Abnormal Psychology Exam #2

suicide

20% of people with panic disorder attempt suicide, even without symptoms of depression anyone who is distressed for a long amount of time is at higher risk for suicide

treatment for agoraphobia

CBT: help clients to venture out farther from homes, gradually entering outside places one step at a time providing support, reasoning (coaxing) for more precise exposure methods often includes additional features... support groups - small groups out together and sessions last a long time, support and encourage each other, coax individuals to go out on own too home-based self help groups - clinicians give clients/families detailed instructions for carrying out exposure treatments themselves 70% improve from this treatment! but partial half-relapse, do often recapture gains if treated gain though less effective CBT alone if with panic disorder

treatment for generalized anxiety disorder: psychodynamic

Freudian: free association, transference, dream analysis to help resolve unconscious issues - become conscious to resolve them (become less afraid of id impulses and more successful in controlling them) modest-moderate effectiveness - works for some but limited support object-relations therapists: help anxious patients identify and settle childhood relationship problems that continue to produce anxiety into adulthood short-term psychodynamic therapy: can significantly reduce levels of anxiety and worry and social difficulty in these patients

famous DID cases

Trudy Chase - 92 distinct personalities wrote a book with the original manuscript in different handwritings

treatment for generalized anxiety disorder: humanistic

client/person centered therapy (Rogerian): providing unconditional positive regard, empathy, and genuineness- helps patient feel secure enough to recognize their true thoughts, needs, emotions and anxiety should subside due to their comfort, helps them to develop unconditional positive self-regard to remove incongruence between true self and false self helping patients to figure out what true fulfillment is and how to unblock themselves from it only modest benefit - not as good as CBT for most (more literature on CBT too) better than nothing but only sometimes better than placebo, has limited support here

brain circuit

have visible fiber pathways between netwprks of brain structures that work together/trigger each other into action

treatment for specific phobias: PD

increase awareness of the unconscious issues that are being projected once the true cause of anxiety is dealt with, there is no more need to project it onto that object

READING: Cultural Impact on Stress Disorders

many impediments to recovery from PTSD - trauma type, history of psychological problems /previous trauma, dissociation, quality of social support and avoidant coping, *cognitive factors such as ongoing negative appraisals of the self, personal actions during the trauma, others, and rumination* decided to look at cognitive appraisals because they are now more interesting based on more cognitive models explaining PTSD, and because they are potentially modifiable (so strategies for preventing or reducing distress and psychological disability may come from this study) cognitive factors are also useful for predicting PTSD so there is that piece, and there is lots of literature emphasizing cultural differences in appraisals with psychology in general so looking at tie to specific disorder appraisals - maintain sense of current threat and promote maladaptive strategies to control threat examples of appraisals: mental defeat and lack of control strategies (during event), permanent change and alienation (after event) - often more severe cases or at least lower treatment success rates in individuals with these believe culture may play role and other background factors - experiences and beliefs - about cognitive appraisals appraisals about self - about autonomy and consistency see themselves as inadequate and unable to cope in current situations appraisals about others and their relationships - cause them to withdrawal in interactions and reduce opportunities to receive social support/correct their negative beliefs independent societies praise autonomy, personal responsibility, and control - psychological distress is related to lack of these and diminished autonomy interdependent societies praise interdependence of individual and social environment - psychological distress is related to perceived alienation and social rejection did measure culture independence, did measure PTSD scale, controlled for lifetime exposure to traumatic events, trauma narratives given and self-cognitions were noted as independent or interdependent aspects of self, interdependence and independence clearly defined, interrater reliability was good mental defeat - perceived loss of psychological autonomy, loss of effort to retain one's identity with individual will control strategies - thinking about/planning in one's mind about what might be able to be done to minimize harm or make experience more tolerable (would be poorer for more distress/neg appraisals) alienation - a general overall feeling that they felt alienated from world and others, interactions described permanent change - sense they viewed life as having been changed forever in negative way results : trauma distribution and PTSD ratings same across groups so no confounding variable there, relatively similar trauma types discussion - *negative appraisals focusing on self (independence, control and agency such as mental defeat/coping strategies/permanent change) were higher for those in independent cultures (and interdependent cultures did not differ in this with or without PTSD so it wasn't even significantly within their culture either) - negative appraisals related to these things are worse and have greater effect on individuals in independent cultures* but, alientation not greater for interdependent cultures - negative cognitive self-appraisals just don't seem to affect disorder course generally in interdependent cultures as much (alienation still high for independent cultures but more in relation to self, having to re-learn world, in interdependent cultures it is more about feeling isolated and failing as a social being and impact public and communal aspects of self - more about reactions of others and their dysfunction in society - still difference culturally, just in course instead of amount) because of cultural differences - says clinical awareness of impact but also cultural differences must be taken into account for treatment, social support provided in addition to CBT (mental defeat and other negative cognitive appraisals don't show same success rate - more cognitive work on top of exposure treatment, but related to culture too acknowledges trauma event type may play role too (and other confounding variables) *cultural variation in self impacts on the role of appraisals in the understanding of PTSD* neg cog appraisals more significant for those with PTSD than without in independent cultures - says something in itself (besides alienation which was more for PTSD people in interdependent cultures too)

obsessive-compulsive and related disorders

patterns of repetitive and excessive behavior that greatly disrupts lives 5% of all people collectively feeling overrun by thoughts that cause anxiety, the need to perform certain repetitive actions to reduce anxiety anxiety is very prominent in these! OCD used to be anxiety, body dysmorphic used to be somatic, hoarding new, excoriation new, trichotillomania used to be impulse-control - realized that obsessions and ritualistic behaviors are all similar so it made sense for new category rather than all under anxiety

PTSD: avoidant symptoms

persistent avoidance of stimuli associated with the event, beginning after it occurred (one or more of following): (goal is to try not to be triggered so they avoid anything that may trigger or remind them - sometimes comorbid with substance abuse due to this to avoid) -avoidance of or efforts to avoid distressing memories, thoughts, feelings about/closely related to event -avoidance of/efforts to avoid external reminds (people, places, conversations, activates, objects, situations) that arouse distressing memories/thoughts/feelings about/closely related to event

causes of PTSD-personality

pessimistic attitude - believing the world is uncontrollable (cannot protect self psychologically if you believe this) coping strategies - resilience means you adapt well and cope effectively and will be less likely to develop (genes, exposure to manageable stressing life, stress pathways managing better all contribute to this

getting a handle on trauma and stress

relationship between trauma, stress, and psychological dysfunction is complex and an unfolding interaction of many variables (bio factors, childhood experiences, personal styles, social supports) clinical are developing more effective treatment programs for people with ASD and PTSD that combine bio, CB, family and group intervention intervention for dissociative disorders has not moved as quickly - growing due to interest in PT stress reactions and physically rooted memory disorders such as Alzheimer's, but not as fast when studied heavily, conclusions can be bold - many are receiving PTSD diagnoses because there is so many symptoms for it and it has received a lot of attention interest in dissociative disorders gives false information about their prevalence (pretty rare overall) the line between enlightenment and over enthusiasm can be thin for diagnoses :)

treatments for dissociative amnesia

based on case studies mainly PD: guide patients to search unconscious to bring forgotten experiences back into consciousness, seems to fit with this disorder well since it recovers memories that are repressed (may be most appropriate) hypnotic/hypnotherapy: hypnotize patients and get them to recall forgotten events (may be helpful if the reason they have DA is self-hypnosis), alone or in combo with other things barbiturate injections: sodium amobarbital (Amytdal) or sodium pentobarbital (Pentohal) to help regain lost memories ("truth serums") by calming people, free their inhibitions so they can recall anxiety-provoking events (likely to be used in combo with something else - do not always work)

Aaron Beck

believed people with GAD hold silent assumptions person is unsafe until proven safe always best to assume the worst

treatment of dissociative disorders (overall)

manage anxiety and depression associated with the episodes since DD are often comorbid with these remove triggers/cues of trauma or at least help them to better cope with triggers psychoanalysis (helpful here b/c of perspective): uncover childhood trauma, establish direct contact with alters and goal is reintegration - not get rid of them but integrate them, can take long time (for DID) no controlled studies regarding effectiveness of treatment - mainly based on case studies and more anecdotal than evidence-based DA treatment is usually effective because the disorder is less complex (usually recover on their own), but DID needs treatment to uncover memories and integrate personalities sometimes, not remembering a trauma is best - only need to bring it up if repression causes distress for all of these: cure lies on will of patient - can be unpredictable, they have to be really motivated and work really hard (especially for DID)

theoretical perspectives (causes) of DID -social-cognitive theory

learned response is dissociating during times of stress negative reinforcement because dissociating alleviates stress form of role-playing with self state-dependent learning: can recall more mems in the state the memory was form - so arousal levels may have set of remembered thoughts/skills/events attached to it, DID may have rigid state to memory links (things may be tied exclusively to particular arousal levels, so they calm themselves to forget their distress but then arousal levels produce different identities (which is why personality switches are sudden and during stressful times)

types of dissociative amnesia

localized: most common, cannot recall a certain time frame usually around the time of the traumatic event or near it (amnestic episode is forgotten event - during it people are confused and seem unaware of their memory difficulties) selective amnesia: bit more specific, forget only distressful aspects of event but can remember other things that happened near it generalized amnesia: people forget large amounts of their lives, memory loss extends far before the upsetting event and they may not recognize relatives/friends but still remember biographical information continuous amnesia: only one where period does not have an end, forgetting everything from event to the present (similar to anterograde except due to emotional trauma)

causes of generalized anxiety disorder: C-B

mainly about cognition for this disease maladaptive and irrational assumptions about the world and their role/place in it, causing them to be overattentive to potentially threatening stimuli and act/react in inappropriate ways (essentially, people with these beliefs are faced with a stressful event, interpret it as dangerous, overreact, feel fear and apply assumptions to more and more events to cause GAD) newer theories... metacognitive theory (Adrian Wells) - belief that worrying is helpful in coping, whereas it can actually be harmful and uncontrollable, implicitly they hold both positive and negative beliefs about worrying: positively they think is it a useful way of appraising and coping with threats in life so they can look for and examine all possible dangers and thus worry constantly, negatively they think it is harmful to worry repeatedly due to society and start meta-worrying and the net effect of all this worrying is GAD (this is a powerful predictor of the disorder) intolerance of uncertainty - we like to know things, plan, and be in control so we are anxious when things are not how we want them or are ambiguous (some cannot tolerate the knowledge that negative events may occur so they worry constantly since life is filled with uncertainty and try to find "correct" solutions for situations in life and restore certainty to them, but can never be sure if their solutions are right so this triggers new worries) -- develops in childhood, can be passed down from parents learning - classical conditioning and overgeneralization (stimulus associates with anxiety and then generalizes to all aspects of life) avoidance and negative reinforcement (Thomas Borkovec) - people with GAD simply have greater bodily arousal at first and worrying reduces this arousal by distracting from their unpleasant physical experiences so the disorder develops, essentially they are less responsive to autonomic restrictors then those with with panic disorders thinking more about upcoming problems to avoid paying attention to potential threats - thinking about small ones to avoid larger or more dangerous ones

causes of panic disorder: general

often develops after life stress but then becomes random (direct experience is true alarm but then after is false alarm) heritability estimated at 73% in twins - definitely genetic basis misattribution of physiological changes - learned alarms (misinterpretation of normal benign physical symptoms - ruminating and catastrophizing makes you more anxious) and thoughts escalating panic (thinking you're going to die causes more panic)

criterion for panic disorder

one month of persistent attacks at least significant change in behavior worry about consequences of attack

normal experiences of DP/DR in life

one-half of all adults have experienced one episode but don't meet full criteria for disorder transient reactions like this are very common 1/3 people say they've felt like they're watching themselves in movie at some point in life 1/3 of individuals who control life-threatening experiences feel this can even be after practicing meditation, traveling to new places young children can have these as they develop capacity for self-awareness most times - affected people can compensate for distortion and function with reasonable effectiveness until temporary episode ends (when too extreme -disorder)

depersonalization & derealization in brains

these are deficits in attention, information processing, short-term memory and spatial reasoning brain imaging in those with disorder show deficits in perception and emotional regulation dysregulation in HPA axis

interaction of DID subpersonalities

they are not always aware of each others memories/thoughts/feelings/behavior - each has unique live mutually amnesias relationships: no awareness of each other mutually cognizant patterns: each is well aware of rest, they may talk among themselves, hear each other, some get along and some may not one-way amnesic relationships (most common) - there are co-conscious subpersonalities: some are aware of others but awareness is not mutual, some watch actions/thoughts of others but do not interact with them (sometimes will give automatic writing or hallucinations to make them aware they are there) some may have host that knows about all others

causes of generalized anxiety disorder: humanistic

this comes from denial of true self (when one stops looking at themselves honestly and acceptingly - children fail to receive unconditional positive regard and thus develop harsh self-standards/conditions of worth and distort/deny their true thoughts/emotions/behavior/experiences to meet standards -- incongruence) threatening self-judgments break through new self regardless and cause anxiety, setting stage for GAD also relates to true fulfillment being blocked, causing anxiety

treatment for generalized anxiety disorder: C-B

*BETTER TOLERATED THAN DRUG THERAPY AND LASTS MUCH LONGER* helping people process threatening information on an emotional level relaxation training cognitive restructuring and rational-emotive therapy (points out irrational assumptions held by clients, suggests more appropriate assumptions, gives HW to challenge old assumptions and apply new ones - moderate relief) Mindfulness-Based Cognitive Therapy: acceptance and commitment - instead of teaching not to feel anxious they teach how to cope and manage it as it is accepted, helps to become less influenced or upset be anxieties, become aware of thoughts and worries as they occur and accept them as mere events of the mind (relates to mindfulness meditation - pay attention to flowing thoughts and feelings and accept them in a nonjudgmental way) new wave: guide to recognize and change dysfunctional use of worrying, educate about role of worrying in disorder and have them observe bodily responses and cognitive responses to life situations, clients appreciate triggers of worrying/misconceptions about worrying/misguided efforts to control lives by worrying, clients start to see world as less threatening and try out constructive ways to deal with arousal and meta-sorry less (has a more concentrated focus on worrying and its role - helps a lot)

READING: Children of Holocaust Survivors

*one's life experience can affect subsequent generations -epigenetic inheritance* changes in genes related to children of survivors - increased likelihood of stress disorders chemical tags attach themselves to DNA to switch genes on and off and these can be passed through generation one region of a specific gene may be related (stress-related gene that shapes way we cope with environment - found in survivors and their children, not result of trauma experienced by children themselves) pre-conception stress events resulting in epigenetic changes in exposed parents and offspring (tags used to be thought to go away after fertilization so this is new data - escape "cleaning process" at fertilization turning gene on or off would have significant impact on how much stress hormone is made and how they cope with stress - could relate to environmental resilience passed on intergenerational effects are not just transmitted by social influences or regular genetic inheritance fine-tuning ways genes respond to world conditioning mice to fear cherry blossom smell - children fear it too (more receptors in brain but fewer epigenetic tags - unsure of meaning) *not first example of epigenetic inheritance, but first demonstration of pre-conception stress effects resulting in epigenetic changes8

anxiety disorders

*the most common mental disorder* 18% in any given year and 29% in lifetime, yet only 20% seek treatment/37% it might be more common because we instill it - heightened societal stress, parents can give children perception that world is not a safe place or pass this belief down, varies by culture non-Hispanic white Americans are the most common to get it often times - if you have one you have another often comorbid with depression

Albert Ellis' basic irrational assumptions for GAD

- it is a dire necessity for a human to be loved and approved of by everyone in their community - it is awful and catastrophic when things aren't the desired way - when something seems dangerous we should be concerned about it and dwell on the possibility of it occurring - one should be competent, adequate, and achieving in all aspects to consider oneself worthwhile

treatment for social anxiety disorder - medications

55% improvement improve functioning in fear circuit which is typically active in SAD (like in GAD) antidepressants like sertraline (Zoloft), paroxetine (Paxil), venlafaxine (efflextor) - but can lead to side effects that worsen it such as increased sweating or weight gain which might make one more self-conscious beta blockers to stop body from physiological reactions to anxiety - classical conditioning helps you associate situations with being relaxed benzos may be used too

treatment for panic disorder

BIO: antidepressants have founds 2/3 improvement and bring indefinite success if continued (increase activity of serotonin and norepinephrine in locus coreleus and other parts of circuit to correct hyperactivity), benzos such as Xanax effective for it alone and with agoraphobia (but used less due to physical risks) C-B: correct their misinterpretations and educate them about the nature of panic attacks/actual causes of body sensations/tendency of clients to misinterpret, teach them to apply more accurate interpretations during stressful situations to short circuit the panic sequence early, teach relaxation and breathing techniques and how to distract themselves from situations, induce panic sensations so new interpretations and skills can be applied without dwelling on attacks biological challenge procedures: 2/3 free of panic after these, at least as helpful as antidepressants or benzos, combining can be helpful too and can work for this with agoraphobia too

treatment for specific phobias: CB

CBT is best therapy! 70% improvement says the only way to get rid of the fear is to face it since avoidance only reinforces it (seeing the thing is not so harmful helps a lot - there is often surprise) exposure-based therapy -- systematic desensitization (gradual) or flooding systematic desensitization: more gentle, good for phobias that affect everyday living - learning to relax while gradually facing object to replace fear response with relaxation (establish fear stimulus hierarchy to start with thing that makes you least nervous, learn relaxation training such as breathing right to associate nice feelings with it, gradual exposure to move up hierarchy - either in vivo (in person - usually more effective), in VR (very effective - larger response rate than even in vivo since it is so intense and often as powerful as real life), or imaginal/covert) flooding (can also be in vivo or covert): not gradual, no relaxation training, exposed repeatedly to stimuli to see they are harmless - can be traumatic/overwhelming, intense emotional arousal, not able to escape in room of spiders harder to do this kind of therapy if you are not motivated - you cannot be forced (many are in ambivalent state where they know they need to change but cannot just quite yet, as compared to an action state) sometimes, modeling is done too: therapist confronts the thing themselves and the patient observes to see the fear is groundless, clients are eventually able to approach it themselves calmly (participant modeling is where the client is actively encouraged to join the therapist)

causes and treatment of/for body dysmorphic disorder

PD: displacement of stress/anxiety - unconscious thought and urges that we transfer to anxiety in this way - keep repressed and unwanted urges out of awareness (treat by making unconscious conscious and resolving) often comorbid with OCD (may have other obsessions and compulsions as well) same treatments as OCD: antidepressants, exposure and response prevention (cannot groom themselves and has to interact with public - want to make them less concerned about defects and spend less time checking themselves and avoiding social interaction) plastic surgery - not really a treatment but often what they turn to - bandaged, anxiety comes back with another sense of flaw and they just repeated it

panic

a false alarm resulting in an overwhelming reaction of intense fear it can be situationally bound/cued (but often starts out as cued and then becomes more generalized and random), it can be unexpected/uncued, or it can be a situationally predisposed panic attack

anxiety

a negative mood state characterized by bodily symptoms of physical tension and a general state of apprehension relates to a vague sense of being in danger - feeling the fear response.alarm but not being able to pinpoint the specific cause relates to: future-oriented thinking, an increased physiological arousal (increase in breathing, muscular tension, perspiration, etc) some anxiety is normal! (it motivates us to perform better and protects us) not normal if it is out of proportion to the threat and impairs functioning - a curvilinear relationship (it can be debilitating if there is too much)

dissociative fugue

a severe form of dissociative amnesia sudden loss of personal memory and the adoption of a new identity in a new locale appears normal with no other symptoms new identity is incomplete when they assume old identity, the new identity disappears from memory (often ends abruptly - may awaken in new place, or lack of personal history brings suspicion to those around them, or searching for missing person, police seeing false ID, therapist asks details about life to remind who they are and begin therapy even before their memories start recovering 0.2% rapid onset, rapid dissipation (mainy regain most or all of memories and never have a recurrence) females>males may occur as people try to confabulate the information missing from their memory - overcompensate with whole new identity can be brief and end suddenly - people only traveled short distances, not too many consequences (reversible with few aftereffects) can be longer and travel far - new relationships and personality traits, trouble readjusting and dealing with consequences of what they did in fugue state

causes of PTSD-bio

abnormal activity of cortisol and norepinephrine (the stress response is overly reactive even before the trauma and more so after it - persistent overactivity locks in brain and body dysfunction) dysfunctional hippocampus causes intrusive memories and unchecked emotions (the chronic activation of stress hormones can cause this permanent hippocampus change) dysfunctional amygdala can lead to repeated emotional symptoms and emotional memories and persistent arousal symptoms family history of anxiety may predispose individual inherited predispositions in children of those with PTSD (tendency for overly reactive brain-body stress pathways and dysfunctional brain stress circuit) dysfunction in stress circuit - related to panic and fear (there is some overlap), amygdala, PFC, anterior cingulate cortex, insula, hippocampus amygdala response is too high, PFC activity too low (flawed interconnection) leading to persistent experience of startle reactions and high heart rate, less ability to control emotions

(common) peculiarities of memory

absentmindedness: not absorbing information in the first place deja vu: recognizing new place jamais vu: daily life scene feels unfamiliar tip-of-the-tongue phenomenon: unable to recall something we know we know memory for music: mentally hearing whole pieces eidetic images: can describe after looking at something once memory under anesthesia: 2/1000, process what is said in surgery - cannot explicitly recall but can understand language verbal memory: remember sounds/words (puns/rhymes often) visual memory; can easily bring images to mind (remember faces often)

integrated model - triple vulnerability model

all these parts interact with each other to make one more vulnerable to developing an anxiety disorder generalized biological vulnerability, generalized psychological vulnerability, specific psychological vulnerability (a traumatic incident, for example)

dissociative disorders

also triggered by traumatic events more about memory difficulties and dissociative symptoms no clear physical factors at work in these dissociation- transient experiences occur in 50% of population normally but these are severe DID, dissociative amnesia with and without fugue (one diagnosis but two subsets), depersonalization/derealization disorder (symptom often comorbid so now one diagnosis) most people have a sense of identity (who they are and how they fit in environment) and memory is a key part of this, so dissociative disorders are where a part of a person's memory and identity becomes dissociated and separated from other parts state-dependent learning/memory plays role in most of these disorders

fear

an immediate reaction to a current danger (*more in the moment*) respond with a fight or flight response - relates to everyday experiences of fear and anxiety that prepare us for action when danger threatens we all experience this sometimes, but when it is excessive and generalized (discomfort is too severe/frequent/lasts too long/is triggered too easily) - can lead to panic disorder if too much

phobias & phobic disorders

an irrational feat that is disproportionate to a threat - is debilitating and one cannot do things related to their fear due to distressed (whereas an aversion can be managed, regular fear) only a disorder when it impairs functioning and is extremely distressful (more intense and persistent than aversions, desire to avoid is stronger) three types of phobias are specific phobias, social phobia, agoraphobia

treatment for PTSD-bio

antidepressants such as sertraline/zoloft (half have reduced symptoms - more about treating negative emotions and arousal than neg mems/dissociations/avoidance) benzos - treat anxiety especially if strong trauma response, sometimes right after trauma to calm down but have high addictive aspect per usual needs to be combined with some psychotherapy or other treatment approach (not used alone)

comorbidity of anxiety disorders: physical disorders

anxiety usually comes first having a mental illness makes treating the physical disorder harder because they play off each other, so comorbidity leads to greater impairment and poorer quality of life examples: thyroid diseases, respiratory diseases (COPD/asthma, worsens fight flight response if feeling like suffocating), gastrointestinal diseases (IBS/Krohn's), arthritis and migraines (any type of pain can cause anxiety essentially and then this anxiety can make the body respond in a way that makes the pain worse -> a relaxed state where you try not to catastrophize and instead try to cope helps), allergies (anxiety can create more hypersensitive response to surroundings so worse allergies but the allergies themselves can also cause anxiety)

treatment for generalized anxiety disorder: bio

benzodiazepines: receptors that normally receive GABA are targeted (since this normally reduces neuronal excitability in the fear response and is not functioning properly in those with GAD) - helps fear circuit to function -- effects with these are short-lived (anxiety comes back worse if stopped), dependence is strong (addictive due to negative reinforcement) and there are undesirable effects if they are mixed with other substances (and can impair functioning in elderly) -- these are more for temporary crises and managing it day to day, quick acting but doesn't last (whereas CB is longer but lasts longer), 60% effects compared to only 40% with placebo drugs (most prescribed but not best course of treatment) anti-depressants: relief to 60% of those who take them with GAD, Venlafaxine (Effexor), Paroxetine (Paxil), Ativan, because serotonin plays a role in circuit it makes sense that meds that influence those transmitters can help (SSRIS) - serotonin and norepinephrine prominent in PFC and amygdala specifically antipsychotics: help some people with GAD by altering the activity of dopamine which is in some parts of the fear circuit but can have serious side effects of their own

four major types of specific phobias

blood-injury-injection: strong vasovagal response when exposed so body overcompensates (fainting) and there thus may be an evolutionary/hereditary aspect, onset around 9 situational type: mid teens to mid twenties, often have poor support systems natural environment type: onset 7 years animal type: creatures such as bugs and amphibians and animals

theoretical perspectives (causes) of DID -bio

brain dysfunction - possible dysfunction in parts of brain associated with body perception, memory, emotion

how social media relates

can cause social anxiety or generalized anxiety - sites can produce significant insecurities and fears 1/3 afraid others will share info or pics of them without permission 1/4 feel pressure to disclose too much info or post material that will be liked discover activities they were disclosed from 1/3 feel worse after visiting network 2/3 feel FOMO without checking more phone use can lead to anxiety - panic when misplacing phone, nomophobia when disconnected

other causes of PTSD

childhood/family instability: overly reactive stress pathways can come from abuse/neglect which reprograms the brain and body stress responses, environment with a lot of chaos like poverty/assault/abuse/catastrophe/multiple traumas/parental separation or divorce/living with a family member with a psychological disorder can all contribute intensity and proximity of trauma: more severe trauma and more prolonged/direct exposure (mutilation, severe physical injury, sexual assault, witnessing death/injury of another or intentionally inflicted traumas) can lead to higher likelihood - 23% of Vietnam veterans good personality but still developed poor social support from family/friends/criminal justice system culture: Hispanic Americans have higher rates with similar events (higher crime propensity, separation from family, may be poorer financial status and limited access to healthcare or may be specific cultural beliefs - some cultures believe traumatic events are inevitable and unchangeable)

causes of generalized anxiety disorder: biological

chronic muscle tension is distinguishing feature generalized biological vulnerabilities (15% of relatives with those with GAD have it too - relatives more likely than non relatives and the closer the relative the more likely) highly sensitive to threats, especially personal ones irregular amygdala and PFC functioning (EEG - shows intense cognitive processing in left frontal lobe, so excessive thought processing when avoiding negative affect and images) deficiencies in GABA or receptors/faulty receptors which is the primary inhibitory neurotransmitter restricted peripheral autonomic nervous system abnormal circuitry - fear responses are tied to brain circuits (PFC, anterior cingulate cortex, amygdala) - fear response is hyperactive (overactive) in those with GAD, could be due to low GABA activity fear circuit not fully understood yet - bed nucleus of stria terminals just discovered, might be two circuits one for physical/behavioral responses with amygdala and other structures and other for cognitive responses with PFC, insula, bed nucleus

causes of PTSD-CB

classical conditioning: event happens and you associate different stimuli to fear responses, heightened and reinforced by avoiding stimuli, triggers can create anxiety so operant conditioning you avoid them

leading explanation for social anxiety disorder

cognitive behavioral: dysfunctional beliefs and expectations regarding the social realm -holding unrealistically high social standards and believing they must perform perfectly in social situations -believing they are unattractive social beings -believing they are socially unskilled or inadequate believing they are always in danger of behaving incompetently in social situations believing they have no control over feelings of anxiety that emerge in social situations tied to genetic predispositions, trait tendencies, biological abnormalities, childhood trauma, overprotective child-parent interactions because of these beliefs - people with this disorder keep anticipating that social disasters will occur, they overestimate how poorly things go in their social interactions and dread most social situations they perform avoidance and safety behaviors to prevent and reduced disasters (avoid interaction, gloves, makeup) -> reinforced by reduced anxiety

trauma examples

combat victimization natural disasters terrorism torture accidents

stress disorder triggers

combat: after Vietnam, people saw soldiers could have symptoms after combat and not just during - 29% had disorder and 22% had stress symptoms, 10%s still deal with PTSD, 20% if Afghanistan/Iraq soldiers, worse when directly exposed to prolonged periods of combat-related stress disasters/accidents: earthquakes/floods/tornadoes/fires/airplane crashes/car accidents (Hurricane Katrina, BP oil spill, tornado in Moore, Oklahoma), more common and trigger stress disorders 10x more than combat, 12-40% of people in car accidents may develop PTSD within year of accident victimization: 1/3 of all victims of physical/sexual assault develop PTSD, Half of victims exposed to terrorism/torture develop it victimization-sexual assault: 27% American Indian women, 22% African American, 19% non-Hispanic white women, 15% Hispanic American, 12% Asian American -- rape occurs 91,000 cases reported a year, most victims are women and rapists men, 1/6 women will be raped, 71% of victims raped by acquaintances/intimates/relatives, psychological impact is immediate (distressed the week of, rises for next three weeks, maintains peak for month improves -94% victims qualify as ASD), effects often last for 18 months or longer (have anxiety, suspiciousness, depression, self-esteem problems, self-blame, flashbacks, sleeping problems, sexual dysfunction), female victims of rape/other crimes more likely to suffer serious longer-term health problems than other women victimization-child/spouse abuse: violates family trust and other disorders can develop as well victimization-terrorism: large response to 9/11 was PTSD, other terrorist attacks have same pattern, 42% adults in US and 70% in NY have high terrorism fears now, 9% NY adults have PTSD, 23% adults feel less safe in home and 15% drink more alcohol victimization-torture: brutal/degrading/disorientating strategies that reduce the victim to the state of utter helplessness to force info or yield confessions (physical - beatings, waterboarding, electrocution) (sexual - rape, genital violence, sexual humiliation) (torture through deprivation (sleep, sensory, social, nutritional, medical, hygiene) (psychological - threats of death, mock executions, verbal abuse/degradation) - 30-50% victims develop PTSD, often have physical ailments as well

causes & treatment of OCD: cognitive-behavioral

compulsion is random at first and then reinforced because the anxiety is reduced thought-action fusion: believing intrusive negative thoughts are equivalent to actions and capable of causing them (fear of unpleasant intrusive thoughts so that the fear of thoughts can become an obsession too) -> leads to neutralizing behaviors that reinforce the thoughts irrational thoughts and perfectionism compulsive behaviors are reinforced by the relief of anxiety more intrusive thoughts, resort to neutralizing acts more than others, experience reductions in anxiety after neutralizing actions treatment: Exposure with Ritual/Response Prevention - put in situation where anxiety is provoked and they are prevented from engaging in behavior that reduces anxiety (compulsion), have to sit with anxiety, 55-85% improvement, can be done over videoconferencing or as HW if compulsions are at home (the idea is that if the reinforcement goes away then the need to prevent it will go away) cognitive restructuring may also be done to see where irrational thoughts are, true vs false thoughts - pointing out misinterpretations, excessive sense of responses, neutralizing acts - challenge distorted cognitions and clients come to appreciate that they are inaccurate occurrences rather than valid and dangerous cognitions for which they are responsible

causes & treatment of OCD: PD

compulsions keep inappropriate urges and thought conclusions away stuck at anal stage around 2 years: control issues due to potty training (too harsh - too controlling, rage and shame, rooted in feelings of insecurity) id impulses lead to obsessions and ego defenses lead to counter thoughts and compulsions feeling the need to express strong aggressive id impulses but know they should restrain/control them (battle between anxiety-provoking id impulses and and anxiety-reducing defense mechanisms, buried in unconscious and played out in overt thoughts and actions) treatment: free association, therapist interpretation to uncover conflict, bringing unconscious into conscious and solving it short-term psychodynamic therapy is more direct and action-oriented

additional info on treatment for PTSD from textbook

couple and family therapy - families see symptoms clearly and are affected by them so this makes sense, the help and support of family members can help patient to learn their impact on others/start to communicate better/improve their problem-solving skills and reestablish closeness feelings group therapy - rap groups in 1980s started this, veterans met with others to share experiences/feelings such as guilt and rage, develop insights, give mutual support (today, Veteran Outreach Centers have these and individual therapy, counseling for spouses/children, family therapy, and assistance in seeking jobs and education benefits, VA hospitals also have treatment and mental health clinics) psych/critical incident stress debriefing - more information on this: relates to immediate community intervention/crisis intervention - talk extensively about feelings and reactions within days of the incident, intense approach often provided without display of symptoms, large mobilizations in various cities, may cause dwelling or unintentionally "suggest" problems to victims to produce stress disorders instead and some believe only high-risk individuals should receive this instead of everyone

comorbidity of anxiety disorders: psychological disorders:

depression - if it is harder to function in life this can make you depressed or anxious (vice versa), very common that it may even be its own diagnosis one day substance abuse - avoid anxiety with substances, it is also reinforcing which can lead to dependence

family pedigree studies

determine how many and which relatives of a person with a disorder have that same disorder

symptoms of generalized anxiety disorder

diagnosis calls for anxiety and worry being associated with three or more of these symptoms (but only 1 physical symptom required for children): restlessness/feeling keyed up or on edge being easily fatigued difficulty concentrating and mind going blank irritability muscle tension (differentiates it from other anxiety disorder - backaches or neck aches) sleep disturbance

posttraumatic stress disorder

didn't have diagnosis for this until after Vietnam war due to lobbying of veterans - "shell shock," "soldier heart", "combat fatigue" new criterion - now we understand that we can have this even without experiencing or witnessing it directly (more people are able to get treatment and be diagnosed due to beneficial opening up of criterion) no longer need shock-horror-fear reaction - people respond differently, some numb exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways: -directly experiencing the traumatic event -witnessing in person the event as it occurred to others -learning that the traumatic event occurred to a family member or close friend (in cases of actual or threatened death of a family member o close friend, the event must have been violent or accidental) -experiencing repeated or extreme exposure to aversive details of the traumatic event (first responders collecting human remains, police officers repeatedly exposed to details of child abuse) (but does not apply to exposure through electronic media, television, movies, or pictures unless this exposure is work related - but can still have negative stress response in body to this) symptoms can begin shortly after or event or even months/years after - 25% don't develop until 6 months later

hoarding disorder

excessive need to save items, distress associated with discarding items due to fear of losing something causes extraordinary accumulation of items that clutter lives/living areas and parts of home may be inaccessible, have many useless items, can be fire hazards and unhealthy sanitation conditions prevalence not available but estimates 2-6% possibility greater among males three times more prevalent in older adults (due to higher sense of loss of independence/control - way to maintain sense of control maybe) obsession is fear of losing things when getting rid of them, compulsion is gathering and not getting rid of lots of things

obsessive-compulsive disorder

different from obsessive compulsive personality disorder (some people say it is a spectrum but currently two different things) - there is much more anxiety and obsessive thoughts and behaviors to reduce anxiety in OCD, OCD is very distressing is persistent, upsetting, and unwanted thoughts (obsessions) that cause anxiety - aware these are excessive these obsessions often center on the possibility of infection/contamination/doing harm to oneself they are excessive and unreasonable, create distress, interfere with daily functioning, and take up time some obsessions make sense and some do not - ones that are irrational are known to be irrational obsessive thoughts may motivate ritualistic and receptive behaviors (compulsions) - these are response/yielding to obsessive thoughts/ideas/urges or help to control them the compulsions avoid some dreaded outcome or reduce feelings of anxiety (themselves are negative reinforcers) most compulsions are checking/cleaning behaviors some people have only obsessions or compulsions but most people have both intense, disturbing, and often bizarre intrusions that impair daily activities - take up more than one hour a day 1-2% year, 3% lifetime (generally rare) 40% receive treatment - often for long time equally common in males and females (but in early childhood males more) equally common in different races and ethnic groups, similar and prevalent cross-culturally does relate to anxiety - obsessions cause it, compulsions prevent it, resisting obsessions or compulsions can cause it usually begins in adolescence or early adulthood but can come as early as 4 (hard to diagnose bc kids like symmetry normally) - persists for may years but symptoms can fluctuate over time

basic themes for obsessions

dirt/contamination orderliness religion sexuality (but can change across cultures - religious obsessions more common in countries with strict moral codes and religious values) violence and aggression

tic disorder and OCD - comorbidity

does indicate there is a neurological component to this disorder 10-40% of children and adolescents with OCD have a tic disorder too small group - OCD occurred after strep throat -- pediatric autoimmune disorder (PANDAS) - after getting strep the OCD traits appeared and did go away with medicine but the virus that causes strep could cause OCD symptoms so there must be a biological component (more likely male, dramatic onset, remission with antibiotic treatment)

more general info about PTSD

duration of disturbance is more than 1 month (key piece - normal to have symptoms but will reside in 1 month unless you have this - persistence is PTSD) disturbance causes clinically significant distress/ impairment in social/occupational/other areas of functioning any age, even childhood 1-14% lifetime (but 3-58% for at risk individuals) 20% women exposed to trauma but only 8% of men (women twice as likely to develop - may be because of higher incidence rates of sexual trauma at earlier ages, may be different dendritic length in circuits or other genetic/brain differences, may be due to nature of trauma, may be evolutionary) lower SES more likely to develop Hispanic/African/Indian Americans more likely around half seek treatment, but not always right away 20% attempt suicide some individuals may be more genetically susceptible (why some people experiencing same event will develop and some won't) weaker support systems, more likely more limited/maladaptive/unhealthy coping skills, more likely lower self-efficacy (feeling of control) and higher hostility, more likely less likely if you find meaning in traumatic event (advocating for change, foundation, spiritual, etc) more dissociative reactions -> higher rate (how "hypnotizable" one is) 3.5% year, 6.8% lifetime treatments are often combined for better results!, often varies based on trauma treatment goals are to end stress reactions, change perspective on painful experiences, return patients to constructive living 1/3 of all cases improve within 12 months of treatment but 1/3 never return to normal functioning for family and society treatment is important because it can be very debilitating for individual

causes of panic disorder: psychodynamic

early object loss/separation anxiety - leads to unconscious fear of loss and abandonment

complex PTSD

encounters with multiple or recurring traumas all same symptoms but also disturbances in emotional control, self-concept and relationships

panic disorder

experience recurrent and terrifying panic attacks/attacks of terror that can come without warning and without apparent reason attacks build to a peak in 10-15 minutes but can last for hours (periodic short bursts and reach peak within minutes but only gradually pass) *fear of having another one is a key piece - this is why there is impairment and altered behavior* initial attack is spontaneous but then recurrent ones become associate with cues may lead to agoraphobia - don't want this to happen in public places (they are often comorbid) prevalence with agoraphobia: 4% lifetime, without 1.1% lifetime (so overall 5.1% lifetime) panic attacks - feel like they are going to vomit, chest constricts, cannot breathe and feel like having a heart attack, lose control of behavior and practically unaware of actions 59% in treatment women and lower socioeconomic status more common (there is more stress and triggers for those of lower SES) prevalence decreases with age late-teens to mid-30s onset - 20 to 24 higher among non-hispanic white Americans than minorities features differ in cultures - Asian Americans more dizziness, African Americans have less unsteadiness and choking than Americans

normal panic attacks

experienced by 1/3 of everyone at some point in life

separation anxiety disorder

extreme anxiety when separated from home or key figures in one's live in children: refusal to go to friends houses, run errands, attend camp or school, plead/cry/throw tantrums to prevent parents from leaving, fear they will get lost or parent will come to accident/illness normal functioning around figures but distress with separation 6 months present for adults and only 4 weeks in children 2% adults and 4% children we often reinforce this by accident

treatment for PTSD-EMDR

eye movement desensitization and reprocessing flooding minds with avoidant images repeated exposure to cues and emotions associated with trauma - following light to move eyes while talking, changes circuit of brain while discussing (changing emotional and physiological response) - may just be exposure itself but effective

agoraphobia

fear of places and situations where escape is not possible or help is unavailable (public places such as stores/movie theaters, crowds, unfamiliar places) may result in avoidance (of crowded streets or stores, driving in parking lots of on bridges traveling on public transportation or airplanes) or enduring situations with marked distress may result in using drugs and alcohol - often comorbidity with men to cope in a way they can may result in interceptive avoidance (avoiding events that may cause similar physiological sensations such as exercise) more common in women and those of lower socioeconomic status (it is more acceptable for women and men should "tough it out" belief, men often use other substances to deal) sometimes comorbid with depression since it puts limitations on ones life those with this often have panic attacks and this can be comorbid with panic disorder 1.7% year, 2.6% in life 46% receive treatment very much based on the individual - some are afraid to leave house (very severe), some leave but only go to familiar places, some force themselves out but still experience distress some will only leave with company or just stay home with company onset is in late adolescence/early adulthood

info about compulsions

generally under voluntary connote but feel like there is little choice recognition that they are unreasonable but feel something terrible will happen if not completed - feel less anxious after performing so they become rituals (must perform in same way with certain rules every time) cleaning, checking, order and balance (perfect order), touching, verbal, counting

causes & treatment of OCD: biological

genetic - family pedigrees show 53% correlation in twin studies low activity of serotonin - role of glutamate, GABA, dopamine, gene that limits glutamate in individuals with this (likely cluster of gene abnormalities) over-arousal of neural networks - amygdala overarousal and PFC underarousal abnormal function of frontal lobes dysfunction in basal ganglia (caudate nucleus) there is a circuit that helps regulate primitive impulses such as sexual desires, aggressive instincts, need to excrete that brings impulses to attention and leads us to act or disregard them circuit includes orbitofrontal cortex, cingulate cortex, striatum (caudate nucleus and putamen), thalamus and if impulses reach thalamus the person is driven to further think about them/maybe act, serotonin glutamate and dopamine all at work the cortico-striato-thalamo cortical circuit is hyperactive in OCD so it is hard to dismiss impulses/needs, may be result of genetic inheritance, known from brain scans OCD symptoms arise when parts of this circuit are damaged treatment: antidepressants SSRIS - 50-80% improvement, relapse is likely if discontinued though, fluoxetine (prozac) fluvoxamine (Luvox) paroxetine (Paxil) clomiprime (anafranil) by increasing serotonin activity in circuit to stop hyperactivity and better interconnect structures, psychosurgery such as deep brain stimulation or lesion the cingulate bundle if not response to drugs to therapy (more invasive)

causes of anxiety disorders: biological contributions

genetic vulnerabilities - certain individuals may be more vulnerable and stress in environment may turn on their response (different response to different stressors - why some people develop and others don't may just be due to vulnerability) vulnerability origins - may come from depleted levels of GABA, dysfunction in the serotonergic neurotransmitter system, dysfunction in the noradrenergic system HPA axis - corticotropin releasing factor (CRF) activates this axis which is connected to multiple parts of the brain such as the limbic system(mediator between brainstem and cortex)/locus corelus/prefrontal cortex/dopaminergic system (if axis is more sensitive then there will be an increased stress response - how we respond to stress depends on how the "brain is wired" behavioral inhibition system is activated by brainstem when there are changes in signaling danger, this descends from the cortex to the septal-hippocampal system which is housed by the amygdala and causes us to freeze/feel anxious/analyze the threat fight/flight system - involved in panic, is activated by brainstem and travels through midbrain structures and gray matter, produce an immediate alarm-and-escape response and may be linked to deficiencies in serotonin (getting started or thinking there is a threat gets the sympathetic nervous system running) may be an overly responsive/overactive limbic system may have deficiencies in the controlling functions of the cerebral frontal cortex (underachieve frontal cortex) life experiences can alter the sensitivity of brain systems as well! - smoking as a teenager can lead to 5x more likely for PD/GAD (somatic symptoms may trigger anxiety - correlation does not necessarily equal causation, just an interesting observation)

causes of specific phobias: CB

has most support learning perspective - Mowrer's Two Factor Model relates to how phobia develops under classical conditioning and is maintained under operant conditioning Little Albert - sees white rabbit, gong hit that startled him, started to associate rabbit with gong and now seeing white startles him (generalized his fear) learning perspective - modeling when one sees other fear something so they do (like parents), buzzing of confederates and screaming caused fear of buzzes (feeling like you don't something they know about why something is scary so now you are scared too)

brains of those with DP/DR

have deficits in attention, information processing, short-term memory, and spatial reasoning brain imaging shows deficits in perception and emotional regulation dysregulation in HPA axis this is not due to a neurological cause but the brain does show responses corresponding to experiences

beliefs of the OCD population

have exceptionally high standards of conduct and morality believe intrusive thoughts are equivalent to actions and capable of causing them (thought-action fusion) believe they should have perfect control over thoughts and behaviors in life everyone has obsessive thoughts sometimes, but can dismiss or ignore them - OCD blame themselves for the thoughts and expect that terrible things will happen (they avoid negative outcomes by neutralizing their thoughts and thinking/behaving in ways to put matters right and make amends)

the different characteristics of DID alters

have own names have different identifying features such as age, gender, race, family history have different abilities and preferences - abstract/encyclopedic memories can be altered, playing instruments, foreign language, handwriting, tastes in music/food/friends/literature psychological responses can differ - BP levels, allergies, measured evoked potentials (response patterns on eEGS), activity to same stimuli shows the same variations normally found in different people

dissociative identity disorder

having two or more distinct personalities (subpersonalities/alters) - original personality counts as one, they are not age or gender-specific average number: 15 for women, 8 for men (but there have been causes of 100) there is often a primary/host that appears more than others they often appear in groups of 2-3 at a time this is NOT schizophrenia - schizophrenia relates to disorganized thinking, hallucinations, delusions - split mind NOT split personalities when one alter takes center stage, it dominates the person's functioning if there is switching back and forth between personalities you can be sure it is not a fugue state used to be called multiple personality disorder childhood abuse causes dissociation in the first place, this starts in childhood and is triggered in adulthood people question if therapists have created this - it hasn't been true in some cases, Hollywood sight of it may be different states of being instead of distinct personality states all the time and extreme cases are personality states (may be a spectrum and we just don't know yet) DID can be very disruptive - may lose time, "wake up" and see things you did not do switches may not be common for some or more common for others - can relate to triggering events, substance use (may be dramatic, is sudden, often triggered by stressful events) individuals have usually experience unpleasant events (significant severe and chronic childhood abuse) - dissociate during abuse, found that they could escape the trauma of abuse by creating "new personalities" to oral with stress so they form fragmented parts of different aspects of themselves as they develop new personalities they are skilled at self-hypnosis medical conditions may differ between alters - optical changes, BP conditions, changes in MRI due to different brain functioning, changed handedness (doesn't seem to be faked) women have more alters than men 1.5 % year when an alter is present, the person loses time (sometimes days) most studies are case studies - it is hard to study so not too reliable diagnosed in late adolescence/early adulthood but symptoms often begin in childhood after trauma/abuse (often sexual) women diagnosed 3x more than men

panic disorder symptoms

heart palpitations, hand/feet tingling, shortness of breathing, sweating, hot and cold flashes, trembling, chest pains, choking sensations, faintness, dizziness, feeling of unreality fear they will go crazy or lose control dysfunctional changes in thinking/behavior as result of attacks - worry about having them, concerns about what they mean, plan lives around possibility of future attacks

causes of specific phobias: behavioral-evolutionary

humans have predispositions to develop certain fears - preparedness to acquire certain phobias and not others these predispositions have been transmitted genetically through evolutionary processes - ancestors with fear inclinations were more likely to survive and pass on genes

causes of panic disorder: biological

improper circuitry (amygdala, locus coreuleus, hypothalamus, hippocampus, norepinephrine, ventromedial nucleus of the hypothalamus, central gray matter) - saw antidepressants helped so realized abnormal norepinephrine was a cause, since the locus coreleus is an on-off switch it causes panic attacks when stimulated (but not just that one transmitter), there is some overlap with fear circuit but panic circuit is more extensive and complex, 31% correlation in twin studies with abnormal circuitry genetic influences sensitive "alarm system" (fight flight responses, specifically to false alarms such as the "suffocation false alarm") role of GABA - lower levels here role of serotonin - regulates emotional states, not regulated properly here biological challenge tests can produce hyperventilation and biological sensations with drugs or other things and PD people more upset during these because they believe the sensations are dangerous and out of their control panic-prone individuals in general experience more frequent and intense bodily sensations either due to abnormal circuitry or trauma-filled events in lives - higher expectations of catastrophe

developmental psychopathology perspective for anxiety and related disorders

influential integrative view today - appreciates principles of various models (emphasizes that each model alone doesn't focus much on development - how and when variables interact) focuses on intersection and context of important factors at key points in time throughout an individual's lifespan bio model: look at genetic variations and hyperactive fear circuits and inhibited fearful temperaments in infants toddlers (children show withdrawn, isolated and cautious pattern with behavioral inhibition - wary of new objects, people, and environments, on guard against potential threats - this inhibited temperament endures throughout life and places some individuals at weighted risk for development of these disorders) CB/PD models: look at role of parenting styles to see if whether every temperament in children will become lifelong posture of worrying (fearful misinterpretations and excessive social concerns and avoidance behaviors) -- overprotective parenting where they rush in too quickly to prevent distress - denies opportunity to learn how to manage distress themselves and develop strong self-confidence, parental accommodations where they allow children to avoid social engagement/answer questions on their behavior/let them stay home/provide excessive reassurances helped promote repeated eruptions of anxiety and sets stage for lifelong anxiety sociocultural: life stress, poverty, school difficulties, family disharmony, peer pressure, community danger can all heighten likelihood some sociocultural factors present in addition to unfavorable bio factors and temperament and parenting experiences can all lead to development variables are often seen as two directional: have impacts by and on various factors may have greater or lesser impact at different points of development (which is why early intervention is good to change later reactions)

social anxiety disorder (social phobia)

intense fear of social/performance situations where they may become embarrassed excessive fear of negative evaluations and repeatedly judging oneself as performing less competently than they actually do ex: stage fright, unable to order food, speech anxiety, quitting varsity football, fear of eating in front of others, difficulty making phone calls may impact career and educational goals - they fail to carry out important responsibilities, may keep fears secret and come off as rude or disinterested or hostile 7% year, 12.1-13% lifetime more common in women and low SES (poor people 50% more likely to develop) non-hispanic white Americans most likely late childhood/adolescence and may continue into adulthood - median age 13 (may relate to self-consciousness in adolescence) associated with history of childhood shyness - exacerbated as they grow up often related to childhood bullying - was judged by others and now fears ut prevalence in US is higher in African Americans and Asian Americans compared to Hispanic Americans not just situational - may be narrow or broad but fear of being judged negatively or embarrassing themselves

developmental psychopathology perspective on PTSD

intersection and context of important variables at key points of time throughout lifespan -says certain people have biological predisposition for overactivity in stress pathways and dysfunctions in brain's stress circuit which sets stage for PTSD (but doesn't guarantee it) -if these people encounter extreme stressors throughout childhood, their pathways become more overactive and stress circuits more dysfunctional so the risk grows -risk grows again if they develop poor coping mechanisms and develop problematic personal styles or have weak social supports -particular vulnerable to PTSD in response to extreme trauma -two-way variables: overactive stress pathways can lead to poor coping, but manageable stress can improve functioning of pathways and coping skills by building resilience (can go in two directions) -timing is important: stressors in childhood disrupt or alter the newly developing brain (thus, pathways and circuits) but are less likely to disrupt these in adulthood - however, extreme stressors at any point in life can still increase vulnerability -multi-finality: same beginning but different endpoints (predisposing stress pathways may or may not lead to PTSD based on timing/context) -equifinality: diff pathways, same endpoints (good pathways and bad may both develop PTSD in response to trauma)

PTSD: physiological reactivity symptoms

marked alterations in arousal and reactivity associated with the event, beginning or worsening after event occurred as evident by two of following: -irritable behavior and angry outbursts (verbal/physical aggression towards people or objects) -reckless/self-destructive behavior (unconscious typically - due to guilt or anger towards world/themselves) -hypervigilance/hyperalertness -exaggerated startle response -problems with concentration (may be due to overalertness_ -sleep disturbance (difficulty falling and staying asleep, restless sleep - afraid to sleep because it is a vulnerable state or they are afraid of nightmares)

theoretical perspectives (causes) of DID -other?

may actually be a subtype of PTSD? there is a developmental window until 9 years old - we are developing our identity and personality in childhood, yet if one dissociates due to a traumatic childhood event they don't have cohesive personality and only have fragments

more on DID

may not recognize the clothes or items the alter has purchased alters can be male, female, or children more present/localized in North America few criminals have been diagnosed with DID - most people do not have a violent alter, more common to have self-destructive (like a suicidal) alter associated with increased risk of suicide some cases may be iatrogenic - produced by practitioners unintentionally (suggesting the existence or asking one to produce alters under hypnosis, having greater interest when signs of dissociation show - many are already in treatment for other things, yet some notice time lapses in lives or alters themselves) theory: self-hypnosis/suggestive state around 4-6 when it often begins, children escape by mentally separating self from body to fulfill wish to be someone else, hypnotic amnesia makes people forget and there is self-induced amnesia in DA so all memories of past and identity are gone special processes: out-of ordinary, brain conscious functioning altered fugue (but self in internal trance) common/social cognitive processes: high motivation, focused attention, self-fulling expectations highly motivating the hypnotic state, performing tasking, proving with suggestions to forget them mechanisms that put them into practice int he first place often comorbid with depression, suicidal thoughts, drug and substance abuse

causes of generalized anxiety disorder: PD

mentions realistic (normal) versus neurotic (anxious/out-of control/excess) versus moral activity (issues of morality in world) all children experience some degree of anxiety growing up and use ego defense mechanisms to control it, but and develop poor defense mechanisms or cannot use them appropriately in adulthood and thus develop GAD (could be due to extreme punishment, overprotection (where there is little opportunity to develop effective defense mechanisms and finding them weak when faced with adult life), unacceptable sexual/aggressive impulses approaching their awareness and believing these id impulses are very dangerous so they have severe anxiety when they arise) of courses also unacceptable repressed issues that we project out so much they might not even be in our consciousness today: more so about inadequacies in early relationships between children and parents, disagree with some aspects of Freud but generally believe those with GAD are more likely to use defense mechanisms such as repression when discussing or maybe just want to avoid embarrassment, extreme punishment for id impulses can lead to anxiety and extreme protectiveness from parents can too

causes of panic disorder: cognitive factors

misinterpreting physiological events - certain people are just prone to more bodily sensations and think they are losing control, fear the worst, lose all perspective and plunge into panic (they interpret danger in their bodily reactions and fear they will return or set themselves up for future panic attacks) (misinterpretations guide behaviors and choices in life - learn to display avoidance and safety behaviors, hold onto people and objects to avoid faintness, move slowly and sit still to avoid high heart rate) -> this leads to anxiety sensitivity where they focus on bodily sensations a lot and are unable to assess them logically so they interpret them as physically harmful anxiety sensitivity higher on tests, 5x more likely to develop this if you score higher - catastrophic thinking causes mild changes to result in significant fear, avoidance reinforces this fear (avoiding situations that may trigger attacks is negative reinforcement)

theoretical perspectives (causes) of DID -PD (most valid for this)

most basic defense mechanism is repression of traumatic memories to prevent them from reaching awareness and fight off anxiety single episode of manic repression is dissociative amnesia, lifetime is DID continuous repression: fear world they live in due to abusive parents, "another person looks on safely from afar," fear impulses due to excessive punishment so they disown and deny them by assigning them to other peronsalities

dissociative amnesia

most common dissociative disorder unable to recall personal information/events (usually of stressful nature) not caused by physical factors - emotional traumatic event, not neurological like brain injury or dementia (instead is directly triggered by traumatic/upsetting event - begin during serious threats to health and safety) can be triggered by childhood abuse/sexual abuse, forgotten events of these, loss of loved one, extreme guilt personal impact depends on how much is forgotten and what changes this causes memory for basic factual/abstract/encyclopedic/historical information remains in tact 1.8% year abuse memories can come out and resurface in therapy - repressed memories illusions can also be created by the confused mind though - suggestibility is when the diagnosis occurs without enough evidence, hypnosis and regression can occur, therapy responses can lead to false memories, there can be biologically false memories too

treatment for PTSD-CBT

most effective! - improvement for half or more veterans repeated exposure to cues and emotions associated with the trauma - exposure is VERY IMPORTANT - always incorporated no matter what, some say -talking about incident - imaginal exposure - watching videos -visiting memorials -virtual reality gradual steps are very helpful and improvement lasts a long time prolonged exposure: addresses cues but also memories (to recall and describe for a while, hold onto them - starts with entire event recollection, then hot spots which are especially dreadful parts, then more about hot spots - can be even more effective than gradual!) cognitive-processing therapy: change dysfunctional attitudes/types of interpretation, dealing with different memories and feelings, accept what they have done and experienced, become less self-judgmental, trust others once again -- acceptance and reappraisal (understanding trauma and challenging things such as survivor guilt) are important also working with mindfulness-based therapy

PTSD: emotional and cognitive symptoms

negative alterations in cognitions and mood associated with the event, beginning or worsening after it occurred (two or more of following): -inability to remember important aspect of event (dissociative type of amnesia - not neurological) -persistent and exaggerated negative beliefs/expectations about oneself/others/world -persistent/distorted cognitions about cause/consequences of event that lead individual to blame himself/herself or others (survivor guilt or guilt about what they had to do to survive) -persistent negative emotional state (depression, anxiety, anger - fluctuation emotions and emotional dysregulation or abile) -markedly diminished interest/participation in significant activities (anxiety/depression partially causing this but also heightened emotional state) -feelings of detachment/estrangement from others (cannot relate or connect) -persistent inability to experience positive emotions -unresponsive to external stimuli (dissociation symptoms - psychological separation, feeling dazed) depersonalization where conscious state/body is unreal, derealization where environment is unreal or strange (30% have dissociative symptoms, most common for combat/sexual or physical abuse)

treatment for PTSD-Psychological Debriefing

not used as much anymore, but therapists quickly come in to help process not very effective anymore - some people need to process in own before processing in therapy so this can make some people worse not good for general population but some professions like firefighters and police officers prefer this method

treatment for specific phobias: bio

occasionally, benzos may be used if the phobia is something you only encounter a couple times a year/very infrequently

dissociative trance disorder

occurs in India, Nigeria (vinusa), Thailand (phii pob), Asian and African countries, African American prayer meetings, Native American rituals, Puerto Rican spirits sessions

READING: Methylation

parental trauma exposure - greater risk for PTSD/mood/anxiety disorders in children bio alterations associated with PTSD and stress-related disorders observed in offspring who did not have trauma exposure or disorder themselves animal behaviors have showed epigenetic alterations in next generation before, and this relates to vulnerability to symptoms in offspring of trauma survivors parental trauma often leads to offspring trauma as symptoms of their own disorders (abuse) so hard to study origin of changes - genetic or actual experience FKBP5 alterations associated with PTSD and intergenerational effects , altered in major depression DNA isolated from blood, the FKBP5 was genotyped with hybridization protocol no major differences demographically between groups *results/discussion: holocaust survivors and offspring both have methylation changes on the same site in a functional intronic region of the FKBP5 gene (does associate preconception stress effects with epigenetic changes in both exposed parents and their offspring in adult humans, blood samples sample to detect parental and offspring experience-dependent epigenetic modifications)* studies before conception, during pregnancy, and postpartum may be able to see sources of epigenetic influences (different stages), maybe other studies could look at differences in maternal and paternal effects, mechanism of intergenerational transmission of trauma and functional importance of site specificity, may want to extend to other traumas, look more at animal models possibility of offspring abuse as indirect consequence of parental trauma - potential confounding variable but accounted for data supports intergenerational epigenetic priming of the physiological response to stress in offspring of highly traumatized individuals - may lead to increased risk for psychopathology in offspring *early detection of these epigenetic marks may help to develop preventive strategies to address the genetic vulnerability of exposure to trauma*

specific phobias

persistent and irrational fear of a specific object or situation or activity (specific animals, heights, enclosed spaces, thunderstorms, blood) - only anxious around that but otherwise completely fine, yet immediate fear when exposed and more comfortable avoiding it and thoughts about it 10% year, 12% lifetime - relatively common rates are lower in other countries 32% seek treatment females > males (double) recognize fear is irrational but try to avoid it regardless impact on life depends on what the specific phobia is - if encountered often, greater impact on life

excoriation (skin-picking disorder)

picking results in skin lesions - open wounds, scabs prevalence 1.4% 75% are female antidepressants and CBT work for this to so it is related to OCD manifests this way instead of hair pulling but similar there is anxiety and picking skin relieves it (compulsion) picking: face, arms, legs, scalp, chest, fingernails, cuticles -- often one area, often with fingers typically triggered by or accompanied with anxiety or stress

body dysmorphic disorder

preoccupation with an imagined defect in physical appearance (obsession with flawed appearance, usually very minor) feeling disfigured high rates of suicidal ideation compulsive grooming - plastic surgery, moisturizing - "fixing flaws" to reduce anxiety or avoidance of others altogether complaints - hair thinning, acne, wrinkles, scars equally common in males and females usually begins in adolescence - body image issues and self-consciousness 2.4% population few people with this disorder get married (not only affects them emotionally but stops them from actively engaging with friends, partners, and coworkers) we see them as regular looking, they see themselves as ugly sometimes not able to leave house, constantly looking in mirror most studied of OCD-related disorders many are housebound and 80% suicidal, 25% attempt suicide

PTSD: intrusive symptoms

presence of one or more of the following intrusion symptoms associated with the traumatic event beginning after it occurred (unwanted, uncontrollable - memories, emotions, physiological responses): -recurrent/involuntary/intrusive/distressing memories of event -recurrent distressing dreams where content and/or affect is related to trauma -dissociative reactions such as flashbacks where individual feels/acts as if traumatic event were recurring -intense or prolonged psychological distress at exposure to internal/external cues that symbolize/resemble aspect of event -marked psychological reactions to internal/external cues that symbolize/resemble aspect of event

causes of anxiety disorders: psychological contributions

psychoanalytic perspective: there are unresolved issues in the past that cause distress today (potentially a fear of loss/abandonment if this happened a child), projecting ones unconscious anxiety onto things such as a current stressor instead behavioral perspective: the modeling of anxious behaviors to children, classical or operant conditioning, the sense of control or lack of control learned from parents (if they were consistently positive you have a strong sense of self, self-efficacy, and independent but if they were overprotective and over intrusive then you have no sense of control and have learned that the "world is a dangerous place")

treatment for panic disorder and agoraphobia - bio

psychopharmacology: antidepressants especially if severe panic attacks, beneficial in beginning to get them to even come to therapy (imipramine or Tofranil, clomipramine or anafranil, paroxetine or pail, sertraline or Zoloft -- since there is probably dysregulation of serotonin, SSRI can help) anxiolytics (anti-anxiety): benzos such as alprazolam or Xanax-these are often seen only as a band aid for day to day and would NOT be used with CBT because we need anxiety for CBT for work, there is correlation with substance abuse and there is a relapse rate of 90% if stopped due to rebound effect: body has sensation of the med depressing the CNS so it will cause more anxiety after stopping the med

causes of social anxiety disorder

react with greater activation of amygdala to angry faces/other negative stimuli inherit biological vulnerability to develop anxiety so stress results in this sensitive fight/flight response poor performance and panic attacks associated with social situations (classical conditioning generalizing this feeling to social situations) unrealistic standards and viewing self negatively anticipating and expecting negative outcomes - self-fulfilling prophecies avoidance reinforces the anxiety *hypersensitive to negative stimuli*

treatment for social anxiety disorder - CBT method (preferred)

really about exposure helping them realize that sufferers have overwhelming social fears and that they often lack skills at starting convos and commanding needs and meeting needs of others cognitive restructuring to view themselves and situations more appropriately role playing to help them feel more comfortable (exposure) social fears -- helps them relapse less so should be featured in the treatment of these always either alone or with meds, exposure therapy to expose them to dreaded social situations and remain until the fear resides gradually, systematic discussions to re-examine and challenge maladaptive beliefs and expectations social skills training - model socially appropriate behaviors and encourage trying them, role playing, rehearsing new behaviors until they are more effective, feedback and reinforcement/praise provided for effective performances social skills training groups and assertiveness training groups where members try out and rehearse new social behaviors with other group members and receive guidance on what is appropriate - receiving reinforcement from others with the same difficulties often is more effective than therapist alone

trichotillomania

recurrent pulling out of one's hair resulting in noticeable hair loss (scalp, eyebrows, eyelashes - typically one or two sites (most commonly scalp) and typically one hair at a time) increasing sense of tension immediately before pulling out hair or when attempting to resist behavior pleasure/gratification/relief when pulling out hair disturbance causes clinically significant distress of impairment in social/occupational/other important areas of functioning more common in females (10 to 1 ratio) 1-5% of college students identified genetic mutation - overgrooming in animals seen too overlap with PTSD related to anxiety - treatment pretty much same as for OCD (some benefit from SSRIs, CBT with exposure and response prevention to reduce or stop behavior) not sure why one develops this versus BDD or any type of OCD-related disorder but manifest differently in different people may have rituals for hair too

generalized anxiety disorder

relates to excessive anxiety and worry occurring more days than not (general and persistent feelings of worry and anxiety - sometimes called free floating anxiety) relates to worrying about minor everyday events (getting things done, small things) 6 months or longer person finds it difficult to control the worry least likely to get treated - feels normal for those with it experience a reduced quality of life but many are able to carry on social relationships and job activity through this difficult 4% in year, 6% in lifetime more females than males (except for in South Africa) onset is mid-adolescence to mid-20s (median age is 31) and it is often chronic and doesn't tend to go away 8% who receive treatment are symptom free after two years... doesn't always go away common in older adults - loss of indolence, friends, unknown futures found in other cultures

acute stress disorder

same symptoms as PTSD (after experiencing trauma - within 4 weeks of event) symptoms reside within one month though (if longer - re-diagnose as PTSD) -subjective sense of numbing/detachment/absence of emotional responsiveness -reduction in awareness of his/her surroundings -- being in a daze -derealization -depersonalization -dissociative amnesia (inability to recall important aspect of trauma) people with this have higher likelihood of developing PTSD but do not always (about half do) - needs different diagnosis bc it doesn't always turn into PTSD like PTSD but with more numbing and dissociative responses

benzodiazepines

sedative-hypnotic drugs that calm people in low doses and can help them fall asleep in higher doses they are less addictive than barbiturates and produce less fatigue so they were used a lot at first they bind to GABA receptors and increase the ability of GABA itself to bind

causes of anxiety disorders: social contributions

stressful events for the individual or world

stress and arousal normally

stressor - event that creates demands (everyday hassles like traffic, turning point events like marriage/graduation, long-term problems like poverty or poor health, traumatic events like accidents/tornadoes/military combat) stress response - person's reaction to demands (we have all experienced stress before) excessive stress, however, can lead to anxiety, depression, schizophrenia, sexual dysfunction, these disorders where reactions to stress become severe and debilitating/last a long time/make it hard for one to live a normal life we are faced with some degree of stress when faced with demands or opportunities that require us to change in some manner -- our response to stress is influenced by the way we judge events and our capacity to react to them an effective way, only chronic or super intense stress is bad (normally the sympathetic NS running is good and helps us respond)

four subtypes of obsessions

symmetry/exactness - most common, having things in certain way or certain number forbidden thoughts or actions - having thoughts of doing something you would never do, do compulsion to avoid doing this cleaning/contamination - constantly washing hands or decontaminating house hoarding

cultural influences in agoraphobia/panic disorder

there is greater incidence rates in Lesotho, Africa prevalence is equal among several countries though disorder manifests itself in different ways (different symptoms) culturally - though we do see anxiety and panic disorders cross culturally still Susto in Latin America: excessive sweating, increased heart rate, insomnia attaques de nervios: panic, shouting uncontrollably, bursting into tears knoll Goeu - Khmer & Vietnamese refugees - wind overload, orthostatic dizziness and sore neck

depersonalization/derealization disorder

this disorder doesn't relate to memory difficulties like other DD depersonalization: experiences of unreality, detachment, or being an observer of one's body/thoughts (body parts feel foreign, can extend to other sensory experiences behavior such as distortions in touch/smell/judgments of time/space/lost control over speech or actions), distorted sense of time, emotional/physical numbing, surreal of being, not feeling like yourself - like watching a movie of your life, doubling where mind seems to be floating a few feet above them, emotional state that is "mechanical"/"dreamlike"/"dizzy" derealization: experiences of unreality, detachment with respect to surroundings, external world feel surreal and strange and people/objects are distorted, dreamlike and foggy, objects may seem to change size and shape and other people may seem removed/mechanical/dead, thinking what you're seeing is not real, you know where you are and are still with reality but it feels off to you you are aware of distorted perceptions and in contact with reality this causes significant distress - if persistent and recurrent it can impair social relationships or job performance onset is sudden with gradual fading 2% population equal in males and females mean age of onset is 16 - adolescents, young adults, hardly ever people over 40 survivors of trauma or life-threatening experiences (hostages/kidnap victims) particular vulnerable it is long -lasting - symptoms can improve and disappear for a bit and then return or intensify in stressful times sufferers fear they are losing their minds and become preoccupied with worry about symptoms few theories to explain this - no studies may be triggered by fatigue, physical pain, intense stress, recovery from substance abuse

causes of generalized anxiety disorder: sociocultural

threatening environments in personal or cultural lives - can increase cultural levels of anxiety (muscle tension, fatigue, sleep disturbances more common for people in stressful situations) times of war, terrorist attacks, crime-ridden or hostile neighborhoods, living near a nuclear power plant esp. with radiation accident in past, poverty communities where high crime rates and fewer educational and job opportunities and greater health problem risks exist GAD rate twice as high in those with low incomes - as wages go down, GAD goes up obviously not the only factor since not everyone in these environments develops GAD race and ethnicity also play role - can affect picture of GAD and pattern of it (called nervios or attaques de nervios for Hispanic individuals and relates to emotional distress, brain aches with poor concentration and nervousness, irritability and tearfulness reactions, headaches, stomachaches, trembling, heat in chest rising to head)

theoretical perspectives (causes) of DID -diathesis-stress model

traits of proneness to fantasize and high ability to hypnotize and openness to altered states of consciousness in individual makes one more susceptible to dissociative disorders if traumatic event occurs (higher propensity to develop DID if event happens because biological aspects like tendency to dissociate and ability to self-hypnotize and be imaginal make one more vulnerable to develop as result of event)

treatment for panic disorder and agoraphobia - therapy

truly based on the individual treating with benzos can interfere with this so they are often not paired found to be more effective than drugs if person is ready fir treatment! -90% improves and has most enduring effects relaxation training, cognitive restructuring, teaching coping techniques, breathing retraining, exposure therapy panic control therapy: not catastrophizing things - creates panic attacks in office and helps them deal with it psychodynamic therapy may be effective too

causes of specific phobias: PD

unconscious impulse of aggression/sexual desires reaching awareness which causes anxiety projection of anxiety onto object - whatever really makes one anxious is too threatening so it is easier to deal with a fear of an object than the real issue

treatment for DID - textbook information

want patient to recognize fully nature of the disorder, recover gaps in their memory, and integrate sub personalities into one functional personality 1 - try to bond with the primary and sub personalities, try to educate patients and help them recognize nature of the disorder (may introduce alters to each other through hypnosis or videos, may use group therapy, may educate spouses and children to help them and help them get info to patient) 2- pscyhodynamic/hypno/drug therapies to recover memories (works slowly because some alters may deny things others recall, one may be a "protector" and want to prevent the primary from suffering the pain of reliving these memories) 3- integration is continuous until patients "own" all of their emotions, sensations, behaviors, knowledge (fusion is the final merging of two or more subpersonalities, this is hard because patients distrust it and see it as a form of death or loss, for help with this part, PD/supportive/cognitive/drug therapies have all been used) once integrated, there is need for further therapy to maintain the complete personality and to teach social and coping skills to prevent later dissociations some therapists have high success rates and others say patients resist fill integration, some therapists even question need for full integration even if fully reintegrated, there is no guarantee the dissociations won't come back some day

obsessive compulsive personality disorder

what media often depicts as OCD characteristic trait where someone likes thinks certain ways, to be in control, has hard time delegating and is rigid in thinking Monica from Friends normal to have routine behaviors

nocturnal panic

when panic attacks occur more often between 1:30 and 3:30 am (circadian rhythm and we often "wake up" temporarily during this time) occurs when going into delta sleep - physical sensation of letting go due to more reflex, relates to how panic disorder often strikes when you are relaxed sleep apnea may be related too but delta wave data unsure released to sleep terrors (walking and talking nightmares) - adult version of it? isolated sleep paralysis - when falling asleep or in process of wakinng up

stress and arousal - normal systems

when we see a stressor as threatening, there is arousal and a sense of fear response that includes physical emotional and cognitive components normally, people differ in their responses slightly and what they respond to hypothalamus releases neurotransmitters and this activates the ANS (nerve fibers that connect us to all other organs and is responsible for all involuntary activities of organs such as breathing, heartbeat, BP, perspiration) and the endocrine system (glands that release hormones into the bloodstream to various organs) - these often overlap in responsibilities these two systems produce arousal in the SNS and the HPA pathway (fight or flight response occurs - arouses body, preps for danger) SNS: stimulates organs directly or stimulates adrenal glands (medulla) to release epinephrine and norepinephrine to produce arousal (second group of ANS nerve fibers is the PNS which calms us down) the HPA pathway: hypothalamus signals pituitary gland which secretes adrenocorticotropic hormone (ACTH) which stimulates the adrenal cortex to release to release corticosteroids (including cortisol)

culture-bound dissociative symptoms

whereas DID is primarily a North American disorder - not seen in other countries, other dissociation and dissociative disorders are cross cultural (people act in different ways, translate states, engage in unusual behavior without memory of it - just cultural spins on disorders) Amok: Southeast Asia and Pacific Islands, trancelike state in which individual violently attacks a person/destroys an object Zar: North Africa and Middle East, spirit possession, engage in unusual behavior

trauma and stressor-related disorders

whole new category in DSM-5 - anxiety is a part of disorder but many other symptoms as well, new diagnoses as well reactive attachment disorder (children removed at early age never learned how to attach or it had to be broken) and disinhibited social engagement disorder used to be childhood, PTSD used to be anxiety, acute stress disorder new, adjustment disorder (depressive symptoms/anxiety symptoms/both - may be normal adjustment in response to stressor but to get help need diagnosis) used to be mood 3.5-6% year, 7-12% lifetime people with stress disorders often develop others as well (depression, anxiety, substance use) and have an increased risk of developing physical ailments (bronchitis, asthma, heart disease, liver disease)

focuses of those with BDD

wrinkles, spots on skin, facial hair, swelling of face, misshapen nose/mouth/jaw/eyebrow some worry about appearance of feet/hands/breasts/penis/other body parts some worry about bad odors from sweat/breath/genitals/rectum normal to worry about appearance some, but tis is severe - limits contact with others, not look others in eye, conceal defects at great lengths (always wearing sunglasses, plastic surgery, dermatology treatments), often feel worse after concealing