Abnormal Psychology Exam 3

Front 1

Substance Abuse: Overview

Back 1

-Umbrella Term
-Use and abuse of psychoactive substances
-wide ranging physiological, psychological, and behavioral effects
-Associated with impairment and significant costs

Front 2

Levels of Involvement: Substance Abuse

Back 2

1st- Substance use
2nd- substance intoxication: reversible condition due to excessive use and significantly maladaptive
3rd- Substance Abuse: Repeted abuse leads to reiccuring problems
-use in hazardous situations (drink and drive)
-legal problems
continued use despite social probs (fight, arguments, etc)
4th-Substance Dependence (most extreme): maladaptive pattern of use
-tolerance (need to drink more than before to get same buzz) and withdrawal (maladaptive beh. when not taking drug)
-use despite medical problems or social disapproval

Front 3

5 main classes of substances

Back 3

1. Depressants: Behavioral Sedation (ex. alcohol)
2. Stimulants: increased alertness and elevate mood (ex. cocaine, nicotine)
3. Opiates: produce analgesia and euphoria (ex. heroin, morphine, codeine)
4. Hallucinogens: alter sensory perceptions (ex. weed, lsd)
5. Other drugs of abuse (ex. inhalants, anabolic steroids, medications)

Front 4

Depressants: Disinhibition
-Blood Alcohol level
-Lethal Dose
-LD50
-Synergistic

Back 4

-disinhibit central nervous system especially GABA
-Disinhibition: substance inhibiting a natural brain inhibitory brain system
-Blood Alcohol Level (0.08 BAL)
-Lethal Dose: kills certain percentage of test animals
-LD50 kills 50% of test animals (usually 0.40 BAL)
-synergistic: multiplicative. multiples the intensity when drugs and alcohol are mixed. 3shots+3lines=9x effect

Front 5

Alcohol (Depressants): Facts and Stats

Back 5

-Most adults condor themselves light drinkers = 92% will use in life
-Use is highest in Whites (56.5%)
-Males use and abuse > females
-23% of Americans binge drink
-violence is associated with alcohol
-Effects of Chronic alcohol use (Dementia, wernickes disease, fetal alcohol syndrome)

Front 6

Alcohol: Chronic illness'
-Cirrhosis of liver
-Korsakoff's Syndrome
-Fetal alcohol Syndrome

Back 6

-Cirrhosis of liver: scar tissue replaces liver tissue leading to loss of function and possibly death
-Korsakoff's Syndrome: cognitive disorder (thiamine deficiency) involving confusion, memory loss, and coordination problems
-Fetal alcohol Syndrome: facial abnormalities (flat nose, no ridge on lips, underdeveloped lips), slow physical growth, cognitive impairment, elementary school learning probs.

Front 7

Depressants: Sedatives, Hypnotics, Anxiolytics

Back 7

-Calming (ex. Barbiturates), sleep inducing, and anxiety reducing (ex. benzodiazepines)
-similar to large doses of alcohol: combining with alc is synergistic
-Depress Central Nervous System (through GABA)
-Primary influence in GABA (inhibitory receptor)

Front 8

Stimulants: Overview
-after effects

Back 8

-Stimulate Central nervous system (increase norepinephrine and dopamine)
-Most widely consumed drugs in the us
-low doses/potency: Alertness, Reduce Fatigue, Elevated Mood
-High doses/potency: Strong Euphoria, Increased sexual drive
-After effects are the reverse of what the chemical is inducing= Fatigue and depression (similar to manic episode)

Front 9

Stimulants: Nicotine

Back 9

-Smoking has declined since 1965 (use in kids has increased since 1992)
-25% of college students smoke regularly
-Most (64%) were Women (maybe to suppress hunger) and White (81%)
-Most smoked occasionally, not everyday
-over half binge drank in the past 2 weeks
-Consequences: high blood pressure, cancers, heart disease

Front 10

Stimulants: Cocaine & Methamphetamine
-Speed Ball
-Symptoms
-Effects of use
-Use in college students

Back 10

-Cocaine: mixed with other stuff called "speed ball"
-Severe Intoxication or overdose
-Cocaine: euphoria, high energy, bizarre, paranoid beh.
-Hallucinations, Intense Panic, Seizures, or coma
-Methamphetamine: called CRANK and makes up 90% of all amphetamine abuse
-Effects of use
-Brain and Liver Damage
-Skin infections, tooth decay (meth mouth)
-Immune system complications and stroke
-College Students: 9.5% tried and 6.6% past year

Front 11

Opiates (narcotics):
-Heroin
-33 year addict study
-Painkillers

Back 11

-Relieve pain and induce sleep (ex. Heroin, morphine, opium)
-Influence natural opioid system (i.e. endorphins, enkephalins)
-Heroin (derived from morphine):
-college students: 0.9% tried and 0.4% past year
-Risk associated with injecting heorin
-33 year follow-up data on addicts: 22% died (1/2 overdosed) and of the survivors- 80% not using and 20% being treated
-Painkillers one of the fastest growing forms of sub. disorders (2.5% of college kids used oxycotin in last year)

Front 12

Hallucinogens:
-Symptoms (esp. LSD&MDMA)
-low dose/high dose
-tolerance/withdrawal

Back 12

-drugs that cause symptoms of psychosis
LSD-spurs dopamine into the brain (like schizophrenia)
Ecstacy (MDMA)- is both stimulant and hallucinogens
-After sensory perception or create sensory experiences (ex. marijuana, LSD, mescaline, ecstacy)
-low doses/potency: relaxation, shifts in attention, impaired memory
-High doses: synthesia (exp. senses with other senses- eating color, hearing color), hallucinations, depersonalization, derealization
-tolerance develops and dissipates quickly
-withdrawal symptoms are uncommon

Front 13

Hallucinogen: Marijuana (cannabis sativa)

Back 13

- stimulates canabinoid receptors
-Most common illicit drug
-49% in college tried and 33% in last year
-Adverse Effects:
-longterm: impaired cognitive functioning
-contributes to psych probs later
-impares lung shape/function
-Theraputic effects
-reduces pain signaling
-reduces side effects of chemo and treats glaucoma

Front 14

Other drugs: Inhalants

Back 14

-EX. glue, gas
-significantlly impairing
-volatile liquids that are breathed directly into the lungs
-rapidly absorbed with effects like alcohol intoxication
-tolerance and prolonged symptoms of withdrawal common
-9% college kids tried

Front 15

other drugs: Designer Drugs & Steroids

Back 15

-Rave type drugs
-produced by pharmacies for treatment of diseases
-Ecstasy, MDEA (eve), Ketamine (Special K) all artificial drugs
-heigtened auditory and visual perceptions, decreased inhibition, disorientation (roofies)
-increased popularity in nightclubs
-produce tolerance and dependence

Steroids: synthetic substances to enhance muscles growth and secondary sexual characteristics to gain competitive edge

Front 16

STUDY- Research on Addictiveness: Hastings

Back 16

-Experts rated "addictiveness" of commonly used drugs
-how easy is it to get hooked on a substance?
-how hard is it to stop using?
-Rankings reflect only addictive potential
-all vary in levels of addictiveness
-LEGAL: nicotine has highest addictive potential
-ALCOHOL is in top 50%
-Stimulants also in top percent

Front 17

Substance Abuse: Biological Risk factors

Back 17

-high heritability for alcoholism (40-60%) but not clear cut b/c of envio. risk factors (may be overestimate)
- genetics for Alcohol may effect metabolism of alc. and sensitivity, and cravings.
-high heritability for cocaine, opiates, and weed
-8x more likely if relative has disorder
-interact significantly w/ fam. and envio. factors
-use highly likely determined by envio. factors
-abuse/dependence determined by genes

Front 18

Substance Abuse: Brain Regions
-Priming
-Drug Cues
-Cravings
-Mesolimbic Pathway
-THEORY: Reward deficiency syndrome

Back 18

-Priming: single drug dose leads to uncontrollable binging
-Drug cues: stimuli associated w/ drug leads to further drug use
-Cravings: obsessive drive for drug use
-Mesolimbic system:Tons od dopamine w/in mesolimbic pathway or "pleasure pathway" (lower d2 receptors)
-goes from prefrontal cortex thru nucleus accumbus to ventricle tagmental area
-Reward deficiency syndrome: fewer specialized dopamine receptors (d2)
-everyday events aren't rewarding
- seek reward/ pleasure thru substances

Front 19

Substance Abuse: Environmental Risk Factors
-Stress induced relapse
-Cognitive factors
-Learning
-emphysema

Back 19

-Stress induced relapse: an activation of certain brain related stress, such as cortisol, that help us cope but also increase dopamine activity in the mesolimbic pathway.
-Stress triggers dual responses in the brain 1) coping and 2) desire for reward
-cognitive distortions- hard to break cycle that creates dependency on substance for anxiety relief
-Learning: subtances dependence learned thru classic conditioning (enviornmantal cues) and substances create a positive reinforcement while the withdrawal creates neg. reinforcement. (operant conditioning)
-Neg. effects often far off and not considered like EMPHYSEMA: lung disease marked by damage to air sacs and hard to breath.

Front 20

Substance Abuse: Environmental Risk Factors
-Modeling
-Personality
-Family Factors

Back 20

-Modeling: ppl immitate their friends drug use especially between the ages of 13-16 yrs (esp. tobacco, marijuana, and alcohol)
-"addictive personality" are people high in impulsivity (risk taking, lack of planning, chaotic lifestyle, immediate gratification, and explosiveness)
- impulsivity associated with dramatic PD's and especially psychopathy (ppl use drugs to cope with stress and "perceived threats")
-Family F

Front 21

• 5 factor model of personality:

Back 21

• Dimensional Perspective: personality traits differ in degree
• 5 factor model of personality:
o Extroversion: High= talkative, assertive, active LOW= silent, passive, reserved
o Agreeable: High= kind, trusting, warm LOW= hostile, selfish, mistrust
o Conscientiousness: High= organized, thorough, reliable LOW= careless, unreliable
o Neuroticism: High= nervous, moody, temperamental LOW= even temp., stable emotions
o Openness to new experience: High= curious, imagine, creative LOW= practical, routine, focused

Front 22

• Personality Disorders: Overview

Back 22

• Two reasons they differ from other MHD’s
• Distinct type of MHD- Axis II
• Enduring stable thru life
• Pattern across 4 domains/multi areas:
o Cognitions: perceiving/interpreting self, others and events
o Affect: range, intensity, ability, appropriateness
o Interpersonal functioning
o Impulse control
o Like traditional disorders = maladaptive, causing distress &/or impairment

Front 23

• Personality Disorders: Clusters (A,B,C)

Back 23

o Cluster A: Odd or eccentric (Prev = 2.1%)
• Paranoid
• Schizoid
• Schizotypal
o Cluster B: Dramatic, emotional, erratic (Prev= 5.5%)
• Antisocial
• Borderline
• Histrionic
• Narcissistic
o Cluster C: fearful or anxious (prev= 2.3%)
• Avoidant
• Dependent
• Obsessive compulsive

Front 24

• Cluster A: Paranoid PD

Back 24

o Pervasive and unjustified mistrust and suspicion
o Ppl “out to get them”
o Disloyal and untrustworthy (blame other for their misfortunes)
o Misinterpret events as threats to themselves
o Hold grudges
o Rigid, controlling, critical, blaming, jealous

Front 25

• Cluster A: Paranoid PD Causes and treatments

Back 25

o Biological/ psychological factors= unclear
o Early learning that ppl/world =dangerous and untrustworthy
• Cluster A: Paranoid PD treatments
o Few seek treatments
o Focus on developing trust
o Cognitive therapy to counter neg. thoughts
o Lack good outcome studies
o Pervasive disorder but treat= lower impairment

Front 26

• Cluster A: Schizoid PD

Back 26

o Pattern of detachment from social relationships
• Almost always choose solitary activity
• No interest in sex/pleasurable activities/relationships
• No close friends or fam.
o Very limited range of emotions
• Not effected by praise/criticism
• Emotional coldness/lack of expression
• Do not show paranoia or suspicion

Front 27

• Cluster A: Schizoid PD Causes & treatment

Back 27

o Unclear
o Childhood shyness/ preference for social isolation like autism
o Treatments: few seek treatment
o Focus on value of interpersonal relationships
o Building empathy and social skills
o Lack of outcome studies

Front 28

• Cluster A: Schizotypal PD

Back 28

o Think events have personal relevance (ideas of reference)
o Social anxiety/ paranoia- does not go away
o Odd/ eccentric in beh. Or appearance
o Inappropriate or constricted affect
o Few friends outside immediate fam.
o Perceptual and cognitive disturbances
o Odd thinking and speech patterns
o Differ from other PD’s: more odd behavior and more cog. Disturbances

Front 29

• Cluster A: Schizotypal PD treatment/cause

Back 29

o Show brief transient psychotic episodes in response to stress (relatively short)
o Most likely to seek treatment for anxiety or mood disorders

Front 30

• Cluster B: Antisocial PD

Back 30

o Failure to comply w/ social norms
o Disregard for /violation of others rights
o Irresponsible, impulsive, deceitful
o Lack of remorse (savvy and smooth talking)
o Unlikely to maintain steady employment
o Must be preceded by Conduct disorder

Front 31

• Conduct disorder (Antisocial PD)

Back 31

o Aggression towards ppl/animals
o property destruction
o deceitfulness or theft
o serious violations of laws/rules
o before the age of 15 to be relevant to ASPD

Front 32

• Cluster B: Psychopathy

Back 32

o Related to but not synonymous w/ antisocial PD
o More interpersonal and affective traits that ASPD
o Not in DSM b/c it takes more time clinically to assess and is not clear cut (behaviors)
o Affect: callous, shallow emotion, say the “right” things but don’t have emotion behind them
o Interpersonal: charming, manipulative, grandiosity, deceitful
o Severe variant of ASPD
o Goal directed to money, sex, and status
o 1/3 of ppl with ASPD

Front 33

• Cluster B: Antisocial PD Biological Risk

Back 33

o Sig. genetic contributions
o Under-arousal hypothesis: abnormally low levels of cortical arousal (limbic system)
• Low heart rate, skin response, etc.
o Fearlessness Hypothesis: abnormally low amygdala reactivity

Front 34

• Cluster B: Antisocial PD psychological risk

Back 34

o Early history of behavioral probs.
o Harsh and inconsistent parental discipline
o Conduct probs. Before 15 (to be able to diagnose)
o Fam. w/ criminal and violent beh.

Front 35

• Cluster B: Antisocial PD treatments

Back 35

o Few seek treatment on own
o Poor prognosis (esp. if early onset)
o Emphasis on prevention and rehab
o Often incarceration=only viable option
o PREVENTION! Reduces prevalence

Front 36

• Cluster B: Histrionic PD

Back 36

o Discomfort in situations where they are not the center of attention
o Emotions that shift rapidly and do not seem “real”
o Suggestible/easily influenced
o Inappropriately provocative or sexually seductive interactions
o Phys. Appearance used to draw attention
o Very dramatic beh. And expression of emotions
o Relationships thought to be more intimate and close than they really are
o Intense need to be loved, desired, and intimate w/ others
o More in women

Front 37

• Cluster B: borderline PD

Back 37

o On “border” of psychosis and neurosis
o Unstable mood and relationships (affect deregulation)
o Impulsivity and FEAR of abandonment
o Very poor self image
o Self-mutilation and suicidal gestures
o Chronic feeling of emptiness
o Dissociations or paranoid thoughts in response to stress

Front 38

• Cluster B: Borderline PD risk factors and comorbidity

Back 38

o Comorbid with: major depressive disorder
• Bipolar disorder
• Sub. Abuse and bulimia
o Suicide rates are high (10%)
o Sig. genetic predisposition
o Early trauma/abuse
o Most frequently diagnosed PD in inpatient treatment
o More in women
o Agression/impulsivity= low seratonin

Front 39

• Cluster B: Borderline PD treatments

Back 39

o Antidepressants
o Dialectical beh. Therapy =most promising

Front 40

• Dialectical Behavior Therapy

Back 40

o Treatment focuses on dialectics
o Acceptance and change
o Zen philosophy and mindfulness (being in the moment)
o 3 simultaneous treatment methods
• 4th treatment deals directly w/ therapist
o 1. Individual sessions→ eliminate beh. That harm self, therapy, and life
o 2. Skill training (group therapy):
• mindfulness: not attaching to things
• distress tolerance: dealing w/ intense neg. emotions
• emotion regulation: identify, evaluate, control
• interpersonal effectiveness: improve rel. while keeping self-respect
o 3. Skills generalization (phone calls)

Front 41

• Dialectical Behavior Therapy: Outcomes

Back 41

• Dialectical Behavior Therapy: Outcomes
o Reduces:
• Self injury/suicide
• Emergency/impatient treatments
• Sub. Abuse
o Improves:
• Depression/aggression
• Impulse control
• Social adjustment

Front 42

• Cluster B: Narcissistic PD

Back 42

o Exaggerated and unreasonable sense of self-importance
o Preoccupation w/ receiving attention
o Lack sensitivity and compassion- “serial friendships”
o Highly sensitive to criticism
o Envious and arrogant
o Marked grandiosity

Front 43

• Cluster B: Narcissistic PD risk and treatments

Back 43

o Failure to learn empathy
o Treatments target grandiosity, building empathy, and lower unrealistic thoughts
o Little evidence that treatment works
o More in men

Front 44

• Cluster C: Avoidant PD

Back 44

o Extremely sensitive to others opinions
o Highly avoidant of interpersonal Rel.
o Interpersonally anxious and fear rejection
o See self as inept, unappealing, and inferior
o Want social interaction but are scared

Front 45

• Cluster C: Avoidant PD causes and treatments

Back 45

o Difficult childhood temp. and early rejection
o Treat: similar to social phobia
• Seek to improve social skills and lower anxiety (cog.beh. therapy)
o More in women

Front 46

• Cluster C: Dependent PD

Back 46

o Difficulty making simple decisions w/out advice/reassurance
o Fear of loss of support or approval = do not disagree w/ others
o Desperate for support and nurturance
o Giving up responsibility for major life areas
o Extreme difficulty doing things alone b/c lack of self esteem
o Helplessness and fear of being left alone
o More in women

Front 47

• Cluster C: Obsessive Compulsive PD

Back 47

o Excessive and rigid fixation on doing things the right way
o Preoccupied w/ details, rules, lists, etc
o Highly perfectionistic → interferes w, completing tasks and deadlines
o Miserly, stubborn, rigid
o OBSESSIONS/CUMPULSTIONS =RARE

Front 48

• Cluster C: Obsessive Compulsive PD risk and treatments

Back 48

o Unknown causes, weak genetic link
o More in women
o Limited data on treatment
o Address fears related to needs for orderliness
o Rumination, procrastination, feelings of inadequacy

Front 49

• Summary of PD’s

Back 49

o Long standing patterns of beh. (begin early and are chronic)
o Dimensional approach→ traits are apparent in everyone to some degree
o DSM has 10 PD’s- 3 clusters
o Causes start in childhood but are difficult to specify
o Treatment= difficult and prognosis= poor

Front 50

• Normal Sexual behaviors

Back 50

o Consensual activity
o Non-distressing to you or partner
o Culturally/socially appropriate
o Does not interfere w/ interpersonal rel., work, finances
o Legal and private endeavor

Front 51

• Sexual Dysfunction: overview

Back 51

o Disturbance in sexual response cycle
• Desire→ arousal→ orgasm
o Or pain during sex
o In both men and women equally
o Effect 43% of women and 31% of men
o Typically axis I

Front 52

• Sexual Dysfunction: classifications

Back 52

o Lifelong vs. acquired (previous period of normal orgasm)
o Generalized vs. situational
o Psychological factors only
o Psych factors and Med. Condition

Front 53

• Hypoactive Sexual Desire Disorder

• Sexual Aversion Disorder

Back 53

o 1st stage of SRC disrupted (desire)
o Low or no interest in sex
o Masturbation, sexual fantasy, and intercourse =rare
o 50% of all complaints @ sexuality


o Little interest in sex
o Extreme fear, panic, or disgust related to phys. Or sex contact

Front 54

• Male Erectile Disorder
• Female Sexual Arousal Disorder

Back 54

o 2nd stage of SRC disrupted (arousal)
o impotence
o difficulty achieving/ maintaining an erection
o main reason men seek help


o Inadequate lubrication
o Problem =AROUSAL not desire

Front 55

• Inhibited orgasm disorder

Back 55

o Female and male orgasmic disorder
o No orgasm despite adequate sexual desire and arousal
o Rare in men common in women
o Female orgasmic disorder: same except an orgasm may occur but is was less intense than usual

Front 56

• Premature Ejaculation

Back 56

o Ejaculating too soon
o Not a problem during masturbation
o Common in younger and inexperienced men
o Most common disorder in men (21%)

Front 57

• Dyspareunia

Back 57

o Extreme pain during sex
o Adequate sex. Desire
o Ability to attain arousal and orgasm
o Must rule out Medical reason

Front 58

• Vaginismus

Back 58

o Perineal muscles at outer 1/3 of vagina spasm painfully
o Feeling of ripping, burning, or tearing

Front 59

• Sexual Dysfunction: Biological and psychological Risk

Back 59

o Physical disease, prescription medication
o Use or abuse of alc./other drugs
o Anti-hypertensive meds
o Anxiety: worry during sex of pleasing others/self
o Distraction→ Spectator Role: evaluating performance rather than enjoying it
o Sexual dysfunctions increase w/ age

Front 60

• Sexual Dysfunction: sociocultural risk and psych/physiological interaction

Back 60

o Erotophobia: learned neg. attitudes about sex
o Neg. or traumatic sexual experience
o Deterioration of rel. and lack of communication
o Blacks= lower desire/pleasure during sex
o Whites= more pain during sex
o “balancing scale”→ presence of risk factors tilts sexual performance towards successful or dysfunctional

Front 61

• Sexual Dysfunction: assessment

Back 61

o Comprehensive interview: detailed history of sexual beh. Lifestyle, and associated factors
o Medical Exam: rule out sole med. Cause
o Psychophysiological Evaluation: exposure to erotic material and determine extent/pattern of sexual arousal
• Male penile plethysmograph
• Female vaginal photoplethysmograph

Front 62

• Sexual dysfunction: Biological treatments

Back 62

o Medications→ sildenafil= increases blood flow to penis to form erection
o Implants→ inflatable, semi-rigid, rigid
o Vacuum system: penis is placed in tube to help draw blood to it
o Antidepressants are used for premature ejaculation and compulsive sexual beh.
o Vaginal lubricants or hormone replacement therapy for women w/ painful intercourse
o Low sexual desire= testosterone hormone therapy (men) or estrogen/androgen hormone treatment (women)

Front 63

• Sexual dysfunction: Psychological treatments

Back 63

o Sex therapy:
o Stop-start procedure: for premature ejaculation→ stimulate penis until ejaculation is about to occur then pinch top of penis to suppress stimulation and block ejaculation= longer erection
o Sensate focus: low sexual desire→ ban sexual contact and rebuild couples sexual repertoire (and introducing fantasy training). Touching nonsexual, touching sexually, foreplay, etc.
o Masturbation Training: orgasmic disorders/painful sex→ clitoral stimulation and prohibiting intercourse, gradually inserting dilators to increase vaginal size, relaxation tech. and kegal exercises
o Sex schedule and increasing sex knowledge

Front 64

• Paraphilia

Back 64

o Misplaced sexual attraction and arousal
o Focused on inappropriate ppl/objects
o High comorbidity (anxiety, mood, sub abuse)
o Several may be present @ once
o Sometimes associated w/ violent beh. And/or rape

Front 65

• Exhibitionist & voyeurism

Back 65

o Exhibitionist: exposure of genitals to unsuspecting strangers
• Elements of thrill and rick necessary for sexual arousal
o Telephone scatalogia: sexual arousal via obscene phone calls
o Voyeurism: observing an unsuspecting individual undressing and/or naked
• Risk associated w/ peeping= sexual arousal
o Abnormal b/c ppl = UNCONSENTING

Front 66

• Fetishism and Transvestic fetishism

Back 66

o Fetishism: sexual attraction to nonliving objects (inanimate and/or tactile) like rubber, hair, feet , shoes
• Held, seen, smelled to achieve sexual arousal
o Transvestic Fetishism: sexual arousal with the act of cross dressing
• Helps person engage in the fantasy of being the opposite sex
• Can be secret or obvious
• Imagine themselves as female (autogynephilia

Front 67

• Frotteurism

Back 67

o Physical contact w/ someone who has not consented
o Ex. Rubbing against someone in subway
o Contact ranges form light in the form of “an accident” to very intrusive (grabbing boobs)
o Fantasy of having long term relationship w/ victims

Front 68

• Sexual Masochism and Sadism

Back 68

o Masochism: suffer pain or humiliation to attain sexual gratification
o Ex. Bondage, treated like a baby, verbal abuse, oxygen deprivation
o Sadism: inflicting pain or humiliation to attain sexual gratification
o Often about controlling the other person during sex

Front 69

• Pedophilia

Back 69

o Sexual attraction to young children
o Victims= male/female kids of very young adolescents
o Acts range from observation→penetration
o Associated features:
• Mostly men
• Most rationalize their beh. (eg. Love or education)
• Not distressed by actions
o @least 16yrs old and victim 5 year age difference

Front 70

• Pedophilia: Child Molestation

Back 70

o Someone who molests children may not be sexual attracted to them but may have sexual contact b/c they:
• lack partner own age
• wish to hurt childs parents
• intoxicated
• cognitive/intellectual deficits

Front 71

• Paraphilia: Risk factors

Back 71

o Biological: not well known but genetics may influence related factors (ex. Violence)
o Associated w/ sexual and social probs.
• Patterns of inappropriate arousal and deficits
o High sex drive coupled w/ suppression on urges
o More common in men
o Typical onset is early 20’s or adolescence

Front 72

• Paraphilia Risk factor Taxonomy

Back 72

o 1) Early inappropriate sexual associations or experience (accidental or vicarious)
o 2) possible inadequate development of consensual adult arousal pattern OR
o 2)possible inadequate development of appropriate social skills for relating to adults
o 3) inappropriate sexual fantasies repeatedly associated w/ masturbatory activities and strongly reinforced
o 4) repeated attempts to inhibit undesired arousal and beh. Resulting in (paradoxical) increase in paraliphic thoughts, fantasies, and behaviors
o 5)paraphilia

Front 73

• Paraphilia: assessment

Back 73

o Psychophysiological assessment: deviant pattern of sexual arousal
o Desired sexual arousal to adult consent
o Social skills
o Nature of adult rel.

Front 74

• Paraphilia: Biological Treatments

Back 74

o Medications: equivalent to chemical castration
• Anti-androgens, low testosterone, sexual urges and fantasies (used for dangerous sex offenders)
o Anti-depressants –SSRI’s- reduce sexual urges, diminish performance, or stop depression
o Good efficacy: low sexual desire, fantasy, and arousal
o Relapse is high if meds. =discontinued

Front 75

• Paraphilia: psychological treatments

Back 75

o Most= behavioral : target deviant and inappropriate sexual associations
o Aversion treatment: paraphilia stimuli→ masturbate→punishment
o Covert sensitization: Imagining aversive cons
o Orgasmic Reconditioning: masturbate + appropriate stimuli
o Masturbatory satiation: after orgasm, keep masturbating to paraliphic stimuli= irritating and boring (mild punishment)
o Family/marital therapy: address interpersonal probs
o Coping and relapse prevention: self control and risk management
o Efficacy: 75%-95% show improvement but poorest outcome in rapists/multi paraphilics
o Chronic course w/ high relapse rate

Front 76

• Gender identity disorder

Back 76

o NOT a paraphilia
o Desire/arousal to be opposite sex (not for sex related reasons)
o Biologically one sex and psychologically the opposite

Front 77

• Gender identity disorder: treatments

Back 77

o Hormone therapy
o Gender reassignment prerequisites→ 1) live 1-2 yrs as opposite sex 2) hormone therapy 3) psychological, financial, and social stability
o Up to 97% are stratified w/ surgery

Front 78

• Schizophrenia: History

Back 78

o Emil Kraeplin- “Dementia Precox”
o Symptoms of catatonia, hebephrinia, and paranoia
o Focus on early onset and “loss of mind”
o Eugen Bleuler- “schizophrenia”
o “splitting of the mind” b/w thoughts an beh.
o Lead to common yet inaccurate confusion w/ multi personality dis. (DID)
o Many of Kraeplins and Bleulers ideas are still practiced
o Importance of understanding onset and course

Front 79

• Schizophrenia: overview

Back 79

o Disturbances in thinking (delusions), perceptions (hallucinations), speech, emotions, and beh.
o 6+ Months
o Schizophrenia Vs. psychosis
o Psychosis: broad diagnostic category characterized by hallucinations and loss of contact w/ reality
o Schizophrenia: type of psychosis
o Schizophrenia and psychosis= heterogeneous
o Symptoms aren’t necessarily shared w/ all sufferers
o 2 clusters of symptoms: neg and pos.

Front 80

• Schizophrenia: Positive Symptoms

Back 80

o Active manifestations of abnormal thoughts, feelings, beh.
o Sig. distortions of normal beh., thoughts, etc
o Includes:
• Delusions
• Hallucinations
• Disorganized speech/beh.

Front 81

• Schizophrenia: Positive Symptom Delusions

Back 81

o Irrational beliefs that are gross misinterpretations of reality
o Highly fixed and resistant
o Persecutory Delusions: irrational beliefs that one id being harmed/harassed in some way
o Control Delusions:
• Thought insertion: putting thought into their mind
• Thought broadcasting: transmitting thoughts to everyone around you
• Thought withdrawal: stealing thoughts and creating memory loss
o Delusions of reference: everyday events have something to do with them
o Grandiose Delusions: belief that one is especially powerful /important
o Somatic delusions: ones physical body is neg. affected by external source

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• Schizophrenia: Positive Symptom Hallucinations

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o Sensory exp. w/ no external input
o Can involve all senses
o Auditory: voices
o Tactile: bizarre skin sensations
o Visual: seeing images or invisible visions
o Olfactory: smelling unusual odors

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• Schizophrenia: Positive Symptom Disorganized symptoms

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o Fragmented, illogical, incoherent
o Neologism: make up words
o Clanging: saying words b/c they rhyme or repeating them
o Tangentality: rapidly and randomly switching topics w/out warning
o Echolalia: repeating others words
o Echopraxia: repeating others actions
o Alogia: not speaking @ all
o Disorganized beh: inappropriate effect
o Catatonia: unusual motor symptoms
• Being unresponsive to envoi. Factors or excited agitation
• Catalepsy/waxy flexibility: One body part staying in unusual position for long periods

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• Schizophrenia: Negative Symptom

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o Absence/deficits I normal beh
o Avolition (or apathy): lack of initiation and persistence
o Anhedonia: lack of pleasure from once pleasurable things
o Affect flattening: unemotional
o Lack of insight: poor awareness of MHD (think everyone else is “sick”)

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• 4 Phases of schizophrenia

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o 1) Prodomal- peculiar beh. Such as minor disturbances in speech /thoughts, odd/withdrawn social interactions, perceptual distortions, anxiety or depression
• mostly neg. symptoms and may resemble depression
o 2) Psychotic Prephase- first full-blown pos. symptom (such as hallucinations) for less than 2 months. Positive sym. Get stronger and person admitted to treatment
o 3) Active phase: 6+ months (1 month of acute symptoms) of full blown positive and negative symptoms. Usually hospitalized.
o 4) Residual Phase: following treatment but resembles prodromal phase (most people remain here most of their life)

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• Schizophrenia Subtypes

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o Paranoid: persecutory or grandiose delusions and auditory hallucinations but no probs putting thoughts together and communicating (best prognosis for subtypes)
o Disorganized: fragmented, incoherent, odd and/or inappropriate speech, beh, emotions
o Catatonic: abnormal motor movements- immobility, odd movements, excessive activity
o Undifferentiated: mix of symptoms
o Residual: after being treated for pos symptoms. Neg symptoms still in effect. Oddities in speech and ongoing perceptual differences
o 3 dimensions: psychotic, disorganized, negative

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• Video Case Study- Schizophrenia

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o Positive symptoms:
o Persecutory delusions:
• Thought mom was gonna shoot him
• Ppl are keeping his kids away
o Disorganized beh.
• Inappropriate affect- laughed at fiancé when she talked about his phases and smiled when calling her a liar
o Neg Symptoms (harder to recover from neg. sym.):
• Flat affect
• Moderate lack of insight

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• Schizophreniform Disorder

• schizoaffective Disorder

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o Only a few months (less than 6)
o Daily functioning not impaired
o Resume normal lives
o 2/3 become schizophrenic


o symptoms of schizophrenia and mood disorder (are independent form each other)- depressive or bipolar subtype
o prognosis like schizophrenia

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• Delusional Disorder

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o Delusions contrary to reality
o Lack of positive or negative symptoms
o Extremely rare better prognosis than schizophrenia
o Delusions are NOT as bizarre
o Erotomanic delusions: person loves them form afar
o Grandiose delusions: special or powerful
o Jealous delusions: spouse is having affair
o Persecutory delusions: someone trying to hurt them
o Somantic delusions: serious medical disease

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• Brief Psychotic Disorder
• Shared Psychotic Disorder (folia due)

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o One or more pos. symptoms of schizophrenia
o Usually brought on by extreme stress/trauma
o Lasts less than 1 month
o Remits on its own
o Postpartum psychosis

o Delusions form one person manifests in another person
o Little is know

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• Schizophrenia: Epidemiology

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o Onset and prevalence WORLD WIDE
o About 0.33% → 0.72%
o Age of onset= 22yrs old
o Somewhat more frequent/severe among men
o Generally chronic
o Moderate to severe impairment
o Life expectancy slightly lower than avg.
o Most often victims of violence b/c of stigma= live on edge of society

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• Schizophrenia: Biological risk factors

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o Strong genetic inheritance from twin and fam. Studies
o Inherit a tendency for schizophrenia (not subtypes)
o Removal of subtypes in DSM V
o Risk higher w/ genetic relatedness
o Kids of ppl with schiz. = 12x more likely
o -50% concordanance rate w/ identical twins
o adoptions studies: risk for schiz. Still high
o genes- polygenic model (lots of genes working together)

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• Schizophrenia: Biological risks neurotransmitters

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o Excessive dopamine hypothesis
o Drugs that are high in dopamine (agonist) result in schiz. Beh.
o Drugs that decreased dopamine (antagonists) reduce schiz. Beh.
o Alladopa- side effects are parkinsins like symptoms
o Dopamine receptors in striatal region of brain: D1 and D2 may be denser
o Dopamine hypothesis=overly simplistic and problematic
o Current Theories- emphasize many transmitters (glutamate)

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• Schizophrenia: Brain Structure

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o Enlarged fluid filled ventricles and reduced TISSUE volume in cortical areas
o Hypofrontality- low active frontal lobes (organizes thoughts)
o Viral infections during early prenatal development
o Findings = not conclusive

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• Schizophrenia: Psychological Risk Factors

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o Stress: may active underlying vulnerability and increase relapse risk
o Family intercations: ineffective communication patterns and high expressed emotion= associated w/ relapse (open criticism/pessimism and highly emotionally over involved)
o Psychological Factorsexert only a minimal effect on schiz.

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• Schizophrenia: Culture, Labeling, and stigma

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o More common in developing countries and among immigrants/migrant workers b/c of Social isolation and low social support
o More sensitive dopamine systems (found through animal models)
o Labeling and stigma: Rosenhan (1973) “psuedopatients” STUDY
o Acted as tho they had a psych disorder to be hospitalized→ started acting normally in hospital and DR’s interpreted the normal beh and “psychotic”
o Neg. effects of labeling/stigma are strong and difficult to challenge

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• Schizophrenia: Medical Treatments

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o Antipsychoti (neuroleptic) Meds: often the first line of treatment
o Most reduce/eliminate pos. symptoms
o Acute and permanent side effects =common
o Extrapyrmidial parkinsin side effects
o Tardive dyskinesia- involuntary tics of the face, mouth, tounge and upper body (Repetative beh.) and potentially irreversible
o Compliance w/ meds=problem

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• Schizophrenia: Historical Psychological Treatment

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o Historicaly viewed as having poor prognosis
o Goals were to reduce neg. outcomes
o Psychosocial approach involves:
o Token economy
o Social/living training
o Cog. Vocational rehab (memory skills, work skills, etc)
o Beh. Family therapy
o Community care programs

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• Schizophrenia: New Psychological Treatments

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o Stigma, trauma, and neurocognitive impairments create neg. selp-experience
o Treatment needs to help reconstruct self-experiences that are richer and more positive
o Personal narratives: writing about self in detail helps to show them that they are more than their stereotypes
o Metacognition-thinking about ones own thinking