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 disorder, which involves gross violation of social norms.
These two disorders frequently co-occur and share some features in common.
But there are differences.
When both conduct disorder and ADHD occur in the same child, the worst features of each are manifest.
Internalizing disorders, such as anxiety and depression, also frequently co-occur with ADHD.
The hyperactive symptoms of ADHD predicted subsequent substance use.
Prevalence of ADHD is 3 to 7 percent.
ADHD symptoms may decline with age, but they do not entirely go away for many people.
Etiology of ADHD
Genetic factors
Genetic factors play are role in ADHD.
Heritability estimates of 70 to 80 percent.
Genes associated with the neurotransmitter dopamine.
A single gene will not ultimately be fount to account for ADHD.
Neurobiological factors
Brain structure and function differ in children with and without ADHD, particularly in brain areas linked to the neurotransmitter dopamine.
Children with ADHD exhibit less activation in frontal areas of the brain while performing different cognitive tasks.
Children with ADHD perform poorly on neuropsychological tests that rely on the frontal lobes. A basic deficit in this part of the brain may be related to the disorder.
Perinatal and prenatal factors
Environmental toxins
Exposure to tobacco in utero is associated with ADHD symptoms.
Chronic exposure to nicotine increases dopamine release in the brain and causes hyperactivity.
Withdrawal form nicotine is associated with decreases in dopamine release in the brain and causes irritability.
Maternal smoking might affect the dopaminergic system of the developing fetus, increasing the risk of developing behavioral disinhibition and ADHD.
Psychological factors in ADHD
The parent-child relationship interacts with neurobiological factors in a complex way to contribute to ADHD symptom expression.
It is also important to consider a parents own history of ADHD.
Treatment of ADHD
ADHD is typically treated with medication and with behavioral therapies based on operant conditioning.
Stimulant medications
The drugs used to treat ADHD reduce disruptive behavior and improve ability to concentrate.
Psychological treatment
Promising treatments for ADHD involve parent training and changes in classroom management.
In these treatments, children’s behavior is monitored at home and in school, and they are reinforced for behaving appropriately. Point systems and daily report cards (DRCs) are typical components of these programs. Children earn points or stars for behaving in certain ways, the children can spend their earnings for rewards.
School interventions for children with ADHD include training teachers to understand the unique needs for these children and to apply operant techniques in the classroom, providing peer tutoring in academic skills, and having teachers provide daily reports to parents about in-school behavior, which are followed by rewards at home.
Certain classroom structures can help children with ADHD.
Ideally, teachers vary the presentation format and materials used for tasks, keep assignments brief and provide immediate feedback on whether they have been done correctly, have an enthusiastic and task-focused style, provide breaks for physical exercise, and schedule academic work during the morning hours.
Intensive behavior therapies can be very helpful to children with ADHD.
Conduct disorder is another externalizing disorder.
The DSM-5 criteria focus on behaviors that violate the basic rights of others and violate major societal norms. Nearly all such behaviors are illegal.
The symptoms of conduct disorder must be frequent and severe enough to go beyond the mischief and pranks common among children and adolescents.
DSM-5 includes a ‘limited prosocial emotions’ diagnostic specifier for children who show characteristics such as lack of remorse, callousness, or shallow emotions.
A related but less well understood externalizing disorder is oppisitional defiant disorder (ODD)
Diagnosed if a child does not meet the criteria for conduct disorder, but exhibits such behaviors as losing his or her temper, arguing with adults, repeatedly refusing to comply with requests from adults, deliberately doing things to annoy others, and being angry, spiteful, touchy, or vindictive.
Commonly comorbid with ODD are ADHD, specific learning disorder, and communication disorders.
ODD is different from ADHD in that the defiant behavior is not thought to arise from attentional deficits or sheer impulsiveness.
More common among boys.
Clinical description, prevalence, and prognosis of conduct disorder
DSM-5 criteria for Conduct disorder
Conduct disorder is defined by the impact of the child’s behavior on people and surroundings.
Many children with conduct disorder display other problems, such as substance abuse and internalizing disorders.
Anxiety and depression are common among children with conduct disorder.
Conduct disorder precedes depression and most anxiety disorders.
Conduct disorder is fairly common, with a prevalence of 9.5 percent.
The prognosis for children diagnosed as having conduct disorder is mixed.
Men and women with the life-course-persistent type of conduct disorder will likely continue to have all sorts of problems in adulthood, including violent and antisocial behavior.
But, conduct disorder in childhood does not inevitably lead to antisocial behavior in adulthood.
Etiology of conduct disorder
Genetic factors
Heritability likely plays a part.
Both environment and genes matters.
Being maltreated was linked to later antisocial behavior via genetics.
Neuropsychological factors and the autonomic nervous system
Childhood profiles of children with conduct disorder
Autonomic nervous system abnormalities are associated with antisocial behavior in adolescents.
Psychological factors
Children with conduct disorder seem to be deficient in moral awareness, lacking remorse for their wrongdoings.
Behavioral theories that look both to modeling and operant conditioning provide useful explanations of the development and maintenance of conduct problems
Aggression is often an effective, albeit unpleasant, means of achieving a goal, it is likely to be reinforced.
Social-cognitive perspective
Aggressive children interpreted ambiguous acts as evidence of hostile intend.
This can create a vicious cycle.
Peer influences
Being rejected by peers is causally related to aggressive behavior, particularly in combination with ADHD.
Associating with other deviant peers also increases the likelihood of delinquent behavior.
Children with conduct disorder choose to associate with like-minded peers and being around deviant peers help initiate antisocial behavior.
Environmental influence, particularly neighborhood and family, factors play a role in whether children associate with deviant peers, and this in turn influences and exacerbates conduct disorder.
Sociocultural factors
The combination of early antisocial behavior in the child and socioeconomic disadvantage in the family predicts early criminal arrests.
Treatment of conduct disordered
The treatment of conduct disorder appears to be most effective when it addresses the multiple systems involve in the life of a child.
Family interventions
Some of the most promising approaches to treating conduct disorder involve intervening with the parents and families of the child.
Intervening early, even just briefly, can make an impact.
Parent management training (PMT)
Parents are taught to modify their responses to their children so that prosocial rather than antisocial behavior is consistently rewarded.
Parents are taught to use techniques such as positive reinforcement when the child exhibits positive behavior and time-out and loss of privileges for aggressive or antisocial behaviors.
Multisystemic treatment
Multisystemic treatment (MST)
Involves delivering intensive and comprehensive therapy services in the community, targeting the adolescent, the family, the school, and, in some cases, the peer group.
The treatment is based on the view that conduct problems are influenced by multiple factors within the family as well as between the family and other social systems.
The therapy’s uniqueness lies in emphasizing individual and family strengths, identifying the social context for the conduct problems, using present-focused and attention-oriented interventions, and using interventions that require daily or weekly efforts by family members.
Treatment is provided in ‘ecologically valid’ settings, such as the home or school to maximize the chances that improvement will carry through into the regular lives of children and their families.
Depression and anxiety commonly co-occur with each other.
Depression
Clinical descriptions and prevalence of depression in childhood and adolescence
Children and adolescents ages 7 to 17 and adults both tend to show the following symptoms:
Children differ from adolescents in showing:
Depression in children is recurrent.
Depression occurs in less than 1 percent of preschoolers.
2 to 3 percent of school-age children.
In adolescence, rates are around 6 percent for girls and 4 percent for boys.
Etiology of depression in childhood and adolescence
Genetic factors play a role.
Early adversity and negative life events also play a role.
Rejection by parents is modestly associated with depression in childhood.
Other interpersonal factors are associated with depression in children
Cognitive distortions and negative attributional styles are associated with depression in children and adolescents in ways similar to what has been found in adults.
Negative thoughts and hopelessness also predict a slower time to recovery from depression among adolescents.
Attribution style does not interact with negative life events to predict depression for young children.
Treatment of childhood and adolescent depression
There are safety concerns about the use of antidepressants among children and adolescents.
Most psychosocial interventions are modeled after treatments developed for adults.
Two types of preventive interventions for depression:
Anxiety
Fears are reported more often for girls than for boys.
Clinical descriptions and prevalence of anxiety in childhood and adolescence
For fears and worries to be classified as disorders according to DSM criteria, children’s functioning must be impaired.
Unlike adults, children need not regard their fear as excessive or unreasonable, because children sometimes are unable to make such judgments.
Prevalence: 3-5%
Separation anxiety disorder
Separation anxiety disorder is characterized by worry that some harm will befall their parents or themselves when they are away from their parents.
When at home, such children shadow one or both of their parents.
DSM-5 criteria for Separation anxiety disorder
Another anxiety disorder among children and adolescents is social anxiety disorder.
Selective mutism: refusing to speak at all in unfamiliar social circumstances.
At home, such children ask their parents endless questions about situations that worry them.
Withdrawn children usually have warm and satisfying relationships with family members and family friends, and they show a desire for affection and acceptance.
Prevalence for social anxiety disorder among children and adolescents is around 1%
Children who are exposed to traumas such as chronic abuse, community violence, and natural disasters may experience symptoms of posttraumatic stress disorder (PTSD) similar to those experienced by adults.
Obsessive compulsive disorder is also found among children and adolescents.
Prevalence 1 to 4%
The symptoms in childhood are similar to symptoms in adulthood.
More common in boys than in girls, but this difference does not remain in adolescence and adulthood.
Etiology of anxiety disorders in childhood and adolescence
Theories of the etiology of social anxiety in children are generally similar to theories of social anxiety in adults.
Children overestimate the danger in many situations and underestimate their ability to cope with them.
The anxiety created by these cognitions then interferes with social interaction, causing the child to avoid social situations and thus not to get much practice at social skills.
Behavioral inhibition is an important risk factor for the development of social anxiety.
Theories about the causes of PTSD in children are similar to the theories for adults.
Some theories suggest that parental reactions to trauma can help to lessen children’s distress. If parents appear in control and calm in the face of stress, a child’s reaction may be less severe.
Treatment of anxiety in childhood and adolescence
Many fears simply dissipate with time and maturation.
For the most part, treatment of such fears is similar to that employed with adults, with suitable modifications to accommodate the different abilities and circumstances of childhood.
The major focus of these treatments is on exposure to the feared object.
Cognitive behavior therapy can be helpful to many children with anxiety disorders.
This type of treatment typically involves working with both children and parents.
One of the more widely used treatments is called the Coping Cat.
Used with children between the ages 7 and 13.
Focuses on confronting fears, developing new ways to think about fears, exposure to feared situations, practice, and relapse prevention.
Parents are also included in a couple of sessions.
A learning disability: a condition in which a person shows a problem in a specific area of academic, language, speech, or motor skills that is not due to intellectual disability or deficient educational opportunities.
Clinical descriptions
DSM-5 criteria for Specific learning disorder
Learning disabilities groups together three categories of disorders
Any of these disorders may apply to a child who fails to develop to the degree appropriate to his or her intellectual level in a specific academic, language, or motor skill area.
Learning disabilities are often identified and treated within the school system.
More common in boys.
Prevalence is 4 -7 percent.
Etiology of learning disabilities
Dyslexia and dyscalculia are coded as specifiers for the DSM-5 category specific learning disorder.
Etiology of dyslexia
There is a heritable component to dyslexia.
The genes that are associated with dyslexia are the same genes associated with typical reading abilities.
Genes play a bigger role in dyslexia among children whose parents have more education.
The core deficits in dyslexia include problems in language processing.
One or more problems in language processing that might underlie dyslexia.
Many of these fall under phonological awareness, which is believed to be critical to development of reading skills
Areas in the left temporal, parietal, and occipital regions of the brain are involved in dyslexia.
Etiology of dyscalculia
Some genetic influence. Particular, the type of math disability that involves poor semantic memory is most likely to be heritable.
Genes associated with dyscalculia are also associated with mathematics ability.
Areas of the parietal lobe are less active. The intraparietal sulcus is less active.
Treatment of learning disabilities
Phonics instruction is beneficial for children with learning difficulties.
Diagnosis and assessment of intellectual disability
DSM-5 criteria for Intellectual disability
The DSM-5 diagnostic criteria for intellectual disability include three criteria.
IQ score most be considered within a person’s cultural context.
Adaptive functioning must be assessed and considered in the light of the person’s age and cultural group.
Severity is assessed in three domains
Etiology of intellectual disability
Genetic or chromosomal abnormalities
One chromosomal abnormality that has been linked with intellectual disability is trisomy 21.
Having an extra copy.
Down syndrome.
Fragile X syndrome.
Underdeveloped ears and a long, thin face.
Many people with fragile X syndrome have intellectual disability. Others may not have intellectual disability, but nonetheless have learning disabilities, difficulties on neuropsychological tests, and mood swings.
Recessive-gene diseases
Several hundred recessive-gene diseases have been identified, and many of them can cause intellectual disability.
Phenylketonuria (PKU)
The infant, born without obvious signs of difficulty, soon begins to suffer from a deficiency of a liver enzyme, phenylalanine hydroxylase. This enzyme is needed to convert phenylalanine, an amino acid contained in protein, to tyrosine, an amino acid that is essential for the production of certain hormones.
Because of this enzyme deficiency, phenylalanine and its derivative, phenylpyruvic acid, are not broken down and instead build up in the body’s fluid.
This build up eventually damages the brain because the unmetabolized amino acid interferes with the process of myelination. The frontal lobes are particularly affected, and intellectual disabilities can be profound.
Infectious diseases
While in utero the fetus is at increased risk of intellectual disabilities resulting from maternal infectious diseases such as rubella.
The consequences of these diseases are most serious during the first trimester of pregnancy, when the fetus has not detectable immunological response.
Infectious diseases can also affect a child’s developing brain after birth.
In adulthood, these infections are usually far less serious.
Environmental hazards
Several environmental pollutants are implicated in intellectual disability.
Treatment of intellectual disability
Residential treatment
Adults with intellectual developmental disorder live in small to medium-sized residents that are integrated into the community.
Behavioral treatment
Early-intervention programs using behavioral techniques have been developed to improve the level of functioning of people with intellectual disability.
Specific behavioral objectives are defined, and children are taught skills in small, sequential steps.
Children with more severe intellectual disability need intensive instruction.
To teach a child a particular routine, the therapist usually begins by dividing the target behavior into smaller components. Operant conditioning is applied. → applied behavior analysis.
Cognitive treatments
Self-instructional training teaches children to guide their problem-solving efforts trough speech.
Computer-assisted instruction
The visual and auditory components of computers can help to maintain the attention of distractible students.
The level of the material can be geared to the individual.
The computer can meet the need for numerous repetitions of the material.
Clinical descriptions, prevalence, and prognosis of autism spectrum disorder
DSM-5 criteria for Autism spectrum disorder
Social and emotional disturbances
Children with ASD can have profound problems with the social world.
They may rarely approach others and may look through or past people or turn their backs on them.
Few children with ASD initiat play with other children, and they are usually unresponsive to anyone who approaches them.
Children with ASD sometimes make eye contact, but their gaze may have an unusual quality.
Problem with joint attention.
Children with ASD do not pay attention to other people’s faces or capture their gaze.
Children with ASD spend much less time in symbolic play.
Disturbances in Theory of mind.
Communication deficits
Even before they acquire language, some children with ASD show deficits in communication.
Babbling is less frequent in infants with ASD and conveys less information.
Language deficits.
Echolalia: the child echoes, usually with remarkable fidelity, what he or she has heard another person say.
Pronoun reversal: children refer to themselves as ‘he’, ‘she’, or ‘you’.
Repetitive and ritualistic acts
Children with ASD can become extremely upset over changes in their daily routines and surroundings.
An obsessional quality may pervade the behavior of children with ASD.
Children with ASD are likely to perform a limited number of behaviors and are less likely to explore new surroundings.
Children with ASD may display stereotypical behavior.
Some children with ASD can become preoccupied with and form strong attachments to simple inanimate objects and more complex mechanical objects.
Comorbidity and ASD
Many children with ASD score below 70 on standardized intelligence tests, which can make it difficult to distinguish between ASD and intellectual disability.
Differences:
ASD is comorbid with learning disorders.
ASD is also comorbid with anxiety.
Prevalence of autism spectrum disorder
ASD begins in early childhood and can be evident in the first months of life.
More body than girls.
Diagnosis is stable
Prognosis for autism spectrum disorder
Children with higher Iqs who learn to speak before age 6 have the best outcomes, and few of these function fairly well in adulthood.
Etiology of autism spectrum disorder
Genetic factors
A genetic component with heritability estimates of around 0.8.
ASD is linked genetically to a broader spectrum of deficits in communication and social interaction.
Neurobiological factors
The brains of adults and children with ASD are larger.
Neurons might not being pruned correctly.
Overgrown areas are the frontal, temporal, and cerebellar, which have been linked to language, social, and emotional functions.
Treatment of autism spectrum disorder
The most promising efforts at treatment of ASD are psychological.
Treatments are usually aimed at reducing unusual behavior and improving their communication and social skills
In most cases, the earlier the intervention begins, the better the outcome.
Behavioral treatment
Operant conditioning.
Education provided by parents is beneficial.
JoHo can really use your help! Check out the various student jobs here that match your studies, improve your competencies, strengthen your CV and contribute to a more tolerant world
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.
Clinical psychology
This is a magazine about clinical psychology
There are several ways to navigate the large amount of summaries, study notes en practice exams on JoHo WorldSupporter.
Do you want to share your summaries with JoHo WorldSupporter and its visitors?
Field of study
Add new contribution