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288 Cards in this Set
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film/guest lecture
symptoms of PTSD (post traumatic stress disorder) |
hypervigilance
flashbacks startle responses intrusive thoughts |
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PTSD was not included in DSM until
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1980, following veterans return
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chapter 4
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anxiety disorders (ptsd and ocd only)
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ptsd overview and defining features (5)
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exposure
experience avoidance numbing hyperarousal |
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post traumatic stress disorder overview and defining features
(7) |
requires exposure to an event resulting in extreme fear, helplessness, or horror (some sort of event that involves actual death, threatened death, or injury)
person continues to experience the event (memories, nightmares, flashbacks) avoidance of cues that serve as reminders of the traumatic event (trying to avoid having conversations of event, inability to remember important parts of events) emotional numbing and interpersonal problems are common (sense of emotional numbing, feeling nothing. detachment/estrangement from other. dissociation - your surroundings just don't seem real) physiological hyperarousal (difficulty falling asleep, hypervigilance, always looking out the window, outlining area and preemptive action) ptsd diagnosis cannot be made earlier than 1 month post-trauma (symptoms need to persist. if call disorder, must have interfered with functionality) |
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dissecting criterion c
numbing/avoidance |
thought not to be grouped together
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several factor analytic studies suggest that there are __ , not __ ptsd symptom clusters
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4, not 3
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__ and __ proposed that avoidance may be driven by psychological processes, whereas biological processes may underlie numbing
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foa and riggs
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one factor analytic study using children exposed to a tornado suggests __ symptom clusters
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6
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ptsd causes and associated features
statistics: ___ and ___ assault are the most common traumas |
combat and sexual assaults
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about ___% of the general population meet criteria for ptsd
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7.8%
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subtypes and associated features of ptsd:
duration of symptoms is 1-3 months following trauma |
acute ptsd
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duration of symptoms is more than 3 months
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chronic ptsd
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onset of symptoms 6 months or more post-trauma; trauma happens, person appears fine, 6 months or later, person starts having symptoms, considered:
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delayed onset ptsd
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diagnosed within first month post-trauma
importance of dissociation: could be during trauma or after. depersonalization, derealization, not part of yourself. |
acute stress disorder
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ptsd treatment
causes of ptsd (5) |
only disorder we can id the causing event
intensity of trauma and one's reaction to it (true trauma) uncontrollability and unpredictability extent of social support, or lack thereof post-trauma direct conditioning and observational learning |
only disorder we can ____
depends on ___ of trauma and one's ____ to it uncontrollability and _______ extent of ___ ___ or lack thereof posttrauma ___ conditioning and ___ learning |
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psychological treatment of ptsd
high effective and generally involve exposure to avoided stimuli as well as cognitive reprocessing |
cognitive behavior therapies (CBT)
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part of cbt, developed in U of PA, empirical support, gives patient opportunity to learn to undo dysfunctional fears. talks to suds 'subjective units of distress'.
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prolonged exposure
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part of cbt, recounting actual experience to therapist over and over. the more times, the less daunting.
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imaginative exposure
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part of cbt, involves written narrative of trauma and focus on meaning attached to event. also form of exposure, but more emphasis on thoughts/meanings
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cognitive processing therapy
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person recounts trauma, then you move finger back and forth in front of face, tell them to track finger with eyes.
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emdr
eye movement desensitization and reprocessing. |
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also effect, exposure that reduces cycle of __ and __
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avoidance and hyperarousal
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contraindicated -- shouldn't do it! involves everyone involved in the experience right after it happens, force everyone to talk of memories. doesn't work but worsens
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cisd
critical incident stress debriefing |
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medical treatment
blood pressure medicine to control ____. helps but not strong enough to alleviate all symptoms and make it go away. |
physiology
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obsessive compulsive disorder overview and defining features
intrusive and nosensical thoughts; images, or urges that one tries to resist or eliminate |
obsessions
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thoughts or actions to suppress the thoughts and provide relief
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compulsions
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most persons with ocd present with cleaning and washing or checking rituals. belief that everyone and themselves are contaminated. agression.
feeling that things won't be right until things are just so, if not, something bad will happen. some are of sexual content, need for symmetry, etc. |
magical thinking
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ocd very likely to be paired __ and __ for people who have obsessions about symmetry - counting
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obsessions and compulsions
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ocd causes and associated features
statistics about __% of general population meet criteria for ocd |
2.6%
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most people with ocd are
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female
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onset is typically in
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early adolescence or young adulthood
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ocd tends to be
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chronic
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cause of ocd
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parallel the other anxiety disorders
early life experiences and learning that some thoughts are dangerous/unacceptable thought action fusion - tendency to view though as similar to action |
parallels:
early life experiences and learning are that some thoughts are __ __ __ tendency to view though as similar to action |
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ocd treament
medication treatment of ocd |
clomipramine and other ssris seem to benefit up to 60% of patients
relapse is common with medication discontinuation psychosurgery (cingulotomy) is used in extreme cases |
____ and other ssris seem to benefit up to __ % of patients
relapse is ____ without medication psychosurgery ______ is used in extreme cases |
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psychological treatment of ocd
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cognitive behavioral therapy is most effective with ocd
cbt invovles exposure and response prevention combining medication with cbt is no more effective than cbt alone cbt because you've taught them skills to deal with their disorder/ansiety |
____ most effected with ocd
involves _____ and ____ ____ combining medication with cbt is ________ than cbt alone cbt because |
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involves exposing person to obsession but preventing them from performing compulsion
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erp
exposure and response prevention - |
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ocd __ people collect trash, cotton balls, things others do not want to keep; piles of trash
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hoarders
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anxiety disorder represent some of the most common
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psychopathology
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from a normal to a disordered experience of anxiety and fear
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requires consideration of biological, psychological, experential, and cues
fear and anxiety persist to cause significant distress and impair functioning symptoms and avoidance cause significant distress and impair functioning |
requires consideration of:
__, ___, ___ and ___ cause significant distress and impair function |
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psychological treatments are generally superior in the long-term
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most treatments for different anxiety disorders involve similar components
suggests that anxiety-related disorders share common processes |
most treatments for different anxiety disorder involves
suggests they share common ___ |
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chapter 5
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somatoform and dissociative disorders
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meaning body
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soma
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somatoform disorders
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preoccupation with health and/or body appearance and functioning
no identifiable medical condition causing the physical complaints shell-shock, etc. characterized by preoccupation, almost obsession with person's health/physical well-being or body appearance and functioning (not anorexia/bulimia) no medical condition that leads to preoccupation of one's condition (ex: if there was a brain tumor, and person preoccupied, then it is not disorder, because there was a reason) |
___ with health/body appearance anf function
no identifiable ___ ___ |
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types of dsm-iv somatoform disorders
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hypochondriasis
somatization disorder conversion disorder pain disorder body dysmorphic disorder |
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hypochondriasis
clinical description |
physical complaints without a clear cause
severe anxiety (worry) focused on the possibility of having or developing a serious disease strong disease conviction - virtually convinced that physical complaints mean physical illness. often mean serious illnesses for person medical reassurance does not seem to help - convinced they're wrong or missing something |
physical ___ without clear cause
severe ___ focused on possibility of having or developing serious disease strong __ conviction - convinced physical complaints mean ___ ___ medical reassurance __ __ __ to help |
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hypochondriasis
statistics |
good prevalence data are lacking
onset at any age, runs a chronic course |
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hypochondriasis cases
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cognitive perceptual distortions - interpret bodily sensations of minor illness as threatening
familial history of illness |
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hypochondriasis treatment
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challenge illness-related misinterpretations
provide more substantial and sensitive reassurance stress management and coping strategies |
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intergrative model of causes of hypochondriasis
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pg. 6 of study guide
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somatization disorder distinguished from hypochondriasis
main difference: |
in soma disorder, person concerned of symptoms, not what they mean:
headache --> tumor ---> hypo headache --> horrible headache --> soma. disorder history of complaints must begin before 30!!!!!! |
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clinical description of somatization disorder (5)
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extended history of physical complaints before age 30
substantial impairment in social or occupational functioning concerned over the symptoms themselves, not what they might mean, as is the case with hypochondriasis symptoms become the person's identity and personality "what is it this week?" numerous visits to physicans; chronic complaints |
extended history of complaints before age:
substantial impairment in ___ or ___ function concerned over the ___, not illness symptoms become person's chronic ___ |
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statistics of somatization disorder (4)
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rare condition
onset usually in adolescence mostly affect unmarried, low ses women, slower social eco stat runs a chronic course |
___ condition
onset in mostly in ___ ___ women runs a __ course |
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somatization disorder causes (2)
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familial history of illness
weak behavioral inhibition system |
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somatization disorder treatment (5)
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no treatment exists with demonstrated effectiveness
reduce the tendency to visit numerous medical specialists assign gatekeeper physician reduce supportive positive consequences of talk about physical symptoms remove secondary gain (babying, etc.) |
no treatment exists with ____ ____
__ tendency to visit specialists assign ___ physician __ supportive positive consequences of talk about symptoms remove ___ ___ |
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conversion disorder clinical description (4)
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physical malfunctioning without any physical or organic pathology (losing hearing without cause, or being blind with no reason, not consciously fake - lose ability to move/reflexive abilities)
malfunctioning often involves sensory-motor areas (vision, hearing, motor (paralysis)) persons show "la belle difference" (almost as if they don't care, their concern for it much less than expected. kid had pseudo-seizures, but brain has no indication of the seizure activities) retain most normal functions |
__ __ w/o any physical pathology
malfunctioning often involves __ __ areas person shows "_ __ ___" they don't care, concern much less. retain most ___ functions |
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conversion disorder statistics (3)
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rare condition, with chronic intermittent course
seen primarily in females, with onset usually in adolescence not uncommon in some cultural and/or religious groups |
___ condition with __ __ course
seen primarily in ___, w/ onset in ___ not ___ in some cultural and religious groups |
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conversion disorder causes (4)
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freudian psychodynamic view is still popular
emphasis on role of trauma, conversion, and primary/secondary gain. (person represses reaction to psychological/physical trauma, and the trauma is converted into physical malfunction UNCONSCIOUSLY) (virtually all cases have an identifiable traumatic event, though not a criteria for DSM. rare disorder) detachment from the trauma and negative reinforcement seem critical |
__ ___ view is popular
emphasis on role of ___, __ and __/___ gain ___ trauma ___ from trauma and negative reinforcement seem critical |
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conversion disorder treatment (5)
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attend to trauma, remove primary/secondary gains
similar to somatization disorder core strategy is attending to the trauma remove sources of secondary gain reduce supportive consequences of talk about physical symptoms |
attend to ___, remove __/__ gains
similar to ___ disorder core strategy, attend to ___ reduce ___ ___ of talk of symptoms |
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body dysmorphic disorder clinical description
_____ with imagined defect in appearance |
preoccupation
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either ___ or ___ of mirrors
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fixation, avoidance
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previously known as
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dysmorphophobia
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suicidal ___ and ___ are common
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ideation, behavior
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often display ideas of ___ for imagined defect
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reference
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statistics of body dysmorphic disorder
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more common than thought
usually runs lifelong chronic disorder seen equally in males and females, with onset usually in early 20s most remain single, and many seek out plastic surgeons |
more common than though
runs ___ __ course seen ___ in males and females onset in |
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body dismorphic disorder causes
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little is known - disorder tends to run in families
shares similarities with obsessive-compulsive disorder |
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body dysmorphic disorder treatment
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treatment parallels that for ocd
medication (SSRIs) that work for ocd provide some relief exposure and response prevention also helpful plastic surgery is often unhelpful |
treatment parallels __
___ work for ocd provide some relief __ and __ ___ also helpful |
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overview of dissociative disorders
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involve severe alterations or detachments in identity, memory, or consciousness
depersonalization - distortion in perception of reality derealization - losing a sense of the external variations of normal depersonalization and derealization experiences |
involves __ __ or __ in identity, memory, or consciousness
distortion in perception of reality: losing sense of the external variation of ____ deperonsaliation and derealization experiences |
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types of dsm-iv dissociative disorders
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depersonalization disorder
dissociative amnesia dissociative fugue dissociative trance disorder dissociative identity disorder |
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depersonalization disorder overview and defining features
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severe and frightening feelings of unreality and detachment
such feelings and experiences dominate and interfere with life functioning primarily problem involves depersonalization and derealization |
severe and frightening feelings of ___ and ___
feelings dominate and interfere with __ __ primary problem involves: |
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depersonalization disorder facts and statistics
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comorbidity with anxiety and mood disorders is extremely high
onset is typically around age 16 usually runs lifelong chronic course |
___ with anxiety and mood disorders are high
onset is around runs __ __ course |
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depersonalization disorder causes
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show cognitive deficits in attention, short-term memory, and spatial reasoning
such person are easily distracted cognitive deficits correspond with reports of tunnel vision and mind emptiness |
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dissociative amnesia overview
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includes several forms of psychogenic memory loss
generalized type - inability to recall anything, including identity localized or selective type - failure to recall specifically (usually traumatic) events |
inability to recall anything, including identity
failure to recall specifics |
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dissociative fugue overview
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related to dissociative amnesia
such persons take off and find themselves in a new place lose ability to remember the past and relocation such persons often assume a new identity |
related to dis. ___
persons take off and find themselves in lose ability to remember the __ and __ |
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dissociative amnesia and fugue causes
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little is known, but trauma and stress seem heavily involved
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dissociative amnesia and fugue statistics
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dissociative amn. and fugue are usually in adulthood
both show rapid onset and dissipation both occur most often in females |
found in __
show __ onset and ___ occur most in ___ |
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dissociative amnesia and fugue treatment
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persons with dissociative amn. and fugue usually get better without treamtnet
most remember what they have forgotten |
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dissociative trance disorder clinical description
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symptoms resemble those of other dissociative disorder
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clinical presentation varies across
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cultures
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involves dissociative symptoms and sudden changes in
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personality
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symptoms and personality changes are often attributed to
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possession by a spirit
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symptoms must be considered ___/___ by the culture
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undesirable/pathological
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dissociative trance disorder facts and statistics
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more common in females
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dissociative trance disorder causes
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often attributable to a life stressor or trauma
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dissociative identity disorder (DID) clinical description
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involves adoption of several identities
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identities display unique sets of
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behaviors, voice, and posture
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formerly known as
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multiple personality disorder
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defining feature is
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dissociation of certain aspects of personality
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unique aspects of DID
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alters - refers to the different identities or personalities in DID
host - the identity that seeks treatment and tries to keep identity fragments together switch - often instantanous transition form one personality to another |
refers to the different identities
identity seeks treatment and tries to keep together instantanous transition from one form to antoher |
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dissociative identity disorder statistics
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average number of identities close to 15
ratio of female to males (9:1) onset is almost always in childhood high comorbidity rates, with lifelong chronic |
average number of identities
female to male ratio onset is almost always __ comorbidity rates __ __ course |
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dissociative identity disorder causes
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almost all patients have histories of horrible, unspeakable child abuse
closely related to ptsd highly suggestible viewed as mechanism of escape from the impact of trauma |
almost all patients have histories of
closely related to ___ highly ___ viewed as __ of escape from trauma |
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did treatment
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focus is on reintegration of identities
aim is to identify and neutralize cues/triggers that provoke memories of trauma/dissociation |
focus on __ of identities
aim is to __ and __ cue/triggers that provoke memories of trauma |
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diagnostic considerations in somatoform and dissociative disorders
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separating real problems from faking
the problem of malingering -- deliberately faking symptoms |
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summary of somatoform and dissociative disorders
features of somatoform disorders |
physical problems without an organic cause
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feature of dissociative disorders
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extreme distortions in perception and memory
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well established treatments are
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lacking
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chapter 6
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mood disorder and suicide
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mood disorders
extremes in normal mood |
nature of depression
nature of mania and hypomania |
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types of dsm-iv depressive disorders
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major depressive disorder
dysthymic disorder double depression |
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types of dsm-iv bipolar disorders
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bipolar i disorder
bipolar ii disorder cyclothymic disorder |
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major depression - overview
major depressive episode - overview and defining features |
extremely depressed mood state lasting at least 2 weeks
cognitive symptoms - feelings of worthlessness, indecisiveness vegetative or somatic symptoms - central to the disorder anhedonia - loss of pleasure/interest in usual activities |
extremely depressed state for at least
feelings of worthlessness, indecisiveness central to the disorder loss of pleasure/interest in usual activities |
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major depressive disorder episodes
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single episode - highly unusual
recurrent episode - more common |
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dysthymia overview and defining features
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defined by persistently depressed mood that continue for at least 2 years
symptoms of depression are milder than major depression symptoms can persist unchanged over long periods (20 or more years) |
persistently depressed that contrinues for at least
depression milder than __ __ persist unchanged over long periods ( __ or more years) |
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dysthymia facts and statistics
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late onset - typically in late 20s
early onset - before age 21, greater chronicity, poorer prognosis |
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double depression overview and defining features
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person experiences major depressive episodes and dysthymic disorder
dysthymic disorder often develops first |
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double depression facts and statistics
associated with ___ ____ associated with a problematic ___ ___ |
severe psychopathology
future course |
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bipolar i disorder overview and defining features
___ between full manic episodes and depressive episodes |
alternation
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bipolar i disorder
manic episode elevated, often eupohric mood, or ___ |
irritable
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racing
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thoughts
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pressured
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speech
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___ need for sleep
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decreased
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___ thoughts
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grandiose
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__ in goal directed or psychomotor agitation
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increase
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___ in risk taking or pleasurable activities
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increase
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may become __/__
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paranoid or psychotic
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bipolar i disorder facts and statistics
average age onset if __ years but can begin in childhood |
18
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tends to be
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chronic
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__ is a common consequence
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suicide
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bipolar ii disorder overview
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alternations between major depressive episodes and hypomanic episodes
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hypomania
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similar to mania, but less severe
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bipolar ii disorder facts and statistics
average age of onset __, but could be in childhood only __ to __ % of cases progress to full bipolar i disorder tends to be ___ |
22
10-13% chronic |
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cyclothymic disorder overview and defining features
more __ version of bipolar disorder __ and major __ episodes are less severe pattern must last for at least _ years (_ year for children and adolescents) |
chronic
manic; depressive 2; 1 |
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cyclothymic disorder facts and statistics
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high risk for developing bipolar i or ii disorder
cyclothymia tends to be chronic and lifelong most are female average age onset is early adolescence (12-14 years of age) |
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additional defining criteria for mood disorders
course specifiers |
longitudinal course - past history and recovery from depression and/or mania
rapid cycling pattern - applies to bipolar i and ii disorder only seasonal pattern - episodes covary with changes in the season |
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mood disorders: additional facts and statistics
life prevalence |
about 7.8% of us population
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sex differences
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females 2x more likely
bipolar disorders distributed equally between males and females |
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mood disorders are fundamentally
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similar in children and adults
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prevalence of depression seems
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to be similar across subcultures
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most depressed persons are
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anxious, not all anxious are depressed
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mood disorders:
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familial and genetic influences
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mood disorder: additional facts and statistics part 2
family studies |
rate of mood disorders is high in relatives of probands
relatives of bipolar probands more likely to have unipolar depression |
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twin studies
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concordance for mood disorders are high in identical twins
severe mood disorders have a stronger genetic contribution heritability rates are higher for females compared to males |
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mood disorders: neurobiological perspectives
neurotransmitter systems |
serotonin and its relation to the other neutrotransmitters
mood disorders are related to low levels of serotonin an overview of the permissive hypothesis and the regulation of neurotransmitters |
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the endocrine system
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elevated cortisol and dexamethasone suppression test (dst)
dexamethasone depresses cortisol secretion persons with mood disorders show less suppression |
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sleep and circadian rhythms
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hall mark of most mood disorders
relation between depression and sleep |
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mood disorder: psychological dimensions
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stressful life events
stress is strongly related to mood disorders poorer response to treatment, longer time before remission link with the diathesis-stress and reciprocal-gene environment models |
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mood disorders: psychological dimensions (learned helplessness)
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the learned helplessness theory of depression
related to lack of perceived control over life events |
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learned helplessness and depressive attributional style
negative outcomes are one's own fault |
internal attributions
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believing future negative outcomes will be one's fault
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stable attributions
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believing negative events will disrupt many life activities
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global attributions
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all three domains contribute to a sense of
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helplessness
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mood disorder - psychological dimensions - cognitive theory
negative coping styles |
depression - tendency to interpret life events negatively
depressed persons engage in cognitive errors |
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types of cognitive errors
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arbitrary inference - overemphasize the negative
overgeneralization - generalize negatives to all aspects of a situation |
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cognitive errors and the depressive cognitive triad
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think negatively of oneself
of the world of the future |
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Beck's cognitive triad for depression
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pg. 15 of study guide
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an integrative theory
shared biological vulnerability |
overactive neurobiological response to stress
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exposure to stress
stress activates |
hormones that affect neurotransmitter systems
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stress turns
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on certain genes
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stress affects
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circadian rhythms
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stress activates
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dormant psychological vulnerability (negative thinking, etc)
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stress contributes to
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sense of uncontrollability
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fosters a sense of
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helplessness and hopelessness
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social and interpersonal relationships/support are
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moderators
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an integrative model of mood disorders
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pg. 16 of study guide
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treatment of mood disorders: tricyclic medications
widely used - |
tofranil, elavil
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block reuptake of
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norepinephrine and other neutrotransmitters
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Takes _ to _ weeks for the Therapeutic Effects to be Known
negative side effects are common may be lethal in excessive doses |
2 - 8
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an integrative model of mood disorders
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pg. 16!!!!
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treatment of mood disorders
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monoamine oxidase (mao) inhibitors
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an enzyme that breaks down serotonin/norepinephrine
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monoamine oxidase (mao)
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mao inhibitors are slightly more effectvie than
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tricyclics
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must avoid food containing ______ (beer, red wine, cheese)
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tyramine
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treatment of mood disorders: ssris stand for
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selective serotonergic reuptake inhibitors
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specifically block reuptake of serotonin of serotonin
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fluoxetine (prozac) most popular
zoloft, paxil celxa - closely related |
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ssris pose no unique risk of
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suicide or violence
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negative side effects are
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UNcommon
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treatment of mood disorders:
|
lithium
|
|
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lithium used for
|
mood stabilizers
|
|
|
|
lithium is a common salt
|
primary drug for bipolar disorders
why lithium works is unclear |
|
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|
Anticonvulsants are
|
tegretol
depakote |
|
|
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treatment of mood disorders: ect
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electroconvulsive therapy
|
|
|
|
ect is effective for cases of
|
severe depression
|
|
|
|
the nature of ect
|
involves applying brief electrical current to the brain
results in temporary seizures usually 6-10 outpatient treatments are required side effects are few and include short term memory loss uncertain why ect works and relapse is common |
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|
psychosocial treatments
|
cognitive therapy
interpersonal psychotherapy |
|
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cognitive therapy
|
addresses cognitive errors in thinking
also includes behavioral components |
|
|
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interpersonal psychotherapy
|
focuses on problematic interpersonal relationships
outcomes with psychological treatments are comparable to medications |
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figure 6.8 patients treated with severe depression of 2000 study shows
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gradual decline, then leveling off
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the nature of suicide: facts and statistics
|
8th leading cause of death in us
overwhelmingly a white and native american phenomenon suicide rates are increasing, especially in adolescents gender differences: males are more successful at committing suicide than females. females attempt suicide more than males (3x) |
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the nature of suicide: risk factors
suicide in the family ____ risk low serotonin level ____ risk (depression) psychological disorder ___ risk alcohol use and abuse past suicidal behavior ____ subsequent risk experience of a shameful/humiliating stressor ____ risk publicity about suicide and media coverage __ risk |
increases
|
|
|
|
summary of mood disorders:
all mood disorders share |
gross deviations in mood
common biological and psychological vulnerability occur in children, adults, and the elderly stress and social support seem critical in onset, maintenance, and treatment suicide is an increasing problem not unique to mood disorders medications and psychotherapy produce comparable results relapse rates for mood disorders are high |
gross deviations in
common ___ and ___ ___ occur in stress and social support team critical in __, __ , and treatment __ increasing problem not unique to mood disorders medications and psychotherapy produce comparable results relapse rates are |
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chapter 8
|
eating disorders
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|
|
|
eating disorders: an overview
two major types of dsm-iv eating disorders |
anorexia nervosa
bulimia nervosa |
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|
|
both involves
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severe disruptions in eating behavior
extreme fear and apprehension about gaining weight strong sociocultural origins - westernized views |
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bulimia nervosa: overview and defining features
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binge eating - hallmark of bulimia
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|
|
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eating excess amounts of food
perceived as |
binge
uncontrollable |
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|
compensatory behaviors of bulimia binging
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purging - self-induced vomiting, diuretics, laxatives
some exercise excessively, whereas others fast |
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|
dsm-iv subtypes of bulimia
|
purging subtype - most common subtype (vomiting, laxatives, enemas)
nonpurging subtype - excess exercise, fasting |
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associated features of bulimia nervosa
|
most are over concerned with body shape, fear gaining weight
comorbid psychological disorders purging methods can result in severe medical problems most are within 10% of target body weight |
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two types
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purging and nonpurging
|
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most people with bulimia are concerned with
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body weight
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|
|
|
bulimics consume about _____ calores in a meal
|
15-20,000
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|
|
|
anorexia nervosa: overview and defining features
|
severe weight loss - hallmark of anorexia
intense fear of obesity and losing control over eating |
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|
|
anorexics show a relentless pursuit of thinness, often beginning with
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dieting
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|
|
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defined as __ below expected weight
|
15%
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|
|
|
dsm-iv subtypes of anorexia
|
restricting subtype - limit caloric intake via diet and fasting
binge-eating-purging subtype - about 50% of anorexics |
|
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|
associated features of anorexia nervosa
|
most show marked disturbance in body image
methods of weight loss can have severe life threatening medical consequences |
|
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|
anorexia
|
most are comorbid for other psychological disorders
|
|
|
|
binge-eating disorder: overview and defining features
binge-eating disorder - appendix of dsm-iv |
experimental diagnostic category
engage in food binges, but do not engage in compensatory behaviors |
|
|
|
associated features of binge-eating disorders
|
many persons with binge-eating disorder are obese
share similar concerns as anorexics and bulimics regarding shape and weight |
|
|
|
bulimia and anorexia: facts and statistics
bulimia: majority are lifetime prevalence about ___ for females, ___ for males tends to be ____ if left untreated |
female with onset around 16-19 years old
1.1% ; 0.1% chronic |
|
|
|
anorexia
majority are ___ and ___ from middle to upper middle class families; average intelligence likely to come from ___ environments usually develops around age __ or early adolescence tends to be more ____ and ____ to treatment than bulimia |
females and white
competitive 13 chronic and resistant |
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|
causes of bulimia and anorexia: toward an integrative model
|
media and cultural considerations
psychological and behavioral considerations an integrative model (male and female ratings of body size) |
|
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|
media and cultural considerations
|
cultural imperative for thinness translates into dieting
standards of ideal body size change as much as clothes |
|
|
|
psychological and behavioral considerations
|
low sense of personal control and self-confidence
food restriction often leads to a preoccupation with food |
|
|
|
an integrative causal model of eating disorders
|
pg. 20!!!
|
|
|
|
medical and psychological treatment of bulimia nervosa
drug treatments |
antidepressants can help reduce binging and purging behavior
antidepressants are not efficacious in the long-term |
|
|
|
medical and psychological treatment of bulimia nervosa
psychosocial treatments |
cognitive-behavior therapy (cbt) is the treatment of choice
interpersonal psychotherapy results in long-term gains similar to cbt |
|
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|
medical and psychological treatment of anorexia nervosa
medical treatment |
there are none with demonstrated efficacy
|
|
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|
medical and psychological treatment of anorexia nervosa
psychological treatment |
weight restoration - first and easiest goal to achieve
treatment involves education, behavioral, and cognitive interventions treatment often involves the family long-term prognosis for anorexia is poorer than for bulimia |
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other eating disorders
chronic regurgitations and reswallowing of partially digested food |
rumination disorder
|
|
|
|
repetitive eating of inedible substances
|
pica
|
|
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|
chapter 9
|
sexual and gender identity disorders
|
|
|
|
sexual and gender identity disorder: an overview
what is normal vs abnormal behavioral |
normative facts and statistics
|
|
|
|
dsm-iv sexual gender identity disorders
|
gender identity disorder
sexual dysfunctions paraphilias |
|
|
|
gonads
|
produce hormones
males - testosterone females - estrogen varying levels of hormones typically lead to varying levels of sexual desire, arousal, and behavior higher levels of testosterone levels lead to higher eveyrthing, not so much high estrogen levels ( do no necessarily lead to the same) generally, link between sexual arousal in females and ovulation |
|
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|
percentage of men 20-39 who have ever had vaginal intercourse
|
95.4
|
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|
|
percentage of men 20-39 who have ever anal intercourse
|
20.1
|
|
|
|
percentage of men 20-39 who have ever performed oral sex
|
75.6
|
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|
|
percentage of men 20-39 who have ever received oral sex
|
78.8
|
|
|
|
percentage of men 20-39 who engaged in vaginal intercourse with either 1-3 partners or 20 or more
1-3 partners ever |
28.2
|
|
|
|
percentage of men 20-39 who engaged in vaginal intercourse with either 1-3 partners or 20 or more
20 partners ever |
23.3
|
|
|
|
females - sexual behavior in 1975, 1986, 1989
|
number of partners stable, still similar, found frequency of condom use to be different due to fear of hiv
|
|
|
|
masturbation
|
90% males
45% females |
|
|
|
males tend to masturbate more and at much younger age; more easily sexual aroused and frequently because of
|
external organ
|
|
|
|
frequency __ more likely than males. masturbation often used as treatment for sexual dysfuntion like erectile dysfunction
|
3x
|
|
|
|
defining gender identity disorder
clinical overview |
person feels trapped in the body of the wrong sex
assume the identity of the desired sex, but the goal is not sexual |
|
|
|
gender identity disorder
causes are unclear |
gender identity develops between 18 months and 3 years of age
|
|
|
|
sex-reassignment as a treatment of gender identity disorder
|
who is a candidate? some basic prereqs for surgery
75% report satisfaction with new identity |
|
|
|
goal of gender identity disorder is
|
not sexual. possible for someone to be homosexual, vast majority seek to suit their supposed sexual identity. not something you can diagnose with first visit
|
|
|
|
psychosocial treatment of gender identity disorder
|
involve realigning the person's psychological gender with their biological sex
few large scale studies |
|
|
|
overview of sexual dysfunctions
sexual dysfunctions involve |
desire, arousal, and/or orgasm
|
|
|
|
males and females experience parallel versions of most dysfunctions
|
most prevalent case of disorder in us
|
|
|
|
classification of sexual dysfunctions
|
lifelong vs acquired
generalized vs situational due to psyc. factors alone or in combo with medical condition |
|
|
|
one has always had this problem
|
lifelong
|
|
|
|
rose sometime after normal sexual behavior
|
acquired
|
|
|
|
always
|
generalized
|
|
|
|
dysfunction occurs more frequently in specific/similar situations
|
situational
|
|
|
|
no physical reason
|
due to psyc
|
|
|
|
in combination
|
underlying medical cause, but psychological factors always contribute to worsening of dysfunction
|
|
|
|
figure 9.3 sex cycle
|
pg. 24!!!!
|
|
|
|
sexual desire disorders: an overview
|
hypoactive sexual desire disorder
sexual aversion disorder causes: abuse, raised in rigid environment can, predisposition, bad experiences don't confuse with ptsd, check and see which is better |
|
|
|
hypoactive sexual desire disorder
|
little or no interest in any type of sexual activity
masturbation, sexual fantasies, and intercourse are rare in this disorder |
|
|
|
sexual aversion disorder
|
little interest in sex
extreme fear, panic, or disgust related to physical or sexual contact 10% of males report panic attacks during attempted sexual activity |
|
|
|
sexual arousal disorders
male: |
male erectile dysfunction
|
|
|
|
male erectile dysfunction
|
difficulty achieving and maintaining an erection
|
|
|
|
female sexual arousal disorder
|
difficulty achieving and maintaining adequate lubrication
|
|
|
|
associated features of sexual arousal disorders
|
problem is arousal, not desire
problem affects about 5% of males, 14% of females males are more troubled by the problem than females |
|
|
|
male erectile
|
to the effect that it'll be negative to relationship/life
comes in often problem is arousal NOT desire. if he wants to and can't, not that he simply doesn't want to. |
|
|
|
orgasm disorders
inhibited orgasm female/male orgasmic disorder |
inability to achieve orgasm despite adequate sexual desire and arousal
rare condition in adult males, but is common complaint in females |
|
|
|
orgasm disorders
premature ejaculation |
ejaculation occurring before the man or partner wishes it to
21% of all adult males meeting criteria for premature ej. most prevalent sexual dysf in males common in younger, inexperienced, but declines with age |
|
|
|
sexual pain disorders
defining feature |
marked pain during intercourse
|
|
|
|
sexual pain disorders
|
dyspareunia
vaginismus |
|
|
|
extreme pain during intercourse
adequrate sexual desire, and ability to attain arousal and orgasm must rule out medical reasons for pain |
dyspareunia
|
|
|
|
limited to females
outer third of the vagina undergoes involuntary spasms complaints include feeling ripping, burning, or tearing affects over 5% of women seeking treatment in us prevalence higher in more conservative countries and subgroups |
vaginismus
|
|
|
|
assessing sexual behavior
psychophysiological evaluation |
exposure to erotic material
determine extent and pattern of physiological and subjective sexual arousal male - penile strain gauge female - vaginal photoplethysmograph |
|
|
|
treatment of sexual dysfunction
|
education alone
surprisingly effective |
|
|
|
masters and johnson's psychosocial intervention
|
education
eliminate performance anxiety - sensate focus and nondemand pleasuring |
|
|
|
additional psychosocial procedures
|
squeeze technique - premature ejaculation
masturbatory training - female orgasm disorder use of dilators - vaginimus exposure to erotic material - low sexual desire problems |
|
|
|
medical treatment of sexual dysfunction
erectile dysfunction |
viagra; levitra
injection of vasodilating drugs into the penis penile prosthesis or implants vascular surgery vacuum device therapy |
|
|
|
few medical procedures exist for
|
female sexual dysfunction
|
|
|
|
paraphilias: clinical descriptions and causes
nature of paraphilias |
sexual attraction and arousal to inappropriate people, or objects
often multiple paraphilic patterns of arousal high comorbidity with anxiety, mood, and substance abuse disorders |
|
|
|
main types of paraphilias
|
fetishism
voyeurism exhibitionism transvestic fetishism sexual sadism and masochism pedophilia |
|
|
|
voyuerism and exhibitionism
practice of observing an unsuspecting individual undressing or naked risk associated with "peeping" is necessary for sexual arousal |
voyeurism
|
|
|
|
exposure of genitals to unsuspecting strangers
element of thrill and risk is necessary for sexual arousal |
exhibitionism
|
|
|
|
involves the non-consensual rubbing against another person to achieve sexual arousal
the person is unsuspecting of this recurrent and intense sexual urges to do so |
frotteurism
|
|
|
|
sexual attraction to nonliving objects (inanimate and/or tactile)
numerous targets of fetistic arousal, fantasy, urges, and desires |
fetishism
|
|
|
|
sexual arousal with the act of cross-dressing
males may show highly masculinized compensatory behaviors most do not show compensatory behaviors many are married and the behavior is known to spouse/partner |
transvestic fetishism
|
|
|
|
if person has one fetish
|
they are more likely to have more than one
|
|
|
|
inflicting pain or humuliation to attain sexual gratification
|
sexual sadism
|
|
|
|
suffer pain or humuliation to attain sexua gratification
|
sexual maschism
|
|
|
|
some rapists are sadists, but most do not show paraphilic patterns of arousal
|
rapists show sexual arousal to violent sexual and non sexual material
|
|
|
|
development of paraphilia
|
pg. 28!!!
|
|
|
|
pedophilia overview
|
pedophiles - sexual attraction to young children
both may involve male and/or female children or very young adolescents pedophilia is rare, but not unheard of, in females |
|
|
|
associated features of pedophilia
|
most rationalize the behavior and engage in other moral compensatory behavior
|
|
|
|
pedophilia: causes
|
pedophilia is associated with sexual and social problems and deficits
patterns of inappropriate arousal and fantasy may be learned early in life |
|
|
|
psychophysiological
|
assessment
|
|
|
|
pedophilia: psychosocial treatment
psychosocial interventions |
most are behavioral and target deviant and inappropriate sexual associations
|
|
|
|
imaginal proceduce involving aversive consequences
|
covert sensitization
|
|
|
|
associate masturbation with appropriate stimuli
|
orgasmic reconditioning
|
|
|
|
address interpersonal problems
|
family/marital therapy
|
|
|
|
teachers self-control and coping with risk
|
coping and relapse prevention
|
|
|
|
efficacy of psychosocial interventions
|
about 70% to 100% of cases show improvement
poorest outcomes are for rapists and person with mulitple paraphilias covert sentitization - imagining getting caught by family |
|
|
|
pedophilia drug treatments
medications: equivalent to chemical castration |
often used for dangerous sexual offenders
|
|
|
|
types of available medications
|
cyproterone acetate - anti-androgen, reduces testosterone, sexual urgers and fantasy
medroxyprogesterone acetate - depo-provera, also reduces testosterone triptoretin - new and more effective druge that inhibit gonadtropic seceretion |
|
|
|
efficacy of medication tratments
|
drugs work to greatly reduce sexual desire, fantasy, arousal
relapse rates are high with medication discontinuation |
|
|
|
summary of sexual and gender identity disorders
|
gender identity disorder
problem not sexual, is feeling trapped in body of wrong sex |
|
|
|
sexual dysfunctions are common in men and women
|
problems with desire, arousal, and/or orgasm
require comprehensiveness assessment and treatment approaches |
|
|
|
paraphilias represent inappropriate sexual attraction
|
desire, arousal, orgasm gone awry
require comprehensive assessment and treatment approaches |
|
|
|
available psychosocial and medical treamtnet opetions are generally
|
efficacious
|
|
