Abnormal Psychology Exam #1

Obsessions

-Thoughts that are invasive and foreign -If you ignore them you get anxiety -They can take various forms: wishes, impulses, images, ideas, doubts -Have common themes: dirt/contamination, violence/aggression, orderliness, religion, sexuality

Why Anxiety According to Cognitive Model

You rehearse bad things that could happen, you have dysfunctional thinking so you have to change the maladaptive assumption.

Why did Elaine finally decide to seek treatment?

The orthopedist referred her because Elaine freaked out when they talked about surgery

abnormal psychology

The scientific study of abnormal behavior undertaken to describe, predict, explain, and change abnormal patterns of functioning.

What event precipitated Elaine's PTSD?

The subway accident followed by a prolonged wait from first responders and then a stressful hospital experience.

Compulsions

-"voluntary" behavior or mental acts -feel mandatory -recognize that it's unreasonable but if not done something bad will happen -If you do the bx the anxiety goes down and so behavior gets reinforced.

Obsessions take many different forms. List 3.

-(Wishes, impulses, images, ideas, doubts—the 5 forms obsessions take) -Idea that bad things will to happen if she is negligent (ideas/impulses) -Worry about causing an accident. Doubted she had not caused an accident (doubts?) -Violent imagery (images and ideas)

Phobia Diagnosis Criteria

-A marked fear about an object or situation. -The object provokes immediate fear. -Object is the avoided. -The fear is disproportional to what the actual danger is. -you must have the fear for longer than 6 months -it can't be related to other Mental Health DX. (You can have more than 1 phobia and it's more common in women)

Treatment for Panic DX

-Antidepressants -Benzodiazepines slows down people -Cognitive Therapy (educates and gives coping mechanisms)

Why Do We Forget Things?

-Decay=memories are not recalled and lose strength as a process of decay -Interference=two different kinds. Retroactive means that older items are forgotten because of new memories and proactive means older items get in the way of learning new ones. -Overwriting=memories are changes by later events (The woman who was told she found her mom in a swimming pool)

Treatment for PTSD

-Drug Therapy (antianxiety or antidepressants. Proprandol, a blood pressure medication, helps) -Exposure techniques -Cognitive processing therapy -Eye movement desensitization reprocessing (tell story but have them move eyes in a certain way) -Group therapy -Insight therapy in order to lessen guilt

Diagnostic Criteria for PTSD

-Exposure to Trauma -Experiences at least 1 intrusive symptom -Person avoids trauma linked stimulus -Experiences negative changes in trauma-linked cognition and moods like experiencing negative emotions -Person displays excessive arousal -Person experiences distress or impairment with sx lasting more than a month.

Dissociative Identity Disorder

-Have subpersonalities. You'll have a primary one and switching between them is dramatic. It's three times more likely in women than men. -Insight of personalities varies from case to case. You can have mutually amnesic, mutually cognizant, or one-way amnesic relationships. -Personalities will have different characteristics. So they'll vary in age, gender, or race and can have different abilities. For example, one personality will be able to drive while another will not or one can speak a foreign language while another cannot. -Personalities will have different physiological responses. So, one personality can be allergic to bees while another one won't be. -You must have 2 or more personalities in order to have this. There's debate whether this actually exists or not or if it's produced by psychologists putting thoughts in their patient's heads.

Diagnosis Criteria for GAD

-Inappropriate worry for more than 6 months -Anxiety is difficult to control -Must have 3 or more of these SX: 1. Restlessness/on edge 2.Easily fatigued 3. Can't concentrate 4. Irritability 5. Muscle Tension 6. Sleep Disturbances -SX must cause distress and impairment -No substance or medical link -No other mental health disorder causing anxiety

Symptoms of PTSD

-Intrusive memories -Avoidant/numbing (Avoids crowd and feeling response) -Hyperarousal -Duration of symptoms are greater than 1 month -Impairment of function

Criteria for Diagnosing a Panic Disorder

-Recurrent, unexpected Panic Attacks -4 SX of panic at once -1 month of intense fear or discomfort after attack about having another attack -You avoid things so you won't have another attack

During the first session, Dr. Fehrman gave Elaine 3 components of her therapy. Describe those 3 componenets.

-Survey all of the different ways in which Elaine's life had been changed by her current fears and anxieties. The create an anxiety hierarchy and she would expose herself to those things -Exposure to the traumatic memory -Monitor feelings and bx

Stress DX

-The persistent feeling of arousal, anxiety, and then depression followed by an event. -Acute Stress DX=symptoms within 4 weeks and last less than a month. -PTSD=Symptoms last for years.

Describe the 4 steps Joe goes through in order to overcome his panic attacks

-Training and relaxation and breathing techniques -Changes cognitive interpretations of panic sensations (He can get up and walk around and he'd be ok) -Repeated exposure to sensations of panic under controlled conditions (He exposed himself to images of planes and visited the airport etc) -Repeated practice in situation that Joe was avoiding or apprehensive about. (Walking outside alone)

Why Do You Get Stress DX

-Traumatic Event sparks it -Severity of trauma -Biological component (Amygdala, which is in charge of fear memories and startle reflex, is overactive. The Hippocampus, which stores memory is affected. In PTSD your medial prefrontal cortex, which helps you to calm down and it's activity is seen to be lower. -Weak support system after event -Stress of adults could be passed to children (9/11 or Holocaust kids. Epigenetics)

Diagnosis Criteria for Agoraphobia

-marked fear of 2+ situations (for example, you have both a fear of open spaces and in closed spaces or of both standing in line and being in a crowd). -Fear of unable to escape or reach help -Avoid situations that trigger fear (so you won't leave the house). -Must last more than 6 months -Not caused by another Mental Health DX

Causes for Panic DX

-norepinephrine is known to be irregular. -associated with amygdala dysfunction, people might be predisposed to it. -Genetic component (In twins if one has it the other has a 33% chance of getting it) -Person misinterprets Body Cues (this is the cognitive view)

Diagnosis Criteria for OCD

-presence of obsessions, compulsions, or both. -compulsions must be time consuming=more than an hour a day -Causes distress or impairment

Dissociative DX

A disorder that has to do with memory. You basically lose your identity because you lose your memory. The DX's we talked abotu were Dissociative Amnesia, Dissociative Fugue, and Dissociative Identity DX. Symptoms include memory loss, identity disruption usually in response to some significant stress.

What modes of therapy did Dr. Fehrman select to assist Elaine with her disorder? Give an example of each type of therapy

A combination of cognitive and behavioral therapy. For example, bx therapy was exposing her to the events either in vivo or imaginatively and listening to a tape recorder of her voice recounting the event. For cognitive, they guided the client to think differently about event and possible current dangers. Challenges the accuracy of the individual's negative cognitions.

How many sessions did it take for her to overcome her household obsessions?

6-7 Session

Stress

Activates the sympathetic nervous system, which is our fight or flight response. People cope and respond to it differently. Stressful events cause arousal and fear.

When do OCD behaviors begin for most individuals

Adolescents and childhood. 19.5 years of age on average.

How did Joe's avoidance of going outside contribute to his panic disorder?

Avoiding going outside prevented Joe from having a positive experience going outside. Just one positive experience would have shown him that his panic attacks were not related to going outside. He was worried he would have a panic attack and not be able to get help.

Why did the dr. diagnose Elaine with PTSD rather than acute stress DX?

Because symptoms lasted more than a month. She was isolated and wouldn't leave the house.

Why do friends and relatives eventually distance themselves from a person who has had a traumatic accident?

Because that's all they talk about. Friends said that when talking to Elaine they felt she wasn't listening and only wanted to bring the topic back to her accident.

Behavioral Model

Believe that bx is based on experience (interaction with environment). Treatments focus on learning i.e. conditioning like Classical-Biological/involuntary change due to pairings of an US to CS (Uses desensitization like exposure therapy for people with phobias), Operant-Voluntary bx due to rewards or punishments, Modeling-Watching/observing modeled bx. The Therapist is the teacher and they teach the client how they should bx and they help eliminate bad bx. This works with ADD really well! Strengths=Powerful movement, Researchable. Weaknesses=Symptoms not always acquired by conditioning (sometimes it has to do with the resiliency factor), Limited (Doesn't focus on the cognitive aspect)

What are symptoms of most panic attacks

Breathlessness, dizziness, chest discomfort, increased heart rate... lots of symptoms.

What type of therapy did Sarah try to overcome her OCD disorder

Cognitive-behavioral therapy. Specifically exposure and response prevention therapy.

What was the purpose of recording Sarah's visually imagine disaster scenes

Continual listening provided exposure to the outcome and helped her anxiety decrease with time. Listening specifically helps her expose herself to the outcome without actually doing the action (she cannot actually expose herself to burning buildings or stabbings)

Which neurotransmitter and which hormone often have abnormal activity in survivors of severe stress?

Cortisol is the hormone and the neurotransmitter is norepinephrine

Anxiety DX

Different from fear because fear is when there is a serious well-known threat that causes immediate alarm. Anxiety is a state of alarm. Worried you could be in danger. most common DX in the US. 4% of population will develop one in Western cultures. It is commonly co-morbid, depression is often associated with it. There are 5 different Anxiety Disorders: 1. GAD=Generalized Anxiety Disorder 2. Phobia 3. Agoraphobia=fear that help won't come 4. Social Anxiety=Anxiety about doing things in front of people. 5. Panic Disorder Has a variety of symptoms: Lots of physical symptoms like trembling or sweating etc. It is abnormal when it's chronic and it interferes with your life. When you're startled too often and causes severe discomfort.

Dissociative Fugue

Dissociative Amnesia in which a person travels to a new location and assumes a new identity. May be brief a couple hours, days, or months. It ends abruptly and they regain their memory. Example, the guy who got married and three days later forgot everything.

Why was Dr. Geller convinced that panic disorders are a combination of biological and cognitive factors?

Dr. Geller pointed out that the flight or flight response and the associated symptoms of panic attacks are normal biological responses. However, he pointed out that Joe was misinterpreting his biological symptoms and panicking. In order to over come his symptoms he needed to change the way he perceived the biological changes. After one panic attack it becomes easy to become confused about your body sensations.

Why Anxiety According to Psychodynamic Model

There is conflict between egos and childhood forces. There was anxiety in childhood, poor defense mechanisms, repression of painful memories that cause anxiety.

Cause of Phobia According to Biological

Emotional memories and fight or flight response.

Treating Agoraphobia

Exposure Therapy is used. So, they walk/go farther and farther from home. 60% tend to get better but relapse is typical.

Treatment for OCD

Exposure and resistance to compulsions. 26% fail to improve at all. Cognitive model would strive to neutralize thoughts and actions and neutralize action as reward and then focus on education Cognitive-BX therapy is most effective and they use exposure and education.

Cognitive Model

Focuses on cognitive processes like assumptions, attitudes and thoughts of client. Looks at illogical thinking like depression and self-worth. Therapy most used and the original model is Beck's Cognitive Therapy to restructure thoughts. Strengths=Huge appeal because you're changing how you think, useful and effective, researchable. Weaknesses=Doesn't work for everybody, newer model, it's a mindfulness based technique

Models of Abnormality

Give guidelines for influence, observations, asking questions, and information that is needed. Types: Biological Psychoanalytic, Behavioral, Cognitive, Humanistic-existential, Sociocultural.

Why Anxiety According to Humanistic Model

Harsh self-standard or self-judgement.

Sociocultural Model

Has a Family-Social Perspective. So it looks at social labels (what it means to be a mother), social connections (others are effected by illness like the family), and has family systems theory (family is a unit with interacting parts). Therapies are group, family, or couple. Show that someone else is going through the exact same thing. Also, has a multicultural perspective and looks at how cultures change from generation to generation and how not all therapies like gender-sensitive or feminist therapies don't work for all. Strengths=Has awareness of social roles and successful when other therapies have failed. Weaknesses=Individual difference aren't taken into account as much and it's difficult to establish that culture is the cause.

What was Joe's outcome

He was panic free and was able to travel to Europe.

Who in Jenny's family appeared to have hoarding tendencies? What situation appeared to trigger an episode?

Her aunt. It was triggered by the death of Andrew, her aunt's son.

How did Jenny's hoarding interfere with her life?

Her kids were embarrassed to bring friends over. Jenny didn't invite people over. Her husband, Steve, eventually separated from her and took the kids. The house was gross. Kept her isolated from her parents and friends.

Why Anxiety According to Biological Model

Hereditary Factor (If you have a close relative with anxiety DX you have a 15% increase in your chances of developing it), don't have enough GABA or some other problem with nerotransmitters. Diet changes can help with anxiety.

Why is Joe's case different from most panic attacks

His symptoms started at age 76. Most people develop panic disorders in their 20's and 30's.

How is it that Jenny didn't think she had a problem until after she had been in treatment for some time?

Hoarding builds up so slowly so they don't notice it. She was also very defensive about her disorder. She had a lack of insight.

Describe the cognitive-behavioral model of hoarding.

Hoarding consists of excessive acquisition and difficulty discarding items, which result in extreme clutter in the living environment. There is a lot of evidence to suggest that hoarding stems from a combination of information-processing deficits, problematic beliefs and bxs, and emotional distress and avoidance.

Humanistic-Existential Model

Humanist (drive to self-actualize, everyone has the potential for goodness, focuses on concern for others). It's client centered therapy. So it's warm and positive and empathetic (This makes it hard to do for criminals but you do see progress). Uses Gestalt Therapy, which looks at self-recognition, role play, and drum therapy. As well as Existential Therapy, which uses accepted responsibility and authenticity. Strengths=Emphasizes the individual, very positive. Weaknesses=Abstract issues, difficult to research (They originally didn't think there was a need for research)

Phobia Treatment

Not often treated. Most common is flooding or exposure. Exposure Therapy=Patient MUST touch object because of memory that drives phobia and you have to create a new memory. A drug can be taken to block the adrenal response.

Why would it not have been effective just to call a junkman to clear everything our of Jenny's house and make a clean start?

It wouldn't actually stop the symptoms. The hoarding won't actually stop. Would have caused her a lot of emotional distress.

What event precipitated Joe's panic attacks

Joe's fall contributed to his panic attacks. He stated that he was afraid of walking. The fall may have made him realize that he was vulnerable and aging. Symptoms also occurred right after the fall. (Nothing specifically happened after Vietnam. It was just an understandably stressful instance in his life)

Beck's Cognitive Therapy

Just called Cognitive Therapy. In this therapists help clients recognize the negative thoughts, biased interpretations, and errors in logic that dominate their thinking and cause them to feel depressed. Helps to stop maladaptive thinking

Psychodynamic Model

Looks at interacting psychological forces influencing the unconscious. It's hard to say why you're doing something because sometimes you don't know. There is a spectrum for normal to abnormal. It's only abnormal if there are conflicts of forces for example, anxiety. Freud was all about this and stressed the importance of developmental stages such as childhood/past and how your bx now links to that. Three Unconscious Forces: 1. Id=Instinctual needs 2. Ego=Think rather than feelings (knows when things are appropriate or not) 3. Super-Ego=Morality/Conscious (You initially adopt your parents superego) The Rorschach Inkblot Test is used in this and it actually is pretty effective. For example, PTSD or the kids who experienced trauma and looked at the mechanic image. Strengths=1st psychological treatment and shows that abnormal and normal aren't so far a part, apply theory and techniques to treatments (can treat schizophrenia), useful for people who don't have cognitive capacity for therapy (like play therapy). Weaknesses=Can't research because you can't test unconscious bx!

Biological Model

Looks at the malfunctioning of the body and brain anatomy, chemistry (in the brain regions), genetic factors, evolution and viruses during development. Strengths=highly respected in the field. Constantly finding new info because it is so researchable (we can look into the brain/study it), and often times the treatments provide relief.

Why do individuals first suspect a general medical condition?

Many of these symptoms are symptoms of heart attacks as well. Many people belief the chest pain and tightness in their chest is caused by a heart attack and go to the emergency room.

OCD

Obsessive Compulsive Disorder. Person has obsessions=persistent thoughts, ideas, impulses or images that are usually disturbing or bothersome and compulsions=repetitive and rigid behavior to help relieve obsessions. Example: The mother who did crazy things to protect her son. OCD related disorders are: Trichotillomania (excessive hair pulling), Body Dysmorphic DX, and Hoarding

According to the text, how long does it typically take for people to recover from PTSD? What percent of people continue to experience symptoms even after receiving treatment

PTSD last for 3 years with treatment and 5.5 years without treatment 12.6 % of people in lower Manhattan had PTSD.

Panic Disorder

Panic is normal, but when it happens for no reason that's abnormal. When having a panic attack most people mistake it for a heart attack and go to the ER. Attacks=Sudden burst of panic when there's no trigger. It happens quickly and then goes away. Attacks aren't uncommon, but when they happen repetitively you have a Panic Disorder. You can actually cause yourself to panic when you ruminate. More common in women and low SES. You have 5% chance of developing it in your lifetime. Not a lot of variety between cultures.

Dissociative Amnesia

Person will have memory impairment with a lack of physical cause. Usually due to some type of trauma. 4 Different Types: -Localized Dissociative Amnesia=Can't remember the actual event but can remember things surrounding it -Selective Dissociative Amnesia=Can remember some but not all details about the event -Generalized Dissociative Amnesia=Memory loss beginning with an event and then extends back to older memories. Loss of identity. (The guy in the Seattle airport) -Continuous Dissociative Amnesia-Forgetting continues into the future and into the past. Can't form new memories and is the most rare of Dissociatice Amnesia

Causes of OCD

Psychodynamic would say that the battle is between conscious. Id impulses=obsessive thoughts and ego defenses=compulsive actions. Behavior would say that they learn the compulsions to treat the obsession because anxiety goes down when the compulsions are done and so bx is reinforced. Biological shows that there's a genetic component and 53% chance of getting it if you have a twin that has it. Linked to Frontal cortex and caudate nucleus being too active. Serotonin also has an effect on the repetitive bx.

Treatment for DID

Psychodynamic, Hypnotic (Shows a good amount of success), Drug (limited success). The goal is to integrate the personalities into one.

How many sessions did it take for Sarah to overcome her OCD disorder related to both household and driving issues?

Sessions 15-18

List some of the beliefs Jenny had about why it was important to hold onto things

She didn't want to forget about her cousin, believed she could use things for arts and crafts or sell these things online were used to justify keeping things.

Why did Elaine fail to take notes of her feared activities as part of her treatment plan? How did Dr. Fehrman handle this problem in his session with Elaine?

She failed to take notes because she was freaked out by surgery. The dr. wanted her to have surgery and that freaked her out so bad so that she felt like she couldn't do anything else. The therapist said to push off the surgery and focus on this treatment instead.

What characteristics did Jenny have as a child that are common in individuals who develop hoarding disorder?

She had ADHD as a child and was indecisive. Disorganized desk and couldn't throw away packaging.

What did Sarah learn from keeping track of her obsessions and compulsions? How did the doctor use this information to help her during her treatment?

She was able to categorize her obsessions and work on them individually. They were also able to create a thorough list of her obsessions so they knew exactly needed to be treated and accomplished, in order for her to live a normal life. They were also able to see which one impacted her life the most. She could see how much time she spent on the tasks and how destructive they were to her life. They were able to work on the smaller more easily overcome tasks to start off, because they knew what they were.

Why did Sarah Finally decide to seek treatment

She was getting married and her fiance asked her to get treatment

What were Sarah's primary obsessions and compulsions

She was obsessed with the apartment destruction, driving, and violent thoughts and images. Her compulsions included driving abnormally, checking and rechecking everything in her apartment, and making sure the violent actions and images had not actually happening.

What was the purpose of recording the traumatizing event?

So that she could listen to it multiple times a day and then it was just exposure therapy so that over time she would overcome her anxiety about the event.

How do we define something as abnormal?

The 4 D's Deviance (different, extreme, unusual, perhaps even bizarre), Distress (unpleasant and upsetting to the person), Dysfunction (interfering with the person's ability to conduct daily activities in a constructive way), and Dangerous (risk or harm to themselves or others, best indicator but it's rare).

Cause of Phobia According to BX Model

They were classically conditioned to fear object or they learned through modeling like observing a parents fearful reaction. Behavioral-Evolutionary says that things that are good for you aren't likely to become phobia's so in some ways we may be programmed to have phobias for survival.

PTSD

Used to be called shell shock. Wasn't really noticed until after Vietnam. 30% of soldiers in Vietnam had PTSD. Additionally 22% had stress symptoms and about 10% still experience symptoms. I order to have PTSD or a stress DX you must be exposed to trauma or stress. For example, Natural disasters (10X more common to see PTSD in natural disaster survivors than in veterans), Victimization (Abuse, 30% of abuse victims develop PTSD, rape, 1 in 3 women who are raped will develop PTSD), Terrorism/Torture.

Agoraphobia

When you are afraid to be without help. More common in low SES (you're 2x more likely to have it). Develops in 20-30s. You will avoid crowded places, public transit, etc. It fluctuates in intensity. (That lady with the bizarre cousin dispute)

Generalized Anxiety Disorder

Worry too much about everything. No reason. It's "free floating"-there's no trigger for it. Symptoms=Restlessness, on edge, fatigue, difficulty concentrating, muscle tension, and/or sleep problems. Usually see it appear in children or adolescence. Women are more likely to be diagnosed 2:1 and it's really hard to diagnose. Onset most common for diagnosis is 30 years old even though kids get it because treatment usually isn't sought out until later so it often goes undiagnosed for years.

Why Anxiety According to Sociocultural Model

cultural differences cause anxiety. Family separation or expectations can cause it. Low SES and environment (you're more likely to have anxiety disorder if you're in poverty and in dangerous social situations), blacks and hispanics born in the US are more likely to have anxiety than those who immigrate here.

What other incident in Elaine's early life may have contributed to her PTSD?

er early upbringing during the Civil Rights Movement. At one point she got arrested with her family for a non-violent protest. Constantly got hate mail and death threats.

mutually cognizant patterns

personalities in DID are aware of each other

mutually amnesic

personalities in DID are not aware of the other personalities.

Physical Stress DX

psychophysiological disorder that changes the body physically. -Ulcers -Asthma -Insomnia -Chronic Headaches -Hypertension -Coronary Heart Disease

norms

society's stated and unstated rules for proper conduct. Bx, thoughts, and emotions that break this in the psychological sense are considered abnormal. This is developed through society's culture.

One-way amnesic relationship

some personalities in DID are aware of other personalities and some are not. This is the most common subpersonality type in DID.