Abnormal Psychology Exam #3
Treatments for Anorexia Nervosa: Limitations
- as many as 25% continue to have difficulties: including lingering emotional problems - recovery is not always permanent
Types of Delusions: Grandeur --> Schizophrenia
- "I am special. God has appointed me the greatest inventor of mankind" - believe themselves to be great inventors, religious saviors, or other specially empowered persons
Types of Delusions: Control --> Schizophrenia
- "The man who lives above me is guiding my thoughts" - believe feelings, thoughts, and actions are being controlled by another
Types of Delusions: Persecution --> Schizophrenia
- "They are spying on me.. I can see them. They want to ruin my life because I know their secrets - being plotted or discriminated against, spied on, slandered, threatened, attacked, or deliberately victimized.
Bulimia Nervosa is listed as:
- "binge-eating disorder" - new syndrome diagnosis in the DSM-5 - symptoms include a pattern of binge eating with no inappropriate compensatory behaviors - two-thirds become overweight or obese
Bulimia Nervosa is also known as:
- "binge-purge syndrome"
Antipsychotic Drugs: Side-Effects: Neuroleptic Maligrant syndrome
- 1% of individuals, particularly elderly - severe, potentially fatal reaction - symptoms include: muscle rigidity, fever, altered consciousness, improper autonomic nervous system functioning - as soon as it is recognized, drug use is ended and each symptom is treated individually
Antipsychotic Drugs: History
- 1950s: the advent of antipsychotic drugs revolutionized treatment for schizophrenia a) discovered when researching antihistamines for allergies (Thorazine) b) drugs developed from the 1960s to 1980s are referred to as conventional or "typical" antipsychotics i) primarily target D-2 receptors although produce neurological side-effects - current anti-psychotics are referred to as "atypical" or "second generation"
Schizophrenia: The Community Approach: - 1963: Community Mental Health Act
- 1963: Community Mental Health Act a) Deinstitutionalization: the discharge of large numbers of patients from long-term institutional care so that they might be treated in community programs b) revolving door: released to the community, readmitted to an institution within months, released a 2nd time, admitted yet again, so on, over
Schizophrenia: The Community Approach: Key features: Partial Hospitalization: Day Programs
- 8 to 5 pm, released to supervised residents
About what percentage does Anorexia Nervosa occur in females?
- 90-95%
Biological Views Of Schizophrenia: Genetic Factors --> Adoption Studies
- Adoption studies have compared adults with schizophenia, who were adopted as infants, with both their biological and adoptive relatives a) biological relatives of adoptees with schizophrenia are more likely to display schizophrenic symptoms than are their adoptive relatives... which implicates genetics - studies indicates possible gene defects on numerous chromosomes, which may predispose individuals to develop schizophrenia
Sexual Dysfunction: Disorders of Excitement
- Excitement phase of the sexual response cycle a) marked by changes in the pelvic region, general physical arousal, and increases in heart rate, muscle tension, blood pressure, and rate of breathing i) in men: erection of the penis, blood pools in the pelvis ii) in women: swelling of the clitoris and labia, and vaginal lubrication
Treatments for Bulimia Nervosa: Cognitive-behavioral therapy is particularly helpful: Behavioral and Cognitive techniques
- Behavioral techniques: a) diaries are often used b) exposure and response prevention (ERP) to break the binge-purge cycle i) taken from OCD, similar to bulimia, they would eat something, but we would prevent the purge/ negative emotions of gaining a ton of weight. - Cognitive techniques (Beck's) a) recognize and change their maladaptive attitudes toward food, eating, weight, and shape b) identify and challenge the negative thoughts that precede the urge to binge Examples: - "I might as well give up." - "I look fat."
Schizophrenia: The Community Approach: Key features: Promise of community treatment
- Despite the shortcomings, has shown great potential - National Alliance on Mental Illness push better community treatment, especially for severe mental dysfunctioning. - major feature of treatment around the world with importance placed on coordination
What are the symptoms of schizophrenia? Positive Symptoms: Hallucinations, Inappropriate affect
- Hallucinations: sensory perceptions that occur in the absence of external stimuli a) most common: auditory b) can involve any of the other senses: tactile, somatic, visual, gustatory, or olfactory - inappropriate affect: emotions that are unsuited to the situation
Paraphilic Disorders: Fetishistic Disorder
- Recurrent and intense sexual urges, fantasies, or behaviors that involve the use of a non-living objects or non-genital part a) often to the exclusion of all other stimuli - the disorder, far more common in men than women, usually begins in adolescence b) almost anything, can be a fetish - women's underwear, shoes, and boots are especially common
How do theorists explain schizophrenia?
- as with many other disorders, biological, psychological, and sociocultural theorists have proposed explanations a) biological explanations have received the most research support - some research has supported a diathesis-stress relationship a) people with a biological predisposition will develop schizophrenia only if certain kinds of stressors or events also occur.
Schizophrenia: Psychotherapy: Social Therapy
- advocates that treatment should include techniques that address social and personal difficulties in the clients' lives a) these include: practical advice, problem solving, decision making, social skills training, medication management, employment counseling, financial assistance, and housing - research finds that this approach reduces re-hospitalization - psychological treatments often used in combination and tailored for the individual
About what percentage have female orgasmic disorder?
- almost 24% of women appear to have this problem - 10% or more of women have never experienced orgasm - most clinicians agree that orgasm during intercourse is not mandatory for normal sexual functioning - women who are more sexually assertive and more comfortable with masturbation tend to have orgasms more regularly
Gender Dysphoria
- a disorder in which a person persistently feels extremely uncomfortable about his or her assigned sex and strongly wishes to be an alternative sex a) also known as transsexualism, and formerly named gender identity disorder - they would like to acquire primary/ secondary sex characteristics of an alternate sex, and often seek treatment - controversial in recent years a) many people believe that transgender experiences reflect alternative- not pathological- ways of experiencing one's gender identity - others argue that gender dysphoria is, in fact, a medical problem that may produce personal unhappiness
Sociocultural Views Of Schizophrenia: Family Dysfunctioning: Facts
- a number of studies suggest that schizophrenia is often linked to family stress: a) parents of people with the disorder often: i) display more conflict ii) have greater difficulty communicating iii) are more critical of and overinvolved with their children than other parents b) family theorists have long recognized that some families are high in "expressed emotion." --> members frequently express criticism, disapproval, and hostility toward each other and intrude on one's another privacy. i) frequently express criticism and hostility, and intrude on each other's privacy; environment linked to relapse
Sexual Dysfunction: Disorders of Desire: Female sexual interest/ arousal disorder
- a persistent reduction or lack of interest in sex and low sexual activity - in some cases, limited excitement and few sexual sensations during sexual activity - as many as 33% of women - includes the desire as well as the excitement phase of the sexual response cycle - most cases of low sexual desire are caused primarily by sociocultural and psychological factors, but biological conditions can also lower sex drive significantly
Schizophrenia
- a psychotic disorder in which personal, social, and occupational functioning deteriorates as a result of perceptual, emotional, cognitive, and potentially motor abnormalities - affects approximately 1 in 100 people in the world - the financial and emotional costs are substantial a) increased risk of suicide and physical illness - schizophrenia is found in all socioeconomic groups although more frequently in lower levels a) watch out for causal interpretation here! b) downward drift theory
Biological Views Of Schizophrenia: Genetic Factors --> Two kinds of (potentially inherited) abnormalities
- abnormal brain structure a) enlarged ventricles, the brain cavities that contain cerebrospinal fluid b) smaller temporal and frontal lobes, and abnormal blood flow to certain brain areas - biochemical abnormalities
Sexual Dysfunction: Possible causes of low sexual desire and excitement (Biological)
- abnormalities in hormone activity, chronic illness including nervous system damage, and medications or substances
Most patients recover from Anorexia Nervosa, but about what percentage become seriously ill and die as a result of medical complications or suicide?
- about 2% and 6% - numerous possible medical complications include: amenorrhea, low body temperature, poor circulation, lanugo, slow heart rate and arrythmias, metabolic and electrolyte imbalances, and lowered testosterone levels
Similar to anorexia, about what percentage of bulimia nervosa cases occur in females?
- about 90%
What causes eating disorders? Cognitive Factors
- according to cognitive theorists, a broad cognitive distortion is at the core of eating disorders - individuals judge themselves based on their shape, their weight, and their ability to control them - supported by research as a characteristic of those with eating disorders
Main diagnoses of Eating Disorders
- anorexia nervosa - bulimia nervosa - binge eating disorder
What are the general features of sex therapy? (Modern sex therapy)
- assessment and conceptualization of the problem - mutual responsibility - education about sexuality - emotion identification - attitude change - elimination of performance anxiety and spectator role - increasing sexual and general communication skills - changing unhelpful lifestyles and marital interactions - addressing physical and medical factors
Antipsychotic Drugs: Side-Effects
- associated with conventional or "typical" antipsychotics - termed extrapyramidal effects because they appear to affect the extrapyramidal areas of the brain a) listed in the DSM-5 as their own separate disorder - most common of the effects produce Parkinson symptoms: a) muscle tremor and rigidity b) bizarre movements of face, neck, tongue, and back c) great restlessness, agitation, and discomfort in limbs
Diagnosing Schizophrenia (DSM-5)
- at least two symptoms present during a 1 month period a) one symptom must be positive - signs/ symptoms of the disorder must persist for 6 months of more - individuals must also show a deterioration in their work, social relations, and ability to care for themselves - can specify first or multiple episodes, as well as with or with catatonia (motor symptoms and how they are moving their body, stuck in a rigid stance)
Institutional Care Takes a Turn for the Better: Milieu Therapy
- based on humanistic principles - focused on social environment or "milieu" that promotes productive, meaningful activities; responsibilities; self-respect - had moderate success
Institutional Care Takes a Turn for the Better: Token Economies
- based on operant conditioning with focus on changing behaviors - patients rewarded when they behave in socially acceptable ways, and are not rewarded with unacceptable behavior a) rewarded behaviors: personal hygiene, work program, speaking appropriately b) rewards: tokens that patients could exchange for food, cigarettes, priveleges, etc.
The key goal with anorexia nervosa is
- becoming thin
Psychological Views Of Schizophrenia: Behavioral Explanation
- behaviorists cite operant conditioning and principles of reinforcement as the cause of schizophrenia - they propose that some people are not reinforced for their attention to social cues and, as a result, they stop attending to those cues and focus instead on irrevelant cues (e.g. room lighting) a) their responses become increasingly bizarre yet are rewarded with attention, and thus, are likely to be repeated - support for this model has been circumstantial and the view is considered (at best) a partial explanation
What percentage of the females develop Anorexia Nervosa in Western Countries?
- between 0.5% and 3.5% - many more display some of its symptoms
The peak age of onset for Anorexia Nervosa is:
- between 14 and 18 years
The peak age of onset for Bulimia Nervosa is:
- between 15 and 21 years - symptoms may last for several years with periodic letup or continuing of symptoms - periods of no symptoms or remission for longer than 1 year are associated with better long-term outcomes
Psychological Views Of Schizophrenia: Overview
- biological views are only part of the explanation a) some people who have these biological problems never develop schizophrenia i) remember diathesis-stress - during the past few decades, psychological factors are again being considered important a) previously considered less important when biological causes were emphasized
Positive Symptoms Of Schizophrenia
- bizarre additions to typical thoughts, emotions, or behavior; excesses to experience that are pathological - include: a) disordered thinking and speech: may include loose associations, neologisms, preservations, and clang b) delusions: faulty although firmly held beliefs or interpretations i) may include delusions of persecutions, reference, grandeur, control
What are binges with Bulimia Nervosa?
- bouts of uncontrollable eating during a limited period of time a) eat objectively more than most people would/ could eat in a similar period b) consumption of 1,000-10,000 calories per binge, occurring 1-30 times per week c) often carried out in secret
What causes Eating Disorders? Biological factors: genes
- certain genes may leave some particular susceptible to eating disorders a) relatives of people with eating disorders are up to 6 times more likely to develop the disorder themselves b) support from twin studies, may be related to low serotonin identical twin, may get it 70% of the time fraternal twin, may get it 20% of the time
What are the symptoms of schizophrenia? Negative symptoms
- characteristics that are lacking in typical thought, emotion, or behaviors; deficits that indicate pathology - poverty of speech: reduction in quantity of speech, speech content, or meaning a) example: "My illness is too great to be cured quickly. I am incurable. Everyone who reads these lines will suffer- they will understand my feelings.. Everyone will feel and understand. I am a man, not a beast. I love everyone, I have faults - blunted and flat affect a) little emotion expression
Delayed ejaculation (male orgasmic disorder/ inhibited male orgasm)
- characterized by a repeated inability to ejaculate or by very delayed ejaculations after normal sexual excitement (occurs in 8% of the male population) - biological: low testosterone, neurological disease, damage to the central nervous system, drugs and anti-depressants - a leading psychological cause appears to be performance anxiety and the spectator role (the cognitive factors also involved in ED)
Paraphilic Disorders: Transvestic Disorder
- characterized by fantasies, urges, or behaviors involving dressing in the clothes of the opposite sex in order to achieve sexual arousal (also known as cross dressing) - the typical person with tranvestic disorder is a heterosexual male who began cross-dressing in childhood or adolescence - transvestic is often confused with gender dysphoria (transsexualism), but the two are separate patterns - development sometimes based on behavioral principles of operant conditioning
Sexual Dysfunction: Disorders of Excitement: Male Erectile Disorder (ED)
- characterized by persistent inability to attain or maintain an adequate erection during sexual activity - occurs in as much as 10% of the general male population - half of all adult men have erectile difficulty during intercourse at least some of the time
Treatment specifics for Anorexia Nervosa: Behavioral
- clients are required to monitor feelings, hunger levels, and food intake and the ties among those variables
Newer Antipsychotic Drugs: Schizophrenia: The "Atypical" or "Second Generation" antipsychotics
- clozaril, resperidal, abilify (also can treat bipolar mood disregularities - These new drugs are called "atypical" because their biological operation differs from that of convential antipsychotics - They appear more effective than conventional antipsychotic drugs, especially for negative symptoms o They cause few extrapyramidal side effects and seem less likely to cause tardive dyskinesia o They do, however, carry a risk of agranulocytosis, a life-threatening drop in white blood cells
Schizophrenia: Psychotherapy can be very helpful when used in combinations with medication
- cognitive-behavioral therapy is research supported a) seek to change how individuals view and react to their hallucinatory experiences 1) provide education and evidence of biological causes of hallucinations 2) learn about patterns of their hallucinations and delusions 3) challenge inaccurate ideas about hallucinations 4) learn to more accurately interpret hallucinations 5) teach techniques for coping
After a binge, people with Bulimia Nervosa try to: (Related to Compensatory Behaviors)
- compensate for or "undo" the caloric effects
Ventromedial hypothalamus (VMH) involved in Eating Disorders: Biological Factors
- consists of bottom/ middle of hypothalamus, reduces hunger when it is activated.
What are the symptoms of schizophrenia? (Types of Delusions)
- control - reference - persecution - grandeur
What do many people with eating disorders, particularly those with bulimia nervosa, experience symptoms of?
- depression
Those with Anorexia Nervosa commonly experience additional psychological problems such as:
- depression, anxiety, low sense of self-worth, obsessive-compulsive patterns
Sexual Dysfunctions: the human sexual response can be described as a cycle with four phases
- desire - excitement - orgasm - resolution: consists of relaxation/ reduction in arousal that follows orgasm. - sexual dysfunctions affect one or more of the first three phases a) they can be lifelong or acquired after a period of normal functioning
Sexual Dysfunction: Disorders of Desire
- desire phase of the sexual response cycle consists of an urge to have sex, sexual fantasies, and sexual attraction to others - two dysfunctions affect this phase: 1) male hypoactive sexual desire disorder 2) female sexual interest/ arousal disorder
Sexual Dysfunctions
- disorders in which people cannot respond normally in key areas of sexual functioning - as many as 31% of men and 43% of women in the U.S. suffer from such as a dysfunction during their lives - typically very distressing, and often lead to sexual frustration, guilt, loss of self-esteem, and interpersonal problems
Sociocultural Views Of Schizophrenia: Family Dysfunctioning: Double mind messages
- double-bind messages typically consists of: a) "primary" verbal communication b) contradictory nonverbal "metacommunication" - a child will adopt a special coping strategy and may possibly progress toward paranoid schizophrenia - this theory is closely related to the psychodynamic notion of a schizophrenogenic mother - it has been similarly unsupported by research, but is popular in clinical practice
Premature Ejaculation
- during almost all occasions of sexual activity with a partner, ejaculation within one minute of beginning the activity and before the person wishes it - difficulty lasts 6 months or more - significant distress or impairment
Treatment for Bulimia Nervosa: Antidepressant medications
- during the past 15 years, all groups of antidepressant drugs have been used in bulimia nervosa treatment - drugs help as many as 40% of patients - medications are best when used in combination with other forms of therapy - reduces binges by 67% - reduces vomiting by 56%
Sexual Dysfunctions: generalized type
- dysfunction present during all sexual situations
Treatment specifics for Anorexia Nervosa: Cognitive
- education about thinking patterns and body distortions - clients are taught to identify and correct their distorted thinking patterns and maladaptive attitudes toward eating and weight a) "I must always be perfect" or "My weight and shape determine my value" - recognize their need for independence and control, and trust inner feelings - may include family therapy, which often works on separation of feelings/ needs and boundaries - ex: "I know that a key feature of anorexia nervosa is a misconception of my own size, so I can expect to feel fat regardless of my actual size."
What is the course of schizophrenia?
- equal numbers of men and women are diagnosed a) the general age of onset for men is in their early 20s, compared to late 20s for women - many sufferers experience three phases: a) prodromal: beginning of deterioration; mild symptoms b) active: symptoms become increasingly apparent c) residual: a return to prodromal-like levels - each phrase of the disorder may last for days or years - one quarter (25%) fully recover
Institutional Care In the Past: Schizophrenia, problems
- eventually, there were problems with overcrowding, understaffing, and poor patient outcomes - not enough funds to keep up with expanding patient load - led to loss of individual care and the creation of "backwards" a) chronic wards for patients who failed to improve b) at risk for developing additional symptoms such as social breakdown syndrome
Schizophrenia: The Community Approach: Key features: Implication of inadequate services
- examples: return to their families without adequate treatment, alternative institutions, prison - one-third of homeless people have a severe mental illness
The driving motivation with anorexia nervosa
- fear
What are the symptoms of schizophrenia? Negative symptoms: Loss of volition (motivation or directedness)
- feeling drained of energy and interest; Apathy - inability to start or follow through on a course of action
Sexual Dysfunction: Disorders of excitement, two dysfunctions affect this phase
- female sexual interest/ arousal disorder - male erectile disorder (formerly "impotence")
How is schizophrenia treated?
- for much of human history, people with schizophrenia and other severe mental disorders were considered beyond help - though schizophrenia is still extremely difficult to treat, the discovery of anti-psychotic drugs has greatly improved treatment efficacy - each of the models offers treatments for schizophrenia, and all have been influential at one time or another
DSM-5 also includes Gender Dysphoria
- formally known as Gender Identity Disorder - a sex-related pattern in which individuals feel they have been assigned to the wrong sex
Biological Views Of Schizophrenia: Genetic Factors --> Family Pedigree
- genetic researchers believe that some people inherit a biological predisposition to schizophrenia - family pedigree studies repeatedly show that schizophrenia is more common among relatives of people with the disorder - the more closely related they are to the person with schizophrenia, the greater their likelihood for developing the disorder
Binges are usually preceded by feelings of:
- great tension and/or anxiety
While binges may be pleasurable, they are usually followed by feelings of
- guilt, blame, depression, and/or fear of weight gain
Institutional Care In the Past: Schizophrenia, history
- historically, individuals with schizophrenia were institutionalized in public mental hospitals - goal: restraint and basic human needs met (asylums) - move toward "moral treatment" in 1793 a) initial goal: treat with kindness and sympathy b) remove daily stresses and offer healthy environment c) states required to provide institutions (state hospitals)
Treatments for Bulimia Nervosa: common alternatives, interpersonal therapy (IPT)
- if clients do not respond to cognitive- behavioral therapy, other approaches may be tried -helps with depression
Treatments for Anorexia Nervosa (history)
- in past, occurred in hospital settings; it is now often offered in day hospitals or outpatient settings - the most popular weight-restoration technique has been the combination of supportive nursing care, nutritional counseling, and high-calorie diets a) may also incorporate use of rewards for appropriate eating
Sexual Dysfunction: Possible Causes of low sexual desire and excitement (psychological)
- increase in negative emotions (depression, anxiety, anger, fear) - maladaptive attitudes or beliefs - performance anxiety and the spectator role (cognitive factor, particularly for ED)
Sexual Dysfunction: Female Orgasmic Disorder Psychological Causes
- increase in negative emotions (same as previous disorders) including depression - psychodynamic/ cognitive theorists might predict memories of childhood traumas and relationships that have sometimes been associated with orgasm problems
Purging behaviors may temporarily relieve these negative feelings attached to binge eating, however:
- it also allows for more bingeing - over time, however, a cycle develops in which purging -> bingeing -> purging
Eating Disorders
- it has not always done so, but Western society today equates thinness with health and beauty - there has been an increase in eating disorders in the past three decades
Sexual Dysfunction: Disorders of Desire: Male hypoactive sexual desire disorder
- lack of interest in sex and little sexual activity - DSM-5 refers to a "deficient" sexual interest: not a gauge to identify, but therapists see whether there are problems within their relationship or experience stress or anxiety - minimum of 6 months duration - physical responses may be normal - 16% of men
Antipsychotic Drugs: Side-Effects: Tardive Dyskinesia
- late-appearing movement disorder a) typically associated with conventional antipsychotics b) includes involuntary writhing or tic-like movements usually of the mouth, lips, tongue, legs, or body c) can be difficult and sometimes impossible to treat d) occurs in 10% of those taking the drugs for an extended time
What causes eating disorders? Biological Factors: Dysfunction of the Hypothalamus
- lateral hypothalamus (LH) - ventromedial hypothalamus (VH) - theorists believe that the hypothalamus, LH and VMH, and chemicals, are responsible for weight set point or "weight thermostat" - set by genetic inheritance and early eating practices, this mechanism is responsible for keeping an individual at a particular weight level - dieters end up in a battle against themselves to lose weight
Psychological Views Of Schizophrenia: Cognitive Explanation
- leading cognitive theorists agree that biological factors produce symptoms - further feature of the disorders emerge because of faulty interpretation and a misunderstanding of symptoms - example: A man experiences auditory hallucination and approaches his friends for help; they deny the reality of his sensations; he concludes that they are trying to hide the truth from his; he begins to reject all feedback and starts feeling persecuted - there is little direct research support for this view
Treatments for Bulimia Nervosa
- left untreated, bulimia nervosa can last for years - treatment provides moderate to significant improvement in about 80% of cases - follow-up studies suggest that 10 years after treatment about 75% of patients have fully or partially recovered - relapse can be a significant problem, even among those who respond successfully to treatment a) often triggered by stress b) relapses are more likely to occur for those who have had longer histories of bulimia nervosa before treatment
Binge-eating/ Purging Type
- like those with bulimia nervosa, people with this subtype may engage in eating binges - lose weight by purging a) forcing themselves to vomit after meals or by abusing laxatives or diuretics
Restricting Type Of Anorexia Nervosa
- lose weight by restricting food intake (dieting, fasting) - show almost no variability in diet
What causes eating disorders? sociocultural: reasons between males and females
- males accounts for approximately 10% of all cases of eating disorders a) caution: this may be low! Some research reports binge in men and women at nearly equivalent rates - reasons for prevalence difference between men and women: a) Western society's double standard for attractiveness b) stigma associated with seeking treatment for a stereotypically female difficulty - a second reason may be the different methods of weight loss favored: a) men are more likely to exercise b) women more often change their diet (fast, purge, skip meals
Schizophrenia: The Community Approach: Key features: Supervised Residences
- many people do not require hospitalizations, but at the same time, are unable to live along or with their families - halfway houses: a residence for people with schizophrenia or other severe problems, often staffed by paraprofessionals. Also known as a group home or crisis house
What causes eating disorders? sociocultural: Western Standards
- many theorists believe that current Western standards of female attractiveness are partly responsible for the emergence of eating disorders - western standards have changed throughout history toward a thinner ideal - Miss America contestants have declined in weight by 0.28 lbs./ yr; winners have declined by 0.37 lbs./ yr - subcultures at greater risk: models, actors, dancers, and certain athletes
Delayed Ejaculation (Male orgasmic disorder/ inhibited male orgasm)
- marked delay, infrequency, or absence of ejaculation during all occasions of sexual activity with a partner. - pattern last 6 months or more - significant distress or impairment - substances that slow down the sympathetic nervous system (such as alcohol, some medications for high blood pressure, and certain psychotropic medications) can also affect ejaculation. - could be past masturbation habits. If a man has masturbated all his life by rubbing his penis against sheets, pillows, or other objects, he may have difficulty reaching orgasm in the absence of these objects during intercourse -may develop out of male hypoactive sexual desire disorder. A man who engages in sex largely because of pressure from his partner, without any real desire for it, simply may not get aroused enough to ejaculate. - sensation are tied to those objects.
Paraphilic Disorders (Statistics)
- may be comorbid or co-occurring - few are diagnosed although behavioral patterns may be common a) Example: Internet markets for paraphiliac pornography - little scientific evidence to support theorized explanations - none of the treatments applied to paraphilias have received much research or been proven clearly effective a) behavioral explanations and treatments often used, including cognitive-behavioral b) biological interventions include antiandrogens and antidepressants, specifically SSRIs, which lower the sex drive
What are the symptoms of schizophrenia? Negative symptoms: Social Withdrawal
- may withdraw from social environment and attend only to their own ideas and fantasies - seems to lead to a breakdown of social skills
Schizophrenia: The Community Approach: What are the features of effective community care?
- medication, psychotherapy, help in handling daily stress and responsibilities, decision-making guidance, social skills, training, residential supervision, and vocational training
Gender Dysphoria (statistics)
- men outnumber women 2 to 1 - often experience anxiety or depression and may have thoughts of suicide - the disorder sometimes emerges in childhood and disappears with adolescence a) in some cases, it develops into adult gender dysphoria - many clinicians suspect biological- perhaps genetic or prenatal- factors a) abnormalities in the brain including the hypothalamus are a potential link
What are the general features of sex therapy? Modern Sex Therapy helping with Disorders of Orgasm
- modern sex therapy is short-term and instructive - therapy typically lasts 15 to 20 sessions - centered on specific sexual problems rather than on broad personality issues a) past psychodynamic approaches emphasized broad personality changes, which was generally unhelpful - therapists now treat a range of individuals and types of couples
What do theorists believe about mood disorders that may "set the stage" for eating disorders
- more people with an eating disorder are diagnosed with major depressive disorder compared to the general population - close relatives of those with eating disorders seem to have higher rates of mood disorders - people with eating disorders, especially those with bulimia nervosa, have serotonin abnormalities
What perspective do most theorists and researchers use to explain eating disorders?
- multidimensional risk perspective - several key factors place individuals at risk: a) psychological problems (cognitive, mood) b) biological factors c) sociocultural conditions (societal pressures, multicultural factors)
Treatments for Anorexia Nervosa (broader goal)
- must also focus on underlying psychological problems to achieve lasting improvement - therapists use a combination of therapy and education to achieve broader goal a) cognitive-behavioral therapy emphasized b) may be used in combination of individual, group, and family approaches c) psychotropic drugs have been helpful in some cases.
Sexual Dysfunction: Female Orgasmic Disorder Biological Causes
- neurological and medical conditions (diabetes), substances and antidepressants, and post-menopausal changes - diabetes can damage the nervous system in ways that interfere with arousal, lubrication of the vagina - post menopausal: in skin sensitivity/ structure of the clitoris, vaginal walls, or the labia, the folds of skin on each side of the vagina
Sexual Dysfunctions: acquired type
- normal sexual functioning precede the dysfunction
Sexual Dysfunction: Disorders of Orgasm
- orgasm phase of the sexual response cycle a) sexual pleasure peaks and sexual tension is released as the muscles in the pelvic region contract rhythmically i) for men, semen is ejaculated ii) for women, the outer third of the vaginal walls contract Examples: Delayed Ejaculation (formally called male orgasmic disorder); female orgasmic disorder
Schizophrenia: Psychotherapy: Family Therapy
- over 50% of persons recovering from schizophrenia and other severe disorders live with family members a) this creates significant family stress along with high expressed emotion (relatives who are very critical, emotionally over-involved and hostile, often have a much higher relapse rate than those living with more positive and supportive relatives. - therapy addresses these difficulties and provides education a) family support groups also offered
Biological Views Of Schizophrenia: Genetic Factors --> Biological Abnormalities
- over the past four decades, researchers have developed a dopamine hypothesis to explain their findings on schizophrenia: a) certain neurons using dopamine fire too often, producing symptoms of schizophrenia - this theory is based on the effectiveness of antipsychotic medication and what research knows of Parkinsonian symptoms a) conclusion: antipsychotic reduce positive by binding to dopamine receptors on postsynaptic neurons, preventing dopamine binding and neuron firing b) D-2 receptors implicated
Lateral Hypothalamus (LH) involved in Eating Disorders: Biological Factors
- part that regulates bodily functions and produces hunger when it is activated. When LH of a laboratory animal is stimulated electrically, the animal eats, even if it has been fed recently
Antipsychotic Drugs: Side Effects: the results of medication-induced reductions of dopamine activity
- particularly in the basal ganglia and substantia nigra, parts of the brain that coordinate motor movement and posture - most cases, side-effects can be reversed with additional medication a) sometimes medication must be ended altogether (e.g. neuroleptic malignant syndrome and tarsive dyskinesia)
Sexual Dysfunction: Female Orgasmic Disorder
- presence of one of the following symptoms during almost all occasions of sexual activity, lasting 6 months or more: a) marked delay, infrequency, or absence of orgasm b) marked reduced intensity of orgasmic sensation
Psychosis
- psychosis is a state defined by a loss of contact with reality a) symptoms may include: i) hallucinations: false sensory perceptions and/or ii) delusions: false beliefs, not based on reality - functioning is significantly impaired - psychosis may be substance-induced or caused by brain injury, but most psychoses appear in the form of schizophrenia
Sociocultural Views Of Schizophrenia: Multicultural Factors
- rates of the disorder differ between racial and ethnic groups a) as many as 2.1% of African Americans are diagnosed, compared with 1.4% of European Americans i) important to note: when economic differences are controlled for, rates of schizophrenia become closer ii) this pattern also emerges for Hispanic Americans, who have a higher likelihood of being diagnosed compared to European Americans.
Paraphilic Disorders
- recurrent and intense sexual urges, fantasies, or behaviors that involve: a) nonhuman objects b) children c) non-consenting adults d) the experience of suffering or humiliation - a diagnosis of paraphilic disorder should be applied when the paraphilia(s) cause significant distress or impairment, or when it places oneself or others at risk a) current or past b) distinction is new to DSM-5
Treatments for Anorexia Nervosa (Immediate aims)
- regain lost weight - recover from malnourishment - eat normally again
Paraphilic Disorders: Voyeuristic Disorder
- repeated and intense sexual urges to observe unsuspecting people as they undress or to spy on couples having intercourse a) the person may masturbate during the act of observing or while remembering it later b) the risk of discovery often adds to the excitement - many psychodynamic theorists propose that voyeurs are seeking power (may feel shyness or adequate) - behaviorists explain voyeuristic disorder as a learned behavior that can be traced to a chance and secret observation of a sexually arousing scene thru operant conditioning
Paraphilic Disorders: Exhibitionistic Disorder
- repeated, sexually arousing urges or fantasies about exposing their genitals in a public setting a) also known as "flashing" b) may act on urges although sexual contact is rarely initiated nor desired - usually begins before age 18 and is common in males - treatment generally includes aversion therapy and masturbation satiation a) may be combined with orgasmic reorientation, social skills training, or cognitive-behavioral therapy
Paraphilic Disorders: Fetishistic Disorder (Statistics)
- research generally unable to pinpoint causes of fetishism - behaviorists propose classical conditioning and target behavioral treatments including: a) aversion therapy b) imaginal exposure/ covert sensitization c) masturbatory satiation d) orgasmic re-orientation
Antipsychotic Drugs: Effectiveness
- research has shown that antipsychotic drugs reduce schizophrenia symptoms in at least 65% of patients a) in direct comparisons, drugs appear to be more effective than any other approach used alone b) often maximum level of improvement in first 6 months of treatment c) symptoms may return if drug is ceased too soon d) reduce the positive symptoms more completely, or at least more quickly, compared to the negative symptoms e) medication compliance can be difficult
Institutional Care Takes a Turn for the Better: Token Economies: Research/ limitations
- research has shown that token economies help reduce schizophrenia-related behavior, improve self-image, and personal care. - limitations: a) research is not well-controlled b) effectiveness: overt behavior is changed although still underlying psychotic beliefs c) ethics?
What causes eating disorders? sociocultural: A new kind of eating disorder almost exclusively among men is:
- reverse anorexia nervosa or muscle dysmorphobia a) continue to strive for muscular "perfect" body through exercise, weight lifting, etc. with cognitive distortions that they are small or thin.
Sexual Disorders and Gender Identity Disorder (GID), Experts recognize two general categories of sexual disorders
- sexual dysfunctions: problems with sexual responses - paraphilic disorders: repeated and intense sexual urges and fantansies in response to socially inappropriate objects or situations
Schizophrenia: The Community Approach: Key features: Occupational training and support
- sheltered workshop: a supervised workplace for people who are not yet ready for competitive jobs. - reasons for this would be for companionship and placement
Sexual Dysfunction: Possible Causes of low sexual desire and excitement (Sociocultural)
- situational pressures or stresses, sexually-related trauma
Sexual Dysfunctions: situational type
- situations tied to particular situations
Sociocultural Views Of Schizophrenia: Overview
- social-cultural theorists believe that three main social forces contribute to schizophrenia: a) multicultural factors b) social labeling c) family dysfunction - although important, research has not yet clarified what their precise causal relationships might be
What causes eating disorders? sociocultural: Economic and Racial
- societal attitudes may explain economic and racial differences seen in prevalence rates - historically, women of higher socioeconomic standards (SES) had higher rates of eating disorders - however, dieting and preoccupation with thinness, along with rates of eating disorders, are increasing in all groups - the socially accepted prejudice against overweight people may perpetuate "fear" of becoming overweight - a recent survey of adolescent girls tied eating disorders and body dissatisfaction to social networking, internet activities, and television browsing
Sociocultural Views Of Schizophrenia: Family Dysfunctioning: Double-bind communication
- some parents repeatedly communicate pairs of mutually contradictory messages that place the child in "double-bind situations" - ex: the child cannot avoid displeasing the parents because nothing the child does is right - in theory, the symptoms of schizophrenia represent the child's attempt to deal with the double binds
Biological Views Of Schizophrenia: Genetic Factors --> Viral Problems
- some suggest that the biochemical and structural brain abnormalities seen schizophrenia in part result from exposure to viruses before birth - evidence showing mothers of children with schizophrenia were more often exposed to the influenza virus during pregnancy - a link between schizophrenia and antibodies to a particular group of viruses found in animals, suggesting that people has at some point been exposed to those particular viruses
Sexual Response Cycle For Females
- sometimes women do not experience orgasm; in that case, the resolution phase is less sudden - sometimes women experience two or more orgasms in succession before the resolution phase
Sexual Dysfunctions: lifelong type
- struggle with sexual dysfunction all of their life
A word of Caution: Paraphilic Disorders
- the definitions of paraphilic disorders, like those of sexual dysfunction, are strongly influenced by the normas of the particular society in which they occur a) can you think of any examples in which paraphilic behavior may be accepted within a culture? - some argue that except when people are hurt by them, many paraphilic behaviors should not be considered disorders at all a) DSM-5 made a more clear attempt to distinguish behavior from disorder i) remember: significant distress or impairment, or risk to self or others
Bulimia is also characterized by inappropriate compensatory behaviors:
- the most effective techniques are vomiting, laxatives, and diuretics although also fasting and exercising - largely fails to prevent the absorption of calories consumed during the binge - repeated vomiting affects the ability to feel satiated -> greater hunger and binging
What causes eating disorders? sociocultural: What seems to be linked in terms of some men developing eating disorders
- the requirements and pressures of a job or sport a) the highest rates of male eating disorders have been found among: jockeys, wrestlers, distance runners, body builders, swimmers
What are the symptoms of schizophrenia?
- the symptoms, triggers, and course of schizophrenia vary greatly - generally, symptoms can be grouped into three categories a) positive symptoms b) negative symptoms c) psychomotor symptoms
Despite their dietary restrictions, people with anorexia nervosa are preoccupied with food. This includes:
- thinking and reading about food - planning for meals - may not be causal, rather the result of food deprivation
Biological Views Of Schizophrenia: Genetic Factors --> Biochemical abnormalities, limitations of the dopamine hypothesis
- though enlightening, the dopamine hypothesis has certain limitations: a) it has been challenged by the disovery of new, more effective antipsychotic drugs ("atypical antipsychotics) i) bind to D-2, D-1, and serotonin receptors - it has also been challenged by theorists who claim that excessive dopamine activity contributes primarily to the positive- rather than negative- symptoms of schizophrenia
Gender Dysphoria (Common Patterns)
- to more effectively assess and treat those with the disorder, clinical theorists have tried to distinguish the most common patterns of gender dysphoria: a) female-to-male: women act more masculine b) male-to-female: androphilic type: very early on, pretty, gentle, heterosexual, tend to be attracted to males c) male-to-female: autogyneophilic type: tends to develop through a longer period of time, attracted to women that takes a longer time to develop; men fantasize themselves as women
Antipyschotic Drugs: Side Effects: Since learning of the unwanted side effects of conventional antipsychotic drugs, clincians have become more careful in their prescription practices by:
- trying to prescribe the lowest effective dose - gradually reduce or stop medication weeks or months after the individual begins functioning normally
Sexual Dysfunction: Female Orgasmic Disorder Sociocultural Causes
- unusually stressful events, traumas, relationship difficulties -likelihood of reaching orgasm may be tied to how much emotional involvement a women had during her first experience of intercourse and how long that relationship lasted, the pleasure the woman obtained during the experience, her current attraction to her partner's body, and her marital happiness - erotic fantasies during sex with their current partner are more common in orgasmic than in non-orgasmic women
Treatments for Bulimia Nervosa: individual, group format, family therapy
- used as a supplement - group therapy is helpful in as many as 75% of cases
Treatments for Anorexia Nervosa: Strengths
- weight gain is often quickly restored a) 90% still showed improvements after several years - menstruation returns - death rate is declining
Types of Delusions: Reference --> Schizophrenia
-" The Bravo channel is sending me cryptic messages that I need to apply for my own reality show" - attach special/ personal meaning to the actions of others or to various objects or events
Institutional Care Takes a Turn for the Better: two approaches
-1950s: two psychological approaches that brought some hope to chronic patients -1. milieu therapy -2. token economies
Schizophrenia: The Community Approach: Key features: Short-term hospitalization
-If the symptom don't subside, short-term hospitalization would be another solution where one would stay at a hospital for a couple weeks or at most a month
Schizophrenia: The Community Approach: Key features: coordinated services
-coordinated services: community mental health centers a) treatment facility that would supply medications, psychotherapy, and inpatient emergency care to people with severe disturbances as well as coordinating services offered in other community services b) usually a one-time stop
Main symptoms of Anorexia Nervosa
-restricted net intake of nourishment, resulting in low body weight a) lower 85% of normal body weight b) KEY FACTOR between anorexia and bulimia - intense fears of gaining weight, or persistent behavior that interferes with weight gain - distorted view of weight and shape a) maladaptive attitudes, overestimate size, low opinion body shape
Schizophrenia: The Community Approach: Failures
1) Poor Coordination of services: a) mental health agencies in a community often fail to communicate with one another b) to combat this problem, a growing number of community therapists have become case managers to provide assistance in coordinating 2) Shortage of Services a) short of programs available and adequate resources b) due to economic reasons and increase in public funds compared to the past.
Two main subtypes of Anorexia Nervosa
1) Restricting Type 2) Binge-eating/ Purging type
How are eating disorders treated? Two main goals
1) correct dangerous eating patterns 2) address broader psychological and situational factors that have led to, and are maintaining, the eating problem - this often requires the participation of family and friends
What is the course of Schizophrenia? Type I vs. Type II
i) type I: primarily positive symptoms, most treatable ii) type II: primarily negative symptoms
