Advanced Psychopathology Quiz (Chapters 11-13)

Front 1

What is the lifetime prevalence rate of anxiety disorders in the general U.S. population? (349)

Back 1

31% of the general population

Front 2

Distinguish repression and dissociation. (474)

Back 2

• Repression is a defense mechanism to ward off internal pressure.
• Dissociation as an alteration in consciousness to deflect the overwhelming impact of ongoing trauma

Front 3

List the five dimensions of dissociation. (474)

Back 3

1. Environment
2. Emotions
3. Physical Sensations and Agency
4. Memory
5. Identity

Front 4

What assumption about dissociative disorders does the DSM-IV not make? What does the DSM-IV assert is typical about this type of disorder? (476)

Back 4

• The DSM does not assume dissociative disorders develop as the result of defense mechanisms used to cope with ongoing trauma
• The DSM does assure that dissociative disorders are typically linked to traumatic events

Front 5

Name the two anxiety disorders that were previously labeled as dissociative disorders (476)

Back 5

• Acute Stress Disorder (ASD)
• Post Traumatic Stress Disorder (PTSD)

Front 6

Among nonclinical populations, when does dissociativity reach its peak? What personal characteristic has a similar age distribution? (478)

Back 6

Dissociativity reaches a peak in early adolescence; hypnotizability

Front 7

What is the reported, though likely excessive, ratio for the occurrence of dissociative disorders across genders? (478)

Back 7

9:1 women to men ratio of DID diagnoses

Front 8

Define autoscopy. (479)

Back 8

An extreme form of depersonalization where an individual encounters a self-image outside of the body.

Front 9

Name the five proposed types of depersonalization. (479)

Back 9

1. Inauthenticity
2. Self-negation
3. Self-objectification
4. Derealization
5. Body detachment.

Front 10

Distinguish depersonalization from psychotic episodes. (480)

Back 10

• Depersonalization experiences are described as experiential detachment with intact reality testing.
• Psychotic episodes involve delusional beliefs.

Front 11

What are the four most common features of depersonalization according to the literature? (480)

Back 11

1. An altered sense of self (“My body doesn’t belong to me.”)
2. A precipitating event (“an accident, substance use.”)
3. A sense of unreality or a dreamlike state (“Nothing seems real.”)
4. Sensory alterations (“Colors seem less vibrant.”)

Front 12

When do depersonalization episodes occur frequently among nonclinical populations? (480)

Back 12

During or shortly after a traumatic event; the also can occur as a by-product of meditation or hypnosis and after psychedelic drug ingestion

Front 13

What are the four types of amnesiac episodes? Briefly define each. (482- 483)

Back 13

-Generalized-amnesia for all or most personal information, including name, history, identity of relatives and friends
- Localized- forgetting what transpired during a certain period although the individual remembers events prior and subsequent
- Selective- Individual may recall some but not all features of a specific event or circumstance
- Systematized- an inability to remember certain categories of experiences (ex. When someone loses a sibling tragically they can’t recall any memories that involve that sibling)

Front 14

Under what conditions is prognosis for dissociative amnesia typically good? (483)

Back 14

When it is not chronic and follows a traumatic event.

Front 15

What two measures should be taken to rule out other possibilities besides dissociative amnesia? (483)

Back 15

A detailed clinical history and laboratory analysis can usually rule out other possibilities.

Front 16

What are some areas that should be investigated if a clinician suspects amnesia? (484)

Back 16

• Memory gaps in everyday life,
• failure to give an account of salient episodes from late childhood onward,
• finding items that recently have been bought but for which the client has no memory.

Front 17

What was dissociative identity disorder formerly called? What are its defining features? (487- 488)

Back 17

• Formally called, multiple personality disorder.
• Defining features: the presence in the person of two or more distinct identities or personality states with enduring patterns of perceiving, relating to and thinking about the self, which recurrently take control of the individual. The other defining feature is psychogenic amnesia.

Front 18

What is the current view of dissociative identity disorder in terms of the personality complexity? (488)

Back 18

• The current view of dissociative disorder is that it fails to have the sort of complex, multifaceted, unified, personality that most of us have.
• Many aspects of personality such as acquiescent or aggressive, Playful or serious are not integrated in these people, they remain isolated and personalized nuclei.

Front 19

What two issues have been vigorously debated in the mental health field about dissociative identity disorder? (489)

Back 19

1. Etiology/reality of the phenomenon
2. Diagnostic reality

Front 20

What percentage of general psychiatric patients reporting clinical levels of dissociation were reported by Saxe as being diagnosed with dissociative disorder NOS? (492)

Back 20

60%

Front 21

What variables must be considered to understand dissociative syndromes? (492)

Back 21

Social, political, gender, and cultural variables must be considered to understand these syndromes

Front 22

What type of phenomena are included in dissociative trance disorder? (493)

Back 22

Trance or spirit possession phenomena

Front 23

What is the diagnostic process for determining a somatoform disorder? (412)

Back 23

Criterion (A) Symptoms must begin before age 30 and result in medical help seeking or lead to significant social or occupational impairment
Criterion (B) Requires four:
1. a history of pain related two at least four different anatomical sites or functions
2. a history of at least two gastrointestinal symptoms other than pain
3. at least one sexual or reproductive symptom other than pain
4. at least one pseudoneurological symptom not related to pain
Criterion (C): No General Medical Condition that can fully explain the symptoms or that the distress and disability are in excess of what can be medically explained

Front 24

What percentage of family medicine practice visits are due to medically unexplained symptoms? (415)

Back 24

25 – 60%

Front 25

What factor hampers the possibility for epidemiological studies of somatoform disorders? (416)

Back 25

Hampered by the necessity for medical evaluation to rule out organic explanations before the diagnosis of somatoform disorders can be made with confidence

Front 26

List five common symptoms associated with conversion disorder. (421)

Back 26

Symptoms resemble those of a neurological disorder
1. Gait disturbances
2. Pseudoseizsures
3. Episodes of fainting or loss of consciousness
4. Muscle tremors, spasms, weakness, or paralysis
5. Sensory changes including parenthesis or anesthesia
6. Speech disturbances (aphonia)
7. Visual disturbances (blindness, diplopia: double vision)

Front 27

Define pseudocyesis. What disorder is it classified as? (421)

Back 27

Defined as hysterical pregnancy. DSM-IV classifies it as somatoform disorder NOS. it is associated with endocrine disturbances, which sets it apart from other conversion symptoms.

Front 28

What are common social ramifications of body dysmorphic disorder? (423)

Back 28

Because patients with BDD are
• preoccupied with the notion that some aspect of their body is misshapen and ugly,
• frequently checking in the mirror to monitor their so-called defect
• may try to camouflage it, usually without success.
• convinced that others are reacting negatively to them,
• commonly have ideas or delusions of reference.
• fear embarrassment and avoid social situations, sometimes to the point of being housebound. This condition usually results in severe social disability.

Front 29

What personality trait is associated with somatoform disorders? (426)

Back 29

Patients with somatoform disorders are more likely to experience:
• affective and anxiety disorders.
• Also give rise to significant somatic symptoms through physiological mechanisms like hyperventilation or sleep disturbance.
• May experiences more frequent, intense, or distressing bodily sensations caused by the dysregulation of autonomic or pain control systems even in the absence of dysphoric mood.

Front 30

What factors may the selective emphasis on somatic symptoms and explanations for distress have more to do with? (429)

Back 30

May have more to do with attribution style, defense style, or structural factors influencing help seeking and stigmatization

Front 31

Why may patients present clinically with somatic symptoms while minimizing underlying emotional distress? (429)

Back 31

An unwillingness or inability to attribute the bodily concomitants of emotional arousal or affective disorder to psychological causes may lead patients to present clinically with somatic symptoms while minimizing underlying emotional distress.

Front 32

What are characteristics of alexithymic individuals? (431)

Back 32

Alexithymic individuals are said to
• lack the ability to discriminate feelings and bodily sensations,
• tend not to express their psychological states,
think in a concrete and action-orientated rather than a reflective way about the world, and lack a rich fantasy life.

Front 33

What might increase a child’s vulnerability to a range of functional disorders? (432)

Back 33

Compared to mothers with a history of stomach ulcers, mothers with irritable bowel symptoms were more likely to take their infants for treatment, providing evidence of early social reinforcement of illness behavior. This early infant experience might increase the child’s vulnerability to a range of functional disorders.

Front 34

What attachment style is most associated with somatoform disorders? (433)

Back 34

Evidence exists that adults with somatoform disorders tend to display insecure attachment styles.

Front 35

What are four sources of social response that may aggravate or resolve somatoform disorders? (436)

Back 35

• Family members,
• Employers
• Health care professionals
• Larger society

Front 36

What types of intervention do many hypochondrical patients respond to? What does this point to? (438)

Back 36

The observation that many hypochondrical patients respond well to systematic reassurance and reattribution training points o the limitations of their earlier encounters with physicians.

Front 37

What type of psychiatric disorders are somatoform disorders commonly secondary to? (439)

Back 37

Symptoms of somatoform disorders are clearly secondary to another antecedent or underlying psychiatric disorder. Somatic symptoms commonly accompany mood and anxiety disorders.

Front 38

How would a patient use a symptom diary to give the clinician a better picture of his/her somatic complaints? (443)

Back 38

This diary involves a form of self-monitoring that may have immediate therapeutic effects and sets the stage for subsequent cognitive and family interventions

Front 39

What two MMPI-2 scales do somatoform sufferers typically have high scores on? (446)

Back 39

1. Hypochondriasis
2. Hysteria

Front 40

List three reasons for gender differences in prevalence of somatoform disorders. (449)

Back 40

• Higher prevalence of related psychiatric disorders among women (i.e., mood and anxiety disorders)
• Social stresses and psychological conflicts associated with gender roles
• Gender bias in the diagnostic process

Front 41

What type of prototypes serve as templates for somatoform symptom experience? (452)

Back 41

• Prototypes in the individual’s own experience
• Prototypes in the experience of their family or friends
• Examples present through mass media

Front 42

What is a panic attack? (349)

Back 42

Constitute a discrete period of intense fear or discomfort that develops abruptly and peaks with 10 minutes of onset.

Front 43

What are the three types of panic attacks? (349 -350)

Back 43

• Unexpected (un-cued): onset associated with a situational trigger
• Situational bound (cued): the attack occurs immediately upon exposure to or in anticipation of exposure to the anxiety producing stimulus
• Situational Predisposed: The attack is more likely to occur upon exposure although not immediately and not every time

Front 44

Define agoraphobia. (350)

Back 44

A fear of being in public places or situations where escape might be difficult or where help may be unavailable should a panic attack occur.

Front 45

Define social anxiety disorder. (351)

Back 45

A marked and persistent fear of social or performance situations in which embarrassment may occur.

Front 46

What is specific phobia? What are the four subtypes of specific phobia? (351)

Back 46

A marked and persistent fear of clearly discernible circumscribed objects or situations.
- Animal Type
- Natural Type
- Blood-injection-injury Type
- Situational Type

Front 47

Define obsessions and compulsions? (352)

Back 47

• Obsessions are recurrent and persistent thoughts, impulses, or images that are intrusive and inappropriate and cause a marked anxiety or distress.
• Compulsions are repetitive behaviors or mental acts that the person feels driven to perform in response to obsessions or according to rigid rules.

Front 48

What are the two requirements for the development of PTSD? (352)

Back 48

Individuals are exposed to a traumatic event in which
(1) The person experienced, witnessed, or was confronted with actual or threatened death or serious injury, or a threat to the physical integrity of self or others, and

(2) The response involved intense fear, helplessness, or horror.

Front 49

What are the ways that PTSD sufferers reexperience the event? (352)

Back 49

Patients with PTSD report "reexperiencing" the event through recurrent and intrusive recollections or dreams, or both; suddenly acting or feeling as if the event were recurring; intense psychological or physical reactivity; and when exposed to events that symbolize or resemble some aspect of the trauma

Front 50

What factor distinguishes the diagnoses of PTSD and Acute Stress Disorder? (353)

Back 50

The duration requirement (ASD-2 days to 4 weeks; PTSD-longer)

Front 51

According to the National Comorbidity Survey Replication (NCSR), what is the lifetime occurrence of an anxiety disorder in the general population? For the past 12 months? (356)

Back 51

• Lifetime occurrence is 31.2% of the general population
• 18.7% of the sample endorsed the presence of an anxiety disorder within the past 12 months.

Front 52

What are the three categories that anxiety symptoms are usually divided into? (357)

Back 52

Subjective Distress (self-report),
2. Physiological Response,
3. Avoidance or Escape Behavior (overt behavioral)

Front 53

What are the psychosocial treatments of choice for anxiety disorders according to compelling empirical data? What procedures do all these anxiety disorder interventions incorporate? (361)

Back 53

• Behavioral or Cognitive Behavioral interventions or treatments are the psychosocial treatments of choice.
• They all incorporate exposure procedures

Front 54

Across all disorders (except specific phobia), what is a predictor for poorer treatment outcome? (364)

Back 54

• severe psychopathology,
• in the form of either the primary anxiety disorder,
• comorbid affective anxiety states, or comorbid Axis II disorders.

Front 55

Among those with a primary anxiety disorder, what percentage of sufferers had at least one other clinically significant anxiety or depressive disorder? (365)

Back 55

50%

Front 56

What types of disorders demonstrate a substantial percentage of comorbidity with an anxiety disorder? (367)

Back 56

An additional anxiety disorder, depressive disorder, personality disorder

Front 57

Compared to children of normal parents, what is the likelihood that children of anxiety disorders patients will develop a psychiatric disorder? (373)

Back 57

Over nine times as likely to have a psychiatric disorder as the children of normal parents

Front 58

What are two assumptions cognitive theories make about anxiety disorders? (377- 378)

Back 58

Those with anxiety disorders process threat information differently. Second, cognitive biases play a role in the maintenances, and perhaps the etiology of anxiety disorders.

Front 59

What is the one type of anxiety disorder (specific phobia) that occurs more in men than women? What type of anxiety disorder occurs in equal proportions between men and women? (379)

Back 59

• A fear of heights most common in men.
• OCD occurs in both men and women in equal proportions

Front 60

Is there a difference across racial and ethnic groups in the rates of anxiety disorders or the symptomatic expression of these disorders? (379)

Back 60

• There are few differences in rates of anxiety disorder across racial and ethnic groups.
• Differences exist in symptomatic expression of these disorders or in co-varying condition

Front 61

1. How do we differentiate between normal levels and clinical levels of anxiousness?

Back 61

• Impairment (social or occupational)
• Intensity
• Irrationality of the thoughts, presentation

Front 62

2. Define Worry

Back 62

• Uncontrollable cognitive intrusions.
• Promotes non-productivity

Front 63

3. Core of anxiety treatment:

Back 63

• Exposure Response Prevention

Front 64

4. Methods of determining what treatment would best work for specific clients.

Back 64

• Intensity
o Gradual
o Intense
• Nature (Type)
o Imaginal
o In Vivo
• In vivo/Gradual- Graduated Exposure
• In vivo/Intense- Flooding
• Imaginal/Gradual - Systemic Desensitization
• Imaginal/Intense - Impulsive Therapy

Front 65

5. Why is the presence of a specific fear stimulus important?

Back 65

• It gives us a place to begin for treatment
• Examples: Known fear stimulus- specific phobia, OCD, bulimia, agoraphobia
• Examples of none- panic disorder

Front 66

6. How do you distinguish between factitious disorders (517) and malingering (739)?

Back 66

• Factitious Disorders: motivation is to assume the sick role, but no real reward can be seen.
• Malingering: taking on the sick role; motivated by external incentives such as avoiding military duties, avoiding work, obtaining financial compensation, evading criminal persecution, or obtaining drugs.

Front 67

7. What are the somatoform disorders? (least to most severe)

Back 67

• Hypochondriasis
• Body Dysmorphic Disorder
• Pain Disorder
• Undifferentiated Somatoform Disorder
• Somatization Disorder
• Conversion Disorder (there is a loss of function)

Front 68

8. What do they (somatoform disorders) have in common?

Back 68

The apparent presence of general medical condition, but with no known form of medical explanation

Front 69

9. What are the dissociative disorders (least to most severe)

Back 69

• Dissociative Amnesia
• Dissociative Fugue
• Depersonalization Disorder
• Dissociative Identity Disorder (formerly Multiple Personality Disorder)