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Psychological Disorders 2


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Panic Disorder Without Agoraphobia
- Overview and Defining Features
o Experience of unexpected panic attack – A false alarm
o Anxiety, worry, or fear, about having another attack
o Symptoms and concern persists for 1 month or more
- Facts and Statistics
o Panic disorder affects about 3.5% of the population (prevalence)
o Two thirds with panic disorder are female.
o Onset is often acute, beginning between ages 25-29.
- Associated features
o Nocturnal panic attacks – 60% panic attacks occur during non-REM sleep
o Interoceptive / exteroceptive avoidance, catastrophic misinterpretation of symptoms
Panic Disorder With Agoraphobia
- Overview and Defining Features
o Experience of unexpected panic attack – A false alarm
o Anxiety, worry, or fear, about having another attack
o Agoraphobia – Fear or avoidance of situations/events
o Symptoms and concern persists for 1 month or more
- Facts and Statistics
o Panic disorder affects about 3.5% of the population (prevalence)
o Two thirds with panic disorder are female.
o Onset is often acute, beginning between ages 25-29.
- Associated features
o Nocturnal panic attacks – 60% panic attacks occur during non-REM sleep
o Interoceptive / exteroceptive avoidance, catastrophic misinterpretation of symptoms
Generalized Anxiety Disorder (GAD)
- Overview and Defining Features
o Excessive uncontrollable anxious apprehension (future orientated) and worry
o Couple with strong, persistent anxiety
o Somatic symptoms differ from panic (e.g., muscle tension, fatigue, irritability)
o Persists for 6 months or more, to distinguish clinical and non-clinical behavior to be sure of the disorder.
o Anxiety disorders as a group usually involve high states of activation.
- Statistics
o GAD affects 4% of the general population (prevalence)
o Females outnumber males approximately 2:1
o Onset is often insidious (being undetectable), beginning in early adulthood
o Tendency to be anxious runs in families.
- Associated Features
o Persons with GAD – Called “autonomic restrictors”. People who may be unspecific about their anxiety and go on to something else. Very related to worry characteristics.
o Fails to process emotional component – thoughts / images.
Social Phobia
- Overview and Defining Features
o Extreme and irrational fear/shyness
o Focused on social and/or performance situations
o Markedly interferes with one’s ability to function
o May avoid social situations or endure them with distress
o Generalized subtype – Anxiety across many social situations
- Facts and Statistics
o Affects about 13% of the general population at some point.
o Females are slightly more represented than males.
o Onset is usually during adolescence.
o Peak age of onset at about 15 years.
- Overview and defining features
o Extreme and irrational fear of a specific object or situation
o Markedly interferes with one’s ability to function
o Recognize fears are unreasonable
o Still go to great lengths to avoid phobic objects.
o Phobias are non-rational reactions to objects that aren’t as bad as they seem.
Post-traumatic Stress Disorder
- Exposure to traumatic event
- Experience to extreme fear, helplessness, and horror.
o Continued re-experience (memories, nightmares, flashbacks)
o Avoid reminders of trauma
o Emotional numbing
o Interpersonal problems
o Markedly interferes with functional capabilities
o Basic PTSD diagnosis: > 1 month post-trauma.
o Unlike panic attacks, PTSD is related to at least one specific event that triggers an attack.
- Subtypes & Associated Features
o Acute: 1-3 months post trauma
o Chronic: More than 3 months post trauma
o Delayed Onset: begins after 6 months post-trauma
o Acute Stress Disorder: Diagnosis of PTSD immediately post-trauma
- Causes, exacerbating factors:
o Trauma intensity and one’s reaction to it
o Uncontrollability and unpredictability
o Extent (or lack) of post-trauma social support
o Direct conditioning & observational learning.
Obsessive-Compulsive Disorder
- Obsessions
o Intrusive/nonsensical thoughts, images, or urges that one tries to resist or eliminate
- Compulsions
o Thoughts or actions to suppress thoughts
o Provide some relief
- Multiple obsessions common
- Cleaning, washing, and/or checking rituals v. common.
- Causes
o Parallel other anxiety disorders
o Early life experiences / learning: some thoughts are dangerous / unacceptable
o Thought Action Fusion: Thinking = Enactment.
Conversion Disorder
A disorder involving the loss or alteration of physical functioning, such as paralysis, voice loss, tunnel vision, or seizures, that is the result of a psychological involvement or need rather than a physical illness or disease.

- Defining Features
o Physical malfunctioning
o Lack physical or organic pathology
o Malfunctioning often involves sensory motor areas
o Persons show “la belle indifference” (despite having such symptoms, people aren’t as concerned about them)
o Retain most normal functions, but lack awareness
- Causes
o Freudian psychodynamic view is still popular
o Focus on past trauma and conversion
o Address primary/secondary gain
o Detachment from the trauma and negative reinforcement
The persistent conviction that one is or is likely to become ill, often involving symptoms when illness is neither present nor likely, and persisting despite reassurance and medical evidence to the contrary. Also called hypochondriasis.

- Overview and Defining Features
o Severe anxiety – the possibility of having a disease
o Strong disease conviction
o Medical reassurance does not seem to help
Somatization Disorder
- Overview and Defining Features
o Extended history of physical complaints before age 30.
o Substantial social and occupational impairment
o Concerned with the symptoms, not what they might mean
o Symptoms become the person’s identity
- Causes
o Familial history of illness
o Relation with antisocial personality disorder
o Weak behavioral inhibition system
Body Dysmorphic Disorder
a mental disorder, which involves a disturbed body image. Body dysmorphic disorder is generally diagnosed of those who are extremely critical of their physique or self image, despite the fact there may be no noticeable disfigurement or defect;
- Defining features
o Previously known as dysmorphophobia
o Preoccupation with imagined defect in appearance
o Either fixation or avoidance of mirrors
o Suicidal ideation and behavior are common
o Often display ideas of reference for imagined defect
Pain Disorder
When a patient experiences chronic and constant pain in one or more areas, and is thought to be caused by psychological stress. The pain is often so severe that it disables the patient from proper functioning. It can last as short as a few days, to as long as many years.
Depersonalization Disorder
- Overview and Defining Features
o Severe, frightening, feelings of unreality / detachment
o Interferes with life functioning
o Involves depersonalization and derealization
- Facts and Statistics
o High co morbidity: anxiety and mood disorders
o Onset: typically adolescence (~ age 16)
o Course: Life-long, chronic.
- Causes
o Cognitive deficits: attention; short-term memory; spatial reasoning
o Tunnel vision and ‘mind emptiness’.
o Heightened distractibility
o May be linked to stress / trauma reactivity
Dissociative Disorder (Multiple PD)
- Severe alterations of consciousness / detachment
- Affect identity, memory, and/or consciousness
- Severe form of normal perceptual experiences
- Depersonalization: Distorted perception of reality
- De-realization: Losing a sense of external world.
- Types of Dissociative Disorders (DSM-IV):
o Depersonalization Dis.
o Dissociative Amnesia; Dissociative Fugue
o Dissociative Trance Dis.; Dissociative Identity Dis.
Major Depressive Disorder
- Major Depressive Episode: Defining Feature
o extremely depressed mood – lasting more than 2 weeks
o Cognitive symptoms (e.g. feel worthless or indecisive)
o Disturbed physical functioning
o Anhedonia: loss of pleasure or interest in usual activities
- Major depressive disorder
o Single episode – Highly unusual
o Recurrent episodes – more common.
Dysthymic Disorder
- Defining features
o Milder symptoms of depression than major depression
o Persists x at least 2 years
o Can persist unchanged over long periods -- > 20 years.
- Facts and Statistics
o Late onset – Typically in the early 20s
o Early Onset – Before age 21
 Greater chronic-icy, poorer prognosis.
Bipolar Disorder I and II
- Defining Features
o Alternating major depressive and manic episodes
- Facts and Statistics
o Average age on onset: 18 years, but may begin with childhood.
o Chronic course, w. suicide common consequence
- Defining features
o Alternating major depressive and hypomanic episodes
- Facts and Statistics
o Average age of onset; 22 years, may begin in childhood
o 10 to 13% of cases progress to full Bipolar I disorder.
o Chronic.
Cyclothymiac Disorder
- Defining features: chronic version, bipolar disorder
o Manic/depressive episodes less severe
o Persisting manic or depressive states (vs. euthymic)
o Pattern: 2 or more years; adult, more than 1 year, child/adolescent
- Facts and Statistics
o Average age of onset: 12 or 14 years, chronic course
o Females more frequently diagnosed
o High risk for bipolar I or II disorder.
Double Depression
- Defining features
o Combined Major depressive episodes + dysthymic disorder (latter develops first)
- Facts and Statistics
o Associated with severe psychopathology
o Associated with a problematic future course
o High recurrence when dysthymia untreated.
Bulimia Nervosa
- Hallmark: Binge Eating
o Consuming excess amounts of food
o Eating perceived as uncontrollable
- Compensatory Behaviors
o Purging – Self-induced vomiting, diuretics, laxatives
o Other: Excessive exercise, fasting
- DSM-IV Subtypes:
o Purging: (most common): vomiting, laxatives, enemas
o Non-purging: (~33%): excess exercise, fasting.
Anorexia Nervosa
- Hallmark: extreme weight loss
o More than 15% below expected weight
o Intense fear of obesity
o Relentless pursuit of thinness, often begins with dieting
- DSM- IV subtypes: equal prevalence
o Restricting: limit caloric intake via diet and fasting
o Binge eating / purging
- Associated features
o Markedly disturbed in body image
o High co-morbidity, other psychological disorders
o Weight loss methods: life threatening consequences
Binge-Eating Disorder
- DSM-IV-TR appendix: Experimental dx
o Food binges without compensatory behaviors
- Associated Features
o Obesity common
o Often older than bulimics and anorexics.
Gender Identity Disorder
- Clinical overview
o Feels trapped in body of the wrong sex
o Assume gender-based identity of the desired sex
- Causes: unclear but early manifestations: 18-36 months
- Sex-reassignment surgery
o Prerequisites
o Satisfaction rate: 75%
o Female to male conversion most successful
Sexual Arousal Disorder
- Male Erectile Disorder
o Difficulty achieving and maintaining an erection
- Female Sexual Arousal Disorder
o Difficulty achieving and maintaining vaginal lubrication
- Associated Features
o Problem is arousal, not desire
o Prevalence: 14% female, 5% male
o Males are more troubled by the problem than females
o Erectile problems main reason males seek help
o Warner et al (fig. 10.4 pg. 351): trends age 40-70
- Key Features
o Sexual Attraction and arousal
o Focus: inappropriate people and/or objects
o Often multiple paraphilic patterns of arousal
o High co-morbidity – anxiety, mood, and substance abuse
- Main Types (6)
o Fetishism
o Voyeurism
o Exhibitionism
o Transvestic fetishism
o Sexual sadism / masochism
o Pedophilia
Delirium Tremens
: Disturbed consciousness / cognition
o Reduced clarity of one’s surroundings
o Impaired ability to focus, sustain, shift attention
Alcohol Intoxication
- Recent ingestion
- Clinically significant maladaptive behavior / psychological changes during/ shortly after use
- More than one of the following signs:
o Slurred speech (dysarthria)
o Inco-ordination
o Unsteady gait (ataxia)
o Nystagmus: involuntary ocular tremor
o Imparied attention / memory
o Stupor / coma
Alcohol Withdrawal
- Sedatives: calming, high A/D risk
o E.g.: barbiturates (amytal, seconal, Nembutal)
- Hypnotics: sleep-inducing
o Barbiturate substitute: (Doriden, Quaalude, Sopor)
- Anxiolytics: anxiety reducing, (lower A/D risk)
o Benzodiazepines: Valium, Xanax, Rohypnol, (‘date rape durg’), Halcion
- Effects similar to large doses of alcohol
o Combined with alcohol produce synergistic effects
- Influence GABA (ETOH also glutamate, serotonin)
Personality Disorder Clusters
- Cluster A: Odd / eccentric (3)
o Paranoid, schizoid, schizotypal
- Cluster B: Dramatic, emotional erratic (4)
o Anti-social, histrionic, borderline, narcissistic
- Cluster C: Fearful, anxious (3)
o Avoidant, dependant, obsessive-compulsive
Cluster A: Paranoid Personality Disorders
- Overview & Clinical features
o Pervasive, unjustified mistrust and suspicions
- Causes
o Biological and psychological contributions unclear
o Early learning: world is a dangerous place
- Treatment
o Few seek help
o Treatment focus: development trust
o Cognitive therapy: counter negativistic thinking
Schizoid Personality Disorder
- Overview & Clinical Features
o Pervasive detachment from social relationships
o Limited range of emotions in interpersonal situations
- Causes: Etiology unclear
o Preference for social isolation resembles autism
- Treatment (few seek help)
o Focus: value of interpersonal relationships
o Building empathy and social skills.
Schizotypal Personality Disorder
- Overview & Clinical Features
o Odd and unusual behavior and appearance
o Socially isolated, highly suspicious
o Magical thinking, ideas of reference, and illusions
o Many meet criteria for major depression
- Causes: Phenotype of schizophrenic genotype?
o More generalized brain deficits
- Treatment
o Main focus: Developing social skills
o Treatment for co-morbid depression
o Medical treatment similar to schizophrenia
o Poor prognosis
Cluster B: Antisocial Personality Disorder
- Overview and Clinical Features
o Noncompliance with social norms
o Violate rights of others
o Irresponsible, impulsive, and deceitful
o Lack a conscience, empathy, and remorse
- Psychopaths and antisocial Personality Disorder
- Relation: Conduct Disorder, early behavior problems
o Early behavioral problems (e.g., conduct disorder)
o Families with inconsistent parental discipline and support
o Families have histories of criminal and violent behavior
- Video Clip: ASPD
Cluster B: Borderline Personality Disorder
- Overview & Clinical Features
o Unstable moods and relationship
o Impulsivity, fear of abandonment, very poor self-image
o Self-mutilation, suicidal gestures are common
o Most common personality disorder in psychiatric settings
o Co-morbidity rates high.
- The causes: early trauma and abuse common
- Treatment options
o Antidepressant medications – short-term relief
o Dialectical behavior therapy – most promising treatment.
Dialectic Behavior Therapy
- Marsha Linehan et al
- Dialetics world view: reality of opposing forces
o Examples: + vs. – emotions; acceptance vs. change
o Dysregulation: affective; interpersonal; self; behavioral; cognitive
o Biological vulnerability + invalidating environment
- 1-year treatment: 1) individual therapy; 2) group skills training; 3) phone consults; 4) therapist support; 5) ancillary
Stage 1, decrease: 1) self-harm; 2) therapy-interference; 3) quality of life interference
Stage 2, increase: Behavioral skills via:
Core Mindfulness Skills
Interpersonal Effectiveness
Emotional Regulation
Distress Tolerance
Overall: Balance, tolerance, flexibility re dialectics
Acceptance vs change
Validation vs problem-solving
Cluster B: Histrionic Personality Disorder
Overview & Clinical Features
Overly dramatic, sensational, and sexually provocative
Impulsive and need to be the center of attention
Thinking and emotions are perceived as shallow
Common diagnosis in females
The Causes
Etiology is largely unknown
Sex-typed variant of antisocial personality?
Treatment Options
Focus on attention seeking / long-term consequences
Address problematic interpersonal behaviors
Little evidence that treatment is effective
Cluster B: Narcissistic PD
Overview & Clinical Features
Exaggerated / unreasonable sense of self-importance
Preoccupation with receiving attention
Lack compassion but sensitive to criticism, arrogant
Early failure to learn empathy
Sociological view: “Me” generation
Treatment (little data)
Focus: grandiosity, low empathy, (co-morbid depression)
Cluster C: Avoidant PD
Overview & Clinical Features
Extreme sensitivity to the opinions of others
Highly avoidant of most interpersonal relationships
Interpersonally anxious and fearful of rejection
Numerous factors have been proposed
Difficult temperament and early rejection
Treatment Options
Well-controlled treatment outcome studies exist
Treatment similar to social phobia
Targets: social skills and anxiety
Cluster C: Dependent PD
Overview and Clinical Features
Reliance on others to make major and minor life decisions
Unreasonable fear of abandonment
Clingy, submissive in interpersonal relationships
Largely unclear, link to disruption re learned independence
Research on treatment efficacy is lacking
Therapy typically progresses gradually
Targets include skills that foster independence
Cluster C: Obsessive-Compulsive PD
Overview & Clinical Features
Rigid fixation: Do things the ‘right way’
Perfectionistic, orderly, and emotionally shallow
True obsessions and compulsions are rare
Causes: Unknown
Treatment: Limited data
Addresses fears related to the need for orderliness
Rumination, procrastination,feeling inadequate
Sexual Pain Disorders
Recurring genital pain in either males or females before, during, or after sexual intercourse.

Vaginismus: Recurring involuntary muslce spasms in the outer third of the vagina that interfere with sexual intercourse.
Sexual Aversion Disorder
Extreme and persistent dislike of sexual contact or similar activites

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