Abnormal B/h: maladaptive b/h: interference w/ daily functioning/growth, or if it is self-defeating
2 Value assumptions:
treatment: for
maladaptive b/f: teaching ind. how to deal w/ reality despite it being
hard
abnormal psychology/psychotherapy:
the field of psych that deals w/ understanding/treatment
3 categories of studies of abnormal b/h
clinical picture: defining the abnormality’s nature
i.e. classification
DSM: classification
of mental disorders
3 approaches to classify b/h:
i.e. axes 4/5 of the DSM
though not everything fits together
DSM
-first 3 axes= present conditionsin #1, 3, more than 1 issue could be the prob.
-last 2 = broader axes
Examples of #1, 2
i.e. destruction of brain tissue, i.e. Alzheimer
functional
psychosis: an organic basis has not been demonstrated
Acute: short duration of disease – i.e. under 6 months
Chronic long standing, usually permanent.
Could also be used for low intensity disease, since long term is usually low intensity
Mild/moderate/severe:
describe severity of the disorder
Episodic: recurring – go up and down. I.e. in schizophrenia/mood disorders
Recurrent: come and go (i.e. episodic)
-range b/w none and catastrophic
90 point scale for functioning
comorbidity: appearance of 2 or more identified disorders in the same psychologically disordered person
Retrospective research: studying the root of the presentlook at earlier event of the subject’s life
Prospective research:
studying the future from the present: i.e. studying the person who is
more likely to get the disease, b/f the fact.
Study of abnormal b/h should be based on:
Case study (N=1 experiment)
= hard to generalize
Sign: objective observations of patient’s physical or mental disorder
Syndrome: patient’s
subjective description of a physical or mental disorder.
Epidemiology: study of the distribution of [mental] illness/b/h in a given population
Prevalence: during a set time, how many cases were identified w/I a population
Incidence: occurrences
(onset) rate of a given disorder in a given population.
History:
Mass madness: in middle ages: groups b/h disordersapparent mass hysteria
Asylums: institutions only for mentally ill
Moral managements: wide –ranging treatment w/ focus on social/ind./occupational needs
Mental hygiene movement:
almost exclusive focus on physical well-being of patient
Medical model: disordered b/h: medical and not cognitive/learnt basis.
Mesmerism: treatment based on animal magnetism (hypnosis)
Nancy school:
thought hysteria was a type of a self-hypnosis
Psychoanalysts: use dream analysis
Etiology: causal patterns underlying abnormal b/h
same rather speak of risk factors
instead of instead of cause (i.e. correlates of the abnormal b/h outcome
diathesis-stress model:
views of abnormal b/has a result of stress operating on an ind. w/ a
bio/psychosocial/sociocultural predisposition t/w de a specific disorder
i.e. predispositions
triggerabnormal
b/h
predisposition: vulnerability
trigger: stressor
=exceeding ind.’s resources
protective factors: factors modifying ind’s resources to environmental stressors making it less likely that he will experience the aversive consequences of the stressor: (i.e. SE/good attachment)
those factors lead to resilience
resilience: the
ability to adopt successfully even to difficult circumstances
note: girls seem less
vulnerable to many psychosocial stressors, (such as parental conflicts)
-sometimes, bad experiences could act as a protective factor:
i.e. prior experience w/ something
makes next time easier
-diathesis-stress models
must be looked at in a broad framework of multicausal development
models
developmental psychopathy:
seeing an abnormal point of dev. by comparing it to normal/expected
changes that occur in dev. process
paradigm shift: shift/reorganization of how people think of an entire field of science:
i.e. Freud: shifted psych. from
bio/moral science to unconscious process
biopsychosocial viewpoint
biopsychosocial viewpoint:
integration of bio/psychosocial and sociocultural factors in psychopathy/treatment
biological factors:
-brain tissue break-down = first bio to be discovered
but not all abnormal b/h is b/c of neurological damage@
and neurological damage does not lead
to abnormal b/h
5 factors of bio causes of maladaptive b/h:
Neurotransmitters/hormonal imbalance in brain
-synaptic cleft = gull of fluid
trans-synaptic transmission = chemicals
called
neurotransmitters
-some activate/others inhibit
post-synaptic cell
imbalance of neurotransmitters
medication: changes
in amount of neurotransmitter released/reuptaken
i.e. Prozac:
slows down serotonin reuptake
monoamines = 1mono acid
-dopamine/norepinephrine =
calecholaminesb/c both are synthesized from amino
acid: imp. for emergency reaction!
Dopamine: = schizophrenia
Serotonin: info-processemotional/mood disorders
GABA: anxiety
-hormones: chemical messengers in blood
released by endocrine glands in our
blood
-hypothalamus effects pituitary
glands, which then in turn controls all the endocrine glands
important set of interactions:
hypothalamic-pituitary-adrenal cortical axis:
-adrenal – top of kidney
produces adrenaline (epinephrine)/hormonal
cortisol
-sex hormonesalso infl. maladaptive b/h
androgens (i.e. testosterone) = male sex gormones
produced by gonadal glands
Genetic vulnerabilities
DNA: located in the chromosomes
abnormalities in the structure/# of chromosomescould lead to abnormal b/h
i.e.
downs syndrome = trisomy (3 chromosomes in #21)
-depression/alcohol/schizophren
Note: genes are not
the causers but rather the disposition (i.e. vulnerability), which w/
environmental stressors case the pathology
-Genotype might shape environment. It might not manifest until later
in life
Genotype-environment correlation: when genotype shapes environment, i.e. aggressive (genotype) kidb/c rejected in early grades, later he learns to b/c delinquent
the genes act on environment
Genotype-environment interaction: diff. sensitivity/susceptibility to environment b/w people w/ diff. genotypes
-i.e. people who are vulnerable to depression will react more to stressors w/ depression than those w/o this vulnerability
h. genes are expresses b/v environments
abnormal b/h= polygenetic
(i.e. many genes acting together!)
faults could be b/c: CNS structure
ways to study genetic infl.
proband/index case: the ind. carrying the studied gene
control group: general populations: see if the family has more than the general populations
genetics?
Prob: family
has some environmental elements!
Concordance
rate: % of identical twins having the trait: if all twins
have itconcordance
rate = 100%then
the issue is all genetic
no
such thing is reality, but when higher than dizotic twins, then genetic
infl, is higher!
General idea:
higher concurrence rate = more genetic infl.
-comparing biological vs.
adopted relatives of the person who has disorder – to compare genetics
vs. environmental infl.
variations:
-if you use all 3 methodsleast
pitfalls
-shared vs. non-shared environments
i.e. family economic
situation i.e. experience @ school
misconceptions of genetics infl.
disadvantaged
kids who are adopted into good homesIQ goes up
No!!! see IQ story!
-not true, since monozygotic twins =w/ time b/c more similar than dizygotic twins
shows
the continual genetic infl.
-Huntington’s disease
= genetics!!! Yet only comes later in life
Constitutional liabilities
-innate/early acquired things
that might infl. b/h
early
intervention helps
kagen:
those things are beyond genetics: pre/postnatal infl.!
personality dev. from temperament:
i.e. conditions for certain things/avoiding other things
brain dysfunction/neural plasticity
-major brain lesions – higher risk for psychotherapy
-->though specific brain lesions rarely primary causer of psychiatric diseases
exception: Alzheimer’s, but that
is b/c aging (primary cause)
developmental systems
approach: genetic activity inf. Neural activitiesinfl.
b/hinfl.
Environment. These influences are by directional
experience can infl. neural plasticity and even genes!!!
Impact of biological view:
-many drugs helped many thing: people think that it will eventually bring a magical, instant cure
common errors:
Imp. to remember: anyone’s probs. isn’t detached from their personalities
humanistic perspective
-humanistic psychopathy: distortion
of natural growth
existential perspective
existential
issues: quest for values/meaning/self-fulfillment
-difficulties to self-fulfillment/self-meaning
Basic existential themes of Rogers’ self-concept:
psychodynamic perspective
structure of personality
Interpsychic conflicts:
conflicts b/w diff. personality structures: Id/Ego/Superego
Anxiety: Freud: b/c of impending imagined/real danger
when threat is unconscious intrapsychic conflict: ego uses ego-defense mechanisms
sometimes, this is adaptive, at other
times it is not
ego-defense mechanisms | |
Repression | Painful/frightening impulses/memories are repressed from conscious awareness |
Rationalization | Assuming logic/socially
desirable motives/explanations to what we do so that we seem to
have acted rationally
racist uses ambiguous scriptures to justify his irrational hate |
Reaction formation | Assuming a strong
tendency to the opposite in order to conceal a motive from themselves.
troubling homosexual feelings: person b/c ‘consciously’ overly anti-homosexual |
Projection | Protects us from
our undesirable traits, by attributing them to others
expansionist leader thinks that other country is going to invade! |
Intellectualization | Detachment from a stressful situation by dealing w/ it in abstract and intellectual terms. |
Denial | Denying that the
unpleasant reality exists when it is too painful.
refusing evidence tying cigarettes to cancer as worthless |
Displacement | If a motive can’t
be gratified one way, it will be channeled a diff., less threatening
way.
argues w/ husband when angry at boss |
Fixation | Attaching oneself
exaggeratedly to some person/developmental stage.
older unmarried man still relies on mom for basic needs |
Regression | -retreat to less
mature responsibilities/stages
adult’s shattered SE = shows off genitals to girls |
Sublimation | Channel frustrated
energy into substitute energy
artist channeling sexual fantasies into erotic pictures |
Psychosexual stages of development
Psychosexual stages of development: 5 periods, from infancy to puberty: characterized by dominant way to achieve sexual pleasure
Oedipus complex: in phallic stage. Oedipus accidentally killed dad and married mom
boy goes through this symbolization: loves mom, rivals dad. Kid fears that dad will try to castrate him (castration anxiety)thus represses both sexual love for mom and hate for dad.
healthy
solution: nonsexual love for mom/identify w/ dad
Electra complex: girl loves dad:
penis envy: b/c/ she thinks that she’s lacking
compromise:
identify w/ mom/wait to get married to a man of her own and have a baby
(penis substitute)
-solution to conflict: satisfactory
heterosexuality
Freud: deterministic/conflict
-Sigmund Freud focused on Id
-2nd generation psychodynamic approaches (vs. Freud: psychoanalytical)
Anna Freud: focused more on ego, its defenses and how it organizes personality
Object-relation theory
emphasis: pre-oedipal part of personality dev.
Mahler: at first, kids don’t distinguish b/w self and other obj.
only later does self differentiate from other objects which are represented
separation-individuation process
Kernberg (obj. relations)
Borderline: instability (mostly in personal relations)
can’t integrate/reconcile pathological objects into a full/stable
personal identity (i.e. self)
Interpersonal approach
-relationships w/ others (past/present)
2nd generation:
-behaviorism – reaction to unscientific method of psychoanalytical school
need directly observable b/h!!!
mostly
in labs
Theme of behaviorism
Learning: modification of b/h through experience
not automatic: animals/humans gain info about CS to know when to expect the UCS
i.e.
if UCS sometimes not accompanied by CSanimal won’t expect UCS from
the CSno
CR!!!
-A learning process where a neutral stimulus get associated w/ another stimuli b/c of repeated pairing of stimuli
i.e. Pavlov study
-attached a fistula (tube) to dog, to saliva gland (to measure saliva flow)
-->light comes on, then
food comes. (UCS) Eventually, dog salivates to only light (CR)
Unconditioned stimulus: (UCS) a stimulus that automatically gets a response, usually w/ no prior conditioning
Unconditioned Response (UCR): the response originally given to a previously unconditioned stimulus
used as a basis for a previously unconditioned
stimulus
Conditioned stimulus (CS) a previous neutral stimulus that comes to evoke a conditioned response through association w/ the unconditioned response
Conditioned responses
(CR): a learned/acquired response to a stimulus that did not evoke that
response, originally.
Dog experiment
Food =UC
Salivation =UCR
Light =CS
Salivation to the light
=CR
-Dog has been 'conditioned'
to associate food w/ light
Extinction: gradual disappearance of a conditioned response that is no longer being reinforced
not unlearning!!! Re: spontaneous
recovery
Spontaneous recovery: the return of a learned response a while after extinction occurred
Reinforcement: the delivery if a reward or pleasant stimulus or escape from aversive stimulus
Conditioned avoidance response:
to aversive events -avoiding the stimulus (i.e. nearly drowning= will
avoid the swimming pool
could
also learn from observe others get rewardthey don’t need reward to get conditioned
cognitive-behavioral approach
-criticized behaviorism for ignoring mental processes
‘thought can also be observed and
measured empirically!!!!’
cognitive-behavioral perspective: how thought/info-processing brings to distorted/faulty emotions and b/h:
i.e. ‘I never get anything right!’
mechanisms
of maintenance of disorders: i.e. depressed: biases to maintain bad
vs. good memories
Bendura:
-People are motivated by internal symbols = thoughts
we can for see us getting stuck in the snow w/ the car, even though it never happened to us, so we go to the garage in the fall
-dysfunctional attribution
styles: i.e. depressed: bad things: internal/stable/global
cognitive therapy
Aaron Beck:
Schema: underlying representation of knowledge that guides current processing of information and often leads to distortions in attention/memory/comprehension
maladaptive schemas (based on early
learning experiences) cause psychopathy
how we interpret events infl. how we react to them
i.e. hearing a crash could be b/c of
burglar or b/c gust of wind
beck shifted the focus to what cognitions produce the overt b/h
negative biases need to be altered
psychosocial causal factors
psychosocial causal factors: those experiences factors which possibly handicap a person, psychologically, making him less resourceful.
-cognitive frameworks to fill in gaps in experiences/observations
schemas infl.:
-self-schema:
our views of what we are and what we might b/c
-schemas shape out daily b/h/decisions
schemas are unconscious so we are not aware of all its assumptions
despite
them possibly being in reality distorted, they are real to us
Predictability/Controllability
-when things are traumatic/harsh family conditionsless predictable/controllable
predictability/controllability = securityworld is save/unthreatening
too
much is of course not too goodneed to also learn to deal w/ stressors
-many uncontrollable/unpredictable things = anxiety
schemas might include possibility that terrible things could occur which are unpredictable and uncontrollable
might
even have a fragmented/incoherent self-schema
-kids form schemas diff, dep. on experiences/abilitymight shape future skill, based on the motivation level it causes.
-When kids grow up in institutions, often less warmth/physical contact
missing much intellectual/social/emotional
stimulation
Protective factors:
Deprivation/abuse in home
-could run from inattention/neglect of kids cruel and abusive treatment
possible result of neglect: failure
to strive syndrome
‘failure to strive ’syndrome:
could
be b/c of prenatal stuff/low birth weight
-some studies show that downright
abuse might be better than infant neglect
outright parental abuse
disorganized attachment
-intergeneration transmission
of violence – 30% chance, since many parents internalize the roles-schema
of violent parents
protective factors incl
Other childhood traumas, that could :
-i.e.:
could be downplayed w/ support of other parent
poor parental styles
-parents make the most significant
social interaction in the first few yrs. Of the kids’ lives
-bi-directional= hard kids
= bad parenting, while bad parenting = bad kids
-parental psychopathy infl. kids (beyond genes)
types of parental styles
best parenting style
-high
on control/warmth
high on warmth/low on control
kid learn aggression impulsivity
the kid jumps into social relationships but usually for manipulatingjust like he manipulated his parents
has
‘entitled’ self-schema
-high
on control/low on warmth
Severe discipline: physical punishment and other poor parenting tools used (vs. privileges withdrawn
kid
uses this as a model for his self-schema
disruptions
in attachment/moodiness/low SE/poor peer relations/poor academic performance
communication:
Inadequate:
i.e. distorting speaker’s intent
i.e. b/c of marital discord/abuseleads
to psych probs.
marital discord/divorce:
marital discord:
often leads to:
protective factors: when parent is:
Effects of divorce on parents:
Effect of Divorce on kids
many kids adjust well: negative effects of parental divorce = modest
since 50’s (especially 70s) negative effects are decreasing = less stigma to divorce?
better to divorce than to be in torn house
remarriage could help, in favorable rearing conditions
usually not so, especially for girls
Maladaptive peer relationships
-in preschoolers: not so refines:
immediate satisfaction means that they will try to reject a kid when
another, favorable kid comes
-peer prob.= linked w/ school drop out/depression/delinquency
sometimes
reflects a heritable diathesis
on the other hand, peer interaction could be a learning experience(give-and-take)
social skill = social competence
practice/experience w/ intimate communication =possible transition from sexual curiosity to genuine love
some things are universal
cultural difference:
note:
-depression = dysphoria
Diff soc. experience depression diff.:
-guilt as part of the westerner’s
depression is not seen in nonwestern cultures.
-in Thailand = culture supports only overcontrolled b/g: politeness//inhibit any anger
apparently: seen less disobedience as compared to US where undercontrolled b/h is more tolerated
question: does that mean that there is more shyness/depression in Thailand?
answer: yes!!! But you also se subtle overcontrolled b/ht/w animals/prob. concentrating
-Thai parents bring their kids less for treatment:
Amok | South Pacific | Brooding followed
by violent behavior/persecutory ideas/amnesia/exhaust
more in men than in women |
Koro | Malaysia/China/Thiland | Fear that sexual organs will shrink into the body, causing death |
Taijin kyofusho | Japan | Intense fear that their body displeases/embarrasses or is offensive to others |
Zar | North Africa/Middle East | -dissociative episodes, since
they think that they are possessed by spirits
-withdrawal/apathy = not eating/working |
-social/sex roles /subgroup roles/norms get passed down:
is
nonviolence is sanctioned, then the kids will learn to settle conflicts
in non-violent ways
-many times, conflicting beliefs
in a society. Yet there are some core values
-expected roles exist also for specific things like students/officer/nurse etc…
person
has many roles through life, and at any moment
-conflicting/unclear/uncomforta
sex roles
-today, androgyny (combo of both sex roles) seems to be the ideal for both genders
many still keep traditional sex roles
Acceptance of sex-roles imp!!!
-low masculinity =tends to be associated
b/c masculinity is associated w/ SE
-high femininity/low masculinity = failure to accept leadership in problem-solving cases
similar to learnt-helplessness
causal factors in depression/anxiety
could
explain why more women experience depressive/anxiety disorders
Other pathogenic social influences
-inverse correlation b/w socioeconomic status and abnormal b/h
stronger correlation for some disorders
over others, for example antisocial.
possible other factors that lead to socioeconomic’ status infl. the poor more than the rich:
poverty and other correlates:
Unemployment
-not only mentally ill lose
job!
-beyond the financials, it
is demoralizing/self-devaluation
unemployment:
increase in depression/marital stress/somatic complaints which usually
stop when reemployed
-resilience in school/peers/familyhelps upwards social mobility
Disorder-endangering social roles
-for example: the role of a
commander in army allows him to tell soldiers to maim/kill othersas
seen in Vietnam = those horrors make people vulnerable to disorders/guilt/etc
Prejudice/discrimination based on race/ethnicity/gender
-many more women suffer from depression/anxiety disorders
passivity/dependence of traditional roles
stressors incl: being both a full time mother and full time worker
studies show that in some cases: working outside home helps
-Education/jobs/families
constant
readjustments cause uncertainty
a disorder could have many causers: genetic/socioculture!!!
Clinical assessment
Clinical assessment:
try to understand client’s symptoms/probsin order to understand nature/extent
use
psych test/observations/interviews
Dynamic formulation: integrated evaluation of ind.’s personality traits/b/h patterns/environmental demands/etc… intended to describe the person’s current situation, and to hypothesize what is driving person to b/h in maladaptive ways
if it shows dysrythmia: use
diff. ways to find prob: perhaps lesions/tumor?
Neurophysical examination
Neuropsychologival assessment:
use of psycholofical tests that measure a person’s cognitive
-i.e. cognitive/motor skills measured: i.e. measures of memory/dementia
Assessment interviews
-overt o/h or emotions/hygiene/symptoms
(i.e. depression/hallucinations/ect…)
Intelligene tests
Projective personality tests
-ambiguous stimuli which ind. is encouraged to interpret/unstructured
-->get
a population range of responses to know deviant responses
Objective personality tests
-Structured personality tests
such as questionnaires/self-inventories
Electrocunvolsive therapy(ECT):
electro shock used to alleviate mostly severe depression/mania
Neurosurgery:
Prefrontal lobotomy:
in 30’s was done to treat various pronblems
** - drugs – p. 95-104
classical psychoanalysis
main idea: insight into
repressed thoughts –frees ind. from need to keep wasting energies
of defense mechanisms
4 basic techniques
-counter-transference:
when analyst b/h in accord w/ transference of the patientcould
ruin the treatment
modern psychoanalytical schools:
-i.e. Sullivan
the
key is the transference, since the therapy activates a maladaptive
early schema of how to relate to people (i.e. to be rejected by everyone)ignore
the drive elements of the psychodynamic theory
behavior therapies
behavior therapies:
use of therapeutic procedures based originally on the principles of
classical/operant conditioning
directly
modifying problem b/h: i.e. counter-conditioning/extinguish
guided exposure
main idea:
unlearning of a maladaptive response to a certain stimuli
Example:
systematic desensitization:
behavior therapy technique aimed at teaching a person to relax or b/h
in some other way that is inconsistent w/ anxiety while in the presence
of (real or imagined) anxiety-producing stimuli
-‘systematic’ = gradually increasing levels of exposure to the aversively conditioned stimuli
counter-conditioning this now-aversive
stimuli
modeling: learning
the skills at hand by imitating another person doing the b/h to be acquired
aversive therapy:
punishment for undesired b/h: i.e. smoking/overeating/drug abuse/bizarre
psychotic b/h
systematic use of reinforcement:
contingency management:
using a systematic program fir the reinforcement to suppress/illicit
a learnt response
response shaping: behavior therapy technique using a positive reinforcement to establish by gradual approximations a response that is actively resisted or is not initially in a person’s behavioral repertoire
token economics:
a b/h modification program, often used in hospitals/institutions where
the rewarding reinforcement is in a form of a token which could be exchanged
for privileges
behavioral contracting:
positive reinforcement technique that uses a contract (usually b/w a
couple or family) that identifies b/h to be changed and specified the
rewards or privileges to follow
biofeedback:
behavioral treatment technique in which a person is taught to influence
his or own physiological processes.
Cognitive/cognitive-behavioral
therapies
Cognitive-behavioral therapy: any therapy based on altering dysfunctional thoughts and cognitive distortions
Cognitive therapy: another
term for cognitive-behavioral therapy
assumption: cognitions
infl. emotion/motivation/behaviors
3 approaches:
-irrational b/hbased on irrational emotionsbased on irrational beliefs
change
irrational beliefs changes the emotions and thus the b/h to more adjustive
Stress-inoculation therapy Donald Meichenbaum
-change self-statements that
are made in stressful situations
Cognitive therapy of Aaron Beck
Change negative view of:
Humanism:
Client-oriented therapy: client is not dependant but a responsible client
therapy just helps clear obstacles
for self-actualization [re: humanism]
Existentialism
Existentialism: concern w/ existence (‘human predicament’)– the person in the human condition
some things are basic/fundamental to the human existence
look
for meaning in life
Existential focus on:
Gestalt therapy: ‘wholeness’: resolve unresolved conflicts: integrate all the hidden thoughts/feelings/actions should integrate into self-awareness
if not, then we tend to act out our past unresolved conflicts/traumas in present relationships. Therapist tries to help obstacles so problem could come into awareness and person could deal w/ the trauma and not have it be expressed in other ways:
i.e. by acting out fantasies
at certain point, patient comes to
impase, and has to deal w/ his true inner feelings
criticism
of humanist/existential/gestalt therapies: lack of systemized models
of human b/h and its specific aberrations
marital therapies
couples therapy: form of interpersonal therapy involving sessions with both members of the couple present. Emphasis is on mutual gratification/social role expectations/communication patterns/similar interpersonal factors
marital therapy: another
name for couples counseling
Chapter 4 – stress-related disorders
stressor: adjustment demands placed on ind. or group
Stress: effort
of the stressor on organism =: it taxes body’s resources
Coping strategies:
ways to cope w/ stress
Interdependent: stress
infl coping techniques and coping techniques infl. stress
Stress
crisis: stressful
situation that approaches/exceeds the adaptive capabilities of ind.
(or group)
factors predisposing person to stress:
responding to stress
3 interacting levels
response to stress
task-oriented response: b/h to deal w/ requirements of stressor.
appraises situationconsider alternative solutionsdecide
on best solution
defense-oriented response:
moight be less productive/more self-defeating
2 kinds:
effects of severe stress:
psychological/personality
decomposition: lowering of adaptive psychologicaql functioning in face
of sustained/severe stressors
bio effects of stress
general adaptation
syndrome (GAS): 3 stage model that helps exmplain course
that bio decomposition takes under extreme stress:
alarm reaction stage of resistence exhaustion
after decompositionbody tries to return to homeostasis
if extreme Damage: need to teach people
to reorganize adaptive b/h /defenses
adjustment disorder
adjustment disorder: maladjusted way to respond to common stressor, i.e. childbirth
must occur w/I 3 month of the stressor
maladaptive response
stressor subsides
-if more than 6 months = mental
disorder
Adjustment disorder:
a disorder where person’s response to a common stressor is maladaptive
and occurs w/I 3 months of stressor
2 kinds of adjustment disorder
Disaster syndrome:
the common reactions of many victims to major catastrophe during/after/long-run
Acute Stress Disorder (ASD) |
Not b/c:
|
Post-Traumatic Stress Disorder (PTSD) |
-difference
from ASD is mostly in the duration
diagnosis:
|
symptoms:
acute: w/I 6 moths
delay:
onset is after 6 months
stages:
gradual
regaining psychological equilibrium
psychological effects of long term stress
-personality decomposition:
certain cource
-anxiety/gastrointestinal upset/lowered
efficiency/signal that mobilizes of adaptive responses is inadequate
–temporary concerted task-orienting response
-ego mechanisms =intensified
-cling to old [mal]adaptive
waysno
reevaluation of responses
inappropriate
way to deal w/ realityi.e. disorganized thought/delusions/hallucination
-->try to salvage psych integration -->tries to reintegrate reality
-->i.e. studies of hostages
PTSD – main symptoms
rape – 5 areas of disruption of functioning
-greater identification w/
psychological
protective barrier
Psychological preparedness:
protective factor for lessening the psychological effect of torture
-prior experience w/. anxiety
= could lessen war PTSD
2 elements of stressors
less
controllability/predictability = more stress
Treatment/prevention
Stress inoculation: train people to tolerate/anticipate stressors
change the things that they say to
themselves
3 stages:
medication
-usually antidepressants
Crisis interventions:
-emotional support – usually
right after trauma
Direct therapeutic exposure
-exposure to feared stimuliw/
relaxation techniques
chapter 5
Anxiety: general
apprehension about possible dangermuch more diffuse than fear
Historically thought to be
part of neurotic b/h
Nerutotic b/h:
exaggerated use of avoidance b/g or defence mechanisms in response to
anxiety
Neurosis: term
used historically to characterize maladaptive b/h resulting from intrapsychic
conflict and marked by prominent use of defense mechanisms
Freud: the anxiety that
causes the neurosis is often masked: i.e. anxiety about sexuality/aggression
might be masked/deflected
many
disorders that Freud classified as neurosis, which did not incl. observed
anxiety were later reclassified
fear/anxiety response patterns
fear/panic: a basic emotion which incl. activation of the ‘fight-or-flight’ response of the sympathetic nervous system
3 parts:
Anxiety:
a whole mix of emotions/cognitions: general apprehension about possible
dangermuch
more diffuse than fear
No fight-or-flight activationjust preparation for it!
-Anxiety is adaptive when mildwhen
chronic = prob.!
-Anxiety and fear are highly
conditionablei.e.
traumas: kid seeing dad beat up mom = anxiety at dad’s car arrive
overview of anxiety disorders
anxiety disorders: any mental disorder characterized by unrealistic/irrational fear or anxiety of disabling intensity. DSM-IV-TR = 7 types:
Phobia: persistent
and disproportionate fear of some specific obj./situation that represents
little/no actual danger to a person
3 types of phobia:
Specific phobias:
persistent or disproportionate fear of other species (i.e. snakes/spiders),
aspects of the environment (high places/water) or situations (airplanes/elevators)
Social phobia:
fear of social situations in which a person might be exposed to a scrutiny
of others and might act in humiliating or embarrassing ways
Agoraphobia: fear of having a panic attack in places you can’t escape or might be embarrassed (fear of either/both [?] open/closed spaces)
-presence or anticipation of stimuli causes strong/persistent fear
when
stimuli is presentimmediate reaction that looks like
a panic attack (just that here, there is an external cause)
subcategories:
-some phobias are exaggerated
fear to specific things that we all fear to some extent
imp: avoidance
is key to phobias: since the phobic response is also unpleasant (i.e.,
climbing up 100 floors instead of elevator
-sometimes phobias are maintained
for secondary-gain purposes: i.e. attention/avoidance of several responsibilities
Name of phobia |
Focus of fear |
Acrophobia |
Heights |
Algophobia | Pain |
Astraphobia | Thunderstorm/lightning |
Claustrophobia | Enclosed places |
Hydrophobia | Water |
Monophobia | Being alone |
Mysophobia | Contamination/germs |
Nyctophobia | Darkness |
Ochlophobia | Crowds |
Pathophobia | Diseases |
Pyrophobia | Fire |
Zoophobia | Animals in general or specific animal |
-fear at sight of blood/injury/injection
-instead of only initial acceleration of heart rate/blood-pressure
also 2nd stage of lowered
heart rate/blood-pressure/dizziness
characteristics
age/gender
-more women than mendiff %, depending on specific phobia
-some at childhood/others,
such as claustrophobiaadolescents
psychosocial causal factors:
psychoanalytical causes:
-anxiety is displaces onto
an external object
behaviorism
-b/c of trauma (i.e. dental/accident
phobia)
-could also be vicarious/observational classical conditioning
TV/mass-mediai.e.
lab monkeys conditioned to be scared of snakes through a television
question: why don’t everyone who experience a trauma undergo phobia conditioning?
Answer:
shows the strength of cognitive element of conditioning: i.e. always looking out for the aversive stimulus!
Biological causal factors
Genetic/temperamental causal factors
Evolutionary Causal factors
-b/c of our evolutionary past, we’re more easily conditioned to fearing things like water/height/snakes, than bikes/cars/guns, though they might be more traumatic
-->Called preparedness
-exposure: stimuli/situation that elicit the phobia is gradually given to the client
could be in-vivo or imagined
-participant modeling:
the psychologist shows the client the b/h that illicit the b/h
social phobia
-specific social phobias = a specific social situation i.e. public speech
-generalized social phobia:
any social situation
-->in feared situation –might
have a panic attack
-->soc. phobia, unlike other
phobias start at childhood
psychosocial/biological causal factors
social phobia as a learned b/h
direct/vicarious classical
conditioning: witnessing/experiencing a perceived social defeat
or humiliation i.e. having isolating parents: many chances at
vicarious social fears
social fears/phobias in evolutionary context
dominance hierarchies:
aggressive encounters w/ other members of group over dominance -->there
is fear, but note that no one tries to leave situation completely!!!
Soc. phobia won’t run away!!! Starts in adolescence where there is
a dominance conflict
genetic/temperamental factors
Perceptions of uncontrollability
-uncontrollable stressful events: leads to submissive/unassertive b/h
-->typical
of soc. phobia
-you tend to see in soc. phobia
a diminished sense of control
cognitive variables
-expectation of rejection/negative evaluation
-senses
vulnerable in presence of others
-->the ‘danger schema’ of the soc. phobics:
-->b/c
less friendly, confirming their expectation
treatment
-Inderal (High Blood pressure drugs) = inhibits the peripherals of autonomic system:
-i.e.
the trembling hands
-for full-blown attacks: antidepressants/anti-anxiety
-->behavioral/cognitive
= best treatment: i.e. recognize the irrational thoughts, such as ‘no
one understands me’
Panic disorders
Panic disorder:
a mental disorder characterized by the occurrence of repeated, unexpected
panic attacks, often accompanied by intense anxiety about having another
suck attack --> must worry for at least a month
-4x more in women than in men
4 of 13, incl.:
-->10 of 13 are somatic!
-such attacks are unpredicted-->unprovoked
by identifiable cues
-sometimes, situationally predisposed,
i.e. nocturnal panic attack
Panic vs. anxiety
-panic: sudden/brief/intense
-anxiety:
chronic
Agoraphobia
Agoraphobia:
fear of being in places/situations which would be physicAllt difficult/psychologically
embarrassing or in which immideate heko would be unavailable in the
event that something would happen
-->fear developed from the
initial [anic attack sin those places
agoraphobia w/o panic
-not linked w/ panic attacks
-->very rare -->called
limited symptoms attack- less than 4 symptoms
comorbidity
drugs
-serotonin drugs
-sometimes, panic attacks associated w/ preaqueductal gray
-->locus coeruleus: in brain stem, and/or preaqueductal gray
-->autonomic storm: panic attack!!!
-->causes anticipatory
anxiety in limbic system -->remembered in the prefrontal cortex
Cognitive/behavioral causal factors
Interoceptive cognitive model
Interoceptive fears: fears focused on various internal bodily sensation
-->i.e.
sense heart palpations and then the anxiety produces the panic attack
recent model: we sense
the internal/external cues and then we get panicked-->eventually
they b/c conditioned to provoke a panic attack
-some people are genetically/temperamentally
prone to panic attacks
-->main idea:
‘fear of fear’
cognitive model
-some people are hypersensitive
to bodily sensations and then catastophize it [interpretation problem!!!]
-->panic attack-->reinforcement of bodily sensations
Diff. b/w cognitive model and interoceptive cognitive model
-in cognitive model, more emphasis on the meaning that people place on the stimuli
-->also gives importance
to the person seeing how drs. and others treat the situation!
Perceived control/anxiety sensations
-more [sense of] control over a situation: less panic
-->the fact that panic
attacks are unpredictable/uncontrollable, actually helps
to maintain them
-some people have higher
anxiety sensitivity: a high level of belief that certain bodily
sensations have bad consequences
-anxiety sensitivity is often
a precursor to panic attacks
medication reduces symptoms but not the underlying problem!
-benzodiazephine (or example Xanax)
-anxiolytics (anti-anxiety)
-antidepressants
behavioral/cognitive based therapies
-based on exposure
-some treatments are based on interoceptive expose: expose the person to the bodily symptoms that lead to the panic attack
-some therapies (more cognitive
oriented) based on automatic catastrophic thoughts
modern way:
generalized anxiety disorder (GAS)
generalized anxiety disorder: a mental disorder characterized by chronic excessive worry about a number of events or activities w/ no specific threats present and is accompanied by at least 3 of the symptoms of:
-must occur at least ½ the
days for at least 6 months
-some don’t come for treatment
b/c they learn to lie w/ it
general characteristics:
comorbidity - usually other axis 1 disorders:
prevalence/age of onset:
-at any yr: 3% of pop
-lifetime: 5%
-X2 more in women (less than
other, more specific phobias)
onset:
-hard to determine onset -->some
think that it was there all their lives, while others remember a slow
and insidious onset
Psychosocial causal factors
of General Anxiety Disorder (GAD):
psychoanalytic
-unconscious conflict b/w id and ego [Freud: sexual or aggressive impulse]
-->defense
mechanisms not functioning well.
-in phobias, repression
and displacement a re working. Here, non are!!!
Behaviorist
-conditioning to many environmental cues (vs. phobias: 1 cue is negatively conditioned)
-->today, behaviorists speak
more about anxiety apprehension
role of predictability/controllability
-more controllability/predictability = the stressor is less stressful.
-->i.e. Mondays, the boss is always angry
-->i.e. if having prior
experience w/ uncontrollable events (i.e. parent who yells at you for
no good reason) = more likely to have GAD
-more early experience w/ control
and mastery = less GAD
-hypervigilence
= might be exactly b/c of those lack of safety signs in their environment
(no predictability!!!)
cognitive:
-automatic thoughts based on maladjusted thought/schemas
-->i.e.
everyone will laugh at me
-->key maladaptive assumption:
‘any strange situation is dangerous’
Advantages that GAD people think that they have
paradox: attempt to
lower anxiety actually brings more!
GAD
worry is self-sustaining
cognitive biases
schemas developed early in
life might infl. automatic thought
Cognitive bias:
GAD people = take the threatening part of the situation and concentrate
on it. Non-GAD people concentrate on the non-threatening part of the
situation (reversed bias)
Example:
Bio basis for GAD
genetics
-genes not directly involved
in GAD, but linked to the personality trait neurotism, which then is
often linked w/ anxiety
Neurotransmitters
-deficiency in GABA (inhibitor
neurotransmitter) - especially in limbic system, is know to be associated
w/ GAD
-serotonin/norepinephrine –
also involved in modulating anxiety
Neurological basis of diff b/w anxiety and panic
-beyond anxiety just being from an unknown source of fear:
medication
cognitive-behavioral
treatment: inc. relaxation treatment as well as cognitive work
on the automatic thoughts
obsessive-compulsive disorder
Obsessive-compulsive
disorder: an anxiety disorder that combines one or both obsessions/compulsions
Obsessions: persistent
intrusion of unwelcome thoughts/images/impulses that elicit anxiety.
Attempts are made to suppress them, are unsuccessful, so they try to
neutralize them w/ other actions
Compulsions:
irresistible urges to carry out certain rituals/acts to reduce anxiety,
usually in response to the obsessive thoughts.
important elements
-obsessive thoughts are often associated w/ the compulsive acts
-->regardless of whether the repetition is a thought or act, the point is the subjective sense of loss of control
-->only
b/c a problem when it interferes w/ daily life
-those people: able to see that their acts are irrational, but are unable to resist them
>feel a release of tension
once the act is preformed
comorbility
body dimorphoic disorder (DD)
body dismorphic disorder: obsessive thoughts about perceived flaw/defect kn person’s appearance ->not like once thought: somatoform prob!
obsessed w/ look: always look at mirror/plastic
surgery
psychochoanalytical viewpoint
oedipal stage fixation:
shame for trying to satisfy id (i.e. soiling)and ego says not
to defense mechanisms lead to OCD
behavioral viewpoint
2 procedss theory of avoisdance learning
-Anxiety= associated w/ 1 stimuli,
and reduced by anotherleads to avoidence conditioning
common types of obsessive thoughts
5 primary times of OCD
examples:
Consistent themes:
OCD’s Memory
-OCD = less/lower non verbal memory
can’t remember if they did the act
preparedness
looking at OCD in evolutionary ways:
evolutionary reasons!?!
Suppression paradox:
Paradox: the more you
try to surpress the more that the obsessive thoughts come
Similar to GAD: people
tyr to surpress the anxiety (in this case, the obsessive thoughts),
but it really increases it!!!
Bio causal factors
treatment:
medication: antidepressants (re serotonin reuptake inhibitors)
behaviorist: exposure/preventation of compulsive acts
brain surgery:
in extreme cases
chapter 6 – mood disorders/suicides
Mood disorders:
mental disorders characterized by disturbances of mood that are intense
and persistent enough to be clearly maladaptive
Mania: emotional
state characterized by intense/unrealistic feelings of excitement/euphoria
Depressions:
emotional state characterized by feelings of extraordinarily sad/dejections
Unipolar disorders: only depressive episodes
Bipolar disorders:
both manic/depressive episodes
Unipolar disorders | Bipolar disorders |
Dysthemia:
At least for 2 yrs.: depressive mood and 2 other depression symptoms: not enough to qualify for a major depression |
Cyclothemia, depressed:
During last 2 yrs, episodes of dysthemia and hypomania |
Adjustment
disorder w/ depressed mood: maladaptively depressed b/c of identifiable
stressor w/I past 3 months (bereavement doesn’t count)
-must remit after maxi. 6 months after end of stressor |
|
Major
depressive disorder:
-1 or more depressive episodes/no mania/hypomania Symptoms incl.:
|
Bipolar I disorder,
depressed
Major depressive episode w/ manic episodes |
Bipolar
II disorder, depressed
Major depressive episode w/ hypomanic episodes |
Hypomanic: mild
form of mania
Grief |
Bowlby:
4 stages:
-this processes is expected
to take approximately a year. If fixated at a stage, it might lead to
chronic grief any might need therapy -healthy resolution of grief includes maintaining connection to the diceased, as part of the survivor’s ongoing life! |
Unipolar disorders | Bipolar disorders |
Dysthemia:
At least for 2 yrs./1 years
for children/adolescants: Must have:
-and 2 other depression
symptoms, which include:
-average = 5 yrs. But could last up to 20 yrs. brief
normal mood remissions symptoms
= not enough to qualify for a major depressiononly diff. is h.m. they feel (i.e.
not feeling the symptoms every day) -has a self-sustaining system -sometimes but not always, there is a onset event |
Cyclothemia, depressed:
During last 2 yrs, episodes of dysthemia and hypomania |
Adjustment
disorder w/ depressed mood: --maladaptively depressed b/c of
identifiable stressor w/I past 3 months (bereavement doesn’t count)
-must remit after maxi. 6 months
after end of stressor Main idea: same symptoms, as dysthemia, just w/ an identifiable stressor |
|
Major
depressive disorder:
-1 or more depressive episodes/no mania/hypomania -more persistent/more symptoms
than dysthemia -persistent depressed mood/loss of pleasure for at least 2 weeks, as well as: 4 or more of the following symptoms incl.:
|
Bipolar I disorder,
depressed
Major depressive episode w/ manic episodes |
Note: depression often
goes w/ anxiety
Subtypes of major depression:
Other symptoms including:
this depression is more infl. genetics than other depressions
most likely to be helped by electoconvulsive
treatment
major depression w/ psychotic episodeslack of contact w/ realitydelusions/hallucinations b/c of the depressions
Distinguishing major depression:
-Sometimes hard, since there are some people who have ‘double depression’:
-chronic dysthemia w/ episodes of major depression
recovery
form the major depression episodes is more common than the recovery
from the chronic dysthemia
Seasonal affective disorder:
mood disorder involving at least 2 episodes of depression in the last
2 year, occurring at the same time of year (usually fall/winter) w/
full remission from each of those episodes occurring at certain time
of year, (usually, spring)
seems
more common in northerly altitudes
Depression as a recurrent disorder
-diagnose differentiates b/w
single (initial?) and recurrent episode (had already been depressed
b/f)
recurring depression = more severe/more
symptoms
probably b/c the run of depression
has not finished its run in that episode
Biological Causal Factors
prob.!!!
unclear hypothesis, since there seems to be a decrease in long term,
of serotonin/norepinephrine
neuroendocrine/neurophysical
hypothalamic-pituitary-adrenal axis: releases cortisol: 50-60% more in depressed people
hypothalamic-pituitary-thyroid
axis: too little thyroid level (hypothyroidism) is associated
w/ expression
Left anterior prefrontal cortex:
disturbances in sleep/other bio rhythms:
-sleep disturbances seen in
depressed people is seen much b/f the depression onset!
Sleep symptoms: especially melancholic depressed
-sleep problems exist also
w/ depression remission
-another causal problem:
circadian rhythm abnormalities: also affects thyroid/melatoning
sunlight/seasons:
seasonal affective disorder might be linked to total amount of light
available in the northerly climates
Psychosocial causal factors
chronic strain:
i.e. poverty: leads to increase in depressive symptoms but not
necessarily to major depression
individual differences in response to stressors:
-beyond genetics/experiences, some people seem more sensitive to the stressors that lead to depression
if
a series of misfortunes, then everyone will b/c depressed, since this
will be beyond everyone’s sensitivity
Some think that stressors
act to cause depression by altering the hormonal/biochemical balance
Types of diathesis-stress models for unipolar depression
Personality/cognitive diathesis:
psychodynamic theories
Freud: finds parallel b/w depression and morning
Karl Abraham: regression to oral stage: (feeling t/w self what he felt to lost person). This usually also means hostile fealsing (since the other person had some control over you.
deresison could be b/c of ‘symbolic loss’
i.e. failure in school/w/ GF = same
as loss of parent
Klein/Jacob: emphasis on quality of mother/child relationship in establishing vulnerability to depression
Bowlby: emphasis on
attachment: secure attachment = less depression
Main idea: parallel
b/w loss and depression, possibly b/c of the symbolic
loss
Diathesis-stress factors
Personality/cognitive diathesis
temperamental sensitivity to negative
stimuli
negative emotions associated w/ neuroticism
feeling
dull = depressions
Early parental loss diathesis
-early parental loss =depression diathesis
unless remaining parental care is good
-Sometimes, it is not parental
loss, but poor parenting, i.e. abuse or family turmoil
several known paths
5 theories of depression
psychodynamic theories
Freud: finds parallel b/w depression and morning
Karl Abraham: regression to oral stage: (feeling t/w self what he felt to lost person). This usually also means hostile fealsing (since the other person had some control over you.
deresison could be b/c of ‘symbolic loss’
i.e. failure in school/w/ GF = same
as loss of parent
Klein/Jacob: emphasis on quality of mother/child relationship in establishing vulnerability to depression
Bowlby: emphasis on
attachment: secure attachment = less depression
behavioral theory
-less reinforcement for what was reinforced to = depression
less positive reinforcement for stimuli-response contingence
i.e.
poor social skills = less reinforcement
depressed
people do seem to get less positive reinforcements
beck’s cognitive theory
-negative cognition precede
depression
-underlying depression:
depressogenic schemes/dysfunctional beliefs
Depressogenic schemas: dysfunctional beliefs that are rigid/extreme/counterproductive
person b/c susceptible of depression in times of stress
Dysfunctional beliefs:
negative beliefs that are rigid/extreme/counterproductive
he will think that he’s being rejected
person
doesn’t have to be aware of those schemas
-they are thought to dev. for poor childhood experience w/ parents
gets activated during stressors, which then create a pattern of negative automatic thoughts
negative
automatic thoughts: thoughts just below consciousness which
involve unpleasant pessimistic predictions, usually centering around
negative cognitive triad
Negative cognitive triad: negative thoughts which center on self/world/future
Cognitive biases/distortions
-those distortions maintasn
the negative triad
depression model of beck
Early experience
Formation of dysfunctional
beliefs
Critical incident(s)
Beliefs activated
Negative automatic thoughts
Symptoms of depression
Behavioral motivational
-Depressed people – negative info-processing bias
as seen in
creates
a vicious cycle of depression: you’re depressed and you see
the world negatively, so you b/c depressed more
-no scientific proof yet of
beck’s claim of depressogenic thoughts causing depression.
Helplessness/Hopelessness theories of depression
Leaned helplessness:
cognitive/motivational deficits exhibited when humans/animals learn
that they don’t have control over aversive events.
seligman’s
animals showed symptoms of human depression, such as lower aggression
levels and weight/appetite loss
role of attributional style and hopelessness
-people might think things
are pretty helpless since the attribute wrongly:
Attribution: process of assigning causes to things that happen: 3 axis:
-Depressogenic attribution for failure (i.e. failure on exam)= Internal.global/stable
‘I am stupid’
-more optimistic view: external/specific/unstable
‘teacher was in a bad mood’
-external = teacher
-specific: only that teacher
-unstable:
not always in a bad mood’
-people have a stable attribution style
some have a depressogenic: pessimistic attribution style
--
hopelessness theory: the theory that a sense of hopelessness about the future following a negative life event is sufficient to cause depression
those
people have an hopeless expectancy: they always expect
things that they have no control over
women = more depression = b/w
discrimination shows that they have no control over events (i.e. less
pay for same job)
Interpersonal effects
of mood disorders
**
chapter 7 – somatoform/dissociative
-often dissociative disorders
go w/ somatoform
Somatoform:
conditions involving physical complaints or disabilities that occur
w/o any evidence of physical pathology to account for them
Dissociative disorder:
conditions involving a disruption ina person’s sense of personal identity
Somatoform disorder
Somatization disorder
Somatization disorder:
a somatoform disorder characterized by multiple complaints of physical
ailment that extend for long periods beginning b/f age 30, that are
inadequately explained by independent findings of physical illness or
injury and lead to medical treatment or to significant life impairments
-claimed illnesses don’t
have to be real. Mere reporting of them is sufficient
at least minimally in 4 areas:
Comorbility:
somatization in women often equals antisocial in men
Hypochondriasis
Hypochondria: a somatoform disorder, characterized by preoccupation w/ the fear of having a serious illness, based on misinterpreting bodily symptoms.
sometimes, w/ no physiologically coherent
symptom patterns
malingering: consciously faking to get a specific non-medical result, i.e. ‘sick benefits’/paid leave.
factitious disorder: a disorder where a person fakes disability in order to gain personal goal of attention
-->the diff. is in the goal. Factitious disorder is merely for the attention
2 psychodynamic reasoning:
a
‘disease’ as a form of communication
history: trauma:
pain disorder
pain disorder:
a somatoform disorder characterized by reported pain of significant
duration and severity to cause significant life disruptions in absence
of medical pathology to explain the cause of the experiences pain
2 subtypes
the medical element is coded in Axis III
but
pain is out of proportion
-psychogenic pain disorders often adopt a invalid lifestyle
go from dr. to dr. in hope of finding medication
sometimes
even mutilating surgery!!!
Conversion disorder
Conversion disorder:
A somatoform disorder where symptoms of some physical malfunction or
loss of control appear w/o any underlying pathology. It was originally
called hysteria
-Freud: repressed sexual energy =hysteria
-->i.e.
guilt from masturbation = paralyzed hand
modern view: to escape some [external] sort of stimuli/responsibility
-->called
secondarey gain in psychoanalytic schools
-decrease in modernity, since
more sophisticated sciences allow us to discover that there is nothing
wrong
common criteria:
Chain of developmental events:
-you can tell that they are
not malingering b/c they are naively willing to discuss their ‘disease’
symptoms in detail
Biology of conversion disorders
-disorder tends to be in left side of body more often
-->nonverbal
right side of brain (?!?)
psychosocial causal factors
Sociocultural causal factors
-in cultures where expression of emotional distress is unacceptable =more somatoform disorders -->they call it ‘neurathenia’ = ‘weak nerves’
-->possibly undifferentiated somatoform disorder
-->not same thing a chronic fatigue
symptoms
Treatment of somatoform disorders
-best not to give anything
(even thought that they are convinced that they have a real disease),
yet sometimes, it is necessary to give anti-anxiety/antidepressants
-->Best treatment:
reassurances/non-threatening explanation of the causes
note: no good prognosis
for full recovery of somatoform diseases, except pain/conversion disorder
dissociative disorders
-nothing wrong w/ dissociation
i.e. in the automatism of doing a task,
while thinking about something else
after
all, many things we do are automatic and not subject to conscious self-awareness
normal preconscious processes:
Implicit memory: memory occurring below conscious level
Implicit perception:
perception occurring below conscious level
Dissociative disorders:
loss of integration: inability to maintain preconscious processes b/c
of severe psych. threat
-like somatoform: avoiding stressful event/anxiety fof saily functions that are threatening
must avoid it!
Pathological dissociation:
dissociative amnesia/fuge
amnesia: inability to remember past experience
could be b/c neurotic/psychotic episodes or brain damage
prob.
in permanent amnesia is usually in the encoding or in the retrieval
stages
type of dissociative amnesia:
symptoms:
-forgetting of name/age/won’t recognize relatives/friends
habits usually remain intact, such as semantics/skills
autobiographical
and episodic memory is usually affected and not semantic/procedural/perceptual
representation/STM
assumes new home/identity/work/new life
after
days/years, they might find themselves in this strange situation [that
they created], and not know how they got there. They will have amnesia
of their fugue period
-in dissociative periods, person
still seems normalyet diff. ‘person’ that previously
Note: in both conversion
disorder and dissociative, person leaves threatening situation
Dissociative identity disorder (DID)
-formerly called multiple
personality disorder
dissociative identity disorder: b/c of a sterssor, person manifests at least 2 more or less complete systems of identity:
split
personalities: stable personalities w/ their own emotions/thought processes
host personality: original personality of person w/ DID
usually, the personalities are strikingly
dif. From one another
Alter identities:
identities other than the host identity in the person w/ the DID
cases
of non-human alters!!!
Nature of alters
-alters are not usually full personalities but usually fragmented, in order to deal w/ an unmanageable psych. distress.
alters play out inter conflicts
-sometimes, 1 alter knows everyone and cooperates w/ therapist
-host identity might not know
of other alters or that that ‘others’ really accompany his body/time/space
more
diagnosis: more acceptance of the diagnosis
-some think that is induced through highly susceptible hypnotable people
brain scans: show diff. activity of
brain for diff. alters!!!
Depersonalization disorder:
Depersonalization: a dissociative in which there is a loss of as sense of self
that their bodies are diff. –i.e.
their bodies have changed, i.e. b/c grotesque
related to realization
i.e. mind leaves/travels for a while
visits
other plants/people in other cities
Derealization: experience in which the external world is perceived as distorted in various ways: it may accompany depersonalization disorder
i.e. people look like zomby/dream-like
depersonalization often occurs w/ acute
stress of an infectious illness
cormobility:
childhood
trauma is a common experience but not as hard as DID disorders
-mild forms happen to everyone!
might
be the early manifestation of decomposition in schizophreniform type
psychotic states
Pathways to DID
-generally, DID is not genetic.
Psychosocial causal factors
-DID is kind of a post-traumatic ‘dissociative’ disorder
usually happens after a trauma
i.e.
after repeated trauma of abuse, the child dev. partly independent alters
each w/ his own coping techniques
studies found connection b/w murders and past experiences:
Things that are highly associated w/ DID
-in some societies, DID-like phenomenon are adaptive
i.e. spirit possession
why it is hard to find causality in dissociative disorders
-in depersonalization –many don’t come for treatment
in
dissociative amnesia/fugue = also, very few cases to study
-diversity for treatment incl.
integrating the alters/making them less controlling of the host
popular, 3 staged approach:
Chapter 9 personality disorders
Personality disorder: mental disorders stemming from gradual dev. of inflexible/distorted personality and b/h pattern that results in persistent maladaptive ways of perceiving/thinking about/relating to the world
usually seen in Axis II
more impulsivity
b/h that leads to contact w/ health
system/legalauthorities
Fearful anxious cluster (Custer C)
Paranoid personality disorder: pervasive suspiciousness/distrust of others
Mood disorders- mental disorders
characterized by disturbances of mood that are intense & persistent
enough to be clearly maladaptive.
2 key moods involved in mood disorders:
Mania- emotional state characterized by intense & unrealistic feelings of excitement & euphoria.
Depression- emotional state
characterized by feelings of extraordinary sadness & dejection.
Difference b/w unipolar disorders & bipolar & their prevalence:
Bipolar disorders- mood
disorders in which a person experiences both manic & depressive
episodes
Diagnosis |
Main Features |
Lifetime Prevalence | Gender Ratio female/male | |
Unipolar Disorders | Dysthymia |
For at least the past 2 yrs., person has been bothered for most of the day, for more days than not, by depressed mood, & at least 2 other depressive symptoms, but not sufficient persistence or severity to meet the criteria for major depression. Person can’t have had any manic or hypomanic episodes. | 6% | 2/1 |
Adjustment disorder w/ depressed mood | Person reactions w/ a maladaptively depressed mood to some identifiable stressor occurring w/in past 3 months. Symptoms stemming from bereavement don’t qualify. Once the stressor has terminated, symptoms must remit w/in 6 months. | Unknown | ||
Major depressive disorder | Person has 1 or more major depressive episodes in the absence of any manic or hypomanic episodes. Symptoms of a major depressive episode include prominent & persistent depressed mood or loss of pleasure for at least 2 weeks, accompanied by 4 or more symptoms such as poor appetite, insomnia, psychomotor retardation, fatigue, feelings of worthlessness or guilt, inability to concentrate, & thoughts of death or suicide. | 16-17% | 2/1 | |
Bipolar Disorders | Cyclothymia, depressed | At present & during past 2 yrs., person has experienced episodes resembling dysthymia, but also has had 1 or more periods of hypomania- characterized by elevated, expansive, or irritable mood not of psychotic proportions. | 0.4%-1% | 1/1 |
Bipolar I disorder, depressed | Person experiences a major depressive episode (as in major depressive disorder) & has had 1 or more manic episodes. | 1% | 1/1 | |
Bipolar II disorder, depressed | Person experiences major depressive episode & has had 1 or more hypomanic episodes. | 0.5% | 1/1 |
Unipolar Mood Disorders
Dysthymia:
Dysthymia- moderately severe mood disorder characterized by a persistently depressed mood (more days than not) lasting for at least 2 years (1 yr. for children & adolescents). One must also have at least 2/6 additional symptoms:
Major Depressive Disorder:
Major depressive disorder- severe mood disorder in which only depressive episodes occur most of every day for at least 2 weeks & person experiences other symptoms such as fatigue, sleep disturbance, loss of appetite & weight, psychomotor agitation or retardation, difficulty in concentrating, self-denunciation, guilt & recurrent thoughts of death or suicide.
Symptoms:
Cognitive & motivational symptoms: cognitive distortions, thinking one is a failure & that everybody thinks that as well, self-blame, self-hatred, anger & lack of trust of family & friends. Hoplessness about the future, but no motivation to try to improve the situation.
Subtypes of Major Depression:
Melancholic type-
subtype of major depression that involves loss of interest or pleasure
in almost all activities & other symptoms, including early morning
awakenings, worsening of depression in the morning, psychomotor agitation
or retardation, loss of appetite & weight, inappropriate or excessive
guilt, & sadness that is qualitatively different from the sadness
usually experienced after a loss.
Severe major depression w/ psychotic features- major depression involving loss of contact w/ reality, often in the form of delusion or hallucinations.
Mood-congruent psychotic features- delusional thinking that is consistent w/ a person’s predominant mood.
Mood incongruent psychotic
features- delusional thinking that is inconsistent w/ a person’s
predominant mood.
Postpartum onset- beginning w/in 4 weeks of the birth of a baby. Typically best understood as an adjustment disorder b/c it tends to be relatively mild & is resolved rather quickly.
Depression as a Recurrent Disorder:
Recurrence- a new occurrence of a disorder after a period of remission of symptoms lasting for at least 2 months.
Relapse- return of symptoms
of a disorder w/in a fairly short period of time.
Seasonal Affective Disorder:
Seasonal affective disorder-
mood disorder involving at least 2 episodes of depression in the past
2 years, occurring at the same time of year (most commonly, fall or
winter) & w/ full remission from each episode occurring at a certain
time of year (most commonly spring).
Biological Causal Factors
-Strong case for some
hereditary contribution to the causal factors for unipolar major depression,
but not so much for milder forms. Liability for unipolar depression
& generalized anxiety disorder actually come from the same genetic
factor.
Biochemical Factors:
-Associated w/ the monoamine
class (neurotransmitters) norepinephrine, dopamine, & serotonin,
there is either a depletion or a net increase of
Neuroendocrine & Neurophysiological Factors:
Disturbances in Sleep & Other Biological Rhythms:
Diathesis-Stress Model:
-People who eventually develop a disorder differ in some underlying way from those who do not, & this underlying difference is known as the diathesis (predisposition). Among those w/ the diathesis, only those who experience stress will actually develop the disorder.
Five major psychological theories of depression:
Interpersonal Effects of Mood Disorders:
Hypomania- mild form of mania
Cyclothymia- mild mood disorder characterized by cyclical periods of hypomanic & depressive symptoms that aren’t disabling.
Bipolar disorder- severe mood disorder in which a person experiences both manic & depressive episodes
Rapid cycling- a pattern of bipolar disorder involving at least 4 manic or depressive episodes per year.
Schizoaffective disorder- severe mood disorder accompanied by at least 2 major symptoms of schizophrenia, such as hallucinations & delusions.
Hereditary Factors:
Biochemical Factors:
Other Biological Causal Factors:
-High levels of stress
are associated w/ the experience of mania, hypomanic or depressive episodes.
Sociocultural Factors
-Bipolar disorder is
more common in higher than lower socioecononic classes. Patients w/
bipolar disorder also tend to have more education than those w/ unipolar
depression. This may be because hypomanic phases may lead to increased
achievement & accomplishment.
Stress & Bipolar Disorder:
Treatments & Outcomes for Mood Disorders
Majority of manics &
depressed patients will recover (at least temporarily) w/in a year.
The natural course of a depressive episode if left untreated is 6-9
months.
Pharmacotherapy & Electroconvulsive Therapy
Psychotherapy
Depression & Marital Violence:
Comorbidity of Anxiety
& Mood Disorders: People w/ high anxiety are also more often high
in a scale of depression. They are both high in negative affect, but
not anxious individuals.
Suicide
Suicide- taking one’s own life.
Suicide Attempts:
Completed Suicide:
Psychosocial Causal Factors
Biological Causal Factors
Sociocultural Causal Factors
Suicidal Ambivalence
-Whether direct or indirect,
communication of suicidal intent usually represents a warning &
cry for help. Failing to receive the support, they go in to suicide.
Suicide Prevention & Intervention
-Helping distressed regain their ability to cope w/ their immediate problems & do so as quickly as possible. Emphasis is usually placed on:
-Such programs haven’t
revealed real impact.
Warning Signs for Student Suicide:
Somatoform disorders- Conditions
involving physical complaints or disabilities that occur w/o any evidence
of physical pathology to account for them.
-All somatoform disorders
share the key feature of being expressions of psychological difficulties
in the “body language” of medical problems that on careful examination
cannot be documented to exist. They are not faking the symptoms, they
genuinely believe that something is wrong w/ their bodies.
-These individuals are typically
preoccupied w/ their state of health & w/ various disorders or diseases
of bodily organs.
-They all involve “neurotic” development, but causation & treatment may differ.
Somatization disorder- a
somatoform disorder characterized by multiple complaints of physical
ailments that extend over a long period, beginning before age 30, that
are inadequately explained by independent findings of physical illness
or injury & that lead to medial treatment or to significant life
impairment.
DSM Symptoms (must be present to at least minimal degree):
-10 times more common among women. Lifetime prevalence of 2%. There is evidence of a familial linkage w/ antisocial personality disorder & that common underlying predisposition leads to antisocial behavior in men & somatization in women. More prevalent among lower socioeconomic status. This may just be linked to gross family disorganization & not to genetics.
Hypochondriasis- a somatoform disorder characterized by the person’s preoccupation w/ the fear that he has a serious disease, based on misinterpretations of bodily symptoms.
Differences b/w Hypochondriasis & Somatization disorder:
-Hypochondriasis is one
of most frequent somatoform disorders w/ 4-9% prevalence. Frequently
they are disappointed when no physical illness is found.
Major characteristics:
More Than Meets the Eye?
Hypochondriac is saying:
Pain disorder- a somatoform
disorder characterized by reported pain of sufficient duration &
severity to case significant life disruption & the absence of medical
pathology that would explain the experienced pain.
DSM Subdiagnoses:
-Somatoform patients often end up disabled through medication addiction or surgery.
Conversion disorder- A somatoform disorder in which symptoms of some physical malfunction or loss of control appear w/o any underlying organic pathology; originally called hysteria.
-Symptoms often mimic neurological
disorders.
Escape & Secondary Gain:
-The physical symptoms are now seen as serving the function of providing a plausible excuse to escape or avoid a stressful situation w/o having to take responsibility for doing so.
Secondary gain- Any external
circumstance that tends to reinforce the maintenance of disability.
Decreasing Incidence:
-Used to be common among
soldiers (Ex. Paralysis of leg gets them out of battle & being called
coward). Constitutes 1-3% of mental health disorders.
DSM recognizes subtypes of conversion disorder according to symptoms:
-Often visceral symptoms
are present.
Sensory Symptoms:
-Research of airmen in WWII w/ conversion disorder revealed that symptoms of each pilot were closely related to his performance duties. Ex. Night pilots were more likely to have night blindness, etc.
-Sensory conversion disorder
sufferers while under hypnosis didn’t endanger themselves. Ex.
“Blind” person didn’t walk into object in his path.
Motor Symptoms:
Visceral Symptoms:
Diagnosis of Conversion Disorders:
Criteria to distinguish conversion disorders from organic disorders:
Precipitating Circumstances:
Distinguish Conversion Disorder from Malingering/Factitious Disorder:
Malingering disorder- Faking being “sick” seeking a specific outcome such (Ex. Award of money or avoidance of an unwanted duty or obligation).
Factitious disorder- A disorder
in which a person feigns disability or illness in order to maintain
the personal benefits the “sick role” may provide, including the
attention & concern of medical personnel &/or family members.
They often alter their own physiology (Ex. by taking drugs) in order
to simulate various real illnesses.
-Individuals w/ conversion disorders are usually dramatic & naive & are not concerned when inconsistencies in their behavior are pointed out. On the other hand factitious disorder patients are defensive, evasive & suspicious.
Biological Causal Factors:
Psychosocial Causal Factors:
Sociocultural Causal Factors:
Chronic fatigue syndrome:
Idea of psychologically caused fatigue is less accepted here than in
other parts of world.
Treatment & Outcomes of Somatoform Disorders:
Dissociative disorders- Conditions involving a disruption in a person’s sense of personal identity.
-These people often cannot
recall who they are/where they are from, or they may have split themselves
into 2 individuals or more having independent
“personalities” & autobiographical memories.
Amnesia- partial or total
inability to recall or identify past
experience.
Types of Dissociative Amnesia:
Psychogenic (dissociative)
amnesia- A dissociative disorder characterized by the inability to
recall personal info, which is still known on an unconscious level.
Types of psychogenic amnesia:
Typical Symptoms:
-Only episodic memory (pertaining to events experienced) or autobiographical memory is affected. Don’t remember names, age, where they live, don’t recognize family & friends, yet basic habit patterns (talking, reading, skilled work) is in tact.
Dissociative Identity Disorder (DID)
Dissociative identity disorder (DID)- a dissociative disorder in which a person manifests at least 2 more or less complete systems of identity; formerly called multiple personality disorder (MPD).
Host personality- the original personality in a person w/ DID.
Alter identities- identities
other than the host personality in a person w/ dissociative identity
disorder
The Nature of Alters:
Common roles in alters include:
Incidence & Prevalence- Why Are Diagnoses Increasing?
The DID Diagnosis: Continuing Controversy:
Depersonalization Disorder
Depersonalization disorder- a dissociative disorder in which there is a loss of the sense of self. More common in adolescents & young adults.
-People feel they are
suddenly different, that they are other people or that their bodies
have drastically changed.
Derealization-
Experience in which the external world is perceived as distorted in
various ways (Ex. out-of-body experience); may accompany depersonalization
disorder.
Causal Factors in Dissociative Disorders
Pathways that may lead to DID (can be more than 1):
Biological Causal Factors:
-No evidence of it.
Psychosocial Causal Factors:
Evidence encouraging development of DID:
-A questionnaire, Dissociative
Experiences Scale, measures to see if one has dissociative tendencies.
Sociocultural Causal Factors:
-Whether dissociative
disorders are culturally accepted as normal behavior or as legitimate
mental disorders has an influence on its prevalence.
Treatment & Outcomes in Dissociative Disorders
-Most therapists try
to integrate the alters into the host personality.
3-stage model for treatment of DID (Kluft):
Personality disorders- Mental disorders stemming from the gradual development of inflexible & distorted personality & behavioral patterns that result in persistently maladaptive ways of perceiving, thinking about, & relating to the world.
-Behavioral deviations of these people is persistent & intrinsic to their personalities
Misdiagnoses occur frequently for these reasons:
Paranoid personality disorder- Personality disorder characterized by pervasive suspiciousness & distrust of others.
Schizoid personality disorder- Personality disorder characterized by the inability to form social relationships or express feelings lack of interest in doing so.
-Once thought that schizoid was precursor to schizophrenia, but this isn’t so. Negative symptoms of schizophrenia (social withdrawal, anhedonia) are however similar schizoid behavior.
Schizotypal personality disorder- Personality disorder characterized by excessive introversion, pervasive social & interpersonal deficits, cognitive & perceptual distortions, & eccentricities in communication & behavior.
Histrionic personality disorder- personality disorder characterized by attention-seeking behavior, emotional instability, & self-dramatization.
Narcissistic personality disorder- personality disorder characterized by an exaggerated sense of self-importance, a preoccupation w/ being admired, & a lack of empathy for the feelings of others.
-Difference b/w narcissist & histrionic: Both may be promiscuous, but narcissist is more dispassionately exploitative, histrionic is more overtly needy. Exhibitionistic (bragging) for histrionic is to seek attention, narcissist for admiration.
Antisocial personality disorder (ASPD)- personality disorder characterized by continual violation of & disregard for the rights of others through deceitful, aggressive, or antisocial behavior, typically w/o remorse or loyalty to anyone.
-Difference b/w antisocial & narcissist: Narcissist exploits to show domination & superiority, whereas antisocial for personal, material gain.
Borderline personality disorder (BPD)- personality disorder characterized by impulsivity & instability in interpersonal relationships, self-image, & moods.
-Differences from other personality disorders: Their exploitative use is an angry & impulsive response to disappointment, whereas the antisocial’s is guiltless & for personal gain.
-Differences: Avoidant & dependant personalities often co-occur, though avoidants don’t initiate relationships to avoid rejection & dependants want to be taken care of. Schizoids are indifferent to criticism, avoidants hypersensitive to it. Similar to generalized social phobia.
-Differences: Both borderline & dependant fear abandonment, but borderlines act w/ rage & dependants w/ submissiveness. Both borderlines & histrionics need reassurance/approval borderlines do it actively demanding attention & dependants do it in a more docile, self-effacing way.
Obsessive compulsive personality disorder- personality disorder characterized by perfectionism & an excessive concern w/ maintaining order & control.
-Differences b/w OCPD & OCD: OCD is persistent intrusion of particular undesired thought/images (obsessions) that are source of anxiety/stress that can only be reduced by performance of compulsive rituals, however OCPD’s aren’t not anxious about the compulsiveness itself.
-Other differences: Narcissists believe they have achieved perfection, OCPD’s are self-critical. Narcissists & antisocials aren’t generous, but will indulge, whereas OCPD’s aren’t generous to themselves or others.
-Beck & colleagues developed scheme that details personality disorder’s overdeveloped & underdeveloped distinct behavior patterns. Sometimes the deficient behavior is somehow a counterpart to the overdeveloped behavior. They also list the core dysfunctional belief of the disorder.
-High level of comorbidity among personality disorders makes difficult to understand which causal factors are associated w/ which disorder.
Early Learning Experiences:
-History childhood abuse
& neglect (especially w/ borderlines) may lead to PD.
Psychodynamic Views:
Kohut: All kids go through normal stage of grandiosity where they think all revolves around them & parents must do some mirroring of the grandiosity in order for kid to develop normal self-confidence.
Millon: Argues opposite of Kohut, that narcissism develops from parental overvaluation.
-Maybe more PD’s in US b/c culture encourages impulse gratification, instant solutions, etc.
-PD’s are pretty resistant to therapy partly b/c their personalities makes it hard for them to have good relationship w/ therapist & also they don’t come in for therapy so much as the people around them. People w/ Axis I disorders as well as PD’s don’t do as well in treatment as those only w/ Axis I.
Pharmacotherapy:
Psychological Treatments:
Psychodynamic therapy:
Primary goal of strengthening weak egos, particular focus in their primary
defense mechanism of splitting which leads them to black & white
thinking & rapid shifts in their reactions to others. This is very
expensive & time-consuming.
Marsha Linehan’s treatment:
-She believes the inability to tolerate strong states of negative affect is central to the disorder. One goal is to encourage the patients to accept this negative affect w/o engaging in self-destructive or other maladaptive behaviors.
-This dialectical behavioral therapy combines individual & group (skills & training for interpersonal skills, emotion regulation, stress tolerance) components.
-Therapist accepts the person for who s/he is (but not approving of inappropriate behavior).
Hierarchy of goals:
-Cluster A & B treatment is not very promising. Cluster C treatment seems more promising. Antidepressants & short-term psychotherapy sometimes are useful in avoidant personality disorder.
-Only individuals 18+ are diagnosed as having antisocial personality
DSM diagnosis:
Psychopathy- a condition
involving the defining features of antisocial personality disorder as
listed in DSM, as well as such traits as lack of empathy, inflated &
arrogant self-appraisal, & glib & superficial charm.
Two Dimensions of Psychopathy:
-Hare & colleagues did research & suggest that ASPD & psychopathy are related but differ in very significant ways. Hare created a 20-item Psychopathy Checklist to aid clinicians in diagnosing it. The list shows there are 2 related, but separable dimensions of psychopathy, w/ each predicting different types of behavior:
-Psychopathy seems to predict
criminal behavior much more than ASPD.
The Clinical Picture in Antisocial Personality & Psychopathy
-Psychopaths & antisocials are often charming, spontaneous & likeable on 1st acquaintance, but they are deceitful, manipulative & callously use others to achieve their needs/desires.
-The below traits are typical
of psychopaths, but they’re not all usually found. Many w/ ASPD also
share at least a subset of these characteristics, though not criteria
for DSM ASPD diagnosis.
Inadequate Conscience Development:
Irresponsible & Impulsive Behavior:
Ability to Impress & Exploit Others:
Genetic Influences:
-Results of adoption &
twin studies show modest heritability for antisocial or criminal behavior.
Results of at least 1 study found same for psychopathy.
Deficient Aversive Emotional Arousal & Conditioning:
-Research
indicates that psychopaths show deficient aversion emotions arousal
making them less prone to fear & anxiety in stressful situations
& less prone to normal conscience development & socialization
(more closely associated w/ egocentric, callous, exploitative dimension
of psychopathy than the antisocial behavioral dimension).
Gray’s model & Fowles’s theory:
More General Emotional Deficits:
-Psychopaths showed less
significant physiological reactivity to distress cues than did nonpsychopaths
which confirms them having low empathy. They weren’t underresponsive
to unconditioned threat cues (slides of sharks, pointed guns).
A Developmental Perspective:
Sociocultural Causal Factors & Psychopathy:
-Cultural variations often occur for frequency of aggressive & violent behavior due to socialization forces (Ex. Psychopaths in China may be less likely to engage in violent behavior).
-Individualistic societies like US (emphasize competitiveness, self-confidence & independence) would be expected to be more likely to promote behavioral characteristics that carried to an extreme result in psychopathy, but evidence here is minimal.
Cognitive-Behavioral Treatments:
Common targets for cognitive-behavioral interventions w/ ASPD & psychopathy:
-These all require a
controlled situation (inpatient or prison setting) in order to succeed.
-Beck & Freeman focus on improving social & moral behavior through examination of self-serving dysfunctional beliefs that psychopaths tend to have (Ex. “Undesirable consequences will not occur or will not matter to me.”). This can also be incorporated w/ ASPD therapy. These programs are more successful in treating young offenders (teenagers).
-Psychopathy is harder to treat than ASPD. Fortunately after age 40 they both improve w/o treatment, possibly b/c of weaker biological drives, better insight into self-defeating behaviors, etc. However, the egocentric, callous & exploitative affective interpersonal dimension doesn’t improve.
Schizophrenias- severe mental
disorders characterized by the breakdown of integrated personality functioning,
withdrawal from reality, emotional blunting & distortion, &
disturbances in thought & behavior.
Psychosis- a significant
loss of contact w/ reality, as when hallucinations or delusions are
present.
Delusional disorder- a nonschizophrenic paranoid disorder in which a person nurtures, gives voice to, & sometimes takes action non beliefs that are considered completely false & absurd by others; formerly called paranoia.
Shared psychotic disorder-
a nonschizophrenic paranoid disorder in which 2 or more people, usually
in the same family, develop persistent, interlocking delusional ideas;
also known as folie deux.
Brief psychotic disorder- a mental disorder characterized by brief episodes (lasting 1 month or less) of otherwise uncomplicated delusional thinking.
-Considered the most serious of all mental disorders.
-No evidence that there is progressive brain deterioration in schizophrenia & where it has occurred it is usually treatment-induced (antipsychotic medication).
-Usually onset is in adolescence or early adulthood.
-In some cultures certain
beliefs are acceptable, but in our culture would be considered crazy.
Allen claims schizophrenia is rarer in traditional, small-scale societies
than in modern.
Point prevalence of schizophrenia: 0.2-2%
Lifetime prevalence: 0.7% among those not currently institutionalized
Incidence (cumulative occurrence rate of new cases): Could be as high as 0.2%
State & county hospitals: 40% of all admissions
Males & females: Same prevalence, men have earlier onset. Males may develop more severe forms of schizophrenia. Late-onset schizophrenia is more common among women.
Positive-syndrome schizophrenia- schizophrenia w/ a symptom pattern characterized by additions to normal behavior & experience, such as marked emotional turmoil, motor agitation, &/or delusions & hallucinations.
-Most patients exhibit both
positive & negative symptoms. However, patients who exhibit more
negative symptoms have a more unfavorable prognosis than those who exhibit
more positive symptoms. The polar terms of positive & negative would
be better conceived as end points of an uninterrupted continuum or even
has 2 independent continua, both which are for some reason involved
in manifest schizophrenic behavior.
DSM:
Formal thought disorder (associative disturbance)- failing to make sense, despite seeming to conform to semantic & syntactic rules of verbal communication. Prime indicator of a schizophrenic disorder.
Delusions- false beliefs about reality that are maintained in spite of strong evidence to the contrary. Ex. One’s thoughts/action are being controlled by external agents. Or a neutral environmental event (TV program) has intended personal meaning (ideas of reference).
-Patient is unable to
sort out & process the great mass of sensory info to which all of
us are constantly exposed.
Hallucinations- false perceptions, such as seeing or hearing things that aren’t real or present. Most often auditory, typically a voice that keeps up a running commentary on the person’s behaviors or thoughts.
-Some claim this is due to malfunctioning neural feedback connections b/w brain regions.
-They display clearly inappropriate emotion & emotional shallowness. However, evidence suggests that the deficit is only one of expressiveness, not feeling.
Anhedonia- inability to experience joy/pleasure
-May feel confused about
identity, often delusional assumption they’re someone else.
Disrupted Volition
-Deterioration of performance
in everyday tasks, possibly due to impairment of prefrontal region of
the cerebral cortex.
Retreat to Inner World
-Withdrawal from reality
that often seems deliberate. Elaboration of an inner world.
Disturbed Motor Behavior
-Peculiarities of movement
(hyperactivity, clumsiness, rigid posturing).
Continuing Problems in Defining Schizophrenia
Dolphus & colleagues suggested 4 discriminable patterns of schizophrenia signs:
-Most patients display mixed.
Schizophrenia, residual type- subtype of schizophrenia used as a diagnostic category for people who have experienced a schizophrenic episode from which they have recovered sufficiently so as to not show prominent symptoms, but who still manifest some mild signs of their past disorder.
Schizophrenia, undifferentiated type- subtype of schizophrenia in which a person meets the usual criteria for schizophrenia- including (in varying combinations) delusions, hallucinations, disordered thoughts, & bizarre behavior- but doesn’t clearly fit into one of the other types b/c of a mixed symptom pattern.
-People often exhibit undifferentiated symptoms in acute, early phases of schizophrenic breakdown. The episode usually clears up in a matter of weeks, at most months. If the “schizophrenoform” disturbance exceeds 6 months, it may qualify as schizophrenia.
Schizophrenia, catatonic type- subtype of schizophrenia in which the central feature is pronounced motor symptoms, either of an excited or stuporous type, which sometimes makes it difficult to differentiate this condition from a psychotic mood disorder.
Schizophrenia, disorganized type- subtype of schizophrenia that usually begins at an earlier age & represents a more severe disintegration of the personality than seen in the other subtypes.
Schizophrenia, paranoid type- subtype of schizophrenia in which a person is increasingly suspicious, has severe difficulties in interpersonal relationships, & experiences absurd, illogical & often changing delusions. (Once made up ½ of hospital admissions, now less & undifferentiated is on rise.)
Schizoaffective disorder-
mental disorder in which a person shows features of both schizophrenia
& severe mood disorder.
Schizophreniform disorder- any schizophrenia-like psychosis of less than 6 months duration (most often seen in an undifferentiated form).
-All recent-onset cases of true schizophrenia presumably must 1st receive a diagnosis of schizophreniform disorder. Better prognosis.
Genetic Influences:
Twin Studies:
Adoption Studies:
Biochemical Factors:
Neuroanatomical Factors:
Neurodevelopmental issues:
-Stress may affect social
& personality development.
Damaging Parent-Child & Family Interactions:
The Role of Excessive Life Stress & Expressed Emotion:
The Effects of Antipsychotic Medication
-Therapy together w/
medication is often helpful.
Family Therapy:
-This is important due
to the relapse hazards due to familial expressed emotion
(EE).
Individual Therapy:
-Can enhance social adjustment
& social role performance. Learning coping skills for managing stressful/emotional
events.
Social-Skills Training & Community Treatment:
-Training in social skills
is helpful in overcoming the embarrassment, ineptitude, awkwardness
& attentional “cluelesness” these people have shown in social
situations.
Assertive community treatment
(ACT)- Community-based psychosocial treatment program for helping
people w/ schizophrenia manage life problems.
Intensive case management (ICM)-
community-based psychosocial treatment program that uses multidisciplinary
teams w/ limited caseloads to ensure that discharged mental patients
don’t get overlooked & “lost” in the system.
A Problem: Overcoming Inertia:
-People overestimate the
power of antipsychotic drugs & underestimate psychosocial therapy.
They should be combined.
-Some psychological problems
are result of damage or defects in the brain tissue. This could disrupt
effective thought, feeling & behavior.
-Structural defects in the
brain present before birth or at an early age may cause mental retardation.
-Injuries, diseases &
toxic substances may cause functional impairment or death of neurons
or their connections. This could cause impaired & maladaptive behavior
(even psychotic). Starting w/ a deficit of this kind vs. having one
later in life is very different. Losing established functioning can
add a psychological burden to the organic one. Or these
patients could be unaware of their losses & thus be poorly motivated
for rehab.
Neuropsychological disorders- Disorders entailing behavioral & mental impairments that occur when there has been significant organic damage to a normal adolescent or adult brain.
-Prior to DSM-IV, most disorders
of this type were called organic mental disorders, however this
term failed to distinguish b/w direct neurological consequences of brain
injury, including various cognitive deficits & the psychopathological
problems sometimes accompanying such injury (ex. depression, paranoid
delusions). The majority of people w/ a neuropsychological disorder
don’t develop psychopathological symptoms, though many will show at
least mild deficits in cognitive processing & self-regulation.
-Psychopathological symptoms
that sometimes accompany brain impairment are less predictable than
symptoms of a neuropsychological disorder & more likely to show
individual nuances consistent w/ prior personality & the total psychological
situation the patient is confronted w/.
-Analogy of brain as being
hardware & the psychosocial experience as being software
-The brain destruction could only cause limited behavioral deficits or could cause a wide range of psychological impairments depending on:
Brain reserve capacity: Intelligent, well-educated, metally active people have enhanced resistance to mental & behavioral deterioration following brain damage, excluding situations where the damage/location is so severe that it can destroy the integrity of the personality.
-Mental symptoms associated w/ neuropsychological disorders are the direct product of physical interruption of established neural pathways in brain. Symptoms include:
Nature & Location of Neural Damage:
-Destruction of cells
bodies & neural pathways is permanent. Some functions lost due to
actual brain damage can be relearned (usually at a less efficient &
compromised level). Rapid recovery is usually due to resolution of temporary
conditions (ex. edema- swelling) produced in tissue spared from actual
damage.
-Location is important factor
in nature of damage. Left hemisphere responsible for serial (order)
processing of language, math equation. Right hemisphere specializes
in configuration, or gestalt (ex. appreciation of patterns), which we
use for grasping new situations, reasoning on a non-verbal, intuitive
level & appreciation of spatial relations.
Frontal area damage is associated w/ 1 of the 2:
Right parietal lobe damage:
Left parietal lobe damage:
Temporal lobe:
Occipital damage:
Diagnostic Issues in Neuropsychological Disorders:
-Many basically medical
disorders have various kinds of associated mental symptoms are coded
on Axis-III (not on Axis-I). The associated mental conditions
are then coded on Axis-I, w/ phrase
“Due to [a specified General Medical Condition (i.e., the disease
process indicated on Axis-III)]”.
-Some pathological brain
changes that may produce mental symptoms are related to abuse of certain
substances (Ex. Long-term excessive alcohol assumption).
Here a specific etiological notation is added in Axis-I, Ex.
“Substance-Induced Persisting Amnestic Disorder”.
-In cases of dementia the presumed underlying neurological disease process is sometimes included in both Axis-I & Axis-III.
Ex. Axis-I: Vascular dementia, Axis-III: Occlusion, cerebral artery
Ex. Axis-I: Dementia of Alzheimer’s Type, Axis-III: Alzheimer’s disease
Syndrome- Group of signs
& symptoms that tend to cluster together.
Categories of syndromes:
-More than 1 syndrome may
be present in a person at a given time & the patterns of the syndromes
may change over disorder’s course of development. Clinicians must
always be aware that the brain impairment itself may be directly responsible
for the clinical phenomena ovserved.
Delirium- neuropsychogical symptom syndrome characterized by relatively rapid onset of widespread disorganization of the higher mental processes (perception, memory, & info processing) & by abnormal psychomotor activity (wild thrashing about, disturbance of sleep cycle); caused by a generalized disturbance in brain metabolism.
Causes of delirium:
Dementia- Neuropsychological
disorder characterized by progressive deterioration of brain functioning
that occurs after the completion of brain maturation (after about age
15) & that involves deficits in memory, abstract thinking, acquisition
of new knowledge or skills, visuospatial comprehension, motor control,
problem solving, & judgement.
Causes of dementia:
Amnestic Syndrome- Neuropsychological disorder characterized by a striking deficit in the ability to recall ongoing events more than a few minutes after they have taken place.
Causes of amnestic syndrome:
Neuropsychological Delusional Syndrome- Disorder characterized by false beliefs or belief systems arising from organic brain pathology.
Causes of neuropsychological delusional syndrome:
Neuropsychological mood syndromes- Serious mood disturbances apparently caused by disruptions in the normal physiology of cerebral functioning.
Causes of neuropsychological mood syndromes:
Neuropsychological personality syndromes- Disorders characterized by notable change in general personality style or personality traits (usually in a socially negative direction) following brain injury of any kind.
Causes of neuropsychological personality syndromes:
Neuropsychological Disorder w/ HIV-1 Infection
AIDS dementia complex (ADC)- General loss of cognitive functioning affecting a substantial proportion of AIDS patients.
-ADC damage seems to
be concentrated in subcortical regions (b/c of notably delayed reaction
time).
Prominent Features:
Neuropsychogical features of AIDS (ADC):
Early stage:
Later stage (rapid):
Prevalence Studies:
AIDS-related complex (ARC)-
Pre-AIDS manifestation of HIV infection, involving minor infections,
various nonspecific symptoms (ex. unexplained fever), blood cell count
abnormalities & sometimes cognitive difficulties.
Treatment:
-Antiviral therapy is
thought to improve cognition & neurological functioning in AIDS
patients, although complete restoration is unlikely. However, due to
the virus adapting over time to the presence of antiviral agents, its
positive effects are viewed as only temporary.
Dementia of the Alzheimer’s Type
Dementia of Alzheimer’s
Type (DAT)- Progressive dementia associated w/ Alzheimer’s
disease & ultimately terminating in death; onset may occur in middle
or old age & symptoms include memory loss, withdrawal, confusion,
& impaired judgement.
Senile dementias- Mental disorders that sometimes accompany brain degeneration in old age.
Presenile dementias- Mental disorders resulting from brain degeneration occuring prior to old age
-Senile & presenile
dementias have different behavioral manifestations & brain tissue
alterations.
The Clinical Picture in DAT:
-Difficult to diagnose
DAT b/c it is only possible to distinguish the Alzheimer neuropathology
by brain tissue samples, which is only possible after autopsy. Brain
structure abnormalities viewed in MRI’s, etc. could be the cause of
a number of different disease conditions. They usually diagnose DAT
by ruling out other potential causes of dementia.
-DAT in older people,
is very gradual, slow mental deterioration making it difficult to determine
onset point. Factors such as support, predisorder personality, stress,
etc. may change the nature & extent of the brain degeneration.
Signs often begin w/ person’s gradual withdrawal from active engagement w/ life:
More severe symptoms:
-In some rare cases the
symptoms may reverse, but in true DAT this is temporary.
Terminal stages: Patient
is reduced to vegetative level & death is usually caused by some
disease that overwhelms the person’s limited defensive resources.
Allowing for individual differences, victim is likely to show one of these behavioral manifestations:
Prevalence of DAT:
-DAT accounts for the
majority of cases of dementia. Higher ratio for older people.
Causal Factors in DAT:
Neuropathology:
Gene-Environment Interaction in DAT:
-DAT may be genetic. It may be related to a genetic connection to Down syndrome. Down syndrome often causes a DAT-like dementia.
-Differing forms of blood protein called ApoE may predict risk for late onset in some cases.
-Monozygotic twin studies
showed that they do not match for DAT, meaning that it could be environmental.
Treatments & Outcomes in DAT:
-No cure, however some of the problematic behaviors associated w/ DAT can be somewhat controlled using behavioral approaches.
-Research has tried providing DAT patients w/ drugs that enhance ACh , however the effects are limited & inconsistent.
-Antidepressants are sometimes administered to depressed DAT patients (but we have to be careful giving them medication, b/c in their states they are susceptible to exaggerated responses)
-The best potential treatment
would be preventative/deployable at 1st
onset of DAT.
Treating Caregivers:
-The caregiver needs to deal w/ the “social death” of the patient. They are at high risk for depression.
-Most DAT patients are cared for at home for emotional reasons.
-The move into an institution
could worsen symptoms. Early rather than later removal to an institution
is better.
Vascular Dementia
Vascular dementia (VAD)- Dementia resulting from a series of circumscribed (determined) cerebral infarcts (small strokes) that cumulatively destroy neurons over expanding regions of the brain, leading to brain atrophy & behavioral impairments that ultimately mimic those of DAT.
-The decline is less smooth for several reasons:
-VAD is far less common than DAT probably b/c many people die from the stroke. Some patients are discovered to have “mixed” dementia- both DAT & VAD.
-Treatment of VAD offers
much more hope. Management measures (not medication) useful for DAT
is probably useful for VAD as well since the psychological & behavioral
aspects of the 2 are alike.
Disorders Involving Head Injury
Traumatic brain injuries
(TBI)- Any brain damage resulting from head trauma, such as
in motor vehicle crashes or gunshot wounds.
-Brain injuries having
notable, long-standing effects on adaptive functioning are coded on
Axis-I using the appropriate syndromal descriptive phrase,
“due to head trauma.”
The Clinical Picture in Head Injury Disorders:
-Most neuropsychologically significant head injuries give rise to immediate acute reactions (ex. unconciousness). In cases of unconciousness, the person often experiences retrograde amnesia- inability to recall events immediately preceding the injury.
Anterograde amnesia (post-traumatic amnesia)- inability to effectively store in memory events happening during variable periods the time after the trauma.
Coma- being unconscious for an extended period of time.
-Anterograde amnesia
has a negative prognosis & prognosis for improvement is poor after
having been in a coma. Coma is sometimes followed by delirium.
-Head injury may cause disruptions of brain function quite often develop into chronic disorders. Most recovery tends to occur in the earliest post-trauma phase.
-Bleeding may occur (intracranial
hemorrhage). Enough blood may accumulate w/in the skull & cause
pressure on neighboring brain regions (subdural hematoma- one type)
if not relieved, this can produce permanent neuronal damage. Petechial
hemorrhages is whne there are small spots of bleeding.
Treatments & Outcomes:
-Immediate medical treatment
of head injuries often needs to be followed by reeducation & rehab.
After-effects of moderate brain injury:
-Extensive brain damage
could cause markedly reduced intellectual level (especially temporal/parietal
lobe lesions).
-Various specific neurological & psychological defects may follow localized brain damage. Ex. Epilepsy.
-In a minority of brain
injury cases personality changes occur (Ex. Phineas Gage, or passivity,
anxiety, depression).
-Most people w/ mild
concussions go back to normal shortly. Moderate brain injuries take
longer & they suffer from the above symptoms. Severe cases can vary
from need to institutionalization to being able to relearn things (intact
brain areas taking over). The younger one is at the time of injury,
the fewer competencies they have & the harder recovery.
Outcomes of brain injury are most favorable when there is:
-Individuals who are
also victims of alcholism, drug dependence, other medical problems are
at greater risk.
Mental Retardation
Mental retardation-
Significantly subaverage general intellectual functioning that is diagnosed
before age 18 & is accompanied by significant limitations in adaptive
functioning in skill areas such as self-care & safety.
Mild Mental Retardation:
Moderate Mental Retardation:
Severe Mental Retardation:
Profound Mental Retardation:
-Usually severe &
profound can be diagnosed in infancy due to delayed development &
physical malformations. They still may have more ability in some areas
than in others.
Diagnosis Guidelines:
-American Association
on Mental Retardation (AAMR) raised cutoff point for diagnosis of mental
retardation to IQ 75 (thus expanding the pool of eligibles). Instead
of listing level of severity they listed level of support needed.
Brain Defects in Mental Retardation
-25% of mental
retardation cases involve organic brain pathology (almost always at
least moderate & profound always).
Genetic-Chromosomal Factors:
Infections & Toxic Agents:
Prematurity & Trauma (Physical Injury):
Ionizing Radiation:
Malnutrition & Other Biological Factors:
Organic Retardation Syndromes
Down syndrome- A condition resulting for a chromosomal abnormality (trisomy 21) & associated w/ moderate to sever mental retardation, typically accompanied by characteristic physical features.
Phenylketonuria (PKU):
PKU- An inheritable condition that can result in mental retardation & that involves the lack of a liver enzyme needed to break down phenylalanine, amino acid found in many foods.
Cranial Anomalies:
Macrocephaly (large-headedness)-
Rare condition associated w/ mental retardation & characterized
by an increase in the size & weight of the brain, enlargement of
the skull, visual impairment, convulsions & other neurological symptoms,
resulting from abnormal growth of the glial cells that form the supporting
structure for brain tissue.
Microcephaly (small-headedness)- Condition characterized by mental retardation resulting from impaired development of the brain & a consequent failure of the cranium to attain normal size.
-Microcephalics range from moderate to profoundly retarded.
-Caused by radiation
& infections in uterus.
Hydrocephalus- Relatively rare condition in which the accumulation of an abnormal amount of cerebrospinal fluid w/in the cranium causes damage to the brain tissues & enlargement of the skull, leading to some degree of intellectual impairment.
-Can be congenital, or can develop in infancy/early childhood due to a tumor, etc. (in those cases it’s always caused by a blockage of cerebrospinal pathways).
-Depending on case the
damage varies. Can cause convulsions, hearing/vision loss. Early diagnosis/treatment
can prevent sever brain damage.
Cultural-Familial Mental Retardation
-Sociocultural conditions, particularly where there is a deprivation of normal environment stimulation, can cause mental retardation (usually only mild). 2 subtypes that may fall into this category:
Treatments, Outcomes, & Prevention
Treatment Facilities & Methods:
-Institutionalization of retarded kids should be a “last resort”. Institutionalized kids fall into 2 groups:
-In these cases social
incompetence is main factor of the decision.
Education & Mainstreaming:
-Educational & training
procedures involve mapping out target areas of improvement. Often step-by-step
training can bring retarded individuals repeated experiences of success
& lead to substantial progress.
Mainstreaming- Placement of mentally retarded children in regular school classrooms for all or part of the day.
-A disadvantage of mainstreaming is deficits in self-esteem experienced by the retarded child, however this can be reduced if they receive social skills training 1st.
-Parallel Alternate Curriculum
emphasizes specialized instruction in a normal class setting & has
shown much promise.
Frontiers in Prevention:
-Programs to prevent
mental retardation have focused on reaching high-risk children early
w/ the intensive cognitive stimulation believed to underlie sound development
of mental ability. It is possible that educational performance of these
kids improves because of temporary enhanced motivation & not higher
rates of cognitive development, meaning that where the environment continues
to be harmful, the gain could be lost upon the end of the short-term
program.
Chapter 14- Disorders of Childhood & Adolescence
Maladaptive Behavior in Different Life Periods
Developmental psychopathology- field of psychology that focuses on determining the origins & course of development of individual maladaption in the context of normal growth processes.
-Important to view child’s
behavior in reference w/ normal child development
Special Vulnerabilities of Young Children
Vulnerabilities of children to development of psychological problems:
-However, kids recover
more quickly from their hurts.
Disorders of Childhood
Attention Deficit/Hyperactivity Disorder
Attention deficit/hyperactivity disorder (ADHD)- disorder of childhood characterized by difficulties that interfere w/ task-oriented behavior such as impulsivity, excessive or exaggerated motor activity, & difficulties in sustaining attention; also known as hyperactivity.
Causal Factors:
-Genetic precursors &
social environment precursors: family pathology, particularly parental
personality problems.
Treatments & Outcomes:
Pharmacological treatments:
Behavior therapy:
Conduct Disorder & Oppositional Defiant Disorder
Conduct disorder- childhood disorder that appears by age 9 & is marked by persistent acts of aggressive or antisocial behavior that may or may not be unlawful.
Oppositional defiant disorder- childhood disorder that appears by age 6 & is characterized by persistent acts of aggressive or antisocial behavior that may or may not be unlawful.
-These disorders are
serious & complex to treat. Oppositional defiant disorder is a developmental
precursor for conduct disorder.
Juvenile delinquency-
legal term used to refer to violations of the law committed by minors.
Anxiety Disorders of Childhood & Adolescence
Separation anxiety disorder- childhood disorder characterized by unrealistic fears, oversensitivity, self-consciousness, nightmares, & chronic anxiety.
Selective mutism- anxiety-based disorder of childhood that involves the persistent
failure to speak in specific social situations, which interferes w/ educational or social adjustment.
Causal Factors in Anxiety Disorders:
Treatment & Outcomes:
Childhood Depression
-Diagnosed same as for
adults, except that irritability (temper tantrums, crying, yelling,
throwing objects) is often found as a major symptom & can be substituted
for depressed mood.
Causal Factors in Childhood Depression:
Treatment & Outcomes:
Symptom Disorders: Enuresis, Encopresis, Sleepwalking, & Tics
Functional Enuresis:
Enuresis- habitual involuntary discharge of urine, usually at night, after the age of expected continence (age 5); in DSM this is bedwetting not organically caused.
Primary functional enuresis- children who have never been continent
Secondary functional enuresis-
children who have been continent for at least 1 yr., but have regressed.
Psychological factors:
Treatment:
Functional Encopresis:
Encopresis- symptom disorder of children who have not learned appropriate toileting for bowel movements after age 4.
Sleepwalking (somnambulism):
Sleepwalking disorder- sleep disorder that usually appears b/w ages 6-12 & involves repeated episodes of leaving the bed & walking around w/o being conscious of the experience or remembering later; also called somnambulism.
Tics:
Tic- any persistent, intermittent muscle twitch or spasm, usually limited to a localized muscle group, often of facial muscles.
Pervasive Developmental Disorder & Autism
Pervasive developmental disorder (PDD)- group of severely disabling conditions considered to result from structural problems in the brain & usually evident at birth or in early childhood.
Asberger’s disorder-
severe & sustained impairment in social interaction that involves
marked stereotypic behavior & inflexible adherence to routines,
but usually appears later than autism.
Autism- A disabling
pervasive developmental disorder that begins in infancy & involves
a wide range of problematic behaviors, including deficits in language,
perceptual, & motor development; defective reality testing, &
an inability to function in social situations.
The Clinical Picture in Autism Disorder
Causal Factors in Autism
Treatment & Outcomes of Autism
Medical Treatment:
-Not effective, though
sometimes they use antipsychotic drugs or antihypersensitive drugs when
the child isn’t manageable.
Behavioral Treatment:
Planning Better Programs to Help Children & Adolescents
Factors that must be considered in providing treatment to children & adolescents:
Q. Why is therapeutic intervention a more complicated process w/ kids than adults?
A. Children may not be
motivated for therapy or sufficiently verbal to benefit from psychotherapeutic
models that work w/ adults.
Using Play Therapy to Resolve Children’s Psychological Problems
Child Abuse
Parents at high risk for child abuse:
-Parents tend to abuse when under stress & when children misbehave.