Clinical psychology
Chapter 6
Anxiety disorders
Introduction
Anxiety: apprehension over an anticipated problem (future)
Fear: a reaction to immediate danger
Both anxiety and fear can involve arousal, or sympathetic nervous system activity.
Anxiety and fear are both adaptive.
In some anxiety disorders, the fear system seems to misfire. A person experiences fear at a time when there is no danger in the environment.
Anxiety creates a U-shape curve with performance.
Anxiety disorders as a group are the most common type of psychiatric diagnosis.
Phobias are particularly common
For each anxiety disorder, several criteria must be met for a DSM-5 diagnoses to be made:
Each disorder, though, is defined by a different set of symptoms related to anxiety or fear.
Anxiety disorders:
Specific phobias
A specific phobia: a disproportionate fear caused by a specific object or situation.
The person recognizes that the fear is excessive, but still goes to great lengths to avoid the feared object or situation.
Specific phobias tend to cluster around a small number of feared objects and situations.
The DSM categorizes specific phobias according to these sources of fear.
A person with one type of specific phobia is very likely to have another type of specific phobia as well. There is high comorbidity of specific phobias.
DSM-5 criteria:
Social anxiety disorder
Social anxiety disorder: a persistent, unrealistically intense fear of social situations that might involve being scrutinized by, or even just exposed to, unfamiliar people.
The problems caused by it tend to be much more pervasive and to interfere much more with normal activities than the problems caused by other phobias.
Social anxiety disorder generally begins during adolescence. For some, though, the symptoms first emerge during childhood.
Without treatment, social anxiety disorder tends to become chronic.
Social anxiety disorder can range in severity from a relatively few specific fears to a more generalized host of fears.
The number of fears experiences is related to more comorbidity with other disorders, and more negative effects on a person’s social and occupational activities.
DSM-5 criteria
Panic disorder
Panic disorder: characterized by frequent panic attacks that are unrelated to specific situations and by worry about having more panic attacks.
Panic attack: a sudden attack of intense apprehension, terror, and feelings of impending doom, accompanied by at least four other symptoms:
The symptoms tend to come on very rapidly and reach a peak of intensity within 10 minutes.
We can think as a panic attack as a misfire of the fear system.
The person experiences a level of sympathetic nervous system arousal matching what most people might experience when faced with an immediate threat to life.
Because the symptoms are inexplicable, the person tries to make sense of the experience.
A person who beings to think that he or she is dying, losing control, or going crazy is likely to feel even more fear.
According to the DSM criteria for panic disorder, a person must experience recurrent panic attacks that are unexpected.
The person must also worry about the attacks of change their behavior because of the attacks for at least 1 month.
The response to the attacks is as important as the attacks themselves in making the diagnosis.
The panic attacks must be recurrent.
Among those who develop panic disorder, the onset is typically adolescence.
DSM-5 criteria
Agoraphobia
Agoraphobia: anxiety about situations in which it would be embarrassing or difficult to escape if anxiety symptoms occurred.
Many people with agoraphobia are virtually unable to leave their house, and even those who can leave do so only with great distress.
DSM-5 criteria:
Generalized anxiety disorder
The central feature of generalized anxiety disorder (GAD) is worry.
People with GAD are persistently worried, often about minor things.
Worry: the cognitive tendency to chew on a problem and the be unable to let go of it.
GAD is not diagnosed if a person worries only about concerns driven by another psychological disorder.
People with GAD worry about everything. And these persistent worries interfere with daily life.
GAD typically beings in adolescence, though may people who have GAD report having had a tendency to worry all their lives.
Once it develops, GAD is often chronic.
DSM-5 criteria
Comorbidity in anxiety disorders
More than half of people with one anxiety disorder meet the criteria for another anxiety disorder during their life.
This comorbidity within the anxiety disorders is particularly pronounced for GAD, which is associated with a fourfold greater risk of developing another anxiety disorder compared to the rates in the general population.
It is very common for people with one anxiety disorder to report subthreshold symptoms of other anxiety disorders.
Subthreshold symptoms: symptoms that do not meet full diagnostic criteria.
Comorbidity within anxiety disorders arises for two primary reasons:
Anxiety disorder are also highly comorbid with other disorders.
Gender and culture are closely tied to the risk for anxiety disorders and to the specific types of symptoms that a person develops.
Gender
Women are at least twice as likely as men to be diagnosed with an anxiety disorder.
Women are more vulnerable to anxiety disorders than men.
Theories why:
Culture
People in every culture seem to experience problems with anxiety disorders.
But the focus on these problems appears to vary by culture.
The objects of anxiety and fear in these syndromes relate to environmental challenges as well as to attitudes that are prevalent in the culture where the syndrome occur. Culture influences what people come to fear.
Beyond culturally-relevant syndromes, the prevalence of anxiety disorders varies across cultures.
Cultures differ with regard to factors such as:
All of these are known to play a role in the occurrence of reporting of anxiety disorder.
Bodily symptoms can vary across cultures.
Classical conditioning of a fear response is at the heart of many anxiety disorders.
Many of the other risk factors can influence how readily a person can be conditioned to develop a new fear response.
The risk factors combine to create an increased sensitivity to threat.
Fear conditioning
Most anxiety disorders involve fears that are more frequent or intense than what most people experience.
Mowrer’s two-factor model. Two steps in the development of an anxiety disorder
But Mowrer’s early version of the two-factor model does not fit the evidence very well.
Once version of the model has been consider different ways in which classical conditioning could occur.
People with anxiety disorders seem to acquire fears more readily through classical conditioning and to show a slower extinction of fears once they are acquired.
Genetic factors: are genes a diathesis for anxiety disorders?
Twin studies suggest a heritability of 20-40 percent for specific phobias, social anxiety disorder, GAD and PTSD, and about 50 percent for panic disorder.
Some genes may elevate risk for several different types of anxiety disorder, while others may elevate risk for a specific type of anxiety disorder.
Neurobiological factors: the fear circuit and the activity of neurotransmitters
Fear circuit: a set of brain structures involved when people are feeling anxious or fearful.
It appears to be related to anxiety disorders.
Many of the neurotransmitters involved in the fear circuit are involved in anxiety disorders.
Personality: behavioral inhibition and neuroticism
Behavioral inhibition: a tendency to become agitated and cry when faced with novel toys, people, or other stimuli.
This behavioral pattern, may be inherited and may set the stage for the later development of anxiety disorders.
Behavioral inhibition appears to be a particularly strong predictor of social anxiety disorder.
Neuroticism: a personality trait defined by the tendency to react to events with greater-than-average negative affect.
Cognitive factors
Sustained negatives beliefs about the future
People with anxiety disorders often report believing that bad thing are likely to happen.
The key issue is not who people think so negatively, but how these beliefs are sustained.
Perceived control
People who think that they lack control over their environment appear to be at greater risk for a broad range of anxiety disorders than people who do not have that belief.
Anxiety disorders often develop after serious life events that threaten the sense of control over one’s life.
Early and recent experiences of lack of control can influence whether a person develops anxiety disorder.
Attention to threat
People with anxiety disorders have been found to pay more attention to negative cues in their environment than do people without anxiety disorders.
The heightened attention to threatening stimuli happens automatically and very quickly.
Etiology of specific phobias
The dominant model of phobias is the two-factor model of behavioral conditioning.
Behavioral factors: conditioning of specific phobias
In the behavioral model, phobias are seen as a conditioned response that develops after a threatening experience and is sustained by avoidant behavior.
The risk factors probably operate as diatheses, vulnerability factors that shape whether or not a phobia will develop in the context of a conditioning experience.
Only certain kinds of stimuli and experiences will contribute to the development of a phobia.
Researchers have suggested, that during the evolution of our species, people learned to react strongly to stimuli that could be life-threatening.
Our fear circuit may have been ‘prepared’ by evolution to learn fear of certain stimuli. → prepared learning.
Etiology of social anxiety disorder
Te trait of behavioral inhibition may also be important in the development of social anxiety disorder.
Behavioral factors: conditioning of social anxiety disorder
Two-factor conditioning model.
Cognitive factors: too much focus on negative self-evaluations
Etiology of panic disorder
All perspectives focus on how people respond to somatic (bodily) changes like increased heart rate
Neurological factors
Panic attack seems to reflect a misfire of the fear circuit, with a concomitant surge in activity in the sympathetic nervous system.
Locus coeruleus: the major sources of the neurotransmitter norepinephrine in the brain.
Norepinephrine plays a major role in triggering sympathetic system activity.
Behavioral factors: classical conditioning
Panic attacks are often triggered by internal bodily sensations of arousal.
Theory suggests that panic attacks are classically conditioned responses to either the situations that trigger anxiety or the internal bodily sensations of arousal.
Interoceptive conditioning: classical conditioning of panic attacks in response to bodily sensations
A person experiences somatic signs of anxiety, which are followed by the person’s fist panic attack. Panic attacks then become a conditioned response to the somatic changes.
Cognitive factors in panic disorder
Cognitive perspectives focus on catastrophic misinterpretations of somatic changes.
Anxiety sensitivity index: measures the extent to which people respond fearfully to their bodily sensations.
Etiology of agoraphobia
The development appears to be related to genetic vulnerability and life events.
Cognitive factors: the fear-of-fear hypotheses
Agoraphobia is driven by negative thoughts about the consequences of experiencing anxiety in public.
Etiology of generalized anxiety disorder
GAD tends to co-occur with other anxiety disorders and depression.
Cognitive factors: why do people worry?
Worry is reinforcing because it distracts people from more powerful negative emotions and images.
Worrying decreases psychophysiological signs of arousal.
By worrying, people with GAD may be avoiding unpleasant emotions that would be more powerful than worry. But as consequence of this avoidance, their underlying anxiety about these images does not extinguish.
Only a small proportion of people with anxiety disorders seek treatment.
Commonalities across psychological treatments
Effective psychological treatments for anxiety disorders share a common focus:
Although exposure is a core aspect of many cognitive behavioral treatments (CBT), these treatments differ in their strategies
The effects of CBT appear to endure when follow-up assessments are conducted 6 months after treatment.
In the years after treatment though, many people experience some return of their anxiety symptoms.
A couple of key principles appear important in protecting against relapse
The behavioral view of exposure is that it works by extinguishing the fear response.
Extinction involves learning new associations to stimuli. These newly learned associations inhibit activation of the fear
Extinction involves learning, not forgetting.
A cognitive view of exposure treatment is that exposure helps people help correcting their mistaken beliefs that they are unable to cope with the stimulus.
Exposure relieves symptoms by allowing people to realize that, contrary to their beliefs, they can tolerate aversive situations without loss of control.
Cognitive approaches of treatment of anxiety disorders typically focus on:
Cognitive treatments typically then invoke exposure, to help people learn that they can cope with these situations.
Psychological treatments of specific anxiety disorders
Psychological treatment of phobias
Many different types of exposure treatments have been developed for phobias.
Exposure treatments often include in vivo (real-life) exposure to feared objects.
Although systematic desensitization is effective, in vivo exposure is more effective than systematic desensitization
Psychological treatment of social anxiety disorder
Exposure also appears to be an effective treatment for social anxiety disorder.
Such treatments often begin with role playing or practicing with the therapists or in small therapy groups before undergoing exposure in some public social situations.
With prolonged exposure, anxiety typically extinguishes.
Social skill training, in which a therapist might provoke extensive modeling of behavior, can help people with social anxiety disorder who may not know what to do or say in social situations.
Safety behaviors are believed to interfere with the extinction of social anxiety.
The effects of exposure treatment seem to be enhances when people with social anxiety disorder are taught to stop using safety behaviors.
Psychological treatment of panic disorder
24 sessions focused on identifying the emotions and meanings surrounding panic attacks.
Therapist help clients gain insight into areas believed to related to panic attacks.
Cognitive behavioral treatments for panic disorder focus on exposure.
Panic control therapy (PCT). Based on the tendency of people with panic disorder to overreact to the bodily sensations.
In PCT, the therapist uses exposure techniques. Then the attacks begins, the person experiences them under safe conditions. In addition, the person practices coping tactics for dealing with somatic symptoms.
With practice and encouragement from the therapist, the person learns to stop seeing internal sensations as signals of loss of control and to see them instead as intrinsically harmless sensations than can be controlled.
In another version of cognitive treatment, the therapist helps the person identify and challenge the thoughts that make the physical sensations threatening.
Psychological treatment of agoraphobia
Focus on exposure, specifically, on the systematic exposure to feared emotions.
More effective when the partner is involved.
The partner without agoraphobia is encouraged to stop catering to the partner’s avoidance of leaving home.
Psychological treatment of generalized anxiety disorder
Almost all tested treatments for GAD include cognitive or behavioral components.
The most widely used behavioral technique involves relaxation training to promote calmness.
One form of cognitive therapy includes strategies to help people tolerate uncertainty. (more helpful than relaxation alone)
Also cognitive behavioral strategies to target worry, such as:
Medications that reduce anxiety
Sedatives, minor tranquilizes, or anxiolytics: drugs that reduce anxiety
Two types of medications are most commonly used for the treatment of anxiety disorders:
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Certain drugs seem to be effective for specific anxiety disorders.
Drug choice:
Psychological treatments are typically considered the preferred treatment of most anxiety disorders, with the possible exception of GAD.
Combining medications with psychological treatment
In general, adding anxiolytics to exposure treatment actually leads to worse long-term outcomes.
D-cycloserine (DCS): a drug that enhances learning.
Enhances effect exposure treatment.
Introduction and historical overview - summary of chapter 1 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)
Clinical psychology
Chapter 1
Introduction and historical overview
Introduction
Psychopathology: the field concerned with the nature, development, and treatment of mental disorders.
Continually developing and adding new findings.
Sigma: the destructive beliefs and attitudes held by a society that are ascribed to groups considered different in some manner, such as people with mental illness.
Stigma has four characteristics:
The treatment of individuals with mental disorders throughout recorded history has not generally been good, and this has contributed to their stigmatization.
Mental illness remains one of the most stigmatized of conditions in the twenty-first century.
Mental disorder is one disorder that contains several characteristics.
Four key characteristics that any comprehensive mental disorder definition ought to have:
No single characteristic can fully define the concept.
Mental disorder is usually determined based on the presence of several characteristics at one time.
Personal distress
A person’s behavior may be classified as disordered if it causes him or her great distress.
But not all mental disorders cause distress.
And not all behavior that causes distress is disordered.
Disability
Impairment in some important area of life.
Disability alone cannot be used to define mental disorder. Not all disorders involve disability.
Other characteristics that might, in some circumstances, be considered disabilities, do not fall within the domain of psychopathology.
Violation of social norms
In the realm of behaviors, social norms are widely held standards that people use consciously or intuitively to make judgments about where behaviors are situated on such scales as good-bad, right-wrong, justified-unjustified, and acceptable-unacceptable.
Behavior that violates social norms might be classified as disordered.
This is not enough for defining mental disorder. It is too broad and too narrow.
And social norms vary across cultures and ethnic groups.
Dysfunction
Harmful dysfunction. Has a value judgment and a objective component (dysfunction).
A judgment
Current paradigms in psychopathology - summary of chapter 2 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 2
Current paradigms in psychopathology
Introduction
Science is a human enterprise that is bound by scientists’ human limitations.
Paradigm: a conceptual framework or approach within a scientist works.
A paradigm as profound implications for how scientist operate at any given time.
Three paradigms that guide the study and treatment of psychopathology
Factors that cut across all the paradigms:
Almost all behavior is heritable to some degree.
Despite this, genes do not operate in isolation from the environment. Through the life span, the environment shapes how our genes are expressed, and our genes also shape the environment.
Nature via nurture.
Without the environment, genes could not express themselves and thus contribute to behavior.
Genes: the carriers of genetic information.
The number of genes is not important. The sequencing, or ordering, of these genes as well as their expression is what makes us unique.
What genes do matters more than the number of genes we have. Genes make proteins that in turn make the body and the brain work.
Gene expression: some proteins switch, or turn, on and off other genes.
Polygenic: several genes turning themselves on and off as they interact with a person’s environment is the essence of genetic vulnerability.
We do not inherit mental illness from our genes. We develop mental illness trough the interaction of our genes with our environment.
Heritability: the extent to which variability in a particular behavior in a population can be accounted for by genetic factors.
Shared environment factors: those things that members of a family have in common, such as parents’ marital status.
Nonshared environment (or unique environment) factors: those things believed to be important in understanding why two siblings from the same family can be so different.
Nonshared environmental experiences have much more to do with the development of mental illness than the shared experiences.
Behavior genetics
Behavior genetics: the study of the degree to which genes and environmental factors influence behavior.
Genotype: the total genetic makeup of an individual, consisting of inherited genes. The genotype cannot be observed outwardly.
Phenotype: the totality of observable behavioral characteristics.
The genotype should not be viewed as a static entity. Genetic programs are quite flexible.
The phenotype changes
Diagnosis and assessment - summary of chapter 3 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 3
Diagnosis and assessment
Introduction
Diagnosis can be the first major step in good clinical care.
Having a correct diagnosis will allow the clinician to describe base rates, causes, and treatment.
Hearing a diagnosis can help a person understand why certain symptoms are occurring.
Two concepts that play a key role in diagnosis and assessment:
Reliability
Reliability: consistency of measurement.
Validity
Validity: whether a measure measures what it is supposed to measure.
Unreliable measures will not have good validity.
Reliability does not guarantee validity.
The diagnostic system of the American psychiatric association: DSM-5
Diagnostic and Statistical Manual of Mental Disorders (DSM).
Multiaxial classification system forces the diagnostician to consider a broad range of information.
Axis:
Removal oaf the multiaxial system
The multiaxinal system developed for DSM-IV-TR is removed in DSM-5.
In place of the first three axes clinicians are simply to note psychiatric and medical diagnoses.
Organizing diagnoses by causes
DSM-5 defines diagnoses entirely on the basis of symptoms.
In the DSM-5, the chapters are reorganized to reflect patterns of comorbidity and shared etiology.
Enhanced sensitivity to the developmental nature of psychopathology
Childhood diagnoses
.....read more Research methods in psychopathology - summary of chapter 4 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 4
Research methods in psychopathology
Introduction
Theory: a set of propositions meant to explain a class observations.
Hypotheses: expectations about what should occur if a theory is true.
The case study
Case study: recording detailed information about one person at a time.
The case study can be used:
The correlational method
Variables are measured as they exist in nature.
Psycho-pathologist will rely on correlational methods when there are ethical reasons not to manipulate a variable.
Comparison of people with and without diagnoses can be correlational as well.
Measuring correlation
Statistical and clinical significance
A statistical correlation is unlikely to have occurred by chance.
A non-significant correlation may have occurred by chance, so it does not provide evidence for an important relationship.
A statistical finding is usually considered significant if the probability that it is a chance finding is 5 less in 100. p<0.05.
In general, as the absolute size of the correlation coefficient increases, the result is more likely to be statistically significant.
The significance is also influenced by the number of participants in the study.
Clinical significance: whether a relationship between variables is large enough to matter.
Problems of causality
Correlational method does not allow determination of cause-effect relationship.
Epidemiology: the study of the distribution of disorders in a population.
Focuses on three features of a disorder
Epidemiological studies are designed to be representative of
.....read more Mood disorders - summary of chapter 5 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 5
Mood disorders
Mood disorders involve disabling disturbances in emotion.
The DSM-5 recognizes two broad types of mood disorders:
Depressive disorders
The cardinal symptoms of depression include profound sadness and/or an inability to experience pleasure.
Physical symptoms of depression are also common
Social withdrawal is common.
Major depressive disorder
Major depressive disorder (MDD)
DSM-5 criteria
Persistent depressive disorder (Dysthymia)
People wit dysthymia are chronically depressed, more then half of the time for at least 2 years. They feel blue or derive little pleasures from usual activities and pastimes.
DSM-5 criteria for persistent depressive disorder (dysthymia)
Anxiety disorders - summary of chapter 6 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 6
Anxiety disorders
Introduction
Anxiety: apprehension over an anticipated problem (future)
Fear: a reaction to immediate danger
Both anxiety and fear can involve arousal, or sympathetic nervous system activity.
Anxiety and fear are both adaptive.
In some anxiety disorders, the fear system seems to misfire. A person experiences fear at a time when there is no danger in the environment.
Anxiety creates a U-shape curve with performance.
Anxiety disorders as a group are the most common type of psychiatric diagnosis.
Phobias are particularly common
For each anxiety disorder, several criteria must be met for a DSM-5 diagnoses to be made:
Each disorder, though, is defined by a different set of symptoms related to anxiety or fear.
Anxiety disorders:
Specific phobias
A specific phobia: a disproportionate fear caused by a specific object or situation.
The person recognizes that the fear is excessive, but still goes to great lengths to avoid the feared object or situation.
Specific phobias tend to cluster around a small number of feared objects and situations.
The DSM categorizes specific phobias according to these sources of fear.
A person with one type of specific phobia is very likely to have another type of specific phobia as well. There is high comorbidity of specific phobias.
DSM-5 criteria:
Social anxiety disorder
Social anxiety disorder: a persistent, unrealistically intense fear of social situations that might involve being scrutinized by, or even just exposed to, unfamiliar people.
The problems caused by it tend to be much more pervasive and to interfere much more with normal activities than the problems caused by other phobias.
Social anxiety disorder generally begins during adolescence. For some, though, the symptoms first emerge during childhood.
Without
Obsessive-compulsive-related and trauma-related disorders - summary of chapter 7 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 7
Obsessive-compulsive-related and trauma-related disorders
OCD is defined by repetitive thoughts and urges (obsessions) as well as an irresistible need to engage in repetitive behaviors or mental acts (compulsions)
Body dysmorphic disorder and hoarding disorder have symptoms or repetitive thoughts and behaviors.
For all three conditions, the repetitive thoughts and behaviors are distressing, feel uncontrollable, and require a considerable amount of time.
For the person with these conditions, the thoughts and behaviors feel unstoppable.
These syndromes often co-occur.
Clinical descriptions and epidemiology of the obsessive-compulsive and related disorders
Obsessive-compulsive disorder
Obsessive-compulsive disorder (OCD) is characterized by obsessions or compulsions.
Obsessions: intrusive and recurring thoughts, images, or impulses that are persistent and uncontrollable and often appear irrational to the person experiencing them.
For people with OCD, obsessions have such force and frequency that they interfere with normal activities.
People with obsessions may also be prone to extreme doubts, procrastination, and indecision.
Compulsions: repetitive, clearly excessive behaviors or mental acts that the person feels driven to perform to reduce the anxiety caused by obsessive thoughts or to prevent some calamity from occurring.
Even though rationally understanding that there is no need for this behavior, the person feels as something dire will happen if the act is not performed.
The sheer frequency with which compulsions are repeated may be staggering.
Commonly reported compulsions:
OCD tends to begin either before age 10 or else in late adolescence/early adulthood.
Slightly more common among women than men.
The pattern of symptoms appears to be similar across cultures.
High comorbidity.
DSM-5 criteria for Obsessive-compulsive disorder
Dissociative disorders and somatic symptom- related disorders - summary of chapter 8 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 8
Dissociative disorders and somatic symptom- related disorders
Introduction
Both types of disorders are hypothesized to be associated with stressful experiences, yet symptoms do not involve direct expressions of anxiety.
Dissociative and somatic symptom-related disorders tend to be comorbid.
The DSM-5 includes three major dissociative disorders:
The dissociative disorders are all presumed to be caused by a common mechanism, dissociation. Which results in some aspect of cognition or experience being inaccessible consciously.
Dissociation and memory
Psychodynamic theory suggests that in dissociative disorder traumatic events are repressed.
In this model, memories are forgotten because they are so aversive.
Memory for emotional relevant stimuli is enhanced by stress, while memory for neutral stimuli is impaired.
Dissociative disorders involve unusual ways of responding to stress.
Extremely high levels of stress hormones could interfere with memory formation.
In the face of severe trauma, memories may be stored in such a way that they are not accessible to awareness later when the person has returned to a more normal state.
Dissociative disorders are considered an extreme outcome of this process.
Dissociative amnesia
The person with dissociative amnesia is unable to recall important personal information, usually information about some traumatic experience.
The holes in memory are too extensive to be explained by ordinary forgetfulness.
The information is not permanently lost, but it cannot be retrieved during the episode of amnesia, which may last for as short a period as several hours, or as long as several years.
The amnesia usually disappears as suddenly as it began, with complete recovery and only a small change of recurrence.
Most of the memory loss involves information about some part of a traumatic experience.
More rarely the amnesia is for entire events during a circumscribed period of distress.
During the period of amnesia, the person’s behavior is otherwise unremarkable, except that the memory loss may cause some disorientation.
In a more severe sub-type of amnesia, fugue, the memory loss is more extensive.
The person not only becomes totally amnesic but suddenly leaves home and work.
Recovery is usually complete, although it takes various amounts of time.
After recovery, people are fully able to remember the details of their life and experiences,
Schizophrenia - summary of chapter 9 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 9
Schizophrenia
Schizophrenia: a disorder characterized by disturbances in thought, emotion and behavior.
>1% prevalence
Slightly more men than women.
Sometimes develops in childhood, but usually appears in late adolescence or early adulthood
people with schizophrenia typically have a number of episodes of their symptoms and less severe but still debilitating symptoms between episodes.
The range of symptoms in the diagnosis of schizophrenia is extensive, although people with schizophrenia typically have only some of these problems at any given time.
No single essential symptom must be present for a diagnosis of schizophrenia.
Researchers divided symptoms in three
DSM-5 criteria of schizophrenia
Positive symptoms
Positive symptoms comprise excesses and distortions, such as hallucinations and delusions.
For the most part, acute episodes of schizophrenia are characterized by positive symptoms.
Delusions
Delusions: beliefs contrary to reality and firmly held in spite of disconfirming evidence.
Common symptoms in schizophrenia.
Delusions take several forms including:
Delusions are also found in other diagnoses,
Hallucinations and other disturbances of perception
Hallucinations: sensory experiences in the absence of any relevant information for the environment.
More often auditory than visual.
Negative symptoms
The negative symptoms of schizophrenia consists of behavioral deficits.
Include:
Negative symptoms tend to endure beyond an acute episode and have profound
.....read more Substance use disorders - summary of chapter 10 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 10
Substance use disorders
Prevalence adolescents: 9,3 to 10 percent.
Addiction: a more severe substance use disorder that is characterized by having more symptoms, tolerance, and withdrawal, by using more of the substance than intended, by trying unsuccessfully to stop, by having physical or psychological problems made worse by the drug, and by experiencing problems at work or with friends.
Tolerance: indicated by either:
Withdrawal: the negative physical and psychological effects that develop when a person stops taking the substance or reduces the amount.
DSM-5 criteria for substance use disorder
Alcohol use disorder
Delirium tremens (DTs): when the level of alcohol in the blood drops suddenly.
Liver enzymes that metabolize alcohol can account to a small extent for tolerance. The central nervous system is responsible as well.
Tolerance results from changes in the number or sensitivity of GABA or glutamate receptors. Withdrawal may result because some neural pathways increase their activation to compensate for alcohol’s inhibitory effects in the brain.
Alcohol use disorder is often part of polydurg abuse.
Polydrug abuse: abusing ore than one drug at a time.
Alcohol and nicotine are cross-tolerant; nicotine can induce tolerance for the rewarding effects of alcohol and vice versa.
Consumption of both drugs may be increased to maintain their rewarding effects.
Prevalence and cost of alcohol abuse and dependence
No yet prevalence estimates.
Especially frequent among college-age adults.
Binge drinking: having five drinks in a short period of time
Heavy-use drinking: having five drinks on the same occasion five or mire times in a 30-day period.
Among college students, binge drinking and heavy-use prevalence rates are 43,5 and 16 percent.
Binge drinking can have serious consequences
More men than women have problems with alcohol, though
.....read more Eating disorders - summary of chapter 11 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 11
Eating disorders
Anorexia nervousa
DSM-5 criteria for anorexia nervousa
Amenorrhea: loss of menstrual period
Two types of anorexia nervosa:
Typically begins in the early to middle teenage years, often after an episode of dieting and the occurrence of life stress.
Lifetime prevalence: less than one percent
10 time more frequent in women than in men.
Suicide rates are quite high for people with anorexia
Physical consequences of anorexia nervosa
Self-starvation and use of laxatives produce numerous undesirable biological consequences in people with anorexia nervosa.
Prognosis
Between 50 and 70 percent of people with anorexia eventually recover.
Recovery often takes 6 to 7 years, and relapses are common before a stable pattern of eating and weight maintenance is achieved.
Anorexia nervosa is a life-threatening illness.
Bulimia nervosa
DSM-5 criteria for bulimia nervosa
Involves episodes of rapid consumption of a large amount of food, followed by compensatory behavior, such as vomiting, fasting, or excessive exercise, to prevent weight gain.
Binge has two characteristics:
Bulimia nervosa is not diagnosed if the bingeing and purging occur only in the context of anorexia nervosa and its extreme weight loss.
The diagnoses in such a case is anorexia nervosa, binge-eating/purgning type.
The key difference between anorexia and bulimia is weight loss.
People with bulimia do not lose a
Sexual disorders - summary of chapter 12 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 12
Sexual disorders
Sexual dysfunctions are defined by persistent disruptions in the ability to experience sexual arousal, desire, orgasm, or by pain associated with intercourse.
Paraphilias are defined by persistent and troubling attractions to unusual sexual activities or objects.
Definitions of what is normal or desirable in human sexual behavior vary with time and place.
Culture influences attitudes and beliefs about sexuality.
Gender and sexuality
Women tend to be more ashamed of any flaws in their appearance than do men, and this shame can interfere with sexual satisfaction.
For women, sexuality appears to be more closely tied to relationship, status, and social norms than for men.
Among women with sexual symptoms, more than half believe their symptoms are caused by relationship problems. Men are more likely to think about their sexuality in terms of power than are women.
There are many parallels in men’s and women’s sexuality.
The sexual response cycle
Four phases in the human sexual response cycle
Sexual dysfunctions
Sexuality usually occurs in the context of an intimate personal relationship.
Our sexuality shapes at least part of our self-concept.
When sexual problems emerge, they can wreak havoc on our self-esteem and relationships.
Clinical descriptions of sexual dysfunctions
The DSM-5 divides sexual dysfunctions into three categories:
Separate diagnoses are provided for men and women.
The diagnostic criteria for all sexual dysfunction specify that dysfunction should be persistent and recurrent and should cause clinically significant distress or problems with functioning.
A diagnoses of sexual dysfunction is not made it the problem is believed to be due entirely to a medical illness or another psychological disorder.
Many people with problems in one phase of the sexual cycle will often report problems in another phase. Some of this may just be a vicious circle.
Sexual problems in one person may lead to sexual problems in the partner.
Disorders involving sexual interest, desire, and arousal
DSM-5 criteria for Male hypoactive sexual desire disorder
DSM-5 criteria for Erectile disorder
DSM-5 criteria for Female sexual interest/arousal disorder
Disorders of childhood - summary of chapter 13 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 13
Disorders of childhood
Most theories of childhood disorder, consider childhood experience and development critically important to adult mental health.
Before making a diagnosis of a particular disorder in children, clinicians must first consider what is typical for a particular age.
Some childhood disorders are unique to children.
The more prevalent childhood disorders are often divided into two broad domains,
Children and adolescents may exhibit symptoms form both domains.
Across cultures, externalizing behaviors are consistently found more often among boys and internalizing behaviors more often among girls, at least in adolescence.
Childhood disorders involve an interaction of genetic, neurobiological, and psychological factors.
Clinical descriptions, prevalence, and prognosis of ADHD
DSM-5 criteria for attention-deficit/hyperactivity disorder
Although children with ADHD are usually friendly and talkative, they often miss subtle social cues.
Children with ADHD can know what the socially correct action is in hypothetical situations but be unable to translate this knowledge into appropriate behavior in real-life social interactions.
DSM-5 includes three specifiers to indicate which symptoms predominate
The combined specifier comprises the majority of children with ADHD.
A difficult differential diagnosis is between ADHD and conduct
.....read more Late life and neurocognitive disorders - summary of chapter 14 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 14
Late life and neurocognitive disorders
As we age, physiological changes are inevitable, and there may be emotional and mental changes as well.
Many of these influence social interactions.
The problems experienced in late life
Mental health is tied to the physical and social problems in a person’s life.
No other have more of these problems than the elderly.
As people age, the quality of depth of sleep declines.
Sleep apnea: a disorder in which a person stops breathing for seconds to minutes during the night. Increase with old age.
Several problems are evident in the medical treatment available during late life.
Research methods in the study of aging
Three kinds of effects:
Two major research designs
The DSM criteria are the same for older and younger adults.
The process of diagnoses must be considered with care. DSM criteria specify that a psychological disorder should not be diagnosed if the symptoms can be accounted for by a medical condition or medication side effects.
Clinicians must be extremely careful to consider the interactions between physical and psychological health.
Estimating the prevalence of psychological disorders in late life
Persons over age 65 have the lowest overall prevalence of mental disorders of all age groups.
Mot people with psychological disorders in late life are experiencing a continuation of symptoms that began earlier.
Why so low?
Methodological issues in estimating the prevalence of psychopathology
Personality disorders summary of chapter 15 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 15
Personality disorders
The personality disorders are a heterogeneous group of disorders defined by problems in forming a stably positive sense of self and with sustaining close and constructive relationships.
People with personality disorders experience difficulties with their identity and their relationship in multiple domains of life, and these problems are sustained for years.
Their personality problems are evident in cognition, emotion, relationships, and impulsive control. The symptoms of personality disorders are pervasive and persistent.
The DSM-5 approach to classification
In the DSM-5, the 10 different personality disorders are classified in three clusters, reflecting the idea that these disorders are characterized by:
Many people with psychological disorder will also experience a personality disorder.
Comorbid personality disorder are associated with more severe symptoms, poorer social functioning, and worse treatment outcomes for may conditions.
Diagnostic reliability
Using structured interviews and multiple informants can improve reliability.
Comorbidity
Personality disorders tend to be comorbid with each other.
Alternative DSM-5 model for personality disorders
Reducing the number of personality disorders, incorporating personality trait dimensions, and diagnosing personality disorders on the basis of extreme scores on personality trait dimensions.
Two types of dimensional scores
Key strengths:
Alternative DSM-5 criteria for Personality disorder
Odd/eccentric cluster includes:
Paranoid personality disorder
DSM-5 criteria for Paranoid personality disorder
Introduction to clinical psychology In this magazine, you can find the information you need for the first year course introduction to clinical psychology in the study psychology at the uva.
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