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207 Cards in this Set

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Criteria for MDD
-at least one major depressive episode (depressed mood or anhedonia NED for 2 weeks)
-no manic/hypomanic symptoms
Criteria for dysthymic disorder
-chronic, milder form of MDD
-general depressed mood for >2 years
-no major depressive episode
Criteria for Bipolar I disorder
-at least one manic episode (elevated, expansive mood; grandiosity)
Criteria for Bipolar II disorder
-at least one MDE
-at least 1 hypomanic episode
-no full blown mania
Criteria for cyclothymia
-dysthymia equivalent for bipolar
-no manic/MDE, rapid mood fluctuations
Differences between unipolar and bipolar disorders
-LP: 16% MDD
-later onset
-more prevalent in women
-responds best to psychotherapy, meds, or both
-LP 2.6% (BI+B2)
-earlier onset
-equal gender prevalence
-responds best to Li/mood stabilizers, NOT psychotherapy alone
Prevalence ~5:1 Uni:Bi
Difference between a mood disorder and a normal shift in mood
-pervasive across situations, persistent over time, does not even temporarily improve
-absence of precipitating events, out of proportion with circumstances
-impaired ability to function in normal social roles
-different feeling than normal sadness
Self-regulation theory
The way in which a person responds to the onset of a depressed mood will determine it's duration
(Rumination vs. Distraction)
Life Events Theory of Depression
People who become depressed actually experience more stressful live events
-issue of direction of effect
-whether the person becomes depressed from the event was more likely if the event matched prior difficulties or gave the person a sense of being devalued as a person
-gender difference: women place more emphasis on experience and have more interpersonal stress in their life than men
Cognitive Theory of Depression
Cognitive distortions, errors, and biases lead to depression:
-overgeneralizing based on negative events
-arbitrary inference about the self in the lbsense of supporting evidence
-selective recall of negative events (disregard + over-exaggerate -)
-subconscious negative schemas are activated by stressful events
Hopelessness Theory
-negative expectations about future events that can't be controlled
-causal attributions: depends on how person responds to events/how much importance they place on the event
-failure is due to something internal (something wrong with them), lead to negative thoughts for future
Biological models/explanations for mood disorders
-bipolar disorders are more heritable than unipolar
-genes influence the person's sensitivity to environmental events, influences risk of developing depression
Analogue Studies
For ethical reasons...
-study a condition that is similar to the disorder, focus on behaviors that resemble the disorder in the natural environment
-strengths;allow greater control by the experimenter
-weaknesses: debatable extent to which the conclusion applies to outside the study
-ex: effect of uncontrollable stress on rats; unclear if the chemical imbalance was a cause or byproduct of the depresion
Treatments for Unipolar mood disorders
-interpersonal therapy
-mindfulness based cognitive therapy
Mindfulness Based Cognitive Therapy
focuses on breaking the cycle of rumination and preventing relapse
-mindfulness as an alternative to rumination, simply being aware of negative thoughts
-effectiveness: works well for people with 3+ episodes and don't have a clear reason why they became depressed
Why is relapse important in MDD?
Many people relapse in MDD, and the more relapses, the more likely future relapses are
Treatments for bipolar disorders
-Lithium is effective as a mood stabilizer
-can't improve with psychotherapy alone, yet an effective supplement
Different "types" of suicide
-Egotistic: persona feels detached, depressed, and apathetic
-Altruistic (sacrifice for society)
-Anomic: breakdown of social order, results in many people committing suicide
-Fatalistic: unbearable life circumstances, use suicide as an escape
Common elements for people who commit suicide
-purpose is to seek a solution
-goal is cessation of consciousness
-cognitive state is ambivalence (simultaneously wish they could find another way out)
-perceptual state is constriction (tunnel vision, all or nothing outlook)
-interpersonal act is communication of intention (have told people about their plans)
Genetic factors for people who commit suicide
moderate the impact of environmental factors on suicidal behavior
-often suicidal people have difficulty regulating serotonin levels
Differences in suicide risk, attempts, and completion by age and gender
highest completion rate= older white men over 50
Attempts:Completions - 10:1 (100:1 for adolescents; teen females make 3x as many attempts, males use more lethal methods)
Suicidal thoughts
-esp. common among depressed adolescents
-24% of high school girls, 15% of high school boys
Suicide warning signs in students
-depressed and withdrawn*
-lowered self esteem
-deterioration of personal hygiene
-loss of interest in studies
-communication of distress

tend to be doing well in school
problems with relationships
How does the self-regulation theory help to explain the relationship between anxiety and depression?
-depression: sense that you can't move toward desired positives
-anxiety: sensing you can't move away from undesired negatives

if you think you can't do one, you may start to think you can't do the other
Exposure treatment (general)
person stays in feared situation preferably until anxiety reduces and they realize that fears are unfounded
Prevalence of anxiety disorders
more common than any other form of mental disorder, but only 25% of people that have it seek treatment
-Specific phobias 9%
-Social phobias 7%
-Panic disorder 3%
-GAD 3%
-OCD 1%
-Agoraphobia w/o panic 1%
Gender differences of anxiety disorders
-relapse rates higher for women than men
-specific phobias 3x as prevalent in women, panic disorder, ag, GAD 2x in women
-OCD no gender difference

explanation for why more common in women: child rearing practices, ways women respond to stress, differences in hormone functions
Biological factors of anxiety disorders
-1st degree relatives of people with disorder are at a high risk of developing some type of anxiety disorder (not necessarily the one had by the relative)
-Genetic risk factors for anxiety disorders are neither highly specific nor highly nonspecific
Psychological factors of the anxiety disorders
-classical conditioning: fears are learned, associate experience with fear
-preparedness model: humans are hard wired to fear certain stimuli: historical fears, threats to survival, based on experience of others
Generalized Anxiety Disorder (GAD) characteristics
general anxiety, not specific to panic attacks, social situations, contamination, etc.
-excessive CNS activity
-revision in DSM: only one month required, doubling the prevalence
Specific Phobia
excessive or unreasonable fear to a stimulus
-cued by presence of object/situation
-person recognizes fear is unreasonable, avoids situation
-interferes with persons routine, functioning, activity
-treat with systematic desensitization/exposure
Social Phobia
-anxiety in social situations, fears he/she will act in a way that is humiliating/embarassing
-treatment: video feedback, realize that its not as abad as they thought
Cognitive factors of social phobia
-people with social phobia believe they look more nervous than they actually are
-consider the worst case
-shift focus to evaluating self, further increasing arousal, dysfunctional performance
Panic Disorder/Agoraphobia
unexpected panic attack
-anxiety about potentially having an attack
-agoraphobia: anxiety about being in a situation from which escape might be difficult
-become increasingly aware and misinterpret internal stimuli/bodily sensations as harmful
Relationship between attachment and PDA
people with anxiety disorders are more likely to have had attachment problems as children
can't get obsessive thoughts our of head even though they want to, causing anxiety
-person recognizes thoughts are from own mind, not imposed from outside
-compulsions: way to manage the obsessions, not realistically connected/designed to prevent the obsessions
DSM Criteria for a major depressive episode
At least 5 of the following, including (a) or (b), NED for 2 weeks:
a) depressed mood most of the day
b) anhedonia most of the day
c) weight loss/gain, persistent change in eating habits
d) insomnia or hypersomnia
e) psychomotor agitation/retardation
f) fatigue or loss of energy
g) feelings of worthlessness/excessive guilt
Post Traumatic Stress Disorder
-exposure to a traumatic event involving actual or threatened death, serious injury, or threat to physical integrity; person's response involved intense fear, helplessness, horror
-event is persistently reexperienced; person feels/acts as if it were actually happening
- avoidance of stimuli associated with the trauma and numbing of responsiveness: person avoids anything associated with trauma, feel detached from others and have restricted emotions
-increased arousal: difficulty falling or staying asleep, irritability, difficulty concentrating, hyper-vigilance
-duration for more than 1 month
-significant distress or impairment in functioning
Acute Stress Disorder
-a less intense reaction to trauma, compared to PTSD
-lasts more than 2 days and less than 4 weeks
Edna Foa's Model of Emotional Processing
Frequency and intensity of symptoms go down over time
-people with PTSD and without get better during the first month, but the people with PTSD show no further improvement
-emotional processing is impaired
Debriefing treatment (CISD)
everyone who witnessed a disaster or emergency situation is "debriefed," encouraged to tell their stories to clinicians and each other
-interventions with true peer support and emphasis on return to normal life may be more successful
Cognitive Behavioral Treatment for PTSD
1. Establishing a trusting therapeutic relationship
2. Psychoeducation
3. Stress management training
4. Exposure
5. Integration
Dissociative Amnesia
A reversible inability to retrieve memories
-usually of personal nature
-often limited to events that occur in a circumscribed period of time
-the diagnosis applies to gaps in recent memories rather than loss of childhood memories
-usually follows a stressful event
Dissociative Fugue
-very rare
-first consider dementia, substance abuse
-extreme form is person moving away and establishing a new identity
-new identity is likely to be more gregarious and uninhibited than usual personality
Dissociative Identity Disorder
-existence within the person of two or more distinct personalities
-at least 2 of these personalities recurrently take control of behavior
-inability to recall important personal info
Bliss' theory of DID
-vulnerability takes the form of being extremely hypnotizable
-exposure to repeated, severe abuse
-person uses self-hypnosis to avoid emotional experience
-eventually loses control of trance states
Treatment of DID
-no strong research support
-promote integration of personalities
Controversy of DID
may be vastly overdiagnosed
-only a few advocates give most of the diagnoses
-rapid increase since it became part of popular culture
-diagnosed much less often in non-western cultures
-people are impacted by the expectations of the psychotherapist and that the person could be influenced when put under hypnosis
How do different pathways in the brain involved in the detection of danger differ?
differ with respect to the amount of conscious thinking/reasoning
Difference between statistical significance and clinical importance
statistical significance could be based on trivial changes in the patient's adjustment
Panic as a "false alarm"
panic is a normal fear response triggered at an inappropriate time
Correlational study
systematically studies the relation between two factors
Reverse causality
the causation could actually be operating in the opposite direction
third variable problem
indicates that a correlation between any two variables might be explained by their joint relation with some unmeasured factor
"harmful dysfunction" definition of abnormality
condition results from the inability of some internal mechanism to perform its natural function, and causes some harm to the person as judged by cultural standards, measured by the person's own distress or difficulty in performing expected social tasks/roles
Prevalence and gender differences of disorders in general
mental disorders have a 46% LP
-most prevalent: major depression, substance abuse, and anxiety disorders also common; less common are schizophrenia and eating disorders
-more common in women: major depression, anxiety, eating disorders
-more common in men: alcoholism, ASPD, schizophrenia
Disease burden
mental disorders comprise 47% of all disability in economically developed countries (second behind heart disease)
Influence of culture on mental disorders
-all mental disorders are shaped, to some extent, by cultural factors, but no disorder is entirely due to cultural/social factors
-psychotic disorders are less influence by cultures
-symptoms of certain disorders are more likely to vary across cultures
case studies
useful for rare conditions
-can't generalize from a case study
-limitation: depends on perspective, logic does not equal true, not always replicable, specific to patient
the branch of medicine that is concerned with the study and treatment of mental disorders. can prescribe medication (MD)
clinical psychology
the application of psychological science to the assessment and treatment of mental disorders (PhD or PsyD)
social work
concerned with helping people to achieve an effective level of psychosocial functioning, based less on scientific knowledge than on a commitment to action
the movement to treat the mentally ill and mentally retarded in communities rather than in large mental hospitals
general tendencies of the media regarding mental disorders
portray mental disorders/people with disorders as:
-dangerous, crime
-negative connotation
-ignore common aspects, only show extreme
Why does the media and popular culture show these kidns of biases?
money, appeals to emotion, people don't need a reasonable explanation for things in the media
Biological paradigm
looks for biological abnormalities that cause abnormal behavior
-however, never really a single, primarily biological cause to a disorder
-reductionism: reduce problems to their smallest biological parts
Psychodynamic paradigm
abnormal behavior is caused by unconscious mental conflicts that have roots in early childhood experience; Sigmund Freud
Pyschoanalytic theory
Freud's theory that many memories, motivations, and protective psychological processes are unconscious
-mind divided into 3 parts (id, ego, superego)
Cognitive-Behavioral Paradigm
views behavior as a product of learning
-classical conditioning: learning through association
-operant conditioning: behavior is a function of its consequences (reinforcement and punishment)
Humanistic Paradigm
human behavior is the product of free will
-impossible to determine the causes of abnormal behavior according to this paradigm
systems theory (biopsychosocial model)
an integrative approach to science that embraces multiple influences on behavior; disorders are never caused by just one factor
Necessary vs. Sufficient
although a factor may be necessary to cause a certain disorder, it's not always sufficient
the view that there are many routes to the same destination (disorder)
the same event can lead to different outcomes
Diathesis-stress Model
mental disorders develop when a stress (difficult experience) is added on top of a predisposition (diathesis, ex: genetics); one or the other is not independently sufficient
reciprocal causation
each factor has the potential to cause the other
palliative, not curative
Clint-centered therapy
-Carl Rogers
*Unconditional positive regard, empathy*
Psychoanalytic therapy
-Freud, focues on the unconscious
-symptoms are symbolic of id, ego, superego
bringing formerly unconscious material into conscious awareness, and analyst offers interpretation of hidden meanings
"working through"
repeating, elaborating, and amplifying interpretations, apply rational throught
the process whereby patients transfer their feelings about some key figure in their life onto the shadowy figure (therapist)
behavior Therapy
-behavior is determined by antecedents and consequences
-positive reinforcement and punishment
-classical and operant conditioning
systematic densensitization
gradual, progressive muscle relaxation, hierarchy of fears, learning process
confronting fears at full intensity
aversion therapy
create an unpleasant response, associate unpleasant response with alcohol for example, helpful in substance use disorders
social skills training
teach clients new ways of behaving that are desirable and likely to be rewarded
cognitive therapy
-emotions determined by self statements
-recognize maladaptive self statements and substitute them with more rational thoughts
-negative thoughts lead to negative emotions (Aaron Beck)
-Third wave therapies: focus on accepting symptoms and not just changing them
allows researchers to combine the results from different studies in a standardized way, allows more reliable estimates of effects
placebo effect
powerful healing by inert treatments
allegiance effect
therapist's allegiance to one form of therapy or another has a powerful influence on whether it is effective
whether treatment can work (i.e., in a lab)
whether treatment does work (i.e., in the real world)
double blind studies
when neither the patient nor the physician know whether the pill is a placebo or not
categorical vs. dimensional approach
categorical: qualitative, either have it or don't
-description--> theory
-as more cases occur over time, course becomes more predictable
dimensional: quantitative, focuses on how much
reliability vs. validity
reliability: concerned with consistency, inter-judge agreement in diagnosis
validity: systematic meaning or importance, no single measure of validity
-validity is limited by reliability
Assessment procedures
-interviews (structured vs. unstructured)
-observation (primarily for kids/adolescents)
-self report (subjective/projective and objective)
-biological measures (not as important, don't have a way to tell if someone is depressed biologically)
limits to confidentiality
if it's harmful to self or others
dual/multiple roles
in a professional relationship only
-client can potentially be harmed by anything more
-psychologist should avoid personal influence
actuarial interpretation
many clinicians analyze the results of a specific test on the basis of an explicit set of rules that are derived from empirical research
Odd Cluster PDs
Paranoid PD
Schizoid PD
Schizotypal PD
paranoid PD
pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent
-suspects others are exploiting, harming, or deceiving them, doubts loyalty, suspicious in general
-difficult to study because they are paranoid, dont want to take part and are suspicious along the way
-proposed causes: parents who are distant rigid fathers/ overcontrolling moms, sadistic or unprotective, concerned with errors and believe child is unique
schizoid PD
pervasive patter of detachment from social relationships and restricted range of expression of emotions in interpersonal settings
-neither desires nor enjoys close relationships, including family
-overall detachment, lack of desire
-NOT that they are schizophrenia or are currently depressed
schizotypal PD
pervasive pattern of social and interpersonal deficits marked by acute discomfort with close relationships as well as cognitive or perceptual distortions and eccentricities of behavior
-bizarre fantasies and unusual perceptual experiences
-don't show much emotion or show inappropriately
-NOT delusional, still in touch with reality
historical relationship of schizotypal to schizophrenia
this PD frequently seen among first degree relatives of schizophrenia people
dramatic cluster of PDs
Narcissistic PD
Antisocial PD
Borderline PD
Histrionic PD
Narcissistic PD
pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy
-overlap with borderline PD
-exaggerated sense of their own importance, preoccupied with their own achievements
-"narcissistic injury:" life is not so great so cover it up with narcissism (defense mechanism for depression)
Antisocial PD
pervasive pattern of disregard for and violation of the rights of others occuring since age 15
-irresponsible and antisocial behavior, impulsive, deceitfulness, failure to plan ahead, reckless
-under 18 = considered conduct disorder
-can either have ASPD just as an adolescent or over entire lifespan (mostly males)
Cleckley's definition of ASPD
"the psychopath:" intelligent and superficially charming but deceitful, unreliable and incapable of learning from experience
-only 35% of ASPD meet this defn
Causes of ASPD
Biological: nature and nurture both important, but nature has more influence
Social: children with a difficult temperament may be irritating to parents and evoke a negative response; hard to break the pattern of antisocial behavior as a child, tend to associate with peers who are also antisocial
Psychological: behavior is unaffected by anticipation of punishment
-either ignore the effects of punishment/don't feel fear and are emotionally impoverished
-or have trouble shifting their attention to consider the negative consequences of their behavior
Borderline PD
pervasive pattern of instability in personal relationships, self-image, and affects, and marked impulsivity
-pattern of unstable and intense personal relationships
-identity disturbance
-self damaging impulsivity
-chronic feelings of emptiness
Comorbidity of BPD
axis I-depression
axis II-overlap with other pds: histrionic, narcissistic, paranoid, dependent, avoidant
Causes of BPD
genetic: predispositions such as neuroticism and impulsivity
childhood: negative consequences of parental loss, neglect, mistreatment; conflicting attachment as a risk factor
Treatment of BPD
Dialectical Behavior Therapy: learning to be more comfortable with strong emotions and think in a more integrated way that accepts the good and bad features of the self and other people
-important that the therapist accepts the patients
-Linehan: founder of this model (D: problem with regulating emotion; S: abusive/invalidating environments)
Histrionic PD
pervasive pattern of excessive emotionality and attention seeking behavior
-thrive on being the center of attention
-inappropriately sexual/provocative
-theatrical, stereotypical of actors
Comorbidity of Histrionic PD
etiological link with ASPD: common underlying tendency toward lack of inhibition: shallow, intense relationships with others, manipulative
-this predisp. causes histrionic in women and ASPD in men
Anxious PDs
Avoidant PD
Dependent PD
avoidant PD
pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
-want to be liked by others but don't think they are good enough to interact
-comorbidity: most people fit criteria for both avoidant PD and social phobia
dependent PD
a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation
pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency
-NOT to be confused with OCD: concerned with only personality traits: high levels of conscientiousness
Dimensional approach for PDs
set an arbitrary threshold because there is no sharp line between normal and abnormal personalities
-five factor model: measure degree of Openness, Conscientiousness, Extraversion, Agreeableness, Neuroticism
Stability of PDs over time
mostly just temporal stability except for ASPD which persists into adulthood
-3/4 of BPD recover after treatment
-less optimistic for schizotypal and schizoid
Prevalence, Comorbidity, and Gender bias/differences of PDs
LP for any PD=10%
-specific disorders: most prevalent are OCPD, ASPD, avoidant (3-4%)
Comorbidity: at least 50% of people who meet criteria for one PD meet criteria for another; 75% of people who qualify for axis II diagnosis qualify for a syndrome such as MDD, substance dependence
Gender bias/differences: controversy that definitions of some are based on sex role stereotypes (easier for women to meet the criteria even if they are not experiencing significant distress or impairment)
Culture and PDs
"appropriate behavior" varies consierably from one society to the next
-when diagnosing, the experiences of people from cultural and ethnic minorities should be considered within a particular society
cross-cultural psychology
the scientific study of ways that human behavior and mental processes are influenced by social and cultural factors
tolerance vs. withdrawal
tolerance: the nervous system becomes less sensitive to the effects of a substance; person needs larger quantities of the drug to achieve the same effects
withdrawal: symptoms experienced when a person stops using the drug
substance abuse vs. substance dependence
abuse: less sever form of disorder, in which drug use interferes with the person's ability to function
-harmful consequences without evidence of tolerance, withdrawal, or compulsive use (makes definition more inclusive)
dependence: more severe; involves a pattern of compulsive use with tolerance and/or withdrawal
Effects of Alcohol
Short term effects: slurred speech, lack of coordination, unsteady gait, nystagmus, impaired attention or memory
Long term effects: disruption of personal relationships, blackouts, decreased job performance, legal problems, disrupt organ systems
Effects of nicotine
short term: increase in heart rate and blood pressure, CNS arousal, release of dopamine, relaxing effect
long term: intense withdrawal symptoms, increased risk of heart and lung diseases, fertility problems
effects of amphetamine and cocaine
activate sympathetic nervous system, suppress appetite and prevent sleep, positive mood state, tolerance develops quickly, acute overdoses can cause fatal consequences
long term: can lead to the onset of psychosis, disruption of occupational and social roles, sacrific everything to finance the drug, increased violent behavior
-do not typically experience withdrawal, rather depression leading to suicide
Statistics and prevalence of substance abuse disorders
30% LP
men outnumber women in all substance abuse/dependence disorders
increased risk of prescription drug abuse among the elderly
stages of alcoholism
1. initiation and continuation
2. escalation and transition to abuse
3. development of tolerance and withdrawal
Social factors of substance abuse disorders
-depends on under what circumstances the person is initially exposed to alcohol
-cultural variations in rates of alcoholism, how it is viewed in the community
-experimentation with drugs/alcohol is most likely to occur among adolescents whose peers and parents model or encourage use (influence of parents is more important for alcohol, peers for drugs)
biological factors of substance abuse disorders
-initial physiological reactions dramatically affect early drinking experiences
-heritability analyses suggest that 2/3 of the variance is due to genetic factors (sharing genes with an alcoholic parent is more influential than being reared by an alcoholic parent)
psychological factors of substance abuse disorders
-tension reduction hypothesis: drinking is positively reinforced by the fact that it is expected to reduce tension
-placebo: generally positive expectations about the way substances make you feel enhances the experience, leading to exaggerated responses; positive expectancies seem more influential than negative ones
opponent process model
emotions often surface in pairs which oppose each other
Challenges and controversy in the treatment of substance use disorders
many people do not acknowledge their difficulties and few seek professional help, compliance is low and dropout rates are high
-complete abstinence or use in moderation as the goal?
detoxification treatment
removal of the drug on which a person has become dependent for 3-6 weeks (usually in a hospital or with close supervision)
-CNS depressants gradually, stimulants can be stopped immediately
Medications for substance abuse
antabuse: blocks chemical breakdown of alcohol, person becomes violently ill if they consume - poor compliance
naltrexone: dampens person's craving - reduces the rewarding effects of alcohol, effective
Self-help groups: Alcoholics anonymous
-spiritual in nature, acceptance of the problem, making amends
-difficult to evaluate effectiveness: long term follow up is difficult and dropout rates are high
CBT for substance use disorders
1. coping skills training
2. relapse prevention
3. short term motivational therapy
coping skills training
train use of social skills, might resist pressures to drink heavily
problem solving procedures which can help the person identify situations that lead to heavy drinking and formulate alternative courses of action
challenging expectation about the effects of alcohol, address negative patterns of thinking about the self
relapse prevention
aimed at helping the addict deal with the challenges of life without drugs
-learn adaptive coping responses
-abstinence violation effect: the guilt and perceived loss of control that the person feels whenever he or she slips after an extended period of absitnence
short term motivational therapy
primary goal is to increase the person's awareness of their problem
-most helpful to people whose problems are not yet severe or chronic
dual diagnosis of mental disorders and substance abuse disorders
generally the mental disorder comes first, substance abuse develops a few years later
-often one problem is diagnosed while the other is missed
symptoms/criteria of anorexia
-refusal to maintain normal body weight
-deny problems with their weight
-disturbance in the way body weight or shape is experienced
-amenorrhea (absence of at least 3 consecutive periods)
defining characteristics of anorexia vs. bulimia
-below normal weight
-proud of diet
-comforted by rigid self control
-normal weight
-ashamed, secretive, aware of problem
-distressed by lack of control
-binging done in secret
comorbidity of anorexia
OCPD traits
depressed mood
social withdrawal
subtypes of anorexia
restricting type
binge-eating/purging type
treatment of anorexia
-help the patient gain at least a minimal amount of weight
-address the broader eating difficulties (parents take over, emphasize uncontrollable nature of anorexia, encouragement)
-overall little to no evidence on efficacy; most patients continue to have problems with eating and weight
symptoms/criteria of bulimia
-recurrent episodes of binge eating, characterized by eating a very large amount of food and asense of lack of control over eating during the episode
-recurrent inappropriate compensatory behavior
-high comorbidity with depression (sometimes B develops as a result of depression)
subtypes of bulimia
purging type: self induced vomiting, laxatives/diuretics
non purging type: fasting, excessive exercise
treatment for bulimia
1. CBT - effective: normalize eating pattern, address the client's broader dysfunctional beliefs about self, appearance and dieting
2. interpersonal therapy: focuses on difficulties in relationships, initially used as a placebo but now very effective, excludes direct discussion on dieting
3. antidepressants - effective in addition to CBT
cohort effect
lifetime prevalence of bulimia was far greater among women born after 1960 than those born before 1960 due to changing cultural standards of beauty
cultural/social factors of eating disorders
-greater emphasis placed on women's appearance and increased negative body image due to media
-troubled family relationships: b-rejection in their family can contribute to depression; a- cohesive and nonconflictual families, can be too close and use anorexia as an escape
-sexual abuse can contribute, but not specific to EDs
-parents are models for children regarding eating habits
psychological factors for eating disorders
-struggle for perfection and control (Bruch: anorexics succeed and take pride in their extreme control, while bulimics continually strive and fail)
-depression, low self esteem, dysphoria
-negative body image: huge gap in women's views on perceived ideal body image and current body image (this is opposite in men)
biological and genetic factors for eating disorders
-body finds it hard to distinguish between intentional attempts to lose weight and potential starvation
-genes may influence personality characteristics such as anxiety that may increase the risk for an ED
gender differences for eating disorders
10x more common in women
-difference in source of self esteem: women associate physical attractiveness with self esteem
-women have a bigger difference in their ideal and current body image
Desire phase sexual dysfunctions
1. hypoactive sexual desire disorder: deficient (or absent) sexual fantasies and desire for sexual activity

2. sexual aversion disorder: extreme aversion to, and avoidance of, all or almost all genital sexual contact with a partner
arousal phase sexual dysfunctions
1. female sexual arousal disorder: inability to attain or maintain an adequate lubrication swelling response of sexual excitement (desire is there but physiological response is inhibited)
2. male erectile disorder: inability to attain or maintain until completion of the sexual activity an adequate erection
orgasm phase of sexual dysfunctions
1. female orgasmic disorder: delay in or absence of orgasm following a normal sexual excitement phase
2. male orgasmic disorder: " "
3. premature ejaculation with minimal sexual stimulation, before or shortly after penetration (most common)
pain phase of sexual dysfunctions
1. dyspareunia: genital pain associated with sexual intercourse (either male or female)
2. vaginismus: involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse
Statistics/gender differences of sexual dysfunctions
-gender differences: women have more trouble with low desire/arousal, men have more trouble with rapid orgasm
-low reliability of diagnostic decisions
-marked distress of interpersonal difficulty is found in all disorders

-premature ejaculation is the most common for men, all other forms are reported more often by women
-prevalence of certain types of dysfunctions are more common among elderly (ED)
Biological causes for sexual dysfunctions
men: testosterone is important for sexual desire
-suggests that hormones influence sexual appetite rather than performance
-vascular/neurological diseases can impair sexual responsiveness
-drug and alcohol abuse is related to negative sexual arousal
women: little research has been done
Master's and Johnson's "maintaining variables"
failure to engage in effective behaviors
performance anxiety (fear of failure)
perceptual and intellectual defenses
communication difficulties
psychological causes for sexual dysfunctions
-M+J maintaining variables
-sexual desire and arousal are determine in part by mental scripts that we learn throughout childhood and adolescence
-quality of relationships is an important factor to consider with regard to low sexual desire
-culturally determined attitudes have a dramatic impact on women's ability to become sexually aroused
-previous harmful or traumatic sexual/parental experiences/relations
Master's and Jonson's intervention
treatment for sexual dysfunctions
-education about normal sexual functioning
-cognitive work with sexual "myths"
-increase communication
-eliminate performance anxiety: sensate focus and non demand pleasuring
-gradually build up to intercourse
Sex therapy
-sensate focus
-education and cognitive restructuring: help the couple correct mistaken beliefs about sexual behaviors
-communication training: structured training procedures aimed at improving the ways in which couples talk to each other
Biological treatments for sexual dysfunctions
-viagra: erectile dysfunction, increased blood flow but many side effects
-injections of drugs into the penis
-penis implants
-few medical treatment/procedures for female dysfunctions
Characteristics of paraphilias
sexual arousal associated with unusual objects and situations
-are they mental disorders or legal issues
-problem is the novel erotic preoccupation that is highly arousing coupled with pressure to act on the fantasy
-diagnosis of paraphilia only made if the person acts on the urges or is distressed by them
-aggression, violence, hostility are common themes

sexual arousal is not connected with intimacy
exposure of genitals to strangers
arousal paired with non-living objects
touching and rubbing others
sexual activity with children
sexual masochism
being made to suffer
sexual sadism
inflicting pain or humiliation
transvestic fetishism
cross-dressing (only in heterosexual men)
observing unsuspecting stranger
rape as a paraphilia
nonconsensual sexual penetration obtained by force, by threat of bodily harm, or when the victim is incapable of giving consent
-not included in DSM, if it were it might imply that rape is always motivated by arousal
types of rapists
-sadistic: behavior determined by a combo of sexual and aggressive impulses
-nonsadistic: preoccupied with fantasies but not with violence or aggression
-vindictive: seem intent on violence directed exclusively toward women
-opportunistic: men with extensive history of impulsive behavior, might be psychopaths, governed by environmental cues
frequency of paraphilia
-almost exclusively male disorders (95%) except sexual masochism
-lots of crossover in paraphilic behaviors
causes of paraphilia
biological: elevated levels of testosterone in sexually violent offenders
social: have somehow failed to learn more adaptive forms of courtship behavior
William Marshall: core feature is failure to achieve intimacy in relationships with adults, maladaptive attempts to achieve intimacy through sex
treatment of paraphilias
most are usually referred by the legal system
1. aversion therapy: try to creat new association with the inappropriate stimulus so it will no longer elicit sexual response, rarely used anymore
2. CBT: build more appropriate social skills and sexual relationships
3. hormones and medication: drugs that reduce testosterone levels, antidepressants work by decreasing interest without affecting other forms of sexual arousal/social anxiety
4. sexual predator laws: designed to keep a criminal in custody indefinitely
gender identity disorder
strong and persistent identification with the opposite gender, discomfort with own gender
treatment for GID
change the person's identity to match anatomy or vice versa (generally the latter is more effective, sex reassignment surgery)
arguments against GID being a mental disorder
-it is a physical condition
-people with GID are not "crazy"
-people with GID suffer due to society only
severe form of abnormal behavior that encompasses what most of us have come to know as madness, characterized by a long term break with reality demonstrated by positive, negative, and disorganized symptoms
positive symptoms of schizophrenia
in excess of normal experience, and are more obvious to untrained observers:
-delusions: bizarre vs. nonbizarre ideas
-inappropriate affect: inappropriate responses
negative symptoms of schizophrenia
lack of normal experience or behavior, and are often just if not more distressing for the individual
-poverty of speech
-alogia (no speech at all)
-poverty of content
-blunted/flat affect
-loss of volition
-social withdrawal
disorganized symptoms of schizophrenia
-loose associations or derailment
-neologisms (made up words)
-perseveration (getting stuck)
phases of schizophrenia
-prodromal phase: obvious deterioration in role functioning, observed change in personality
-active phase: psychosis
-residual phase: typically improvement in positive symptoms, continued negative symptoms
diagnostic criteria for schizophrenia
during a 1 month period, 2+ of the following:
-delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, negative symptoms
subtypes of schizophrenia
1. catatonic: symptoms of motor immobility or excessive and purposeless motor activity
2. disorganized: d/o speech, behavior, and flat/inappropriate affect. need all 3. high social impairment
3. paranoid: systematic delusions with grandiose content, preoccupied with frequent hallucinations
4. undifferentiated: obviously psychotic but either meet more than one subtype or none at all
5. residual: not longer meet criteria for an active phase but demonstrate ctd negative symptoms
problems with traditional subtypes of schizophrenia
-not consistent over time
-diagnostic reliability is low
-not associated with treatment response
-not etiologically distinct
-may reflect varying stages or levels of severity
-subtypes do not run in families, although schizophrenia in general does
schizoaffective disorder
describes the symptoms of patients who fall on the boundary between schizophrenia and mood disorder with psychotic features
delusional disorder
does not meet the full symptomatic criteria for schizophrenia, but patient is preoccupied for at least one month with delusions that are not bizarre
brief psychotic disorder
exhibit psychotic symptoms for at least one day but no more than one month
-typically accompanied by confusion and emotional turmoil often following a markedly stressful event, then returns to normal
course of schizophrenia
half partially recover, half don't
typically has a poor outcome, successful aging rare
gender differences in schizophrenia
men are 30-40% more likely to develop than women, have earlier onset, more likely to exhibit negative symptoms and follow a deteriorating course
-although initially thought no gender difference
cross cultural comparison in schizophrenia
universal disorder, but urban populations have higher rates than rural
biological factors of schizophrenia
some kind of predisposition is inherited but genetics do not explain the whole story
-overall pattern suggests that vulnerability to schizophrenia is sometimes expressed as schizophrenia-like personality traits
-some patients have enlarged ventricles, but NOT DIAGNOSTIC TESTS
social factors of schizophrenia
inverse relation between social class and schizophrenia
-social causation hypothesis: harmful events associated with membership in the lowest social class play a causal role
-social selection hypothesis: those who delop schizophrenia may be less able to complete a higher level of education or to hold a well paying job which causes downward social mobility
higher rates among people who have migrated to a new country
psychological factors of schizophrenia
expressed emotions: statements that reflect negative or intrusive attitudes toward the patient. overprotective or too closely identified with the patient-patients who return to live with families are more likely to relapse
vulnerabilities/markers for schizophrenia
-must distinguish between people who already have schizophrenia and those who do not
-must be stable over time
-be more common among first degree relatives of schizophrenia patients
-predict future episodes of schizophrenia among those who have the 'sign" during adolescence
Paul Meehl's model of schizophrenia
-schizotaxia: an inherited, subtle neurological defect
-shizotypy: odd behaviors
-schizophrenia: full-blown symptoms of the disorder
medication treatment for schizophrenia
reduces the severity of psychotic symptoms
-positive symptoms respond better than negative ones
-motor and weight gain side effects
psychosocial treatment of schizophrenia
family oriented aftercare: attempt to improve comping skills of family
social skills training: drug therapy supplemented by psychological programs that address residual aspects of the disorder deficits in social skills