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118 Cards in this Set
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What are the criteria for a panic attack?
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• At the root of anxiety disorders
• Criteria listed on page 209 • Discrete episode of panic • Very intense anxiety • Comes on very abruptly • Symptoms increase and develop quickly • Person usually has a list of cognitive symptoms such as “I’m going to die”, “I’m going to lose control” • Physiological symptoms o Shortness of breath o Chest pounding o Nausea o Choking • Feelings of depersonalization (feel extended from self or that the world isn’t real) • Usually panic attack peaks within a few minutes (usually 10) and then starts dissipating • Usually goes away after the peaking but then person may feel anxious for the rest of the day or several days (don’t quite return to baseline for some people) • No number of panic attacks within a certain time frame o Up to professional to determine if person qualifies (as long as they have the appropriate symptoms) |
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What are the types of panic attacks?
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• Two kinds of panic attacks
o Cued or triggered • Occurred when triggered by something • A certain stimulus that the person is responding to • As a result of the stimulus the person has a panic attack • Example: if the person is afraid of heights and are on a ladder, the fear of heights triggers the panic attack • These are the type that are seen in all the other anxiety disorders o Uncued or untriggered • Not triggered by anything • Term “out of the blue” is often used to describe this • Person could be sitting there, standing there, thinking about anything and they have a panic attack • These are the type that are seen in panic disorder |
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What are the criteria for panic disorder?
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• Must have uncued/untriggered panic attacks
• Must have at least 1 of the following 3 symptoms: o Person must have concern with having future panic attacks • May end up having panic attacks about panic attacks • Preoccupation with panic attacks make them more likely to occur o Worry about the implications of the panic attacks • What does it mean • Thoughts such as “I’m going to die”, “I’m going to lose control”, “I’m going to embarrass myself” o Person makes changes in his/her behavior • Start doing things differently in order to accommodate for attacks • Avoiding people, places, things • “Environmental Engineering” – arrange our world to avoid what we are afraid of (a person afraid of snakes doesn’t camp). If our environmental engineering fails, this is when you start to see panic attacks |
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Other typical symptoms of panic disorder
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• Person feels like they are going to pass out
o This may even be a fear that they will pass out o Passing out is very rare o Question if they are augmenting their symptoms • May have night panics o Not a nightmare o Will wake from sleep with a panic attack o Adults will remember these awakenings (which makes them different from night terrors in children where they usually do not remember) • People with panic disorders usually are screened for phobias as well o What happens if a person is petting a dog and they have a panic attack? Person may develop a phobia of dogs (think classical conditioning – Pavlov’s dog) o Phobias can lead to panic attacks but panic attacks can also lead to phobias • More likely to have a panic attack after physical exertion o The body is already pumped up a little bit and more likely to have attack o Video client states that as long as he is at work and working he’s fine, but when he stops working, he has attacks |
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What are the types of panic disorder?
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Panic Disorder with Agoraphobia
Panic Disorder without Agoraphobia |
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What are the symptoms of agoraphobia?
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o Two symptoms of agoraphobia (person just needs one)
• Person avoids situations where escape may be difficult or embarrassing • Person avoids situations where help isn’t available • Therefore these people may not want to be alone |
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What is the controversy regarding panic disorder without agoraphobia?
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o There is some controversy about the diagnosis Panic Disorder without agoraphobia
• Some say that this is the early stages of panic disorder and they will develop agoraphobia eventually • *Remember – panic disorder has to have untriggered panic attacks so agoraphobia is usually tied in |
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What are the symptoms/criteria for specific phobias?
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• Person has a fear or panic reaction to a specific situation or object
• Person acknowledges that when they are outside or away from that situation/object, that their fear is excessive or unreasonable o This is not true with children – they don’t generally have this awareness • Because of great fear, they either o Avoid the situation/object o Endure it with great dread • Interferes with person’s functioning (jobs, academic, work) and causes problems |
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In specific phobias, the amount of dread and fear may depend on what?
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• Amount of fear and dread may depend on
o proximity of object (how close is it) • This is also a good way to determine how severe the disorder is • Example: can they be in the same room with the object o If there are avenues of escape • If there are ways to escape, they may have less anxiety |
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What are the different subtypes of phobias?
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o Animal
• Living creatures • Includes insects o Natural Environment • Water • Storm • Fire • Heights o Blood/Injection/Injury • Person sees some kind of invasive procedure involving blood, injection, or injury • For these individuals, invasive is a relative term • Could be getting their teeth cleaned • These individuals have a very specific reaction to blood – they faint • This is specific to this subtype • This is seen to run in families • Could be genetic or environmental • Avoid routine medical procedures • Therefore, what could be minor becomes major • Setting themselves up for more severe procedures that cause more anxiety that could have been avoided • End up having fairly significant problems o Situational • Tunnels • Flying • Bridges o Other • Anything else that doesn’t fall into these categories • Kind of an NOS category • Example: clowns |
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How is social phobia classified?
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• Classified as it’s own disorder, not under specific phobias
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What are the major symptoms of social phobia?
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• Two things to look at (two major symptoms)
o Person is afraid of being humiliated or embarrassed • By their performance or what they’re doing o Afraid that other people may pick up on their anxiety symptoms • Other people will see their hands shake, voice quiver |
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What are the two kinds of social phobia?
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• Two kinds of social phobias
o Global • Person avoids all social and interpersonal situations • Could be 1 person or 100 • If they don’t avoid at all costs, they will endure with great dread • Occurs even with familiar people o Circumscribed • Specific situations • Giving a speech, performing music • More in front of an audience |
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In OCD, the obsessions can consist of what?
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• Consists of obsessions
o Thoughts o Impulses o Images |
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In OCD, the obsessions creat what?
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• Obsessions create
o Stress o Tension o Anxiety |
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Explain what "obsessions are intrusive means".
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• Obsessions are intrusive
o Person has trouble not doing them o There is a drive to obsess about whatever the person has |
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What are compulsions?
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• Compulsions are an act or response to an obsession
o It’s the act to neutralize the obsession • Typically think behavior but can also be mental or verbal (saying a prayer, thinking a mantra, visualizing something) • If it is a behavior, usually there is a very strict set of rules that go along with the behavior |
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What are the different types of behavioral compulsions?
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• There are different kinds of behavioral compulsions (also called rituals)
o Checking o Washing and cleaning o Counting o Ordering and arranging o Saving and collecting |
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What group of disorders is PTSD grouped with? Why?
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• This is a disorder where they weren’t quite sure where to put it
o Decided on anxiety disorders based on the third cluster of symptoms (increased arousal) o Some say it should be with dissociative disorders due to flashbacks o Some say it should have it’s own categories o Relatively new in DSM but symptoms have been around for a number of years |
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What does PTSD result from?
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• Can have PTSD from any traumatic event
o Accidents o Assaults o Natural events o Anything that is perceived traumatic by the person |
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How are the symptoms of PTSD categorized?
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Criterion A: A1, A2
Criterion B Criterion C Criterion D |
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What are the symptoms for Criterion A in PTSD?
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The person has been exposed to a traumatic event in which both of the following (A1 and A2) were present:
• A1 • Person experienced, witnessed, or confronted with o Experienced: Means they themselves actually experienced the trauma • Could be a serious threat instead(close call of the trauma) • Compromise of physical integrity (e.g., sexual assault) o Witnessed: saw someone else experience the trauma o Confronted with: heard about the event/trauma • Applies usually only with family or close friends • The knock at the door at 2 a.m. with the news that a family/close friend was injured or killed • A2 • Person needs to respond with horror, terror, hopelessness, extreme strong emotional reaction o Usually ask, “What was your physical reaction?” o Did the person freeze? Wet or soil self? Go “numb”? o Sometimes they will say they shut off emotionally • See this missed a lot, people don’t assess this • Trauma is relative, what is traumatic for one may be exciting/stimulating for the other • What’s the person’s perception of the event? • Need to get the details about the person’s reaction |
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What are the Criterion B symptoms of PTSD known as?
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Re-experiencing symptoms
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What are the Criterion C symptoms of PTSD known as?
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Avoidance or numbing symptoms
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What are the Criterion D symptoms of PTSD known as?
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Increased arousal symptoms
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What are the symptoms for Criterion B in PTSD?
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• Number of ways to do this but only need one of five symptoms
• Recurrent and intrusive thoughts o They are obsessed about the event o They can’t NOT think about it o Think about the details, what happened, what could’ve happened o Interferes with their ability to function • Nightmares o About the event o Not generic nightmares – they are related to the traumatic event o May not be exactly what happened but they are the same dream o Often times, the person feels helpless in the dream (e.g., dream you are in combat and unable to load gun) • Flashback o Dissociative symptom o Person feels like they are transported in time and space and they are reliving the event again o They’re awake and aware o Feels like they’re reliving it • Seeing the people that were there, experiencing the circumstances o Sometimes called a waking dream – not preferred because easily confused with nightmare • Physiological reactions to cues similar to the event o Example: panic attack • Psychological reactions to cues similar to the event o Example: anxiety due to smell of diesel |
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What are the symptoms for Criterion C in PTSD?
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• Need 3 of these
• Avoid thinking or talking about event • May avoid certain people, places or events that may remind them of event Veteran may avoid hunting • Dissociative amnesia Doesn’t remember parts of events Memory of certain event is gone • Decreased interest in participation in activities they used to enjoy doing Lost interest in hobbies Don’t do what they used to • Feeling detached or alienated from other individuals Tend to become isolated or withdrawn • Restricted range of affect Feel numb or cold Sometimes use word “calloused” Little empathy or sympathy for others • Sense of a foreshortened future Survivor guilt Feel like they’re living on borrowed time “I should have died” Outlook on future is poor May begin to engage in careless behavior |
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What are the symptoms for Criterion D in PTSD?
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• These are the symptoms that place PTSD within the anxiety disorders
• Need 2 of these symptoms Sleep disturbances • Trouble falling asleep, staying asleep, waking up prematurely Anger and irritability • Comes out of nowhere • Out of proportion for what’s going on • A bit of a “flash” Concentration difficulties • Trouble focusing, drift off, have to reread something 3 or 4 times Hypervigilance • Person is on guard or watchful • Always aware of surroundings • Might do sweeps in the middle of the night (checking doors and windows) Exaggerated startle response • Hears unexpected noise or touch • They may swing, kick, or dive for cover |
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What are the specifiers with PTSD?
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• Acute and chronic
• Acute – symptoms are less than 3 months • Chronic – symptoms are more than 3 months • Delayed onset • Symptoms don’t start until at least 6 months after trauma • Could start years or even decades after trauma |
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What are the symptoms of Acute Stress Disorder?
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• Criterion A is the same as it is for PTSD
• Criterion B is different o More dissociative types of symptoms • Depersonalization, derealization • May experience these symptoms elsewhere as associated with these disorders • Criterion C is re-experiencing symptoms, numbing symptoms, increased arousal symptoms o Nightmares, reoccurring thoughts |
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What are the time limitations of Acute Stress Disorder?
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Lasts no more than 4 weeks (this is why it’s called “acute”)
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What is the main feature of Generalized Anxiety Disorder (GAD)?
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Main feature is excessive and persistent worry
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How does GAD differ from worrying?
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• Different from your normal worry
• These people can’t NOT worry • They have to be worrying about something • Worry about things that are really unusual o Things that we wouldn’t think about worrying about • To the point that they feel like they’ve lost control of their worrying and ability to not worry • Usually seen with other anxiety disorders |
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Describe Anxiety Disorder NOS
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Anxiety Disorder NOS
• Change in functioning • Have anxiety but don’t meet other criteria • Example: Almost PTSD but don’t meet all criteria, all symptoms but no avoidance |
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What Axis are Personality Disorders on?
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Axis II
*Remember: Axis II disorders are more enduring, engrained pattern of thoughts, feelings and behavior The only two disorders on Axis II are personality disorders and Mental Retardation (Axis I is clinical disorders and other conditions that may be a focus of clinical attention) |
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When do personality disorders usually start?
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During adolescence
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What are the features of personality disorders that make them disorders?
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• Patterns are inflexible and maladaptive
o Typically if you use a strategy and it doesn’t work, you’ll change it o People with personality disorders don’t do this – they’ll do the same strategies over and over • Strategies create problems o Things get worse o See a vicious cycle – have a problem, things get worse, try to cope with problem, things get worse • Other people seem to be more disturbed about their behavior than the actual person with the disorder is |
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What is the controversy over personality disorders classification?
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• A lot of debate about these disorders
• Should they be categorized? • More dimensional o Higher/lower levels of neuroticism, impulsivity o People could have different levels at different dimensions and based on this would determine the type of personality disorder |
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Aaron Beck's cognitive dimensions are used to explain the personality disorders. What are Beck's dimensions?
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• View of self
o How to they view themselves • View of others o How to they view the rest of the world • Strategies o What kind to they use to cope • What are their coping strategies o Tend to be pervasive in each disorder • Affect o Is there a particular affect? o With the worried group – tends to be anxiety • Basic beliefs o What’s the core or foundational beliefs that we all tend to filter our world through o For the personality disorders, there’s a certain basic belief that describes how the person sees the world and themselves |
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Personality disorders are put into groups called what?
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Clusters
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What are the three "W's" in personality disorders?
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The Weird (Cluster A)
The Wild (Cluster B) The Worried (Cluster C) |
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What personality disorders are included in Cluster A?
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Paranoid
Schizoid Schizotypal |
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What personality disorders are included in Cluster B?
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Antisocial
Borderline Histrionic Narcissistic |
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What personality disorders are included in Cluster C?
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Avoidant
Dependent Obsessive-Compulsive |
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What are the tendencies of Cluster A personality disorders?
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o Tend to be odd or eccentric – the Weird
o Tend to keep people away and keep them at a distance |
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What are the symptoms of Paranoid Personality Disorder?
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Pervasive and unwarranted suspiciousness and mistrust
• Suspicious and mistrustful all the time (pervasive) • Really no reason for them to be this way (unwarranted) but distort facts and reality Hypersensitive • Always on alert, on guard • Easily take things the wrong way Tend to be emotionally detached • Don’t want to get involved with anyone because they can’t trust them Tend to be very litigious • Know the rules, regulations • Any variation from that is a personal attack |
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How do Beck's dimensions look with Paranoid Personality Disorder?
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• View themselves as righteous and mistreated
• View others as being devious and treacherous • Strategy is to be on guard, watchful, untrusting • Common affect is irritability • Basic belief is everybody is an adversary • Can work, are employable – don’t have the psychotic symptoms as someone with paranoid schizophrenia as so can function on some level o These are the individuals that there is a right and wrong at work |
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What are the symptoms of Schizoid Personality Disorder?
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Minimal or no social interpersonal interactions
• That’s the way they like it • Most comfortable by themselves and people are leaving them alone • Prefer solitary activities They have restricted affect • Don’t display any feelings (positive, negative, anger, warmth, tenderness) • Have been described as “emotionally beige” Tend to be indifferent towards praise or criticism • Because the praiser or criticizer is not important Despite of the name schizoid, they do not show psychotic symptoms • No other eccentric types of thinking, speech, beliefs • No more likely than anyone else to develop schizophrenia |
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How do Beck's dimensions look with Schizoid Personality Disorder?
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Beck’s dimensions
• View themselves as self-sufficient and independent • View others as intrusive • Strategies is to keep a distance between themselves and everyone else • Affect is very little o Maybe some anxiety if they’re forced to interact with someone or there are potential interpersonal encounters • Basic belief is “I must have plenty of space” |
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What are the symptoms of Schizotypal Personality Disorder?
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Minimal social interpersonal interaction
• May have relationships with relatives/family • Makes it different from schizoid in that schizoids isolate from everyone Tend to have odd psychotic kinds of behavior • Magical thinking, believe they have telepathy, delusional kind of thinking, may think they have abilities they do not have |
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Beck doesn't apply his dimensions to Schizotypal Personality Disorder. Why?
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Beck doesn’t use dimensions (view of self, others, affect, etc.) for this because there are some precursors for a psychotic disorder
• About half end up being diagnosed with schizophrenia • If they are ever diagnosed with schizophrenia, you would drop the axis II schizotypal diagnosis |
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What are the symptoms of Histrionic Personality Disorder?
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Tend to be overdramatic
Want to draw a lot of attention to themselves Get bored easily Crave a lot of novelty and stimulation (because they’re bored easily) Can be superficially charming (want to engage people and connect with people) Relationships tend to be shallow and lack genuineness • Main goal is to get attention from people – as long as they get attention, they’re fine • Not mutual relationships – very one-sided • “What can you do for me?” Feel helpless without other people If the overdramatic and exciting doesn’t work, they might become even more dramatic and engage in threatening behavior (e.g., suicidal behavior) • They’ll kick it up a few notches to get attention |
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How do Beck's dimensions look with Histrionic Personality Disorder?
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• See themselves as glamorous and impressive
o Externally they will be glamorous – do what they can to get people to notice them • See others as source of attention and affection o These individuals lack internal self-esteem so they have to borrow self-esteem from someone else • Strategy o Dramatic, overemotional – get lots of attention o find themselves interesting to other people • Affect o Anxiety because they need others to feel good about themselves o Probably won’t have the insight to know they are anxious |
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What are the symptoms of Narcissistic Personality Disorder?
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As the name implies, these individuals have grandiose self-importance
Two features of self importance • High sense of uniqueness o We’re all unique but these individuals take it to extremes o Societal rules don’t apply to them o “You all have to certain things but I don’t because I’m unique” • Sense of entitlement o “I should get what I want, when I want, because I want it, just because of who I am” Another feature is creating an image of success • Very superficial – usually not much success or very little success • Have all the “trappings” of being successful – may use credit cards to buy things but they don’t have to pay because of who they are Intolerant to criticism • “Who are you to criticize me?” Get their attention by tying up their time and money Interpersonally selfish |
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How do Beck's dimensions look with Narcissistic Personality Disorder?
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Beck’s dimensions
• View themselves as special and superior • View others as inferior • Strategy – whatever it takes to maintain their image • Affect – anger when questioned o Term – narcissistic rage • Belief o “I am special” |
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What are the symptoms of Antisocial Personality Disorder?
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Main feature is continuous violation of the rights of others
Can be very charming and appealing also May be very socially adept and good at sizing up social situations quickly • They know what to say and how to act Also get bored easily • Crave stimulation and novelty They live in the here and now • If it sounds like a good idea, they do it • More of a doer than a thinker • Past consequences don’t effect them – don’t deter them because they don’t think about them • Impulsive and don’t think ahead and don’t anticipate future consequences Milan calls it the aggressive pattern • Milan sees these traits as a broader spectrum in that some of the traits can be pro-social however, they cross a line where it becomes antisocial Don’t experience much remorse • May experience some remorse and anxiety in response to being caught but not in response to what they did from a moralistic sense Have to be diagnosed with conduct disorder first • Have to review their history and see if they met conduct disorder as an adolescent Tends to burnout around the age of 40s or 50s • Start to become depressed and somatic • Bodies can’t keep up • Not always though – seen 70 year olds that are still going strong |
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How do Beck's dimensions look with Antisocial Personality Disorder?
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Beck’s dimensions
• They view themselves as strong and autonomous • They view others as weak, vulnerable, and deserving to be preyed upon • Strategy o Con, manipulate, and exploit • Affect o Maybe some anxiety and depression in response to being caught • Basic belief o “People are here for me to take advantage of” – and they do |
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What are the symptoms of Borderline Personality Disorder?
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Milan calls it the unstable pattern
Thoughts, patterns, behaviors are changing and unstable, unpredictable Not only is the person unstable, but also very extreme You’re either the best therapist in the world or you’re not worth the grease on your chair • Can change over minutes Sense of emptiness or a void • There’s nothing inside This individual tries to draw people in to fill that void May engage in extreme unstable behavior in order to get attention or draw people to him or her (may even include suicidal acts) Known for cutting – remember: just because a person cuts though doesn’t mean they have BPD and just because they have BPD doesn’t mean they cut |
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How do Beck's dimensions look with Borderline Personality Disorder?
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Beck’s dimensions
• View themselves as empty • View others as extremely good or extremely bad • Strategy o Manipulation – particularly with potentially self-destructive kinds of things • Affect o “Name it” (every affect and lots of it) o very extreme • Basic belief o I am empty |
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What are the symptoms of Avoidant Personality Disorder?
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Experience extreme social discomfort for fear of being embarrassed or judged negatively
Hypersensitive to rejection and humiliation Only time they’re comfortable accepting relationships is when they are guaranteed acceptance Social withdrawal on one hand but a desire for attention and comfort from others • This is what makes them differ from schizoids |
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How do Beck's dimensions look with Avoidant Personality Disorder?
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Beck’s dimensions
• View of self is inept and incompetent • View others as critical and demeaning • Strategy is avoidance and to avoid people • Affect is dysphoria and anxiety o Dysphoric over being alone o Anxious over being with others • Basic belief o Everyone will hurt me |
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What are the symptoms of Dependent Personality Disorder?
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Passively allow others to take responsibility for major areas of their life
Lack self-confidence to do so themselves or want others to take on these responsibilities Avoid situations where they need to be self-reliant Left to their own devices, they are very indecisive |
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How do Beck's dimensions look with Dependent Personality Disorder?
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Beck’s dimensions
• View themselves as weak, helpless, and incompetent • View others as strong caretakers • Strategy o Subordinate their own needs for the needs of the caretaker • Affect o Anxiety over potential loss of whom they are dependent • Basic belief o “I am helpless” |
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What are the symptoms of Obsessive Compulsive Personality Disorder?
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Notice there is obsessive-compulsive disorder that is axis I and under anxiety disorders
This is different, this is obsessive-compulsive personality disorder and is axis II Inability to express warmth and tenderness Obsessive devotion to work and productivity Tend to be very perfectionistic to the point that they focus on small details and miss the big picture Because of perfectionism, they tend to be indecisive |
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How do Beck's dimensions look with Obsessive Compulsive Personality Disorder?
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Beck’s dimensions
• View themselves as responsible and upstanding • View others as irresponsible and incompetent • Strategy o Follow rules, regulations, and shoulds o They “should” on themselves • Affect o Worry – about not being perfect and about making a mistake • Basic belief o Mistakes are terrible, I must not make a mistake o Everyone should be perfect and everyone should follow the shoulds |
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How do you classify a personality disorder if it doesn't quite meet specific criteria but meet criteria for general cluster?
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• May see “Cluster A Personality Disorder” on axis II
• Sometimes if they’re a little more one than the other, you might see something like “Cluster A Personality Disorder with Paranoid Features” |
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Adjustments are the middle ground between what?
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• Middle ground between personality disorders and normal reactions to normal problems
o More severe than normal problems and are disruptive and distressing to people (just less so than personality disorders) |
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What are the features of Adjustment Disorders?
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• Involve one of two features (or both)
o Impaired functioning o Struggle/Disruption is more than what would be for a normal person |
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What are the time limitations of Adjustment Disorders?
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• Reaction has to occur within three months of the stressor
• Symptoms don’t last any longer than 6 months after the stressor stops • Sometimes the stressor continues, and then the symptoms can last longer than 6 months o Examples would be unemployment, drawn-out divorce |
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What are the types of Adjustment Disorders?
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With Depressed Mood
With Anxiety With Mixed Anxiety and Depressed Mood With Disturbance of Conduct With Mixed Disturbance of Emotions and Conduct Unspecified |
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What are the criteria for Adjustment Disorder with Depressed Mood?
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when the predominant manifestations are symptoms such as depressed mood, tearfulness, or feelings of hopelessness
*Remember: make sure the client doesn't meet criteria for major depressive disorder or anxiety disorder, otherwise you would diagnose with MDD or Anxiety |
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What are the criteria for Adjustment Disorder with Anxiety?
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when the predominating manifestations are symptoms such as nervousness, worry, or jitteriness, or in children, fears of separation from major attachment figures
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What are the criteria for Adjustment Disorder with Mixed Anxiety and Depressed Mood?
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when the predominant manifestation is a combination of depression and anxiety
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What are the criteria for Adjustment Disorder with Disturbance of Conduct?
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when the predominant manifestation is a disturbance in conduct in which there is violation of the rights of others or of major age-appropriate societal norms and rules.
Examples: truancy vandalism reckless driving fighting defaulting on legal responsibilities |
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What are the criteria for Adjustment Disorder with Mixed Disturbance of Emotions and Conduct?
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when the predominant manifestation are both emotional symptoms (e.g., depression, anxiety) and a disturbance of conduct
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What are the criteria for Adjustment Disorder Unspecified?
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for maladaptive reactions (e.g., physical complaints, social withdrawal, or work or academic inhibition) to stressors that are not classifiable as one of the specific subtypes of Adjustment Disorders
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What are the three features of impulse control disorder?
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• 3 features
o Person can’t resist impulse to do something • Potentially this impulse is harmful to themselves or someone else o As person attempts to resist impulse, tension and anxiety goes up o After they act on the impulse, they feel some relief or satisfaction • After initial relief and satisfaction, they feel remorse and guilt for what they did |
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Explain Impulse Control Disorders in terms of resisting urges and deliberate attempts.
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• More about trouble resisting urges and less about deliberate attempts
o Almost to the point where the person can’t not do whatever the impulse is |
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What are the types of Impulse Control Disorders?
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Intermittent Explosive Disorder
Kleptomania Pyromania Pathological Gambling Trichotillomania NOS |
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What are the features of Intermittent Explosive Disorder?
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• Person experiences impulse to act violently
• Usually against property however can be against people • Very quick urge that develops – arises very quickly almost like a panic attack • Impulse comes about quick and then acts violently • Usually provoked but provocation isn’t what would provoke people without this disorder • After explosion, person does feel guilt and remorse about behavior • Generally do accept responsibility • Say that they overreacted or that the provocation didn’t warrant level of response • A lot of these are co-occurring disorders and you will see this with people with personality disorders • Therefore if someone has this, important to do assessment of personality disorders as well • Usually see them because they’ve done something and it’s part of a legal or occupational event |
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What are the features of Kleptomania?
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• The urge that the person has is to steal
• Urge that builds and builds • The more they try to resist, the more stress they feel • Eventually they will steal/take something • Often will feel regret and remorse for taking the item • Usually the item is irrelevant – will often have no utility or value to them • The urge is the actual stealing – not the item being stolen • A lot of time, these individuals are not “good” theives because it is not premeditated but driven by an urge that they have trouble resisting • Therefore, not unusual for these people to be caught • If someone is stealing something that is their style/size, have to question if it’s really kleptomania • Frequently has a high rate of co-occurring disorders • See it with mood, anxiety, or substance use disorders • Rare to see someone with just this disorder |
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What are the features of Pyromania?
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• Urge or impulse is to start fires
• More planful or premeditated • Get more satisfaction out of planning it than other impulse disorders • May be months or years before they actually do it • May be obsessed with fire fighting or fire equipment • May even be a fire fighter • Get some satisfactions and manage urges by being around fires |
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What are the features of Pathological Gambling?
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• Not considered substance disorder according to DSM even though it’s treated like an addiction
• Do mind bets sometimes • Example of mind bet: Bet which car is going to go through a green light first • Always looking for wager or bet even if there isn’t money on it • Mood is a function of their earnings • As they win, mood gets better • As they lose, get more depressed • Mood disorders seen commonly with this disorder o Which came first? Depressed about gambling or gambling because they’re depressed? • not unusual to have a history of a substance abuse • have to make sure the person doesn’t gamble only during a manic episode because if they do, then their gambling is a symptom of their mania, and not an impulse control disorder |
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What are the features of Trichotillomania?
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• Usually women
• Uncontrollable impulse or urge to pull out hair • Single hair at a time • Usually off their head but may try to hide it and pull from hidden areas • Will often pull eyebrows and eyelashes as well • Person may say that they have a disease but dermatologist can determine by looking at skin if the hair was pulled out or fell out • Co-occurring with substance use and eating disorders |
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What are the features of Impulse Control Disorder NOS?
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• Person is doing something in response to urge they can’t resist
• Feel relief or satisfaction after doing • Then feel remorse or guilt • Has to interfere with functioning Example: skin picking |
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Define substance according to the DSM.
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• Refers to any substance that can alter someone’s mood or status
o Cocaine, caffeine, nicotine, prescription medications, things that aren’t intended to be ingested (toxins, sprays, solvents) o Substance is a very broad term in DSM |
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What terms in regards to substance use will you not see in the DSM? What term should you use?
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• Won’t see terms “alcoholic” or “addict” in DSM
• Won’t see “chemical dependency” either o This is a treatment term from the Minnesota model o Say “substance use disorders” |
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What groups are substance-related disorders divided into?
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Substance Use Disorders
Substance-Induced Disorders |
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What are the types of Substance Use Disorders?
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Substance Dependence
Substance Abuse |
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What are the types of Substance-Induced Disorders?
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Substance Intoxication
Substance Withdrawal Substance-Induced Delirium Substance-Induced Persisting Dementia Substance-Induced Persisting Amnestic Disorder Substance-Induced Psychotic Disorder Substance-Induced Mood Disorder Substance-Induced Anxiety Disorder Substance-Induced Sexual Dysfunction Substance-Induced Sleep Disorder |
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What type of substance is there no dependency diagnosis for?
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Caffeine
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Do you use different criteria for substance dependency depending on the substance?
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No. Only need to learn one set of criteria because the criteria are the same, regardless of the substance
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What axis is substance dependency put on?
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Axis I.
When you put on Axis I, you put what the substance is as well |
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What is polysubstance dependence?
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o Person has to be dependent on at least 3 substances and sees no priority in any of them
o Don’t prefer any over the other o If they have preferences, then you list all substance out separately on Axis I o See this wrong a lot – just because client is using 3 substances does not mean they have polysubstance o No such thing as polysubstance abuse |
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What are the criteria for substance dependence?
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• Criteria (need a minimum of 3 in one year)
o Tolerance • Person needs more of the substance to get the same effect • Example: used to get buzzed on 2 beers, now they need 4 o Withdrawal • When the person cuts back or stops, they experience withdrawal symptoms • Looks different with different substances • Withdrawal symptoms are substance specific • When assessing, have to make sure that the person gives their body a chance to withdrawal (if a person has been drinking consistently, they may not have ever given their body a chance to withdrawal) o Person uses more of the substance than intended or uses for longer period of time than intended • Gets at the idea of loss of control • Intention was to stop by the bar for an hour and have 2 beers and were actually there all night and lose track of how much they’ve consumed o Persistent desires to stop or cut down or unsuccessful attempts to stop or cut down use of the substance • Again getting at the idea of loss of control • The person can’t not use the substance • They’ve tried to cut down or stop and they are struggling with that o Person invests more time or energy in obtaining the substance or recovering from the substance • Recovering meaning short term recovery • Next day, hangovers o Person sacrifices other roles • Social roles, family roles, occupational roles • Substance becomes a priority over everything else o Using the substance in spite of knowing that they have substance related physical or psychological consequences |
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What are the specifiers for substance dependence?
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• Remission specifiers
o Early remission • Person hasn’t met criteria for substance dependence for at least a month but less than a year o Sustained remission • Person hasn’t met criteria for over a year o Full • Meet zero criteria o Partial • Meet 1 or 2 criteria • Therefore, a person may be using but be considered in partial remission • This probably won’t last o On agonist therapy • Agonist is a medication that stimulates or blocks a receptor • Takes away some of the craving for the substance • Example – methadone for opiate dependence • Another example is buprenorphine • Have to be in withdrawal from opiates (if not, it will push them into withdrawal) o On antagonist therapy • Blocks the receptor (but doesn’t stimulate the receptor) • Example – Naltrexone also used for opiates but doesn’t stimulate the receptor o In protected environment • Prison, jail, mental health unit |
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Which substance can not be classified under substance abuse?
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Caffeine
Nicotine Polysubstance |
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Can you be diagnosed with substance abuse if you've been diagnosed with dependency for that substance?
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• If you’ve ever been diagnosed as substance dependence for a certain substance, you can never be diagnosed as substance abuse for that same substance
o Before diagnosing someone with abuse, make sure they don’t meet criteria and have never met criteria for abuse |
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What are the criteria for substance abuse?
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• Criteria
o Using a substance and not fulfilling certain roles • Family, occupational • Substance becomes more important than those roles o Using a substance where it’s physically hazardous to use • Partake in activities when under the influence of this that are dangerous • Use power tools • Drive o Doing things that the person wouldn’t normally do that result in legal problems • Most common is DUI • Also see domestic violence and terroristic threats o Continue to use despite of knowing it’s causing impairment or problems |
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When do substance-induced disorders occur?
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Intoxication
Withdrawal Both (Depends on the disorder and substance) |
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What are the features of substance intoxication?
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• Substance Intoxication
o When the person has been ingesting the substance and has created changes within the person’s mood or status o Applies to everything but nicotine o Criteria (substance specific) o Generally criteria is opposite of withdrawal |
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What are the features of substance withdrawal?
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o Person stops using the substance and goes through withdrawal as the body clears itself
o Generally, criteria is opposite of intoxication o No such thing as caffeine withdrawal or cannabis withdrawal |
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What are the features of substance-induced delirium?
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o Clouding of consciousness
o Disorientation o Can occur during intoxication or withdrawal depending on the substance |
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What are the features of substance-induced persisting dementia?
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o Impaired memory
o Impaired executive functioning o Agnosia, aphasia, apraxia, and … o Note this is persisting • Occurs after having the substance leave the body • No longer intoxicated and not withdrawing from the substance anymore o Used to be referred to as “wet brain” |
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What are the features of substance-induced persisting amnestic disorder?
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o Memory loss persists after intoxication and withdrawal
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What are the features of substance-induced psychotic disorder?
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o See “i” or “w” meaning intoxication and withdrawal
o Dependent on substance • Alcohol – intoxication or withdrawal • Amphetamines – only intoxication; no such thing as psychotic when withdrawing from amphetamines o All you need is some psychotic symptoms – don’t have to meet 2 out of 5 like for schizophrenia o Other disorders that look like psychotic disorders • Alcohol withdrawal with perceptual disturbances • See things, hear things, feel things that really aren’t there • Need to make a distinction between these • With perceptual disturbance is that the person has insight – knows that they are experiencing these things due to the result of the perceptual disturbances • Hallucinogen persistent percepting disorder otherwise known as flashbacks • Used LSD in the past and continue to see things/hear things that aren’t there • Different than having psychotic disorder while intoxicated on hallucinogens • If the person hasn’t used for a long time (and they don’t have schizophrenia or something else), you would diagnose with this – can happen months or even years after |
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What are the features of substance-induced mood disorder?
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o Are they depressed, manic
o Don’t have to meet same criteria as other mood disorders – just marked disturbance in mood |
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What are the features of substance-induced anxiety disorder?
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o Person doesn’t have to meet specific disorder criteria
o Can indicate if there is a certain type of prevalence towards one disorder or another • Generalized anxiety, panic attacks, OCD |
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What are the features of substance-induced sexual dysfunction?
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o Some substance include sexual dysfunction
o All are during intoxication |
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What are the features of substance-induced sleep disorder?
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o Can be intoxication, withdrawal, or both depending on substance
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What are the different models regarding the etiology of substance dependence?
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Genetic and Biological Model
Disease Model Moral Model Social Learning Model Public Health Model |
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What are the features of the Genetic and Biological Model of substance dependence?
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• Develop due to genetic transmission or because of the way their brain is “wired”
• Maybe inherited a certain process |
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What are the features of the Disease Model of substance dependence?
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• Related to biological genetic
• You’ve inherited disease • Person experiences irresistible cravings • Somewhat of an impulse disorder – can’t not drink • Replaced moral model • Instead of being bad people, they were sick people • Instead of treating like criminals, should be treated like sick people |
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What are the features of the Moral Model of substance dependence?
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• These are bad, evil, no good people
• Disease model came in response to this • If we made them better people (more moralistic and ethical), they wouldn’t be doing this |
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What are the features of the Social Learning Model of substance dependence?
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• Based on pretty basic learning models
• Classical conditioning • Drink in certain situations and when you return to this situation, you will want to drink again • Alcohol commercials play into this • Operant conditioning • If you feel anxious and use the substance and the anxiety goes away, you will want to drink again to take away anxiety • Negative reinforcement o Negative because it takes away something (the anxiety) • Cultural • Beer commercials on TV, you’ll have friends and be popular • If I drink or smoke certain things, I’ll be better |
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What are the features of the Public Health Model of substance dependence?
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• Pulls together genetic/biological, disease, and social learning models
• This model is more popular in the rest of the world • Disease model is used more in USA • Some actually refer to it as American Disease Model • Looks at the substance • What does the substance contribute? • Crack cocaine is more addicting than powder cocaine • Meth is more addicting than cannabis • The pharmacology of the substance contributes to the addiction • Also look at the person • This is where the genetic/biology comes into the picture • If the person is more impulsive, maybe they will be more likely to try substances • Maybe they have an irritable temperament so they use substances for that o Look at soothability – how can we relax ourselves or calm ourselves down? If a client can’t, may be more likely to turn to substance • What’s their past history? Are they using to cope with trauma? • Third, look at cultural • What’s the context in which the person is operating? • As taxes go up on a substance, the consumption goes down • Another example is happy hours and times that bars and liquor stores stay open |
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What are the stages of change?
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o Stages of change (also called continuum of change or readiness of change)
• Pre-contemplation • No problems • This issue is not an issue • Used to be called denial • Contemplation • Person starts wondering • On the fence • Ambivalent • Not convinced but starting to think about it • Determination/Preparation • Person says that it is a problem and I should do something about it • They’re not doing anything about the problem yet but have decided there is a problem • Action • Start doing something • Start taking steps and make the change • Maintenance • Gone through initial changes and are relatively stable • Used to be thought that once you hit the maintenance level, you’re on “easy street” |
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What are some treatment and rehabilitation options for substance use disorders?
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o Sober support network
• Hang out with like-minded people • Be with people who are doing healthy things • Things other than AA • Women for Sobriety o Made by Jean Kirkpatrick o Didn’t care for AA – thought it tore down self esteem • SMART o Self management and recover training • Alcoholics Victorious o Christian and bible-based o Harm reduction • Methadone maintenance • Sober cab • Needle exchange • Instead of shooting optimal goals, shooting for realistic goals • Shooting galleries in Europe • Safe place to use drugs • Condom use o Spontaneous Recovery • People change on their own • Get better without help from professionals • Author Ann Fletcher • Wrote books Thin Forever and Sober Forever |
