Abnormal Psychology II - Exam 2

Reactive Attachment Disorder Criteria:

- A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following: o The child rarely or minimally seeks comfort when distressed. o The child rarely or minimally responds to comfort when distressed. - A persistent social and emotional disturbance characterized by at least two of the following: o Minimal social and emotional responsiveness to others o Limited positive affect o Episodes of unexplained irritability, sadness, or fearfulness that are evident even during non-threatening interactions with adult caregivers - The child has experienced a pattern of extremes or insufficient care as evidenced by at least one of the following: o Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults. o Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care). o Rearing in unusual setting that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios) - The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A. (e.g., the disturbances in criterion A began following the lack of adequate care in Criterion C.) - The criteria are not met for autism spectrum disorder. - The disturbance is evident before age 5. - The child has a developmental age of at least 9 months. o Specify if: § Persistent: The disorder has been present for more than 12 months. § Specify current severity: Reactive attachment disorder is specified as severe when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.

Hypomanic Episode Symptoms:

- A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day. - During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree: o Inflated self-esteem or grandiosity o Decreased need for sleep (e.g., feels rested after only 3 hours of sleep) o More talkative than usual or pressure to keep talking o Flight of ideas or subjective experience that thoughts are racing o Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. o Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation. o Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). - The episode is associated with an unequivocal change in functioning that is uncharacteristic of the induvial when not symptomatic - The disturbance in mood and the change in functioning are observable by others. - The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode, is by definition, manic. - The episode is not attributable to the physiological effects of a substance.

Disinhibited Social Engagement Disorder Criteria:

- A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following: o Reduced or absent reticence in approaching and interacting with unfamiliar adults. o Overly familiar verbal or physical behavior (hat is not consistent with culturally sanctioned and age-appropriate social boundaries) o Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings. o Willingness to go off with an unfamiliar adult with minimal or no hesitation. - The behaviors in Criterion A are not limited to impulsivity (as in attention-deficit/hyperactivity disorder) but include socially disinhibited behavior. - The child has experienced a pattern of extremes of insufficient care as evidenced by at lease one of the following: o Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults. o Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care). o Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratio). - The care in criterion C is presumed to be responsible for the disturbed behavior in criterion A (e.g., the disturbances in criterion A began following the pathogenic care in criterion C) - The child has a developmental age of at least 9 months. o Specify if: § Persistent: The disorder has been present for more than 12 months o Specify current severity: § Disinhibited social engagement disorder is specified as severe when the child exhibits all symptoms of the disorder with each symptom manifesting at relatively high levels.

Bipolar I Disorder Symptoms

- Criteria have not been met for at least one manic episode (Criteria A-D under Manic Episode) - The occurrence of the manic and major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

Persistent Depressive Disorder (Dysthymia) Criteria:

- Depressed mood for most of the day, for most days than not, as indicated by either subjective account or observations by others, for at least 2 years. - Presence, while depressed, of two or more of the following: o Poor appetite or overeating o Insomnia or hypersomnia o Low energy or fatigue o Low Self-esteem o Poor concentration or difficulty making decisions o Feelings of hopelessness - During the 2-year-period (1 year for children or adolescents) of the disturbances, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time - Criteria for a major depressive disorder may be continuously present for 2 years - There has never been a manic episode or a hypomanic episode, and criteria have never been met for the cyclothymic disorder. - The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder, - The symptoms are not attributable to the physiological effects of a substance (e.g., a drug or abuse, a medication) or another medical condition (e.g., hypothyroidism) - The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. o Specify if: § With anxious distress § With mixed features § With melancholic features § With atypical features § With mood-congruent psychotic features § With mood-incongruent psychotic features § With peripartum onset § In partial remission § In full remission § Early onset: Before 21 years of age § Late onset: After 21 years of age § With pure dysthymic syndrome: Full criteria for a major depressive episode have not been met in at least the preceding 2 years. § With persistent major depressive episode: full criteria for a major depressive episode have been met throughout the preceding 2-year period. § With intermittent major depressive episodes, with current episode: Full criteria for a major depressive episode are currently met, but there have been periods of at least 8 weeks in at least the preceding 2 years with symptoms below the threshold for a full major depressive episode. § With intermittent major depressive episodes, without current episodes: Full criteria for a major depressive episode are not currently met, but there has been one or more major depressive episodes in at least the preceding 2 years. § Mild § Moderate § Severe

- Evaluation - Descriptive Theory:

- Does it describe how people who are depressed really are - Explains a lot of characteristics of depression

Acute Stress Disorder Criteria:

- Exposure to actual or threatened death, serious injury, or sexual violation in one, or more, of the following ways: o Directly experiencing the traumatic events o Witnessing, in person, the events as it occurred to others o Learning that the events occurred to a close family member or close friend. § Note: In cases of actual or threatened death of a family member or friend, the events must have been violent or accidental o Experiencing repeated or extreme exposure to aversive details of a traumatic event (e.g., first responders collecting human remains, police officers repeatedly exposed to details of child abuse). - Presence of nine or more of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event occurred: o Intrusion Symptoms: § Recurrent, involuntary, and intrusive distressing memories of the traumatic events § Recurrent distressing dreams in which the content and/or effect of the dream are related to the event. § Dissociative reactions (flashbacks) in which the individual feels or acts as if the traumatic events were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings). § Intense and prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic events. o Negative Moods: § Persistent inability to experience positive emotions (inability to experience happiness, satisfaction, or loving feelings). o Dissociative Symptoms: § An altered sense of the reality of one's surroundings or oneself (e.g., seeing oneself from another's perspective, being in a daze, tim slowing) § Inability to remember an important aspect if the traumatic events (typically due to dissociative amnesia and not to other factors sch as head injury, alcohol, or drugs). o Avoidance Symptoms: § Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic events. § Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic events. o Arousal Symptoms: § Sleep disturbances (e.g., difficulty falling or staying asleep, restless sleep) § Irritable behavior and angry outburst (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects. § Hypervigilance § Problems with concentration § Exaggerated startle response - Duration of the disturbance (symptoms in criterion B) is 3 days to 1 month after trauma exposure. - The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. - The disturbance is not attributable to the physiological effects of a substance (e.g., medication or alcohol) or another medical condition (e.g., mild traumatic brain injury) and is not better explained by brief psychotic disorder.

Major Depressive Episode Symptoms:

- Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. o Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note, in children and adolescents, can be irritable mood). o Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation). o Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decreased or increased appetite nearly every day. (Note, in children, consider failure to make expected weight gain). o Insomnia or hypersomnia nearly every day. o Psychomotor agitation or retardation nearly every day (observable by others; not merely subjective feelings of restlessness or being slowed down). o Fatigue or loss of energy nearly every day. o Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). o Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others). o Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or suicide attempt or a specific plan for committing suicide. - The symptoms cause clinically significant distress or impairment in social, occupational, or other areas of functioning. - The episode is not attributable to the physiological effects of a substance or another medical condition.

Major Depressive Disorder Criteria

- Five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either depressed mood or loss of interest of pleasure. o Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful) o Markedly diminished interest or pleasure in all, or most of all, activities most of the day, nearly every day (as indicated by either subjective account or observation). o Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease in appetite nearly every day. o Insomnia or hypersomnia nearly every day o Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings or restlessness or being slowed down) o Fatigue or loss of energy nearly every day o Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). o Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) o Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. - The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. - The episode is not attributable to the physiological effects of a substance or to another medical condition. - The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorder. - There has never been a manic episode or a hypomanic episode. o Specify if: § With anxious distress § With mixed features § With melancholic features § With atypical features § With mood-congruent psychotic features § With mood-incongruent psychotic features § With catatonia § With peripartum onset § With seasonal pattern

Posttraumatic Stress Disorder for children 6 years and younger Criteria:

- In children 6 years and younger, exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following days: o Directly experiencing the traumatic events o Witnessing, in person, the events as it occurred to others, especially primary caregivers o Learning that the traumatic events occurred to a parent or caregiver figure - Presence of one or more of the following intrusion symptoms associated with the traumatic events beginning after the traumatic event occurred: o Recurrent, involuntary, and intrusive distressing memories of the traumatic event o Recurrent distressing dreams in which the contend and/or affect of the dream are related to the traumatic event o Dissociative reactions (flashbacks) in which the child feels or acts as if the traumatic event were recurring. o Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic events. o Marked physiological reactions to reminders of the traumatic events. - One or more of the following symptoms, representing either persistent avoidance of stimuli associated with the traumatic events or negative alterations in cognitions and mood associated with the traumatic events, must be present, beginning after the events or worsening after the events: o Persistent avoidance of stimuli: § Avoidance of or efforts to avoid activities, places, or physical reminders that arouse recollections of traumatic events § Avoidance of or efforts to avoid people, conversations, or interpersonal situations that arouse recollections of the traumatic events. o Negative Alterations in Cognitions: § Substantially increased frequency of negative emotional states § Marked diminished interest or participation in significant activities, including constriction of play § Socially withdrawn behavior § Persistent reduction in expression of positive emotions - Alterations in arousal and reactivity associated with the traumatic events, beginning or worsening after the traumatic events occurred, as evident by two or more of the following: o Irritable behavior and angry outbursts, typically expressed as verbal or physical aggression toward people or objects o Hypervigilance o Exaggerated startle response o Problems with concentration o Sleep disturbances - The duration of the disturbance is more than 1 month - The disturbance causes clinically significant distress or impairment in relationship with parents, siblings, peers, or other caregivers or with school behavior - The disturbances is not attributable to the physiological effects of a substance or another medical condition o Specify if: § With dissociate symptoms: The individual's symptoms meet the criteria for posttraumatic stress disorder, and the individual experiences persistent or recurrent symptoms of either of the following: · Depersonalization: Persistent or recurrent experiences of feeling detached from and as if one were an outside observer of one's mental processes or body · Derealization: Persistent or recurrent experiences of unreality of surroundings o With delayed expression: If the full diagnostic criteria are not met within at least 6 months after the event.

Premenstrual Dysphoric Disorder Criteria

- In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses, - One or more of the following symptoms must be present: o Marked affective lability (e.g., mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection) o Marked irritability or anger or increased interpersonal conflicts. o Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts, o Marked anxiety, tension, and/or feelings of being keyed up or on edge. - One or more of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms of criterion B above. o Decreased interest in usual activity (work, school, friends, hobbies) o Subjective difficulty in concentration o Lethargy, easy fatigability, or marked lack of energy o Marked change in appetite; overeating; or specific food cravings o Hypersomnia or insomnia o A sense of being overwhelmed or out of control o Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of bloating, or weight gain - The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationship with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home) - The disturbance is mot merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder, or a personality disorder (although it may co-occur with any of these disorders) - Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles. - The symptoms are not attributable to the physiological effects of a substance or another medical condition.

Cognitive Theory:

- Negative patterns of thinking that are automatic

Disruptive Mood Dysregulation Disorder Criteria

- Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation. - The temper outbursts are inconsistent with developmental level. - The temper outbursts occur, on average, three or more times per week. - The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers). - Criterion A-D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A-D. - Criteria A and D are present in at least two or three settings (i.e., at home, at school, with peers) and are severe in at least one of these. - The diagnosis should not be made for the first time before age 6 or after 18 years of age. - By history or observation, the age at onset of criteria A-E is before 10 years old. - There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met. - The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g., autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder). - The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition.

Stressful Life Events:

- Stressful life events can often serve as a precipitating factor of depression - Connection between stressful life events and depression tends to be particularly strong in young adult females

Other Methodological factors in prevalence rates study:

- Study: 21% for self-report questionnaires compared to 4% of PTSD diagnoses due to a mental health specialist -> Angleheart 2007

Chronic is referring to how long for adults?

2 years

When do gender differences begin to arise when being diagnosed with depression?

Adolescences

What other disorders can run side by side with depression (comorbidity)?

Anxiety disorders and substance use disorders

Are black Americans or white Americans more likely to experience traumatic events?

Black Americans

How can someone blame the victim without meaning too?

Digging beneath the trauma and trying to know more details than necessary. Trying to find a way to blame the victim.

Persistent Depressive Disorder focuses on what symptom?

Depressed mood

Rothbaum B.O., & FOA, E.B. (1993) Subtypes of post-traumatic stress disorder and duration of the symptoms. In J.R.T. Davidson & E.B. Foa (Eds.), Posttraumatic stress disorder: DSM-IV and beyond (pp. 23-35). Washington, DC: American Psychiatric Press,

Duration of symptoms 95% of women who were sexually assaulted met symptom criteria for PTSD 2 weeks after the assault 1 month after the assault, it had declined to 63% 3 months after the assault, it dropped to 46% Natural recovery with time tends to be a pretty common pattern - this is good news!

Avoidance (PTSD)

Efforts to avoid the thoughts, feelings, and reminders of the event

Overall Prevalence for PTSD?

Estimated lifetime prevalence rates are around 6.8%.

Are introverts or extroverts more likely to experience traumatic events?

Extroverts

Arousal and Reactivity (PTSD)

Hypervigilance - head on a swivel Constantly on the lookout for someone/something Exaggerated startle response - easily jumpy Being aggressive and losing your temper

Our ability to remember really bad things that happened to us is an evolutionary advantage, it's about survival. But when does PTSD get involved?

If it's tormenting us, it's one thing to be able to remember those things and another to be tormented by those things.

Gender differences for depressive disorders:

Increasing for both men and women. But women are still experiencing/being diagnosed with depression significantly more than men are.

Recent increases for prevalence in depressive disorders:

Increasing with fairly alarming frequency over the last 10-15 years

Summary of symptoms for PTSD:

Intrusion Avoidance Cognitions and Mood Arousal and Reactivity

Intrusion (PTSD)

Intrusive thoughts, memories, nightmares Intruding on your life and mind Flashbacks

Why isn't it a good thing to tell someone with PTSD to just "give it time"

It will invalidate someone's experience. While time can help heal PTSD, it won't help heal all PTSD and shouldn't be used as a saying because it isn't the right approach.

When does the onset of depression occur?

Late adolescence/early adulthood. but could go through middle adulthood.

Are men or women more likely to experience traumatic events?

Men

What occupations are more likely to experience PTSD?

Police Officers, Solider, Paramedic

Cognitions and Mood (PTSD)

Self-blame If someone happens to you or if it happens to someone else - survival guilt If I chose somewhere else or done something else, it would've have happened to me

Human Intention vs Not Human Intention

Traumatic events are far from rare, they happen all over the world. Rates of PTSD differ based on types of trauma.

Gender Difference for PTSD?

Women: Estimated 9.7%. Men: Estimated 3.6%.

Can people be diagnosed with both persistent depressive disorder and major depressive disorder?

Yes

Can those in childhood be diagnosed with depression?

Yes, but only 2-3% will be diagnosed with depression.

Does family history play a role in those who experience the traumatic events?

Yes, if you have a family history of psychological problems, depression, anxiety, substance abuse, etc., you are more likely to experience traumatic events.

Does having a lower level than college education matter when it comes to PTSD?

Yes, those who have a lower education than college often experience traumatic events more than those with a college education.

Do those with conduct problems in childhood experience traumatic events more than those who did not have conduct problems?

Yes, those with conduct problems in childhood experience traumatic events more.

Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K.B., Kohlenberg, R. J., Addis, M. E., et al. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of

adults with major depression. Journal of Consulting and Clinical Psychology, 74, 658-70 ○ Done with people with moderately depression ○ Behavioral activation, cognitive therapy, and medication ○ Behavioral activation therapy - just after treatment better than cognitive therapy and the same as medication ○ Follow up, cognitive therapy tended to be superior to medication and behavioral activation treatment Possible that cognitive therapy is more sustainable and long-lasting

Posttraumatic Stress Disorder Criteria:

o (The following criteria apply to adults, adolescents, and children over the age of 6.) - Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: o Directly experiencing the traumatic events o Witnessing, in person, the event(s) as it occurred to others o Learning that the traumatic event occurred to close family member or close friend. In cases of actual or threatened death of a family member or close friend, the event must have been violent or accidental. o Experiencing repeated or extreme exposure to aversive details of the traumatic event (e.g., first responders collecting human remains, police officers repeatedly exposed to details of child abuse). - Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic even occurred: o Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s) § Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic events are expressed. o Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic events § Note: In children, there may be frightening dreams without recognizable content. o Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic events were recurring. (such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings). § Note: In children, trauma-specific reenactment may occur in play. o Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect to the traumatic event. o Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic events - Persistent avoidance of stimuli associated with the traumatic events, beginning after the traumatic events occurred, as evidenced by one or both of the following: o Avoidance of or efforts to avoid distressing memories, thoughts, or feelings bout or closely associated with the traumatic events. o Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic events. - Negative alternations in cognitions and mood associated with the traumatic events, beginning or worsening after the traumatic events occurred, as evidenced by two (or more) of the following: o Inability to remember an important aspect of the traumatic events (typically due to dissociative amnesia and not to other facts such as head injury, alcohol, or drugs). o Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., I feel bad, no one cam be trusted, the world is completely dangerous, my whole nervous system is permanently ruined) o Persistent, distorted cognitions about the cause or consequences of the traumatic events that lead the individual to blame himself/herself or others o Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame) o Markedly diminished interest or participation in significant activites. o Feelings of detachment or estrangement from others. o Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings). - Marked alternations in arousal and reactivity associated with the traumatic events, beginning or worsening after the traumatic events occurred, as evidenced by two or more of the following: o Irritable behaviors and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects o Reckless or self-destructive behavior o Hypervigilance o Exaggerated startle response o Problems with concentrating o Sleep disturbances - Duration of the disturbance is more than 1 month - The disturbances cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. - The disturbance is not attributable to the physiological effects of a substance or another medical condition. o Specify if: § With dissociative symptoms: The individual's symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following: · Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one's mental processes or body (e.g., feelings as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly) · Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted) § With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event

Manic Episode Symptoms

o A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary). o During the period of mood disturbance and increased energy or activity, there (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior. § Inflated self-esteem or grandiosity § Decreased need for sleep (e.g., feels rested after only 3 hours of sleep). § More talkative than usual or pressure to keep talking § Flight of ideas or subjective experience that thoughts are racing. § Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. § Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity). § Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments) o The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. o The episode is not attributable to the psychological effects of a substance or to another medical condition.

Prolonged Exposure

• Vividly recount the traumatic event, over and over again in detail, until the emotional response associated with it begins to subside • Exposure to things related to the events - maybe what they are avoiding • Makes people come face to face with what they are dealing with • Trying relaxation techniques, breathing techniques, try to keep themselves calm

Bipolar II Disorder Symptoms:

o Criteria have been met for at least one hypomanic episode (Criteria A-F under Hypomanic episode) and at least one major depressive episode (criteria A-C under Major Depressive Episode). o There has never been a manic episode o The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specific or unspecific schizophrenia spectrum and other psychotic disorder. o The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomanic causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Cyclothymic Disorder Symptoms:

o For at least 2 years (at least 1 for children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode. o During the above 2-year period, the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time. o Criteria for a major depressive, manic, or hypomanic episode have not been met. o The symptoms in Criteria A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. o The symptoms are not attributable to the physiological effects of a substance or another medical condition. o The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Any research that looks at the effectiveness of prolonged exposure, it's important for the researchers to consider and take into account what?

the drop-out rates

Examples of independent life events:

§ Company shutting down, rear ended

Pre-Existing Psychological Difficulties

• When traumatic events happen, the duration afterwards of experiencing PTSD. Pre-existing psychological difficulties contribute to this.

Cognitive Therapy

§ Dysfunctional Beliefs § Negative Automatic Thoughts § Cognitive Biases ○ Wanting to combat everything above ○ We tend to not evaluate them because they are so automatic. We do not look at the thought and see what evidence points to it and against it ○ Cognitive therapy recognizes those thoughts and then we combat those thoughts. We evaluate the thoughts and see how we can change it. Looking for evidence for and against those thoughts ○ Treat thoughts like a hypothesis § Working with a women in therapy, comes in and says "my husband doesn't love me anymore". Can ask "that must be a horrible thing to think, what's the evidence behind that statement?" When he comes home from work, he watches TV, goes straight to bed, and never talks to me. Then ask for evidence against that statement, we had a nice weekend last weekend. Would there be any other explanation to why he acts like this at night? ○ Cognitive therapy tends to be effective - still diagnosed with depression but isn't as bad as it used to be

○ Global vs. Specific

§ Global is everything □ Fail an exam = I'm a loser = global § Specific is just this one thing □ Fail an exam = I struggle with essays = specific

Cognitive Biases: Arbitrary Inference

§ Jumping to a conclusion based on minimal or no evidence toward the negative § One bad day = Life is going to be horrible

○ Kendler, K. S., Karkowski, L. M., & Prescott, C. A. (1999). Causal relationship between stressful life events and the onset of major depression. American Journal of Psychiatry, 156(6), 837-41.

§ Shows that dependent events are particularly connected to depression

Stable vs. Unstable

§ Stable □ Always going to be like this □ I'll never graduate § Unstable □ Fluke

Role of Stressors

§ Stressors do matter § Stressors instigate negative automatic thoughts § You do not need the stressors nowadays to lead to the negative thoughts § Studies done where going to a lab and a group of people are induced with a depressed mood through sad music. Sad music isn't a stressor. But people who are at risk of depression is enough to trigger negative thoughts

Cognitive Biases: Selective Abstraction

§ Tendency to focus on one negative detail while ignoring all other elements § Having a great time but one person said a negative comment - letting that ruin the situation

Cognitive Biases: All-or-nothing

§ Tendency to think in extremes § You have ONE argument in a relationship and it is ALL bad

Evaluation, descriptive Theory: Negative Thinking:

§ Those with depression are more negative in their thinking § More negative in their thinking when they're depressed than when they are not depressed § More negative in themselves, their future, those around them § Looking at people who are not depressed are overly optimistic about their reality □ Tend to be bias in remembering good things than the bad, doesn't necessarily hurt them, but they are not realistic about their situations □ A family vacation that goes bad - some people will laugh about it years later while others try to actively avoid it and completely forget about it § If you're already depressed, then you focus on depressing things more, causing you to be even more depressed

Coryell, W., Endicott, J., Maser, J. D., Mueller, T., Lavori, P., & Keller, M. (1995). The likelihood of recurrence in bipolar affective disorder: The importance of episode recency. Journal of Affective Disorders, 33, 201-06.

• A 20-year study where they followed people who were averaged at 17 and then followed them for 20 years • Even after recovery from the episodes, 24% had relapsed within 6 months to some sort of episode. • 77% had a new episode within 4 years • 82% had a new episode within 7 years • Relapse is very likely even with treatment - heartbreaking • Getting a diagnosis is not an all or nothing thing, it doesn't mean that treatment isn't doing anything. They still have the diagnosis but they are functioning at a better level.

Symptomatology (bipolar disorder)

• Classic manic symptoms alternating with the depressive symptoms • Recurrent disorder - it's unusual for someone to have a single manic episode and never have one again • The manic episode will either be before or immediately follows the depressive episode - 2/3 of cases • Manic episode into depressive episode - evens out and the persons mood is okay until it happens again • Manic episodes are shorter than the depressive episodes

Cognitive Therapy:

• Cognitions are important for PTSD • One's thought processes are important • Modify Excessive Negative Appraisal ○ Talking about self-blame - your own behavior and so forth ○ With many traumatic events, there's often little things involved that could've made a difference. However, that's just life and we cannot continue to blame ourselves. § Different route to work - wouldn't have gotten in accident § Forgot milk at the grocery store so you go to the convenience store and it gets robbed - if I didn't forget the milk, I wouldn't have been in this situation • Decrease Threat Experienced with Memories ○ These are just memories, it's not happening to me right now ○ I'm not in danger now • 70-90% effectiveness for cognitive therapy ○ Functioning better in life ○ No longer have the diagnosis. The dropout rate tends to be a lot lower than prolonged exposure

Virtual Reality Exposure

• Computer simulations, can be part of exposure therapy • Combat situations - work with them and customize an experience that is similar to what they went through • Early reports on virtual reality tends to be positive and show decreases in PTSD symptoms • Despite the fact that in some ways it would seem worse to do a virtual reality that would be related to their PTSD - most men/people are more open to it and show better results using virtual reality than just talking

Sandweiss, D. A., Slymen, D. J., Leard-Mann, C. A., Smith, B., White, M. R., Boyko, E. J., et al. (2011). Preinjury psychiatric status, injury severity, and post-deployment posttraumatic stress disorder. Archives of General Psychiatry, 68, 496-504.

• Done on military personal • Longitudinal study. • Confirmed that psychiatric problems before deployment significantly increase the risk of developing PTSD. • With US Personal in Iraq and Afghanistan. • Giving a questionnaire before and after deployment. • PTSD diagnosis was 2.5 times greater for those who were positive for one mental health problem before deployment. • Would it be important for the military to conduct pre-deployment questionnaires for PTSD before giving them a "job"

Negative Cognitive Triad

○ Self: I'm worthless ○ World/Others: Everyone is mean ○ Future: It's going to get excuse

Berntsen, D., & Rubin, D. C. (2015). Pre-traumatic stress reactions in soldiers deployed to Afghanistan. Clinical Psychological Science, 3, 663-74

• Evidence that people who have thoughts, bad images, etc., of what might happen to them in the future, tend to be more vulnerable to PTSD. • Given a questionnaire beforehand on pre-traumatic stress reactions based on thoughts, what could happen, what they've seen online, and they have it in their mind already what could happen • Those individuals are more likely to get PTSD and for it to be more severe

Tolin, D. F., & Foa, E. B. (2006). Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research. Psychological Bulletin, 132, 959-92.

• Most research tends to point in the direction that men are more likely to experience traumatic events - but women have much higher prevalence rates for PTSD. • Men and traumatic events: Combat and war, serious accidents (driving), witness death, physical assaults, serious injury in some sort of way. • Women are more likely to experience sexual assault • There's something fundamentally different about sexual assault - there's a personal aspect of it, which is different than getting into a car wreck. Rape and sexual assault tend to be inheritably more traumatic, due to it being personal.

Prevalence (bipolar disorder)

• Much less common than depressive disorders • Estimates of it vary, but the most classic is the manic depressive at 1% • Unlike depression, there is no real gender difference. They are roughly equal in likely to get bipolar

Likelihood of Experiencing Traumatic Event

• Not everyone is equally likely to experiencing the traumatic event • Certain occupations, police officer, soldier, paramedic, etc., more likely to experience PTSD • Men are more likely to experience traumatic events than women are • Having less than a college education - lower level tend to be more likely to experience traumatic events • People who had conduct problems during childhood • Black Americans are more likely to experience traumatic events than White Americans • Family history of psychological problems - depression, anxiety, substance abuse - more at risk for experiencing PTSD • Extroverts are more likely to experience traumatic events than introverts • Can happen to anyone, there's a way to look at it appropriately and a way to look at it inappropriately - like blaming the victim is a no-no

Intrusive memories and Tetris:

• Over the last 10-15 years • Reducing intrusive memories • Have participants watch disturbing things on video - real life deaths • And then have them play Tetris (experimental and control group) for 15-20 minutes A cognitive demanding thing that needs to be focused on, they then report in over the next one to two weeks and the research shows that the Tetris group has way few intrusive memories. Looked at in emergency rooms

Shalev, A. Y., & Freedman, S. (2005). PTSD following terrorist attacks: A prospective evaluation. American Journal of Psychiatry, 162, 1118-91.

• PTSD following terrorist attacks • Middle eastern community • Compared PTSD from serious car accidents vs. terrorist attack • Interview 1 week after the traumatic event and then again 4 months later • No differences in symptoms after 1 week • The people who experienced the terrorist attacks had more severe PTSD after 4 months • Traumatic events that involve human beings that do terrible things to other human beings, particularly difficult to come to terms with

Functioning (bipolar disorder)

• Periods of normality are not usually periods of normality for people like us, but they are functioning, just not as quite where they should be. There are still mood problems - normal in the sense that it's not manic or depressed • Manic and depressive episodes = huge loss of functioning

Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S.J., & Foa, E. B. (2010). A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clinical Psychology Review, 30, 635-641

• Prolonged exposure to PTSD • 13 studies and the key criteria for the studies, there needs to be some sort of control. Comparing prolonged exposure to some sort of control group • They found that there was a strong effect for prolonged exposure ○ The average prolonged exposure patient did better than 86% of the controls ○ Follow-up analysis showed that it retained most of its effectiveness • Trust is important, relationships are important, do not try in the second session, you want to build a trusting therapeutic relationship with the patient

Rapid Cycling (bipolar disorder)

• Relatively unusual • 5-10% of people will experience rapid cycling - at least 4 episodes a year (either manic or depressive), depending on the individual, it can be more than 4 • Bipolar I is diagnosed by the manic episodes, but for rapid cycling, it can be can combination of episodes, 2 and 2 or 4 and 0, etc.

Prognosis

• The probability of full recovery tends to be fairly low - data is somewhat discouraging - even with medication (lithium)

Interviews vs. Self-Report Questionnaires

• Those prevalence rates tends to be way different from self-report questionnaires compared to interviews. • Was it a mental health specialist that diagnosed you or did you just fill out a questionnaire and it told you that you had PTSD. Self-Report Questionnaires tend to show higher PTSD rates.

Social Support

• True regardless of any sort of traumatic event • Having more support helps, from people you love and from people that love you • Returning to a negative environment after war tends to show increased vulnerability ○ Societal level, Vietnam veterans coming back were spit on and downgraded -> increased PTSD

Bipolar Disorder - Treatment: Lithium (Mood Stabilizer)

• Used in both manic episodes and depressive episodes. Wants to stabilize the moods in both • Effectiveness ○ It's effective and in some cases it's a life saver ○ 3/4 of people with manic episodes, lithium provides some improvement with functioning. Definitely better than not taking lithium at all. ○ Sometimes in the depressive episode, people are prescribed antidepressants instead of lithium. Which can cause the manic episode to possibly be worse since antidepressants will not help with the episode. ○ Patients are encouraged to stay on the lithium all of the time, even when the mood is "normal, to ward off future episodes. While this is useful, there can be no motivation to take it if the patient is feeling okay.

Age of Onset (bipolar disorder)

• Usually it starts in adolescence or early adulthood • Average age is roughly 18-22 to be diagnosed

Morale

• Whether you believe in the cause or the larger picture of what you are doing • That you're doing something good, protecting others, or your country • Do you like your commander? Do you want to do a good job for them? Do you hate them or do you like them? Or if you do not feel good about it, being shot at or killing others. --> more vulnerable to PTSD

- Chronic Stress:

○ Also very connected

Keller, M. B., Hirschfeld, R. M. A., & Hanks, D. (1997). Double depression: A distinctive subtype of unipolar depression. Journal of Affective Disorders, 45, 65-73

○ Clinical sample of people already in treatment ○ Adolescents and young adults with persistent depressive disorder ○ They followed them for 10 years In those 10 years, 84% of them experienced at least 1 major depressive episode

Hasin, D.S., Sarvet, A.L., Meyers, J.L., Saha, T.D., Ruan, W.J., Stohl, M. & Grant, B.F. (2018). Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States. Journal of the American Medical Association, 75, 336-346.

○ Conducted over a year ○ Data was gathered through interviews ○ Numbers for both men and women are stunning and increasing alarmingly - significant jump ○ Study in 2018 ○ Reason to believe it could be worse now than when this study was conducted In the US

Marital/Family Therapy (bipolar)

○ Have been effective in reducing relapse ○ If the family is involved in the individuals treatment, then the period of relative normality tend to last longer

Dysfunctional Beliefs

○ If everyone doesn't love me then my life is worthless ○ If I'm not perfectly successful, I'm a nobody ○ Difference between believing those things and acting like you believe those things ○ Is and can be a result of negative experiences with parents

- Attributions:

○ Internal vs. external: What caused the event to happen? § Was the events due to yourself or outside factors § Good or bad □ Fails an exam ® Internal: "I'm just stupid" ® External: "Teacher hates you"

Neuroticism

○ Key personality factor of vulnerability to depression ○ Personality factors are genetic, and, as such, are relatively stable ○ Involves a temperamental sensitivity to the negative ○ Have more stressful life events ○ People who have a high level of neuroticism are more vulnerable to depression ○ Pessimistic outlook leads them to evaluate events as stressful whereas people who aren't depressed or neurotic don't look at it as stressful ○ Very similar to GAD

- Behavioral Theory

○ Lack of reinforcements § People who are depressed tend to receive fewer positive reinforcements in their life § Lower activity levels, miss out on fun activities § Fewer positive reinforcements from family and friends

What are the two main side effects of lithium?

○ Lethargy - lack of energy ○ Feeling cognitively slower - cannot put thoughts together

Cognitive Ability: • Breslau, N., Lucia, V.C., & Alvarado, G.F. (2006). Intelligence and other predisposing factors in exposure to trauma and posttraumatic stress disorder: A follow up at age 17 years. Archives of General Psychology, 63, 1238-45.

○ Longitudinal study ○ IQ data from 6-year-olds who lived in or around Detroit ○ When these children reached 17, 11 years later, they were interviewed and assessed for PTSD or any other trauma ○ Children at age 6 who had IQ scores of 115 or above (1 SD above the mean) § Less likely to experience the traumatic event by age 17 § Even if they had been exposed to trauma, they were at a lower risk for developing PTSD § More hope for the future § Better and able to make sense of it all and realize that it wasn't their fault

Lam, D. H., Hayward, P., Watkins, E. R., Wright, K., & Sham, P. (2005). Relapse prevention in patients with bipolar disorder: Cognitive therapy outcome after 2 years. American Journal of Psychiatry, 162, 324-29.

○ Looked at patients with bipolar disorder ○ Followed them for 2 years ○ Cognitive therapy + medicine had lower relapse rates than just medication ○ Therapy is beneficial if it is paired with medication

Psychoeducation (bipolar)

○ Making patients understand why they should stay on lithium, telling them the pros over the cons

Genetic Factors: Twin Studies

○ Mono vs Dizygotic ○ Mono (identical)) § Twice as likely to develop the disorder if their twin also has it compared to dizygotic § In cases that are really strong, genetics will play a key role ○ Overall, the genetic influence for depression is moderate

Genetic Factors: Family Studies

○ Mood Disorders are about 2 to 3 times higher among blood relatives with those with major depression

Behavioral Activation Treatment

○ More behavioral therapy ○ People with depression tend to not do what they enjoy because they do not get enjoyment anymore ○ Behavioral activation treatment is where you plan it out and then push them to go do that behavior ○ More active and engaged with the environment and people

Age Differences

○ Onset: late adolescence/early adulthood - can be through middle adulthood ○ Used to think depression didn't happen in childhood - it's less common in childhood, but more recent research shows 2-3% of children can be diagnosed with some sort of depression ○ It is during adolescents where the gender differences begin to arise ○ Post 65 tend to have lower rates of depression than those younger than them § Older people are less vulnerable to depression than younger people § Is this a cohort thing, where these post 65 people are less depressed because they were less depressed 20 years ago

- Dependent Life Events:

○ Partly generated by the individual's own behavior or personality

Cognitive Behavioral Therapy (bipolar)

○ Problem solving ○ Coping mechanisms - how to deal with the problems at hand ○ Daily routine

Evaluation - Causal Aspects of Theory

○ Prospective Studies § Take people who are not depressed and you test them for the dysfunctional negative thoughts and then you follow them for 6 months or 6 years and you are checking in with them, if they're experiencing stressors. You assess them for depression as they go through life. Some studies have found that you can be prone to depression. But other studies have shown that you cannot be prone to depression.

Side Effects of lithium:

○ Standard discomfort side effects ○ Lethargy - lack of energy ○ Feeling cognitively slower - cannot put thoughts together ○ Weight gain, gastrointestinal problems ○ Highs feel so good compared to lows, having energy and being able to get things done - making it difficult for people to stay on it when they're in their high period

- Independent Life Events:

○ Things that just happen ○ Independent of behavior and personality

- Severe Stressful Events:

○ Very connected to major depressive disorder