models anaclitic: dependant derpssion

arises from oral phase development infant dependant on powerfull other, distrutpion fo paternal neurtrance and susquent sence of secutiy, neglectivfull aprents,
resutls in dependant character structure
depressions temps from teh loss of loved ones.
fundimental fear is abandonment.
introjective self critical dynamic interpersonal models part 2: arises from pre odipal stage of development
demanding deprecatory and hostile parent child relationships, parents critisize them for not being good enough and the child feel unlovable.

results in self critical character structure.

equtes acheivment with love,

acheivment related fear triggers depression
brown harris: stressfull fie events preced depression

many of these event sare interpesonal in nature
marital dissatisifaciton adn absence of social support
david zuroff: selection of romanitic parnters, personality styles selcted ifferant types of romanit partners.
dependant
sefl critical, leak hostility towards other person.
these persoanlity structures may stet up ionterpsonal scyels with outehr peopel that put you at risk for interperonsal loss.
beck cognative processe s: depression stems from negative cognitions

self critsisim

deprivation - alone and unlovable

self command - continualy nag themselves and prod thesmeleves

arbitiary inference, coming to the conclstion even when evdience does not say that one test

selective abstraction
focus on one deatial taken out of context.

activation fo negative schema leads to biased proces fo contempary life events

overly engative interpretaion of events
memory bias for negative information.
interpersonal psychotherapy: often arises form interpsonal events

IPT works on person current interpeoanl problems

role disputs

realtionship loss
relation intialion
deficition social skils
preventing relapse from depression: mindfulness based cognative thearpy

teach patients to disengage from negative thinking styles that will lead to relapse

cut the relapse rate in nearly half
Suicide: 1 suicide every 40 second
acutal rate may be high
4th leading cause of death
suicide rates more: women are three times more likley than men to attempt suicide. men are 4-5 times to compeltle the job, becuase they select more lethal methods
risk factors for sucuice: recent losses, sever stress
intoxication, alchol drug use= more likily to kill themselves msot atake place when ineibrated
active psychotic symtomps
recent psychtic relase
chrinicl illness paiun injury
exposure to suicide( media)
prevous suicde attemps
unemployment- particulary amoung men
warnign sighns clinical suicide: acutall suciside thinking preoccuaption
scuidie paln is
specific
lethal
active
revous attemps
sever hoplessness
marked chagne in bebhvoir
biological theories of suciide: genetic thoery - disroder genes increase the risk fo suicide (Adoptions tudies
neutrontramitter theory- deficiens in serotonin lead ot imp;lusive violent behvir
Psychological theories of suicide: psychodyanmic theories - suicide is the extrme expression of anger at the love obeject abandoned the person

cognative theories - (black and white )) hopelessness dichotomous, thinking suicide.
treatment suicide: routine assesment is cruical
particuarly follwing risk events
dissicuing scudie does not faciliatite suciide

cognative behvoiral threatments

problem solving - these people think the only way out is to kill thmeslves, ways to solve the problem

emtional regualtion - peopple can learn how to manage thse emtions and over powier them
developing social competence - help them develop satisfying relationships

coping skills - altnerative ways to ahndle emtiosn and lfie problems
eating disroers epidemiology: widespread and increasing
more than 100% increase in torontow in 11 years
Anorexia: refusal to maintain body weight or at above minimaly nomral weight for age

85% of expected boy wieght

voluntary restriciton of food

intense fear of gianign wieght becoming fat

disturbance in body perception
feel overweight
self esteem high dependant on body shape weight
deny meidcal implicaiton and need for treatment
amenhorrrea - menstrual cycle stops
types of anorexia: restrciting type : refusing to eat as a way of prevening weight gain

bring purge type: self induced vomiting or misuse of laxatives or didarsitics
at leat 15% below average body weight
clinical picture of anorexia: 1% lifetime pervailence
90-95 % women

onset age 15-19

often follows stresfull life event
often chronic
10% long term mortaity
many medical complcaitons

cardiovasicual, kideny, gastrointnesinal, electrolye imbalnce dental
Bumemia nervossa: recurrent epsidoes of binge eating

greater consumption than normal
a sence of lack of control over eating

recurrent compensatory behvoir to prevent weight gain

self induced vomiting
excesive exerercise

laxative diaretics

self evalatuion infleunded by body shape and weight , however mostly normal body weight
types of bulmia: puring type
non purigung: excessive exerzie of fasting
clinical picture of bulimia nervosa: lifetime pervalence 1.1 percent
onset in adolences or early adutl life
6-8% of university women

persits a number of years
primarly femaile
assocaited with outher disroders
depression axneity and substance abuse

medical complccations, kideny gastronenstial dental electrlye imablance
binge eating disroers: provisioanl diagnostic category

recurrent epsidoes of binge eating

unuusal eating patterns
rapid
uncomfortaibly full
eating when not hungery
soltary eating
self disgust
clinical picture of binge eating disroders: triggered by dysphoric moods
often obese
interperonsal problems
biological contriubtions eating disroders: hertuabluty
- anorrexia suggest almsot 48-74 percent
bulimia 59-83 percent

personaliuty factors

emtional laiblity
poor impluse contorls

neurochemistry
sertonin imblanances, associted with carbohydrate craivng
dysregulation of the hyptohalamus
hypothalamus regualtes eating behovir included by monamine tranmitters

socio cultural contributions
69% of play centeroflds classify for anorexi a
girls who watch more tv reprot more body dissatisifaction
emphasis on thiness

university women judge ideal feamle body weight tat men would hcoose

psych9ological contributions

family factors
succesfull hard driving
family proccuaption with appearnce emehsed diminsed sence of contorl
over concern with outhers opions
rigid dichotomous thinking style perfectionism.

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