Abnormal Psychology Exam 2 (chapters 4-6)

-Books Definition of adjustment disorder:

is a psychological response too a common stressor the results in clinical significant behavioral or emotional symptoms

Adjustment disorder:

it is a mild disorder (lease severe disorder in DSM), when people have temporary difficulty adjusting to a situation (for example: students who go away for the first time in their life to attend college) —While adjusting, their symptoms lesson or disappear when the stressor ends or the person learns to adapt

Another dimension is the method of assessment

there are a couple of ways to assess ptsd (one is a questionnaire and the other is a clinical interview) the rates of reported ptsd are dramatically different depending on if you have had the questionnaire or the clinical interview (questionnaire is 21% rate of ptsd, stunted clinical interview: 4%)

Crisis intervention has been tried

this can help sometimes, the person has to be trained

Psychological debriefing has been tried

this is done for students who have been through something traumatic such as a school shooting, they give people a chance to talk. This is sometimes conducted by people who have little to no mental health training, this is better with trained professionals.

-many patients are not willing to go through the treatment

-she has a clinic and many refuse to go through the treatment the dropout rate and cancellation rate for the treatment is very high, higher than average because it is a difficult treatment

Structured interviews

(not used often): rigid list of questions they ask the client (requires a lot of time and training to ask the questions. Limitations: forecloses certain responses, closed ended questions, client can't speak freely, may not get the information you are seeking You have to use structured interviews in research protocol

It has been found that those who have ptsd have a smaller hippocampus

(structure in the limbic system which is heavily involved in memory) but what caused what? Did the smaller hippocampus higher your risk of ptsd or did ptsd make your hippocampus smaller? We don't know the circle of causality

Doctor Edna Foa

(treats people who have ptsd especially rape victims): she states: if you are a surviver of trauma you should follow you own natural inclination to talk or not talk about the problem and you should choose who you want to talk to and who you don't want to talk to. She was invited by the university of Pennsylvania for a fantastic position.

—How prevalent are the rates of trauma from military combat?

-Iraq war the ptsd was 12.9% -Afghanistan war the estimate is 7.1%, -Vietnam estimate was 12—16%

How therapists use prolonged exposure:

-first, the person must have trust with the therapist, if they have a good bond they agree in advance that they are going to use the treatment -next, they talk about it in great detail (relive the horrific event) it will be painful and difficult and must be able to tolerate it but if they don't do it they will not be able to recover

People have speculated that we should prepare people in advance for the stressor (most have not been successful, empirically speaking it doesn't work that well)

-stress inoculation training: supposed to get you ready for a stressful event simulated in advance or tell you what's going to happen (trying to prepare people is not very effective there is not really anything you can do to prepare someone for a very traumatic event)

They have done different studies that estimate the prevalence of ptsd; the studies vary widely in their conclusion of how common ptsd is —The rate that is reported varies widely, why?

1. -The rate of ptsd depends on the kind of stressor that was faced 2. -Another dimension is how direct was your exposure to the stressor 3. -Another dimension is the method of assessment

The DSM has 3 stress related disorders:

1. Adjustment disorder 2. Acute stress disorder 3. Post Traumatic stress disorder (most severe)

What are the risk facts of getting ptsd?

1. Being a female 2. Higher level of neuroticism 3. Preexisting problems of anxiety and depression 3. Family history of depression, anxiety, and substance abuse 4. Low levels of social support These factors increase a person's likelihood of getting ptsd

What are the risk factors for trauma?

1. Being a male 2. Having less than a college education 3. Having conduct problems in childhood 4. A family history of psychiatric disorder 5. Scoring high on the 2 big 5 traits of extraversion and neuroticism 6. Being an African American

Sociocultural risk factors of PTSD

1. Being a member of a minority group (there was a grater incidence of ptsd from the world trade center in Hispanic and African Americans) 2. Being more educated and having a higher income means you are less likely to get ptsd (you are less likely to be exposed to ptsd: safer jobs, safer environments) 3. Returning to an unsupportive environment

Main approaches to diagnosing:

1. DSM-5 (most controversial) 2. ICD-10 (International classifications of disorder) adopted by WHO and the rest of the word 3. PDM psychodynamic system (uses personality structures to diagnose people) They thought the DSM overlapped too much

4 characteristics of PTSD includes:

1. Intrusion: recurrent experience of the traumatic event (it keeps coming back) 2. Avoidance: the patient makes serous efforts to avoid thoughts, feeling or reminders of the trauma 3. Negative alterations in cognition and mood: feelings of detachment, shame, anger, and blame of oneself or others 4. Arousal and reactivity: people who have PTSD have hyper-vigilance: high startle repose, and can become reckless

What has been tried to reduce stress disorders?

1. Reduce the frequency of traumatic events in peoples lives 2. People have speculated that we should prepare people in advance for the stressor 3. Support 4. Telephone hotlines 5. Crisis intervention 6. Psychological debriefing: 7. Critical incidence stress debriefing 8. Medication

What are the three major models of establishing classification:

1. The categorical approach 2. The dimensional approach 3. The prototypal

Causes and risk factors of PTSD:

A traumatic event is believed to cause a pathological memory (the pathological memory shows itself as symptoms in 4 main areas and you have to have all)

Acute stress disorder:

Like temporary PTSD, symptoms of PTSD that are temporary If the symptoms last for more than one month you have to be reassess to see if you have a different disorder

What is the dimensional approach?

DSM put dimensional approach in DSM-5 as a experimental category in the back of the book. The dimensional approach involves quantitative measurement. (Professor likes this approach). Assumes that disorders exist on a scale (low, moderate or high), it assumes you can quantitatively measures the disorder. The MMPI involves a dimensional scale (10 clinical scale with a mean of 50 and a SD of 10). To what extent does the patient have the problem, do they score 60 above the scale (?) which is 1 SD above the national average. You can make a more accurate judgment with this. If the person scores above 70 they are more than 2 SD above the population and it is clinically significant. If they scored above 70 on the depression scale they would be clinically depressed. It tells you what disorder you have and to what extent. You can assess mood, emotional stability, anxiousness, social introversion, etc. You can measure anything and then compare it to others. This approach is more sophisticated.

What should you consider regarding clinical assessments?

FIRST: any potential cultural bias of the test and instrument you are administering (if you are giving the test to a minority does it have appropriate norms they follow?) Is the instillment properly normed for the person you are giving the test to? If the norms are compiled only on white people they may not be applicable to other people Many instruments in the United States have been properly normed but not all SECOND: must be aware of the theoretical orientation of the clinician, the clinician looks at different things in the patent. How do they see the patient? This can affect treatment. THIRD: Underemphasis of external situations and overestimate of personality traits of the patients. This means that some people have a lot of external stressors that the therapist may not understand. Therapist can under appreciate the stressful environmental and blame the patient (we must account for both) FOURTH: insufficient validation of the test used. Some tests are highly valid (does the test measure what it really measures?), however some have low validity. If they do not have sufficiently validity they should not be used (the draw a person test: does not have good validity and should not be used). FIFTH: inaccurate data or premature evaluations, inaccurate data can happen if you score the test incorrectly and you wont be able t make proper inferences or you get a little bit of test data and assume the rest.

What else can affect ptsd:

Forms of support can help! (Access to the internet can help people cope because they can feel more connected to people such as family)

Protective factors against ptsd:

Good cognitive ability (higher IQ) (there was a study in Detroit that looked at trauma children have experienced, they found that if their IQ was higher than 115 or higher made it much less likely that you would be exposed to trauma or develop ptsd; you may get yourself into a safer environment and avoid the risk or your intelligence may help you cope with the trauma (arms forces qualifying test: an IQ test in military, if you scored in they highest quarter you had at 48% change lower risk of ptsd)

Long term affects of PTSD:

Hard to assess It often doesn't go away or diminish with time unless or until they can receive proper treatment for it

Clinical assessment:

How do you go about assessing mental disorders? -give the patient some psychological tests then the clinician can interpret the tests and diagnose the patient

pre morbid level of adjustment

How well adjusted were you before the trauma

What is the incidence of anxiety disorders:

In the United Stated: 29% of the population Therefore, it is a very common disorder and it the most common of disorder for women and the second most common of category of disorder for men

DSM:

It has gone through five versions. The first two were called DSM and DSM 2 and the disorders were explained by a narrative description of the disorders and then DSM 3 came out in 1980 they changed it to diagnostic categories that continued into DSM 4 which came out in 2000. And then the DSM 5 came out in 2013.

Are there biological factors related to ptsd?

It is not clear —they thought that higher cortisol meant higher ptsd—turned out to be incorrect some people who have ptsd have lower levels of cortisol -However, women with ptsd did have higher level of cortisol

Post Traumatic Stress Disorder (PTSD):

It is often misunderstood, misdiagnosed and misapplied (the criteria that is used to diagnose ptsd has changed over time)

Does giving the personal a label (mental health diagnosis) create problems for them?

It may cause issues for some individuals

When was PTSD discovered?

It was first discovered when veterans who came home from Vietnam were not able to adjust back to every day life. They decided that any extremely life threatening terrifying event you may get ptsd (war, rape, physical assault, natural disaster) outside the bounds of every day experience. At this point they stated PTSD is normal response to an abnormal stressor.

Problem of Labeling:

Once assigned it may close off further inquiry; you get a label and you stop looking at real aspects of the person, you make the person into the illness, the person may find out and accept and redefine their identity. They get scared and think they are really disturbed; when this is not always the case. Getting a diagnoses also comes with stigma, label is often assumed to be permanent (bad effect on moral, self esteem, relationships with others) Recovery from mental illness is entirely possible.

One of the primary symptoms of PTSD is:

intrusive memories

Anxiety

involves a general feeling of apprehension about possible future danger (worry about what could happen)

BEST treatment for ptsd:

Prolonged exposure to the stressor (live or imagination) that is the method that DR. Foa used to treat people who have been raped and it helped a lot.

Why is there such a big difference between the questionnaire and the clinical interview?

Questionnaires overestimate the problem 1. The questionnaire the respondent may misunderstand the meaning of the question 2. The questionnaire respondent may report symptoms that cause little impairment of functioning 3. The questionnaire the respondent may include symptoms that began at a time other than the time of the traumatic event (reporting things not related to the trauma)

How to prevent stress disorders:

Reducing the frequency of traumatic events in peoples lives will help prevent stress disorders (if we enacted gun control and took away automatic weapons, this would reduce shootings, this would reduce school shoots for example)

—The military has a significant problem with soldiers committing suicide, it is prevent in all branches but is the worst in the Army in the United States

Reporting mental health problems in the military is looked down upon it is seen as weakness and as a result soldiers do not get help

Study of long term affects of soldiers who fought in Vietnam:

Studies during Vietnam include: soldiers had ptsd for a long time and it was sometimes hard to determine what exactly caused it; one variable induced how well adjusted the person was before combat, this is called pre morbid level of adjustment

Which version of the DSM is the most controversial?

The DSM-5 is the most controversial and disagreed upon version. People even protested it. In addition, society of personality assessment wrote a formal letter to American Psychotic Association protesting the limitations in DSM-5.

Interviews:

The book is not fond of unstructured interviews (which is the most common form) they say that the interviews are unfiltered; however this is not always the case. They have mischaracterized and misunderstood the meaning of unstructured interview. Dr. Berrigan likes unstructured interviews. The interview appears to be unstructured but it is not; the structure is there.

Ethical issues and assessment:

The conclusion of the assessment cannot be given to others unless the patient gives written consent. HIPPA: confidentiality law

Telephone hotlines have been tried for PTSD

The public believed this would work; however the research shows mixed results. They are often run by volunteers and people with limited mental health training. However, empathy and referrals (referring them to professionals) can be very beneficial.

What if symptoms continue for more than 6 months?

Then its no longer an adjustment disorder

What is within class homogeneity?

This means that you if you have a disorder you can differentiate between it and those who have the disorder will have very similar symptoms.

The shear number of disorders has increased enormously from DSM-1 to DSM-5 True or False?

True

True or False: Anxiety disorder are the single most common from of psychopathology that people experience (most common disorder)

True

True or False: Anxiety disorder have the earliest stage of onset of any disorder

True

True or False: Many more males than female are diagnosed with antisocial personality

True

True or False: People with anxiety disorders are high users of medical services

True

True or False: They found that those who were poorly adjusted were much more likely to get ptsd than those who are well adjusted

True

True or False: —There are individual risk factors for experiencing trauma and different risk factors for developing ptsd

True

True or False: Many more females get the diagnosis of histrionic personality disorder

True

We are only approximately accurate when diagnosing people. True or False?

True

What is the second leading cause of psychologists licenses being suspended in California?

Violations of confidentiality is the second leading cause of psychologists licenses being suspended in California (the first is sexual conduct)

What is one reason why the number of disorders has increased from the DSM 1 to the DSM 5?

We are over pathologizing the human experience For example: pre-menstral syndrome: a "new" mood disorder for women but it is extremely controversial;

What is the prototypal approach?

What is a prototype? It is conceptual entity depicting an idealized combination of characteristics that more or less regularly occur together in a less than prefect standard way at the level of actual observation. This means that it gives an example of disorders such as borderline (tells you the characteristic) theoretically perfect explanation of the disorder (but no one actually fits the perfect prototype) therefore; it is an idealized version of the disorder. Its like the perfect example of the disorder so you can identify it but everyone has variations in their disorder. The categories the DSM has represents prototypes of the disorders so it's really a prototypal system. The central features of the disorders are often vague and so are the boundaries that separate disorders. Empirically speaking the categories overlap a lot.

Are there predispositions of genes that can expose you to ptsd?

Yes, There is a gene called 5httlpr is a gene which increases your risk for depression and ptsd IF you have a particular form of the gene (which is a serotonin transporter gene) you must have the short form of the allele on both components of the gene (ss gene), research shows that you are at a greater risk of getting ptsd (It is an important finding but you cannot change your genetic make-up)

Understanding a persons cultural background

You need to consider the following 4 dimensions: 1. Ethnicity and culture 2. The patients level of English language comprehension 3. The patients religious background 4. The extent of the patients acclamation to United Sates Culture If you don't consider theses it can result in an incorrect diagnosis

Program evaluation

a series of steps in which the researcher looks at the effectiveness of the program, it is a very useful tool because it tells us if a program actually works (many programs have not worked)

Fear

an alarm reaction that occurs in response to immediate danger There is a empirical difference between anxiety and fear

What is the history of anxiety disorders:

anxiety disorders were considered to be an neurotic disorder (they don't recognize them under the term neurotic anymore)

Classifying abnormal behavior

classification is important in any science, in abnormal psych classification involves an attempt to delineate meaningful sub-varieties of maladaptive behavior (there are many different sub categories of personality disorders) This can help us introduce order into the discussion of the patient and help us understand the nature, causes and treatment of a particular disorder. It makes it possible for us to communicate meaningfully about a particular disorder

How do we make classifications?

clinical judgement

Other problem these soldiers face include:

depression, aggressive behavior, substance abuse It is higher among those who see combat than those who don't see combat

The way we see ptsd has changed:

emotional response to the stressor is important, now we look at how people cope instead of just looking at the stressor(some people who have traumatic experiences may not develop PTSD) Now we see PTSD as an abnormal response to a serious stressor.

The rate of ptsd depends on the kind of stressor that was faced

for example: if the stressor is another person trying to harm you then the incidence of ptsd will be higher than a stressor such as an automobile accident or natural disaster It seems like one factor that affect ptsd is: what is the stressor

Stress Symptoms from traumatic event:

for most people stress symptoms abate over time (95% of women who have been raped have symptoms of PTSD after 2 weeks, 1 months after 63% had PTSD, after 3 months 46% patients had PTSD) this concludes that natural recovery happens —Some individuals do not recover the symptoms do not decrease, if they fail to decrease when the traumatic event has passed then they have PTSD because PTSD doesn't go away. PTSD means the person re-expriences the traumatic experience with the same force and emotions they felt when it first happened

Unstructured interview

having a model in your mind, asking the clients questions and following up (allowing them to speak freely but have structure) The book mischaracterizes unstructured interviews

Anxiety disorders are associated with:

increased prevalence of a number medical conditions including: increase of asthma, chronic pain, hypertension, arthritis, cardiovascular disease, irritable bowl syndrome (IBS)

Cognitive restructuring has also been tried to help those who suffer from PTSD

it teaches the person to think differently about the traumatic experience (may work better for some stressors but not others), the book says it is highly effective but this is not the case.

Distinctions we need to draw to figure out a person's problems:

make a distinction between a symptom (patients subjective description of their complaints) AND sign (objective observations made my the professional; make directly or indirectly) both can be used to formulate diagnoses

Trauma of military combat

many people who serve in military combat experience devastating problems fro weeks or months afterwards, they cannot readjust to civilian life This was first recognized under the name as shell shock, then they renamed it operational fatigue, then it was renamed again to combat fatigue (one thing they tried was supportive therapy where they tired to patch up the shoulder and send them back into combat: this did NOT work well), the last name was ptsd

A feel good gesture:

programs that the public wants to work but when looked at empirically has little to no effectiveness (Nancy Reagans "say no" program, people liked it and thought it was a good idea but it didn't work at all)

People who have ptsd sometimes do not seek professional treatment for it; sometimes with supportive family or fiends can help relieve the person

seeking support helps

What is the categorical approach?

the DSM-5 states that it uses the categorical approach. The assumptions include: all human behavior can be divided into the categories of healthy and disordered, within the category "disordered" there exists discrete non overlapping classes or types of disorder that have a high degree of within class homogeneity in symptoms displayed and the underlying organization of the disorder. The problem is that this is not the empirical reality of disorders the symptoms overlap between disorders (people fit more than one categories and the symptoms overlap). The clinical reality is that the symptoms overlap with each other. For example, some symptoms of personality disorders overlap.

Critical incidence stress debriefing has been tried

this is supposed to help you get over the incident that you have and you can sit down and talk with someone. It has been evaluated empirically and there is little to no evidence to support the effectiveness of critical incidence stress debriefing

Another dimension is how direct was your exposure to the stressor

those who experience actual combat are more likely to get ptsd than those who are not on the front lines, how directly are you experiencing the stressor

Medication

various medication has been tried such as antidepressants, antipsychotic, etc. The book state ; evidence for the effectiveness fo medications for the treatment of ptsd is slim. Medication usually does not work.

Differential diagnosis:

what is the proper diagnosis (not always apparent) people get misdiagnosed because symptoms can be similar to other disorders in the DSM

What is the prevalence of PTSD in the general population:

—lifetime risk in United States is 6.8% in general population —Among men: 3.6% —Among women: 9.7%

Why is the cause of ptsd controversial?

—people think its victim blaming (it was taboo to talk about it at first, however, it became clear that some factors have a greater influence than others)