Psyc 306 (Exam 2)

What is Stress?

A byproduct of poor/inadequate coping skills

Factitious Disorder

Condition in which a person acts as if he or she has a physical or mental illness when he or she is not really sick. Formerly known as muhcausen's syndrome goes to extremes to cause/create illness

GAD Diagnostic criteria

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about a number of events or activities B. The person finds it difficult to control the worry. C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for past 6 months). Note: Only one item is required in children: 1.restlessness or feeling keyed up or on edge 2. being easily fatigued 3. difficulty concentrating or the mind going blank 4. irritability 5. muscle tension 6. difficulty falling or staying asleep, or restless sleep D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder)

Commonality of anxiety disorders

Annual prevalence 18% Lifetime prevalence 29% Only ⅕ seek treatment Most common disorder in the U.S

Eating Disorder Onset

Anorexia - 16-20 yrs Bulimia - 21-24 yrs Binge Eating Disorder - 30-50 yrs

Panic Attack vs Anxiety Attack

Anxiety symptoms vary in intensity, from mild to severe. Panic attacks appear suddenly, while anxiety symptoms become gradually more intense over minutes, hours, or days. Panic attacks usually subside after a few minutes, while anxiety symptoms can prevail for long periods.

somatic symptom disorder Cognitive causes

Attentional bias by illness Prior experience with illness Trait-Based Risk factors

Excoriation Treatment

CBT

somatic symptom disorder Treatments

CBT ERP Medical management: doc only focuses on new complaints, antidepressants also helpful

Agoraphobia treatment

CBT exposure = most common and effective!

GAD Treatment

CBT, SSRI, SNRI = first line Buspirone, TCA, BZD = second line

SAD Treatment

CBT, medication (antidepressants, higher rate or relapse with meds)

Specific Phobia diagnostic criteria

Cardinal characteristics = avoidance of the object or situation Most phobias are categorized as specific but there are also broader disorders

Other factors that develop stress

Crises → overwhelms our coping strategies, very intense stressors that overwhelm any kind of coping skill Life changes → positive OR negative (getting married, having a kid) Perception of benefits → personal growth, if you can identify at least a positive aspect derived from that stressor you will most likely be able to manage it better

ED Comorbidities

Clinical Depression: AN = 68% BN = 63% BED = 50% OCD Substance Abuse Disorder: Binge/purge of BN & AN but NOT the restrictive type BED = 23% Personality Disorders: 58% of those with an ED also have a PD Some symptoms may be a consequence of malnourishment vs comorbid diagnosis

Treatment of ED

Clinical Depression: AN = 68% BN = 63% BED = 50% OCD Substance Abuse Disorder: Binge/purge of BN & AN but NOT the restrictive type BED = 23% Personality Disorders: 58% of those with an ED also have a PD Some symptoms may be a consequence of malnourishment vs comorbid diagnosis

Specific phobia psychoanalytic explanation

Defense against anxiety stemming from repressed id impulses

somatic symptom disorder Diagnosis criterion

(a) 1+ Somatic Symptoms, Chronic & Distressing o Pain is most common (b) Dysfunctional thoughts, feeling, behaviors about that symptom: o Disproportionate & persistent thoughts about seriousness of symptoms o High levels of anxiety about health or symptoms (c) Symptoms may not be persistently present o State of being symptomatic IS persistent (+6 months) o "I don't feel it now, but it is only a matter of time till it comes back"

Negative Stress

(distress) bad stress

Anorexia onset

- 16-20 yrs. Old - 0.9% in women - 0.3% in men

Risk factors for developing stress

- Genetics (polygenic component) - Experience 1+ crisis - Significant life events (+/-) - Individual perception of stressor - Individual Stress tolerance

Stress Protective Factors

- Male gender - older age - higher education - economic resources - positive outlook on life - self-confidence - social support

Dissociative disorders

- characterized by SIGNIFICANT memory loss, or identity disruption/failure

OCD diagnostic criteria

-recurrent obsessions or compulsions (or both) take up more than 1 hour a day or cause considerable stress to the individual -not caused by substance, medication use, or other disorders - interferes with daily functioning - causes great distress

Types of Dissociative Amnesia

1. Localized 2. Selective 3. Generalized 4. Continuous in all 4: procedural, semantic, and short-term memory systems stay intact, long-term is lost/disturbed

PTSD Causal Factors

1. Nature of trauma (e.g. human intent vs natural disaster) 2. Degree of direct exposure to event 2. Individual risk factors (female; neuroticism; family hist of or preexisting depr, anxiety, subst abuse) (biological: s/s genotype, smaller hippocampus, cortisol response [women]) 3. Sociocultural risk factors (social isolation)

What systems are activated with the "normal" stress response?

1. Sympathetic-adrenomedullary (SAM) system - fight or flight responses 2. Hypothalamus-pituitary-adrenal (HPA) system - releases cortisol 3. Parasympathetic Nervous (PNS) system - When the perceived danger passes, the PNS helps return body processes to normal levels (homeostasis)

SAD Prevalence and Comorbidity

12% lifetime Women more 2:1 Typically adolescence of early adulthood · Other anxiety disorders · Depression (50%) · Substance abuse (to reduce anxiety → 33%)

Why are rates of suicidal ideation and attempts higher for panic disorder?

?

PTSD Treatment

Cognitive behavioral therapy exposure therapy antidepressants/antipsychotics

Comorbidities of anxiety disorders

Depression another anxiety disorder 2 or more anxiety disorders caused by the other 55% 2 or more individual anxiety disorders 26% 1 anxiety disorder only 19%

BDD comorbidity

Depression (50%) Suicide

Eating Disorder gender differences

Female : Male - 10:1 → 3:1 Due to stigma in being diagnosed Woman tend to be more appearance-focused than man Gay & bisexual men > heterosexual men

GAD: The Psychodynamic Perspective

Freud believed that all people experience anxiety, use defense mechanisms to help control it (conflicting id & ego) 3 types: Realistic, Neurotic, Moral

Specific Phobia biological perspective

GENETICS Superior fear conditioning enhance resistance to extinction Identical twins are more likely to share animal and situational phobias

Biological formulation (GAD)

Genetics, neurotransmitters (GABA, serotonin), HPA system

Conversion Disorder Treatment

Integrating the subpersonalities Integration into a single identity Integration is a continuous process Following integration, further therapy is typically needed to: Maintain the complete personality Teach social and coping skills to prevent later dissociation Treatment is based on POSTTRAUMATIC THEORY Hypnosis commonly used Uncovers & processes traumatic experiences Less successful than treatment for DA

Acute stress disorder diagnostic criteria

Intrusion symptoms = nightmares, intrusive images, physiological reactivity to trauma reminders Negative mood = persistent inability to experience positive mood Dissociative symptoms = being in a daze, time slowing, observing oneself from others perspective, impaired memory of an event Avoidance symptoms = efforts to avoid thoughts, feelin, or reminders Arousal symptoms = hypervigilance, excessive response when startled, irritability, disturbed sleep, difficulty concentrating

Agoraphobia Prevalence/Comorbidity

PREVALENCE: Þ 1.4% lifetime Þ 2:1 - Women to Men COMORBIDITY: Þ Panic disorder

GAD: The Cognitive Perspective

Perception of uncontrollability and unpredictability Negative consequences of worry Cognitive biases (anxious people are more attuned to threatening cues // non anxious show no bias or opposite bias)

Hoarding Disorder

Persistent difficulty discarding or parting with possessions, regardless of their actual value

Specific phobia behavioral explanation

Phobias are learned behavior Maintained through avoidance May developing in GAD when a person acquires a large number of them

OCD treatment

Psychotherapy treatment = exposure and response prevention (ERP) Clients are repeatedly exposed to anxiety provoking stimuli and are told to resist performing the compulsions. Gradually move through hierarchy of stimuli 76% improve 25% fail to improve THERAPY ALONE (VS COMBINED WITH MEDS) MAY BE MOST EFFECTIVE

Excoriation (Skin-Picking) Disorder

Recurrent skin picking resulting in skin lesions Spend significant time per day

why does PTSD develop?

SAM systems = fight or flight freeze response It is unconscious, automatic, and normal

Eating Disorders

Severe disturbances in eating behavior characterized by preoccupation with weight concerns and unhealthy efforts to control weight.

Key factors of stressors

Severity → stressors that are more severe in nature will more likely impact the individual Chronicity → the longer that the stressor operates, the longer that the stressor will be present, and the consequences will be worst Timing → how close in time do stressors occur? If in close succession, the stress' impact and potency will increase substantially Degree of impact → if more closely involved in a situation, it will impact you more Predictability → if we can predict a stress coming up, we can prepare ourselves mentally. If unpredictable, it will lead to higher levels of stress Controllability → if there's no way to reduce impact of stressor, there will be a higher likelihood of stress development

Binge-Purge Cycle

Tension / cravings Binge eating Purge to avoid wt. gain Shame/guilt/disgust Strict dieting

Trichotillomania (Hair-Pulling Disorder)

The compulsive, persistent urge to pull out one's own hair. Must cause clinically significant distress

ANXIETY

The condition of feeling uneasy or worried about what may happen

ED prevalence

U.S. Lifetime Prevalence: Bulimia - 1.5% women, 0.05% men Anorexia - 0.9% women, 0.3% men Binge Eating - 3.5% women, 2% men In obese people → 6.5-8% Occupations: Women: dancers (ballet), models, actresses Men: jockeys, wrestlers, distance runners, body builders, swimmers

Impact of relationships & social support on PTSD?

We know that the impact of a relationship can either cause PTSD or help ease the symptoms with social support and a strong social circle. An emotions trauma that can cause PTSD symptoms is infidelity the three stages of recovering from PTSD causes by a partners infidelity Absorbing the blow Giving meaning, establishing new assumptions Moving forward

Generalized Anxiety Disorder (GAD)

a diffuse state of constant anxiety not associated with any specific object or event

obsessive-compulsive disorder (OCD)

a disorder in which repetitive, intrusive thoughts (obsessions) and ritualistic behaviors (compulsions) designed to fend off those thoughts interfere significantly with an individual's functioning

Panic Disorder formulations

a. BIOLOGICAL PERSPECTIVES: ¯ GENETICS o 30-34% due to genes ¯ BRAIN FUNCTIONING o Amygdala o Hippocampus o Higher cortical centers § EXTREME stimulation in these areas ¯ BIOCHEMICAL o Panic provocation procedure (fear network that is activated more quickly) o Noradrenergic & Serotonergic systems → not functioning properly, intense physiological responses develop o Low levels of GABA & Serotonin b. PSYCHOLOGICAL PERSPECTIVE ¯ Cognitive Theory of Panic: o Panic-prone individuals are very sensitive to certain bodily sensations § Interpret them as medical catastrophe (automatic thoughts) ¯ Learning Theory of Panic: o Panic attack becomes associated with neutral internal & external cues (interoceptive & exteroceptive conditioning) § The more intense the panic attack, the more robust the conditioning will be ¯ Anxiety Sensitivity: o Focus on bodily sensations § Unable to assess logically, interpret as potentially harmful

PTSD Symptom Cluster (need to have 1+)

a. Intrusion Symptoms (+1) → nightmares, intrusive images, physiological reactivity to trauma reminders b. Avoidance Symptoms (+1) → efforts to avoid thoughts, feelings, or reminders of trauma c. Negative Alterations in Cognition and Mood (+2) → detachment, shame, anger, distorted blame of self/pothers, impaired memory of event d. Arousal & Reactivity Symptoms (+2) → hypervigilance, excessive response when startled, irritability, disturbed sleep, difficulty concentrating DISSOCIATIVE SYMPTOMS: a. Depersonalization → persistent/recurrent experience of feeling detached from body (dream state; self or body isn't real; slow-motion time) b. Derealization → persistent/recurrent experiences that world is unreal, dreamlike, distant, distorted

Subpersonality Interactions

a. Mutually Amnesic Relationships → subpersonalities have NO awareness of one another b. Mutually Cognizant Patterns → each subpersonality is well aware of the rest c. One-Way Amnesic Relationships → some personalities are aware of others, but awareness is not mutual (most common) d. Co-conscious Subpersonalities → those that are aware are "quiet observers"

What Causes Conversion disorders?

a. POST-TRAUMATIC THEORY: · 95% patients with DID report severe, horrific childhood abuse · Child attempts to cope with abuse by dissociating - escape into fantasy/become someone else o Reduction in pain → reinforcement o Children who are fantasy-prone & easily hypnotized have diathesis for DID · Complex PTSD? o Anxiety: PTSD > DID o Dissociation: PTSD < DID b. SOCIOCOGNITIVE THEORY: · Highly susceptible person learns to adopt & enact multiple identities following inadvertent behaviors of clinicians o Through suggestion, legitimization, or reinforcement clinicians are responsible for eliciting disorder o Study found that identities could be induced

Cause of Eating Disorders

a. PSYCHODYNAMIC THEORIES: ¯ Parents respond to their children ineffectively, failing to attend to biological + emotional needs ¯ Deficiencies in parenting contribute to a broad cognitive distortion underlying disordered eating o Negative self-judgement based on body shape and weight ¯ ANOREXIA o Stems from an effort to delay/interrupt sexual maturation o Reflects a passive-aggressive response to conflicts around control & autonomy ¯ BULIMIA o reflects self-nurturing with food in the absence of adequate parental nurturing BIOLOGICAL FACTORS: ¯ Serotonin malfunction ¯ Hypothalamus and related brain areas may be responsible for weight "set-point" or "weight thermostat" o Set by genetic inheritance & early eating practices o Mechanism responsible for keeping an individual at a particular weight level § If weight falls below set point: hunger, metabolic rate → binges § If weight rises above set point: hunger, metabolic rate o ANOREXIA § is a constant fight to reduce hunger MOOD DISORDERS: ¯ Persons with EDs have higher rates of major depressive disorder ¯ People with EDs (especially BN), have serotonin abnormalities o Symptoms of EDs are helped by antidepressant meds SOCIOCULTURAL FACTORS: ¯ Societal pressures → western standards of attractiveness may contribute to emergence of EDs o Western standards have changed throughout history: § "Thinner" → ideal for women § "Muscular" → ideal for men o Models, actors, dancers, athletes are at higher risk for EDs § 9% collegiate athletes full criteria for ED § 50% has 1 or more symptoms § 20% gymnast appear to have EDs ¯ Socially accepted prejudice against overweight people may also add the "fear" and preoccupation about weight o Estimated that as many as 50% of elementary, 61% of middle school girls are dieting e. FAMILY INFLUENCES - play important roles in developing EDs ¯ Half of families of those with EDs, have long history of emphasizing thinness, appearance, dieting ¯ Emphasis on propriety and rule-mindedness ¯ Parental over-direction of child or subtle discouragement of autonomous strivings o Poor skills in conflict resolution ¯ Preoccupations regarding desirability of thinness, dieting, good physique d. INDIVIDUAL RISK FCATORS: ¯ Gender o Female - AN, BN most common o Male - BED most common o Sexual orientation - risk for males ¯ Internalization of thin ideal o Perfectionism o Negative body image ¯ Dieting ¯ Negative emotionally ¯ Childhood sexual abuse

SAD Formulations

a. PSYCHOLOGICAL FACTORS ¯ Learned or vicarious behaviors ¯ Perceptions of uncontrollability & unpredictability -- People are unpredictable, you don't have control over them b. BIOLOGICAL FACTORS ¯ Genetics: 12-30% of variance due to genes ¯ Temperament: behavioral inhibition

What Causes dissociative disorders?

a. PSYCHOLOGICAL PERSPECTIVE: ¯ Unconscious attempts to avoid thoughts about a situation o Physical Avoidance ¯ Presented w/ unpleasant situation o no clear way to escape o large segments of personality and memory are suppressed BRAIN IMAGING: ¯ Case studies show differences in brain activity ¯ Frontal & temporal regions

dissociative fugue

a. extreme case of dissociative amnesia, people not only forget their personal identities and details of the past but also flee to an entirely different location o For some is brief, matter of hours or days, and ends suddenly o For others is more severe: people may travel far from home, take a new name, establish new relationships, new work (new personality characteristics) Þ FUGUE = FLIGHT Þ 0.2% population → it usually follows a stressful event Þ Ends abruptly → therapists may have to constantly remind them of their own identity Þ Most people regain most or all of their memories → never have a recurrence

Anorexia Nervosa

an eating disorder in which an irrational fear of weight gain leads people to starve themselves *significantly underweight*

Panic Disorder treatments

antidepressant drugs restore proper norepinephrine activity in locus coeruleus and help reduce panic / cognitive behavioral therapy Improvement in 80% of patients Anxiolytics like xanax are also effective Antidepressants are better Therapy = psychoeducation, teach about accurate interpretations of bodily sensations, coping skills, combine with behavioral therapy like exposure Effective 70-90% become panic free Useful for panic disorder with agoraphobia

Trichotillomania comorbidity

anxiety depression

Panic Disorder

characterized by recurrent, unexpected panic attacks

Effects of short-term stress

compromised immune system

Anorexia Medical Complications

death from heart arrhythmias, kidney damage, renal failure

Specific phobia treatment

exposure, flooding, modeling

Social Anxiety Disorder (Social Phobia)

extreme, enduring, irrational fear and avoidance of social or performance situations Narrow: talking, performing, eating, writing in public Broad: general fear of functioning poorly in front of others

Specific Phobia

fear of objects or specific situations or events

Agoraphobia

fear or avoidance of situations, such as crowds or wide open places, where one has felt loss of control and panic

Trait anxiety

general anxiety level, baseline level

Effects of long-term stress

global immunosuppression and inflammation chronic problems at immune system level may lead to behavioral changes/psychiatric problems

depersonalization/derealization disorder

individuals feel detached from their own mind and body (depersonalization) or from their surroundings (derealization) UNKNOWN TREATMENT

Body Dysmorphic Disorder (BDD)

obsession with some perceived flaw or flaws in one's appearance results in: a. Repetitive behaviors (mirror checking, excessive grooming, seeking reassurance) b. Mental acts (comparing appearance to others)

Positive Stress

planning a wedding, having a baby

Adjustment disorder, Acute Stress Disorder, Posttraumatic Stress Disorder

psychological responses to a common stressor

State Anxiety

refers to "right now" feelings that change from moment to moment

somatic symptom disorder Behavioral causes

reinforcement observational learning

Anorexia nervosa subtypes and symptoms

restricting type and binge-eating/purging type · Despite dietary restrictions, exhibit high preoccupation with food o Excessive thoughts/plans around mealtimes · Distorted cognitions o Low opinion of body shape o Overestimate their size/proportions o Maladaptive attitudes & misperceptions

Fear

the usual reaction when a stressor involves immediate danger

GAD Prevalence

§ 6% lifetime prevalence § 3% annual prevalence o Women outnumber men by 2:1 § 60-80% report feeling anxious all their lives Typically age of onset is during adolescence

Sp. Phobia Prevalence

§ Lifetime = 12% § Women outnumber men by 2:1 § Age of onset varies by type of phobia: a) Childhood - animals, blood-injection-injury, dental b) Adolescence/early adulthood - claustrophobia, driving § Most people do not seek treatment

anorexia treatment

§ Promote normal eating behavior § Weight restoration o Supportive nursing care o Nutritional counseling o High calorie diets o Life-threatening cases: IV feeding tubes § Medications o Antipsychotics o Antidepressants § Must overcome underlying psychological problems to achieve a lasting-improvement § Treatment Programs (in-patient): o Clients monitor feelings, hunger levels, food intake and ties among them o Recognize underlying feelings o Change attitudes about eating & weight o Inclusion of family § POSITIVE OUTCOMES: o Wt. gain is often quickly restored, and maintains improvement o Menstruation resumes after returning to normal wt. § NEGATIVE OUTCOMES o 25% patients fail to improve o Initial recovery is not often permanent § Anorexic behaviors are triggered by new stresses § Still express concern about wt. & appearance o Lingering emotional problems § Suicide risk is HIGH → 18x higher likelihood § Poor long-term prognosis § Disordered relationship. with food persists § COURSE & OUTCOMES: o After 21 yrs - 51% fully recovered - 21% partially recovered - 10% not recovered - 16% no longer alive

factitious disorder imposed on another

¯ Individual is intentionally making someone sick o Munchausen Syndrome by Proxy ¯ Caregiving role (parent to child or vice versa) o Usually parent → child ¯ HARD TO DIAGNOSE!! o Takes very long for data to be collected (avg 14 months) o Caretaker is resistant to admit the truth (denial) o If caretaker becomes suspicious, seeks new doctor § Doctor's concerns may suffer with incorrect diagnosis, liability § Use of covert observations (video, supervision) o 10% of known cases result in a child dying

Conversion disorder causes

¯ Primary gain = reduction in anxiety ¯ Secondary gain = sympathy, attention a. PSYCHODYNAMIC PERSPECTIVE **: ¯ Unconscious conflict o Sexual conflict converted to bodily disturbances/sensations ¯ Anxiety is converted into bodily disturbance b. BEHAVIORAL PERSPECTIVE: ¯ Reinforcement o Positive & Negative ¯ Avoid punishment o Unable to express feelings

Factitious disorder causes

¯ Unknown ¯ Unclear secondary gain (social gains, reinforcement)

factitious disorder prevalence

· 0.5-0.8% in general hospital setting · Women > men

OCD prevalence and comorbidity

· 1 year= 1% · lifetime= 2-3% · No gender differences · Age of onset = late adolescents, early adulthood · Disorder "waxes and wanes": sometimes they are less severe, and then in other periods they are way more severe and difficult to manage Þ Other anxiety-depression disorder Þ Depression (80%) → "this is hopeless, I can't stop doing it", isolating

DID Prevalence/Onset/Comorbidities

· 1.5% community sample · 6% trauma sample · Women diagnosed 3-9x more than men o And also have MORE personalities than men ONSET: · Early childhood (~5 yrs) · Most commonly after episodes of abuse · Initial diagnosis occurs in adolescence/early adulthood COMORBIDITIES: · Depression · PTSD · Substance-use · Borderline Personality Disorder o Research = average of 5 comorbid disorders

dissociative identity disorder (DID)

· 2+ distinct personalities ("Alter Egos") - each with unique set of memories, behaviors, thoughts, and emotions · Formerly known as "Multiple Personality Disorder" · Recurrent episodes of amnesia o Each time a personality comes forward, that personality is the one storing information/memories in their system · 1 of the Subpersonalities dominates the person's functioning at any given time o 1 Subpersonality - the primary or "host" personality - appears more often than others o Transition from one subpersonality to the next ("switching") - is usually sudden and may be dramatic

Bulimia onset and comorbidities

· 21-24 yrs · 1.5% women · 0.05% men · Clinical Depression: 65% · OCD · Substance Abuse Disorder · Personality Disorder: 58%

BED Onset, Comorbidities

· 30-50 yrs. · 3.5% in Women · 2% in Men · 6.5-8% in Obese People Þ Clinical Depression - 50% Þ OCD Þ Substance Abuse Disorder - 23%

conversion disorder prevalence/onset/comorbidities

· 5% - Neurological Clinics · .005% - General Population (very rare) · Decreased significantly with technological advancements · Patients are medically unsophisticated · 2-3x more common in women ONSET: Early adolescence Early adulthood COMORBIDITIES: Þ Depression Þ Anxiety Þ Other Somatic or Dissociative disorder

Panic disorder comorbidity

· 83% have at least 1 comorbid disorder · 50-70% serious depression at some point in their lives · Suicidal ideation & suicide attempts · Agoraphobia o NOTE: panic w/o agoraphobia is more common o More common agoraphobia w/panic · Only about 35% seek treatment

Acute Stress Disorder prevalence

· < 20% - non-interpersonal trauma (13-21% motor vehicle accident) · 20-50% - interpersonal trauma (rape, assault, witnessing mass shooting) · More prevalent in females: · Because women are more likely to experience traumas that are more interpersonal in nature

Conversion disorder treatments

· Behavioral Therapy for Motor Symptoms → changes reinforcement structures · CBT for seizures · Hypnosis + Problem Solving Strategies § If anxiety is high, get into deep relaxation state, symptoms relief

Bulimia diagnostic criteria

· Binge & Purge at least 1x per week, for 3 months · ~1 up to ~30 binge episodes per week · Usually binge in secret o Massive amounts of food in very short time o Usually high-calorie food with soft texture · "pleasurable" at the moment o Followed by extreme self-guilt, blame, depression, etc... Þ Compensate to "undo" caloric effects by: o Purging → resort to vomit Þ Fail to prevent absorption of some calories consumed Þ Repeated vomiting affects ability to feel satiated → leading to > hunger, > binging

somatic symptom disorder

· Captures 3 disorders lumped together, including: o Hypochondriasis o Somatization disorder o Pain disorder

Bullimia Nervosa

· Characterized by BINGES o Repeated bouts of uncontrolled overeating during a very short period of time · Average wt. or slightly overweight · Characterized by PURGES o Inappropriate compensatory behavior to get "rid" of excessive food consumed (binged) o Forced vomiting o Misuse of laxatives, diuretics, enemas o Fasting o Overexercising

orthorexia nervosa

· Compulsive checking ingredient lists, nutritional labels · Increase concern about health/food composition/ingredients · Cutting out an increasing amount of food groups o All sugars o All carbs o All dairy o All meats · Inability to eat anything but a narrow group of "safe foods" · Spend hours per day planning meals/alternatives at events · High levels of distress when "safe foods" aren't available · Body image may or may not be a concern

BED Treatment

· Eliminate binge pattern · Promote normal eating behavior · Medications: o Antidepressant o Appetite suppressants o Comorbid BED and MDD · Cognitive-Behavioral & Interpersonal Therapy: o IPT > CBT · 60% in remission after 6 yrs

Binge Eating Disorder (BED)

· Engaged in repeated binging episodes with complete loss of control · Do NOT perform compensatory behaviors · 2/3 of BED people become overweight or obese

somatic symptom disorder functional impairments

· Extremely high medical costs (constantly going to doctor, having medical procedures done) · Difficulty maintaining employment (having sick breaks) · Relationship distress

Risk factors for developing PTSD

· Female gender · Higher levels of neuroticism (negative affect) · Pre-existing problems with depression & anxiety · Family history of depression, anxiety, substance abuse · Low levels of social support

Adjustment disorder comorbidities

· Frequently accompanies medical illness and injury · least stigmatized diagnosis

PTSD Prevalence

· Lifetime prevalence rate in US is 6.8% · Females → 9.7% vs 3.6% for males · Highest rates (33-50%) among survivors of military combat and/or captivity, rape

PTSD Risk factors for exposure to trauma

· Occupation (military, first responders) · Male gender · Lack of college ed · Family history or psychiatric disorder · Scoring high on measures of extraversion and neuroticism (negative mood)

dissociative amnesia

· People are unable to recall important information about their lives · Loss of memory is more extensive than normal forgetting, not caused by physical factors · Often an episode of Amnesia is directly triggered by a specific upsetting event: o follows high stress o Episodes last between a few days - a few years o Most experience only 1 episode, some have multiple

Adjustment disorder diagnostic criteria

· Symptoms emerge within 3 months of stressor · Distress is disproportionate to severity/intensity of stressor · significant impairment · does not meet criteria for other dx or exacerbation of preexisting dx When stressor ends, symptoms do not persist for >6 months after

posttraumatic stress disorder (PTSD) diagnosis criteria

· Symptoms must remain present for 1+ months · 50% of those diagnosed with Acute Stress Disorder will be re-diagnosed with PTSD · Main difference between ASD (3 days-1 month) and PTSD (1 month or more) is timeline · Exposure to actual/threatened death, serious injury, or sexual violation · Direct experience · Witnessing event · Learning that occurred to a loved one

PTSD Comorbidity

· Those with PTSD diagnosis are 80% more likely to have at least another diagnosis (depression, bipolar, anxiety, substance use) · OEF/OIF combat veterans with PTSD: 48% also have mild TBI · Children: comorbid Oppositional Defiant Disorder or Separation Anxiety Disorder

Bulimia outcomes

· Treatment provides immediate, significant improvement in about 40% cases o Additional 40% shows moderate response · Relapse can be a problem o Triggered by stress o More likely among those with: § Longer history of symptoms § Frequent vomiting § Substance use § Interpersonal problems · 70% in remission after 11-12 years · Long-term prognosis is relatively good

Adjustment disorder prevalence

· Very common · Private practice - 5-20% outpatient setting · Clinics - 50% inpatient setting

Panic Disorder prevalence

· ¼ adults will experience 1+ panic attack in their lifetime · Timing of first attack = usually following extreme distress event · 2.4% each year, 5% over a lifetime Women: 2:1 Develops between ages 20-40 · Low SES are 50% more likely to develop it

depersonalization/derealization disorder prevalence/comorbidity

Þ 1-2% lifetime Þ Female = Male Þ Onset is typically from 16-25 yrs old o Very rare to be diagnosed after 25 yrs, and even more after 40 yrs COMORBIDITIES: · Depression · Anxiety · Personality Disorders - Avoidant - Borderline - OCD

Prevalence of BDD

Þ 2% in general population o Little prevalence bc it has been normalized nowadays o may not be seeking psychological treatment, but instead running to doctors/surgery/plastic surgery Þ NO gender differences Þ Onset typically in adolescence o Puberty o Body shape, body size changes o Acne pops

somatic symptom disorder prevalence/comorbidities

Þ 5-7% but hard to say (go to medical settings for pain) Þ Females > males Þ Patients may disregard doctors' comments if it is not what they want to hear Þ Anxiety Þ Depression

conversion disorder

Þ Display physical impairment in voluntary motor or sensory functioning, but the symptoms are inconsistent with known neurological or medical diseases can present blindness, deafness, paralysis, quasi-seizures

Panic Disorder diagnostic criteria

Þ Extreme anxiety reaction Þ Panic ATTACKS are short episodes that occur suddenly, reach a peak, and then pass Þ Attacks are recurrent and unexpected Þ 13+ SYMPTOMS → diagnostic criteria require abrupt onset of 4 § 10 of those 13 are physical symptoms § 3 are cognitive symptoms Þ The person fears he/she will die, go crazy, lose control, in the presence of no real threat

Hoarding disorder prevalence

Þ General population: 3-5% Þ Individuals with OCD: 10-40%

How do subpersonalities differ?

Þ Identifying Features (age, gender, race, family history, sexual orientation) Þ Abilities and Preferences (ability to drive, speak a foreign language, play a musical instrument) Þ Physiological Features (autonomic nervous system activity, blood pressure levels)

How common is DID

Þ Increasing number of people being diagnosed o 1000 cases have been documented in the US and Canada alone Þ 2 factors may account for this increase: o Growing number of clinicians believe that the disorder does exist and are willing to diagnose it o Diagnostic procedures have become more accurate

Excoriation prevalence

Þ Lifetime prevalence = 1-4% Þ Gender difference = 75% female

OCD Formulations

Þ Other anxiety-depression disorder Þ Depression (80%) → "this is hopeless, I can't stop doing it", isolating, FORMULATIONS: WHAT causes OCD? a. BIOLOGICAL PERSPECTIVES: ¯ GENETICS: o 3-12x higher rates in first degree relatives ¯ BRAIN FUNCTIONING ¯ NEUROCHEMISTRY o Low Serotonin TREATMENTS: Þ Serotonin-based Antidepressants o SSRIs b. PSYCHODYNAMIC PERSPECTIVE: ¯ Anxiety disorders develop when children come to fear their impulses and use ego defense mechanisms to lessen their anxiety ¯ OCD differs from other anxiety disorders in that the "battle" is not unconscious; it is played out in overt thoughts and actions o Id impulses = obsessive thoughts (e.g., reaction formation) o Ego defenses = compulsive actions (e.g., undoing) c. BEHAVIORAL & COGNITIVE PERSPECTIVE ¯ Cognitive Therapists focus on the cognitive processes that help to produce and maintain obsession o Suppressing unwanted thoughts INCREASE thoughts → not an effective way o Those with OCD have cognitive biases toward material relative to their obsessions ¯ Thought-Action Fusion

ED Crossover

Þ People with EDs often later develop OTHER EDs o Bidirectional transitions between 2 subtypes of anorexia (Restrictive → Binge/Purge) o Shift from anorexia to bulimia o Few transitions from bulimia to anorexia o No shift from restricting anorexia to bulimia o No shift from binging to anorexia or vice versa

depersonalization/derealization disorder symptoms

Þ Persistent/recurrent Þ Considerable distress Þ Interfere with social relationships and job performance o 80% chronic, little/no fluctuations

illness anxiety disorder (hypochondriasis)

Þ Preoccupation with having or developing serious illness Þ No present of somatic symptom of any pain/disorder o If ever present, it would be extremely mild o Concerns about predispositions due to family history illness Þ High anxiety about health easily alarmed about health status o Excessive health related behaviors (repeatedly check their bodies for sign of illness) o Maladaptive avoidance (avoids doctor appointments or hospitals) o Symptoms are merely normal bodily changes (occasional coughing, sores, sweating) Þ Illness preoccupation present for 6+ months (focus can change) o One day can be focused about having diabetes, other can be appendicitis, cancer, ... shifts from day to day

Bulimia Treatment

Þ Promote normal eating behavior Þ Cognitive-Behavioral Therapy