Notes on Modern Psychopathology

7/23/2019 Notes on Modern Psychopathology

1/24

Name the 2 Kinds of Panic Attacks

List 5 different anxiety D/Os

Merna is a 28 year-od femae a! "rad# $om%ains a&o't e(erythin" to the %oint !here !ork is

affected# )'s&and com%ained# *asiy fati"'ed+ see% dist'r&ance+ irrita&iity# Present for ,

months# )y%erthyroid condition# .hat disorder

0his disorder has an eary onset in eary ad'thood# 2/1 are femaes# One of the most common

anxiety disorders#

,5 year od mae in ,th# 3'iet/shy at schoo# 4'ied in th# )ates "oin" to schoo+ !orried a&o't

"oin" cra6y# Na'seo's+ s!eaty+ t!itchy e%isodes for 1 months# .hat disorder

Define crisis /2#

7e%aration anxiety D/O /2

Ne'rotransmitters

Amnesia

*$0

)eath/7%orts Psychoo"y 7t'ff

)o! on" does it take to dia"nose a D/O# f it "oes 'ntreated+ ho! on" co'd it ast

Pre(aences

Psychosis9 &road term referrin" to ha'cinations and/or de'sions# Does not a%%y ony to

schi6o%hrenia9 aso de%ressi(e/manic e%isodes# $an &e ac'te or chronic#

Anxiety is a ne"ati(e mood state characteri6ed &y &odiy sym%toms of %hysica tension and

a%%rehension a&o't the f't're# $an &e a s'&:ecti(e sense of 'nease+ a set of &eha(iors ;ookin"

!orried/anxio's+ fid"etin"


2/24

Fear is an immediate aarm reaction to dan"er# Like anxiety+ fear can &e "ood for 's# A massi(e

res%onse from the AN7 ;increased )= and 4P< and a s'&:ecti(e sense of terror ena&e

esca%e/attack#

@ear and anxiety reactions differ%sychoo"icay and %hysioo"icay#

Anxiety is a future-oriented mood state characteri6ed &y a%%rehension &eca'se !e cannot

%redict or contro '%comin" e(ents#

4y contrast+ fear is an immediate emotiona reaction to c'rrent dan"er characteri6ed &y stron"

esca%ist action tendencies and+ (ery often+ a s'r"e in the sym%athetic &ranch of the AN7#

retchen B %anic attack#

7te(e B %anic disorder#

Panic is named after the reek "od Pan+ !ho terrified tra(eers !ith &ood-c'rdin" screams#

Panic attack is an a&r'%t ex%erience of intense fear or ac'te discomfort+ accom%anied &y

%hysica sym%toms that 's'ay inc'de heart %a%itations+ chest %ain+ shortness of &reath+ and+

%ossi&y+ di66iness#

0here are 2 &asic ty%es of %anic attacks9 expected (cued) and unexpected (uncued)#

Cnex%ected attacks are im%ortant in panic disorder#

*x%ected attacks are more common in specific phobias or social anxiety disorder#

*d(ard M'nch>s 7cream? is a de%iction of his o!n %anic attacks#

Panic attacks reach a %eak !ithin min'tes#

.e inherit a tendency to &e tense+ '%ti"ht+ and anxio's# 0he tendency to %anic seems to r'n in

famiies and %ro&a&y has a "enetic com%onent that differs some!hat from "enetic contri&'tions

to anxiety# As !ith amost a emotiona and traits and %sychoo"ica disorders+ no sin"e "ene

seems to ca'se anxiety or %anic# nstead+ contri&'tions from coections of "enes in se(era areas

on chromosomes make 's ('nera&e !hen certain %sychoo"ica and socia factors are in %ace#


3/24

De%eted e(es of GABA are associated !ith anxiety# 0he noradrener"ic system has &een

im%icated in anxiety+ and f'rther e(idence s'""ests that the serotoner"ic system may aso &e

in(o(ed#

Corticotropin-releasing factor (CF) acti(ates the hy%othaamic-%it'itary-adrenocortica

;)PA< axis+ !hich is %art of the $=@ system+ and this $=@ system has !ide-ran"in" effects on

areas of the &rain im%icated in anxiety+ inc'din" the emotiona &rain ;im&ic system


4/24

4eha(iora theorists tho'"ht anxiety !as the %rod'ct of eary cassica conditionin"+ modein"+

or other forms of earnin"#

0he contin''m of %erce%tion may ran"e from tota confidence in o'r contro of a as%ects of o'r

i(es to dee% 'ncertainty a&o't o'rse(es and o'r a&iity to dea !ith '%comin" e(ents#

A "enera sense of 'ncontroa&iity? may de(eo% eary as a f'nction of '%&rin"in" and other

disr'%ti(e or tra'matic en(ironmenta factors#

Parents !ho interact in a %ositi(e and %redicta&e !ay !ith their chidren &y res%ondin" to their

needs+ %artic'ary !hen the chid comm'nicates needs for attention+ food+ reief from %ain+ and

so on+ teach their chidren that they ha(e contro o(er their en(ironment and their res%onses ha(e

an effect on their %arents and their en(ironment#

Parents !ho %ro(ide a sec're home &ase? &'t ao! their chidren to ex%ore their !ord and

de(eo% the necessary skis to co%e !ith 'nex%ected occ'rrences ena&e their chidren to

de(eo% a heathy sense of contro#

n contrast+ %arents !ho are o(er%rotecti(e and o(erintr'si(e and !ho cear the !ay? for their

chidren+ ne(er ettin" them ex%erience any ad(ersity+ create a sit'ation in !hich chidren ne(er

earn ho! to co%e !ith ad(ersity !hen it comes aon"# 0herefore+ these chidren don>t earn that

they can contro their en(ironment#

Most %sychoo"ica acco'nts of %anic ;as o%%osed to anxiety< in(oke conditionin" and co"niti(eex%anations that are diffic't to se%arate#

%xternal cues are %aces or sit'ations simiar to the one !here he initia %anic attack occ'rred#

#nternal cues are increases in )= or res%iration that !ere associated !ith the initia %anic attack+

e(en if they are no! the res't of norma circ'mstances+ s'ch as exercise# .hen yo'r heart is

&eatin" fast+ yo'>re more ikey to think of+ and ex%erience+ a %anic attack than !hen it>s &eatin"

normay#

$'es or tri""ers may tra(e from the eyes directy to the amy"daa !itho't "oin" thro'"h the

cortex# o' may not &e a!are of yo'r c'es#

7tressf' ife e(ents tri""er o'r &ioo"ica and %sychoo"ica ('nera&iities to anxiety# Most are

socia and inter%ersona in nat're E marria"e+ di(orce+ diffic'ties at !ork+ death of a o(ed one+

%ress'res to exce in schoo+ and so on# 7ome mi"ht &e %hysica+ s'ch as an in:'ry or iness#


5/24

0he same stressors can tri""er %hysica reactions+ s'ch as headaches or hy%ertension+ and

emotiona reactions+ s'ch as %anic attacks# 0he symptoms of stress seem to r'n in famiies#

0here>s a %ossi&e "enetic contri&'tion to %anic attacks#

&riple "ulnerability &heory to anxiety9 a< "enerai6ed &ioo"ica ('nera&iity# A tendency to &e

hi"h-str'n" or '%ti"ht may &e inherited+ &'t a "enerai6ed &ioo"ica ('nera&iity to de(eo%

anxiety is not s'fficient to %rod'ce anxiety itsef#

&< "enerai6ed %sychoo"ica ('nera&iity9 "ro! '% &eie(in" the !ord is dan"ero's and o't of

contro#

c< 7%ecific %sychoo"ica ('nera&iity9 earn from eary ex%erience that some sit'ations or

o&:ects are fra'"ht !ith dan"er+ e(en if they reay aren>t#

f yo' are 'nder a ot of %ress're+ %artic'ary from inter%ersona stressors+ a "i(en stressor co'd

acti(ate yo'r &ioo"ica tendencies to &e anxio's and yo'r %sychoo"ica tendencies to fee yo'

mi"ht not &e a&e to dea !ith the sit'ation and contro the stress# Once this cyce starts+ it tendsto feed on itsef+ so it mi"ht not sto% e(en once the %artic'ar ife stressor has on" %assed#

Anxiety can &e "enera+ &'t it>s 's'ay focused on one area+ s'ch as socia e(a'ations or "rades#

Anxiety increases the likelihood of panic# @rom an e(o'tionary %oint of (ie!+ sensin" a

%ossi&e f't're threat or dan"er ;anxiety< sho'd %re%are 's to react instantaneo'sy !ith an

aarm res%onse if the dan"er &ecomes imminent# Anxiety and %anic need not occ'r to"ether+ &'t

it makes sense that they often do#

Comorbidity B the co-occ'rrence of t!o or more disorders in a sin"e indi(id'a#

55F of %atients !ho recei(ed a %rinci%a dia"nosis of an anxiety or de%ressi(e disorder had at

east one additiona anxiety or de%ressi(e disorder at the time of assessment# f !e consider

!hether the %atient met criteria for another dia"nosis at any time in his ife+ the rate increases to

GF#

4y far+ the most common additiona dia"nosis for a anxiety disorders !as ma'or depression+

!hich occ'rred in 5F of the cases o(er the co'rse of the %atient>s ife# Additiona dia"noses of

de%ression or acoho/s'&stance a&'se make it ess ikey that yo' !i reco(er from an anxiety

disorder+ and more ikey that yo' !i rea%se if yo' do#

Anxiety can aso co-occ'r !ith se(era %hysica conditions9 the %resence of any anxiety disorder

!as 'niH'ey and si"nificanty associated !ith thyroid disease+ res%iratory disease+

"astrointestina disease+ arthritis+ mi"raine headaches+ and aer"ic conditions# 0he anxiety most

often &e"ins before the %hysica disorder#


6/24

2F of indi(id'as !ith %anic disorder ha(e attem%ted s'icide# 0he risk of s'icide in indi(id'as

!ith %anic disorder is com%ara&e to that for indi(id'as !ith ma:or de%ression#

$uicidal ideation B ha(in" tho'"hts a&o't s'icide#

0he rates of comor&idity amon" anxiety disorders is hi"h &eca'se they share the common

feat'res of anxiety and %anic#

Anxiety disorders ist9 "enerai6ed anxiety disorder+ %anic disorder and a"ora%ho&ia+ s%ecific

%ho&ia+ and socia anxiety disorder+ as !e as 2 ne! disorders+ se%aration anxiety disorder and

seecti(e m'tism#

rene B "enerai6ed anxiety disorder# ndiscriminate+ 'n%rod'cti(e !orryin" a&o't e(erythin"#

Life as a series of im%endin" catastro%hes#

AD is the &asic syndrome that characteri6es e(ery anxiety and reated disorder considered in

this cha%ter#

At east six months of excessi(e anxiety and !orry ;a%%rehensi(e ex%ectation< m'st &e on"oin"

more days than not+ a&o't a n'm&er of e(ents or acti(ities# M'st &e diffic't to t'rn off or

contro the !orry %rocess E the hamark of %athoo"ica !orryin"#

.hereas %anic is associated !ith a'tonomic aro'sa+ as a res't of an 7N7 s'r"e ;increased heart

rate+ %a%itations+ %ers%iration+ and trem&in"


7/24

0he one %hysioo"ica feat're that distin"'ishes indici(id'as !ith AD from non-anxio's

indi(id'as is muscle tension#

Beniodiaepines are most commony %rescri&ed for AD+ atho'"h they seem to im%air &oth

co"niti(e and motor f'nctionin"# O%tima for short-term reief of anxiety associated !ith a

tem%roar crisis or stressf' e(ent#

Antide%ressants ike paroexetine and "enlafaxine may &e a &etter choice#

Psychoo"ica treatments are eH'ay effecti(e to &en6os in the short term+ &'t are more effecti(e

in the on" term# ndi(id'as !ith AD seem to a"oid? feein"s of anxiety and the ne"ati(e

affect associated !ith threatenin" ima"es# $40 in !hich %atients e(oke the !orry %rocess d'rin"

thera%y sessions and confront anxiety-%ro(okin" tho'"hts and ima"es head-on# 0he %atient

earns to 'se co"niti(e thera%y and other co%in" techniH'es to co'nteract and contro the !orry

%rocess#

Panic disorder (P) B se(ere and 'nex%ected %anic attacks# An indi(id'a may think they>re

dyin" or other!ise osin" contro# n many cases+ &'t not a+ %anic disorder is accom%anied &y a

cosey reated disorder caed agoraphobia+ !hich is fear and a(oidance of sit'ations in !hich a

%erson fees 'nsafe or 'na&e to esca%e to "et home or to a hos%ita in the e(ent of de(eo%in"

%anic sym%toms or other %hysica sym%toms+ s'ch as oss of &adder contro#

Peo%e de(eo% a"ora%ho&ia &eca'se they ne(er kno! !hen these sym%toms may occ'r# n

se(ere cases+ %eo%e !ith a"ora%ho&ia are 'na&e to ea(e the ho'se+ sometimes for years on end#

n PD+ anxiety and %anic are com&ined in an intricate reationshi% that can &ecome de(astatin"#

Panic attacks m'st &e rec'rrent or 'nex%ected# At east one of the attacks m'st ha(e &een

foo!ed &y at east one month or &oth of the foo!in"9 %ersistent !orry or concern a&o't

s'&seH'ent %anic attacks/conseH'ences+ or a si"nificant maada%ti(e chan"e in &eha(ior reated

to the attacks#

Anxiety is diminished for indi(id'as !ith a"ora%ho&ia if they think a %erson or ocation is

*safe+,

A"ora%ho&ia can exist inde%endent of %anic attacks#

+./ of indi(id'as meet the criteria for PD# G5F of them are !omen#

.+/ of indi(id'as meet the criteria for a"ora%ho&ia#

Onset &e"ins in eary ad't ifeI %'&erty is a %redictor#


8/24

01/ of indi"iduals 2ith P ha"e experienced *nocturnal attacks+, Panic attacks occ'r more

freH'enty &et!een ,91 Am and 191 AM# Noct'rna attacks occ'r d'rin" deta sta"e ;so!

!a(e< see%+ the dee%est sta"e of see%# &hey are not dreaming#

#solated sleep paralysis 3 transition &et!een =*M and !akin"#

4earned alarms B interna and externa %anic c'es#

8F to ,2F of indi(id'as ha(e occasiona 'nex%ected %anic attacks+ 's'ay %ro(oked &y intense

stress#

@ase aarms &ecome earned aarms thro'"h association !ith somatic sensations ;interoce%ti(e

c'es+ ike a %o'ndin" heart


9/24

0here are fo'r ma:or s'&ty%es of s%ecific %ho&ia9 ,< anima ty%e+ 2< nat'ra en(ironment ty%e

;e#"#+ hei"hts+ storms+ and !ater< 1< &ood-in:'ry-in:ection ty%e+ and < sit'ationa ty%e ;e#"#

%anes+ ee(ators+ encosed s%aces


10/24

Pho&ias can aso &e de(eo%ed as a res't of ex%eriencin" a fase aarm ;%anic attack< in a

s%ecific sit'ation#

%motions are "ery contagious#

A tr'e %ho&ia aso reH'ires anxiety o(er the %ossi&iity of another extremey tra'matic e(ent or

fase aarm# A %ersistent antici%ation of somethin" terri&e+ and an a(oidance of sit'ations !here

that terror mi"ht occ'r#

7%ecific %ho&ias reH'ire structured and consistent exposure-based exercises# Post-treatment+

res%onsi(eness decreases in the amy"daa+ ins'a+ and cin"'ate cortex+ &'t increases in the

%refronta cortica areas+ s'""estin" that more rationa a%%raisas !ere inhi&itin" emotiona

a%%raisas of dan"er# 0hese treatments re!ire? the &rain# irt'a reaity ex%os're-thera%y may

aso &e 'sed#

$eparation anxiety disorder is 'niH'e to chidren# t>s characteri6ed &y a chid>s 'nreaistic and

%ersistent !orry that somethin" !i ha%%en to his %arents or other im%ortant %eo%e in his ife+ or

that somethin" !i ha%%en to the chid himsef that !i se%arate him from his %arents ;e#"#+ he

!i &e ost+ or h'rt in an accident


11/24

,1#1F of indi(id'as ex%erience 7AD at some %oint in their i(es# 7i"hty hi"her femae sex

ratio# Cs'ay &e"ins d'rin" adoescence+ !ith a %eak a"e of onset at a&o't ,5 years# More

%re(aent in yo'n"+ 'ndered'cated+ sin"e+ o! socioeconomic stat's#

7lfactory reference syndrome - 0he key feat're is %reocc'%ation !ith a &eief that one is

em&arrassin" onesef and offendin" others !itha fo' &ody odor# $ommon in a%an#

.e inherit a tendency to fear an"ry faces# ndi(id'as !ith 7AD tend to react to an"ry faces !ith

"reater acti(ation of the amy"daa and ess cortica contro or re"'ation than nonanxio's

indi(id'as#

Peo%e !ith 7AD ha(e &iased socia %erce%tions and ex%ectations that ead them to &eha(e in

certain maada%ti(e !ays in socia sit'ations# 0he socia &eha(ior of the sociay anxio's %erson

in t'rn eicits ne"ati(e reactions from others+ !hich confirms the &iased %erce%tions#

Peo%e !ith 7AD incorrecty inter%ret others> &eha(ior as cod or 'nfriendy+ and they seecti(ey

attend to ne"ati(e socia information and to anxiety-reated sym%toms that are noticea&e to

others+ s'ch as &'shin"#

Peo%e !ith 7AD make more *up2ard comparisons, ;assessments that someone ese is

s'%erior to them< and fe!er do!n!ard com%arisons? than others+ and that the '%!ard

com%arisons that %eo%e !ith 7AD make ca'se them more anxiety and distress#

0he indi(id'a !ith the ('nera&iities and ex%ectations :'st descri&ed must aso ha(e earned

"ro!in" '% that socia e(a'ation s%ecificay can &e dan"ero's# 0he %arents of %eo%e !ith 7ADare si"nificanty more concerned !ith the o%inions of others than are the %arents of chidren !ith

%anic disorder and they %ass these concerns on to their chidren#

Cogniti"e-beha"ioral group therapy (CBG&) is an effecti(e treatment for 7AD+ in !hich

"ro'%s of %atients rehearse or roe-%ay their sociay %ho&ic sit'ations in front of one another# At

the same time+ their thera%ist cond'cts rather intensi(e co"niti(e thera%y aimed at 'nco(erin"

and chaen"in" the a'tomatic or 'nconscio's %erce%tions of dan"er that the sociay %ho&ic

ass'mes to exist#

@or a time+ cinicians ass'med that &eta&ockers ;dr'"s that o!er )= and 4P< !o'd !ork+ &'t

the e(idence did not seem to s'%%ort their contention# 7ince ,+ the 77=s Paxi+ ooft+ and

*ffexor ha(e recei(ed a%%ro(a of treatment for 7AD#

Addition of the dr'" D-cycoserine ;D$7< to co"niti(e-&eha(iora treatments si"nificanty

enhances the effects of treatment# Makes extinction !ork faster and ast on"er# 0his dr'" !orks

in the amy"daa+ a str'ct're in the &rain in(o(ed in the earnin" and 'nearnin" of fear and


12/24

anxiety# t faciitates extinction of anxiety &y modifyin" ne'rotransmitter fo! in the "'tamate

system#

$electi"e mutism ($5) is a rare chidhood disorder characteri6ed &y a ack of s%eech in one or

more settin"s in !hich s%eakin" is sociay ex%ected# t seems ceary dri(en &y socia anxiety+ as

the fai're to s%eak is not &eca'se of a ack of kno!ed"e of s%eech or any %hysica diffic'ties# t

commony occ'rs in some settin"s+ &'t not others E hence the moniker seecti(e#?

Neary a chidren !ith 7D aso meet criteria for 7AD# t>s hy%othesi6ed that !e-meanin"

%arents ena&e this &eha(ior &y &ein" more readiy a&e to inter(ene and do their takin" for

them#?

Post-traumatic stress disorder (P&$) is the emotiona disorder that foo!s a tra'ma# ictims

re-ex%erience the e(ent thro'"h memories and ni"htmares# .hen memories occ'r (ery s'ddeny

and the (ictims find themse(es rei(in" the e(ent+ they are ha(in" a flashback# ictims a(oidanythin" that reminds them of the tra'ma# 0hey often dis%ay a characteristic restriction or

n'm&in" of emotiona res%onsi(eness+ !hich may &e (ery disr'%ti(e to inter%ersona

reationshi%s# 0hey are sometimes 'na&e to remem&er s%ecific as%ects of the e(ent# t is %ossi&e

that (ictims 'nconscio'sy ty to a(oid the ex%erience of emotion itsef+ ike %eo%e !ith PD+

&eca'se intense emotions co'd &rin" &ack memories of the tra'ma# @inay+ (ictims are

chronicay o(eraro'sed+ easiy started+ and H'ick to an"er# =eckess or sef-destr'cti(e

&eha(ior? is one si"n of increased aro'sa and reacti(ity#

0he addition of a *dissociati"e, s'&ty%e of P07D descri&es (ictims !ho do not necessariy react

!ith the re-ex%eriencin" or hy%eraro'sa characteristic of P07D# =ather+ they ha(e ess aro'sathan norma aon" !ith ;dissociati(e< feein"s of 'nreaity# 0hey res%ond differenty to treatment#

n ,+ foo!in" the reat @ire of London+ 7am'e Pe%ys ex%erienced P07D# Diffic'ty

see%in" and rec'rrin" intensi(e dreams of the e(ent are %rominent feat'res of P07D# 7'(i(or>s

'it? is aso a sym%tom#

P&$ cannot be diagnosed until a month after the trauma+

Acute stress disorder is an analogue to P&$ that occurs 2ithin the first month after the

trauma+ A "ery se"ere! immediate reaction+

5F %ercent of indi(id'as !ith ac'te stress disorder "o on to de(eo% P07D# et+ as many as

52F of tra'ma s'r(i(ors !ho de(eo% P07D did not meet the criteria for ac'te stress disorder in

the month foo!in" the tra'ma#

Ner(o's &reakdo!n? is a ay term commony 'sed to refer to a se(ere %sychoo"ica '%set#

=a%e has the most si"nificant emotiona im%act#


13/24

0he "reater one>s "enerai6ed &ioo"ica+ %sychoo"ica+ socia+ and c't'ra ('nera&iities+ the

"reater one>s ikeihood of de(eo%in" P07D foo!in" ex%os're to a tra'ma#

P07D in(o(es a n'm&er of ne'ro&io"ica systems+ %artic'ary ee(ated or restricted

corticotro%in-reeasin" factor ;$=@s mo(in" fin"er !ith their eyes+ a !hie kee%in" he ima"e of the

tra'ma in mind# 0his techniH'e is said to faciitate ra%id re%rocessin" of the tra'matic e(ent#


14/24

0he 77=s are 'sef' in reie(in" the se(ere anxiety and %anic attacks so %rominent in P07D#

Ad'ustment disorders descri&e anxio's o de%ressi(e reactions to ife stress that are "eneray

mider than one !o'd see in ac'te stress disorder or P07D &'t are ne(ertheess im%airin" in

terms of interferin" !ith schoo or !ork %erformance+ inter%ersona reationshi%s+ or other areas

of i(in"# Partic'ay in adoescence+ the ife stress may %ro(oke some cond'ct %ro&ems# f

sym%toms %ersist for more than six months follo2ing the remo(a of the stress or its

conseH'ences+ the ad:'stment disorder !o'd &e considered chronic#

Attachment disorders refer to dist'r&ed and de(eo%mentay ina%%ro%riate &eha(iors in

chidren+ emer"in" &efore fi(e years of a"e+ in !hich the chid is 'na&e or 'n!iin" to form

norma attachment reationshi%s !ith care"i(in" ad'ts# D'e to inadeH'ate or a&'si(e chid-

rearin" %ractices# Often ca'sed &y freH'ent chan"es in the %rimary care"i(er &eca'se of m'ti%e

foster care %acements+ or %ossi&y ne"ect in the home#

0he res't is a fai're to meet the chid>s &asic emotiona needs for affection+ comfort+ or e(en

%ro(idin" for the &asic necessities of daiy i(in"# 0hese disorders are considered to &e

%athoo"ica reactions to eary extreme stress#

eacti"e attachment disorderE the chid !i (ery sedom seek o't a care"i(er for %rotection+

s'%%ort+ and n'rt'rane and !i sedom res%ond to offers from care"i(ers to %ro(ide this kind of

care# eneray+ they !o'd e(idence ack of res%onsi(eness+ imited %ositi(e affect+ and

additiona hei"htened emotionaity+ s'ch as fearf'ness and intense sadness#

isinhibited social engagement disorder res'ts in a %attern of &eha(ior in !hich the chidsho!s no inhi&itions !hatsoe(er to a%%roachin" ad'ts# 7'ch a chid mi"ht en"a"e in

ina%%ro%riatey intimate &eha(ior &y sho!in" a !iin"ness to immediatey accom%any an

'nfamiiar ad't fi"'re some!here !itho't first checkin" &ack !ith a care"i(er#

7bsessi"e-compulsi"e disorder (7C) is the de(astatin" c'mination of the anxiety and reated

disorders# t>s not 'ncommon for someone !ith O$D to ex%erience se(ere "enerai6ed anxiety+

rec'rrent %anic attacks+ de&iitatin" a(oidance+ and ma:or de%ression+ a occ'rrin"

sim'taneo'sy in con:'nction !ith o&sessi(e-com%'si(e sym%toms#

n O$D+ the dan"ero's e(ent is a tho'"ht+ ima"e+ or im%'se that the cient attem%ts to a(oid as

com%etey as someone !ith a snake %ho&ia a(oids snakes#

7bsessions are intr'si(e and mosty nonsensica tho'"hts+ ima"es+ or 'r"es that the indi(id'a

tries to resist or eiminate#

Compulsions are the tho'"hts or actions 'sed to s'%ress the o&sessions and %ro(ide reief#


15/24

$om%'sions can &e either &eha(iora ;hand!ashin"+ checkin"< or menta ;thinkin" a&o't certain

!ords in a s%ecific order+ co'ntin"+ %rayin"s disorder# n some cases+ these

mo(ements ae not tics &'t com%'sions# 0he o&sessions in tic-reated O$D are amost a!ays

reated to symmetry#

&ic-related 7C may emerge in children after exposure to strep throat# Kno!n as

PANDA7#?

Lifetime %re(aence of O$D is ,#F to 2#1F# n a "i(en one-year %eriod+ %re(aence is ,F# A

neary ,9, femae/mae ratio#

Most effecti(e meds are those that s%ecificay inhi&it the re'%take of serotonin+ s'ch as

comi%ramine or the 77=s+ !hich &enefit '% to F of %atients !ith O$D# =ea%se freH'enty

occ'rs !hen dr'" is discontin'ed# )i"hy str'ct'red %sychoo"ica treatments !ork some!hat

&etter than dr'"s# 0he most effecti(e a%%roach is exposure and ritual pre"ention (%P)+ a

%rocess !here&y rit'as are acti(ey %re(ented and the %atient is systematicay and "rad'ay

ex%osed to the feared tho'"hts or sit'ations# 0hese %roced'res seem to faciitate reaity testin"#?

$40 is aso effecti(e# Psychos'r"ery+ esionin" the cin"'ate &'nde ;cin"'otomy< and

ca%s'otomy are 1F effecti(e in extreme cases# Dee% &rain stim'ation is aso he%f'#

Body dysmorphic disorder (B) centers aro'nd a %reocc'%ation !ith some ima"ined defect

in a%%earance &y someone !ho act'ay ooks reasona&y norma# 0his disorder has &een referred

to as ima"ined '"iness#? *+ im !ith a sH'are head#


16/24

#deas of reference B they think e(erythin" that "oes on in their !ord someho! is reated to

them E in this case+ to their ima"ined defect#

GF if coe"e st'dents re%ort at east some dissatisfaction !ith their &odies+ !ith F to 28F of

these a%%earin" to meet the criteria for 4DD# Psychoanaytic s%ec'ations foc's on the defensi(e

mechanism of dis%acement E an 'nderyin" 'nconscio's confict !o'd &e too anxiety-

%ro(okin" to admit into conscio'sness+ so the %erson dis%aces it onto a &ody %art#

A%%roximatey ,5F of %atients !ith eatin" disorders s'ffer from comor&id 4DD+ !ith their

&ody dysmor%hic concenrs 'nreated to !ei"ht and sha%e#

Ony effecti(e treatments are9 ,< d'r"s that %re(ent the re'%take of serotonin+ and 2< ex%os're

and res%onse %re(ention $40# 0he exact same treatments effecti(e in O$D#

Peo%e !ith 4DD &eie(e they>re deformed in some !ay and "o to medica doctors to attem%t tocorrect their deficits# G#F of %atients seek this treatment and F end '% recei(in" it#

Dermatoo"y !as most recei(ed+ foo!ed &y %astic s'r"ery# 8F to 25F of a %atients !ho

reH'est %astic s'r"ery ha(e 4DD#

8oarding disorderE 2F to 5F of the %o%'ation# 0!ice as hi"h as the %re(aence of O$D#

*xcessi(e acH'isition of thin"s+ diffic'ty discardin" anythin"+ and i(in" !ith excessi(e c'tter

'nder conditions &est characteri6ed as "ross disor"ani6ation#

&richotillomaniaE the 'r"e to %' o't one>s o!n hair from any!here on the &ody+ inc'din" the

sca%+ eye&ro!s+ and arms# ,F to 5F of 'ni(ersity st'dents# Lar"ey femae#

%xcoriationE skin %ickin" disorder# $haracteri6ed &y re%etiti(e and com%'si(e %ickin" of the

skin+ eadin" to tiss'e dama"e# ,F to 5F of %o%'ation# Lar"ey femae#

4oth a&o(ementioned disorders often co-occ'r !ith O$D and &ody dysmor%hic disorder+ as !e

as !ith each other# )a&it-re(ersa trainin" is effecti(e#

O&sessi(e-com%'si(e and reated disorders9 O$D+ 4DD+trichotiomania+ excoriation+ and

hoardin" disorder#

$omatic symptom disorders a seemin" %reocc'%ation !ith %hysica disorders#

issociati"e disorders intense and extreme ex%eriences of detachment from onesef or one>s

s'rro'ndin"s that ca'se %atients to ose their identity entirey and ass'me a ne! one+ or ose their

memory or sense of reaity and are 'na&e to f'nction#


17/24

4oth casses share common characteristics and !ere formery "ro'%ed to"ether 'nder the

headin" hysterical neurosis#

@re'd>s con"ersion hysteriaE 'nex%ained %hysica sym%toms indicated the con(ersion of

'nconscio's emotiona conficts into a more acce%ta&e form#

9eurotic disorders res't from 'nderyin" 'nconscio's conficts+ anxiety that res'ts from these

conficts+ and the im%ementation of e"o defense mechanisms# 9eurosis !as eiminated from the

dia"nostic system in ,8 for &ein" too (a"'e#

7omatic sym%tom and reared disorders9 iness anxiety disorder+ somatic sym%tom disorder+

%sychoo"ica factors affectin" medica condition+ con(ersion disorder+ and factitio's disorder# n

each+ indi(id'as are %athoo"icay concerned !ith the a%%earance or f'nctionin" of their

&odies#

7omatic sym%tom disorder !as formery kno!n as Bri:uet6s syndrome# One or more somatic

sym%toms that are disressin" or res't in si"nificant disr'%tion of daiy ife# *xcessi(e tho'"hts+

feein"s+ and &eha(iors reated to the somatic sym%toms or associated heath concerns# months#

Peo%e !ith somatic sym%tom disorder don>t a!ays fee the 'r"ency to take action+ &'t

contin'ay fee !eak and i# 0hey a(oid exercisin"+ thinkin" it !i make them !orse# Patients

identify !ith their sym%toms#

7e(re %ain may &e ex%erienced !hen %sychoo"ica factors %ay a ma:or roe in maintainin" or

exacer&atin" the %ain !hether there is a cear %hysica reason for the %ain or not# .hether the%ain has a medica ca'se or not is not the iss'e#

#llness anxiety disorder !as formery kno!n as hy%ochondriasis# Physica sym%toms are either

not exoerienced at the %resent time or are (ery mid+ &'t se(er anxiety is foc'sed on the

%ossi&iity of ha(in" or de(eo%in" a serio's disease# months# f one or more of the %hysica

sym%toms are reati(ey se(ere and are associated !ith anxiety and distress+ the dia"nosis !o'd

&e somatic sym%tom disorder#

n iness anxiety disorder+ the concern is %rimariy !ith the ideaof &ein" sick instead of the

%hysica sym%tom itsef# 0he threat seems to &e so se(ere that reass'rance from %hysicians does

not he%#

0hese disorders seem to de(eo% in the context of a stressf' ife e(ent+ as do many other

disorders+ inc'din" anxiety disorders# 7'ch e(ents often in(o(e death or iness# 7econd+ %eo%e

!ho de(eo% these disorders tend to ha(e a dis%ro%ortionate incidence of disease in their famiy


18/24

!hen they !ere chidren# 0h's+ e(en if they don>t de(eo% somatic sym%tom disorders 'nti

ad'thood+ they carry stron" memories of iness that co'd easiy &ecome the foc's of anxiety#

0hird+ an im%ortant socia and inter%ersona inf'ence may &e in(o(ed# 7ome %eo%e !ho come

from famiies !here iness is a ma:or iss'e seem to ha(e earned that an i %erson often "ets a

ot of attention# 0he &enefits? of &ein" sick mi"ht contri&'te to the de(eo%ment of the disorder

in some %eo%e# A sick %erson? !ho recei(es increased attention for &ein" i and is a&e to

a(oid !ork or other res%onsi&iities is descri&ed as ado%tin" a sick role#?

7e(ere forms of somatic sym%tom disorder are stron"y inked in famiy and "enetic st'dies to

antisocial personality disorder+ !hich is characteri6ed &y (andaism+ %ersistent yin"+ theft+

irres%onsi&iity !ith finances and at !ork+ and o'tri"ht %hysica a""ression# AP7D occ'rs

%rimariy in maes+ and se(ere forms of 77D occ'r %rimariy in femaes# 0hese disorders co'd

share a ne'ro&ioo"icay-&ased disinhi&ition syndrome characteri6ed &y im%'si(e &eha(ior#

Many of the &eha(iors and traits associated !ith AP7D seem to refect short-term "ain at the

ex%ense of on"-term %ro&ems# 0he contin'a de(eo%ment of somatic sym%toms "ainsimmediate sym%athy and attention+ &'t e(ent'ay socia isoation#

$40 foc'sed on identifyin" and chaen"in" iness-reated misinter%retations of %hysica

sensations and on sho!in" %atients ho! to create sym%toms? &y foc'sin" attention on certain

&ody areas is effecti(e# 4rin"in" on their o!n sym%toms %ers'aded many %atients that s'ch

e(ents !ere 'nder their contro#

Psychological factors affecting medical condition refers to the %resence of a pre-existing

medica condition s'ch as asthma+ dia&etes+ or se(ere %ain ceary ca'sed &y a kno!n medica

condition s'ch as cancer !hich is ad(ersey affected ;increased in freH'ency or se(erity< &y oneor more %sychoo"ica or &eha(iora factors#

Con"ersion disorder is aso kno!n as functional neurological symptom disorder# n it+

f'nctiona? refers to a sym%tom !itho't an or"anic ca'se# 0hese disorders "eneray ha(e to do

!ith %hysica maf'nctionin"+ s'ch as %araysis+ &indness+ or diffic't ys%eakin" ;a%honia


19/24

4a belle indifferenceE a hamark of con(ersion reactions# 0he same H'aity of indifference to

the sym%toms that is %resent in some %eo%e !ith se(ere somatic sym%tom disorder#

$on(ersion sym%toms are often %receded &y intense stress# Often+ this stresss takes the form of a

%hysica in:'ry#

0he ri"ht inferior %arieta cortex f'nctions to com%are interna %redictions !ith act'a e(ents#

Factitious disorders fa some!here &et!een main"erin" and con(ersion disorders# 0he

sym%toms are 'nder (o'ntary contro+ as !ith main"erin"+ &'t the %erson has no o&(io's reason

for (o'ntariy %rod'cin" the sym%toms exce%t+ %ossi&y+ to ass'me the sick roe and recei(e

increased attention# An ad't can make other members of their family sick, for attention and

pity. 0his is kno!n as factitio's disorder im%osed on another# Pre(io'sy kno!n as Mancha'sen

syndrome &y %roxy#

1F of ne'roo"ica %atients ha(e con(ersion disorder# 1F of e%ie%tic %atients ha(e

%sycho"enic sei6'res#

@re'd>s %rocesses in the de(eo%ment of con(ersion disorder9 ,< the indi(id'a ex%eriences a

tra'matic e(entI an 'nacce%ta&e+ 'nconscio's confict# 2< &eca'sr the confict and res'tin"

anxiety are 'nacce%ta&e+ the %erson re%resses the confict+ makin" it 'nconscio's# 1< the a&xiety

contin'es to increase and threatens to emer"e into conscio'sness+ and the %erson con(erts? it

into %hysica sym%toms+ there&y reie(in" the %ress're of ha(in" to dea directy !ith the

confict# 0his red'ction of anxiety is considered to &e the %rimary reinforcin" e(ent that

maintains the con(ersion sym%tom# < the indi(id'a recei(es "reaty increased attention andsym%athy from o(ed ones and may aso &e ao!ed to a(oid a diffic't sit'ation or task# 7'ch

attention and a(oidance !ere (ie!ed &y @r'ed as secondary "ains#

A %rinci%a strate"y in treatin" con(ersion d/o is to identify and attend to the tra'matic or

stressf' ife e(ent+ if it is sti %resent ;in rea ife or in memory


20/24

.hen feein"s of 'nreaity are so se(ere and fri"htenin" that they dominate an indi(id'a>s ife

and %re(ent norma f'nctionin"+ cinicians may dia"nose the (ery rare depersonaliation-

derealiation disorder# 0he indi(id'a has re%eated ex%eriences of feein" detached from his or

her o!n tho'"hts or &ody# An O4*# Cnike %sychosis+ the indi(id'a remains in "ood contact

!ith reaity E the %erson kno!s that they aren>t really an o'tside o&ser(er of their o!n &ody#

)PA axis is dysf'nctiona#

issociati"e amnesia inc'des se(era different %atterns# Peo%e !ho are 'na&e to remem&er

anythin" E inc'din" !ho they are E are said to ha(e generalied amnesia+ May & ifeon" or

extend from a %eriod months to , year in the %ast# More common is localied or selecti"e

amnesia+ a fai're to reca s%ecific e(ents+ 's'ay tra'matic+ that occ'r d'rin" a s%ecific %eriod#

ery common d'rin" !ar#

issociati"e fugue is a s'&ty%e of dissociati(e amnesia# @'"'e means fi"ht#? n these cases+

memory oss re(o(es aro'nd a s%ecific incident E an 'nex%ected tri% ;or tri%s


21/24

Onset is often a!ays in chidhood# A'ditory ha'cinatons comin" from inside the head are

common+ 'nike %sychotic a'ditory ha'cinations+ !hich come from outside the head# Amost

e(ery %atient re%orts that they !ere horri&y+ often 'ns%eaka&y+ a&'sed as a chid#

Accordin" to the autohypnotic model+ %eo%e !ho are s'""esti&e may &e a&e to 'se

dissociation as a defense a"ainst extreme tra'ma# As many as 5F of DD %atients remem&er

ha(in" ima"inary friends in chidhood#

Patients !ho ex%erience dissociati(e amnesia or a f'"'e state usually get better on their o2n

and remember 2hat they ha"e forgotten# )y%nosis is often 'sed in DD E it rarey im%ro(es

s%ontaneo'sy#

&he fundamental experiences of depression and mania contribute! either singly or together!

to all mood disorders#

0he most commony dia"nosed and most se(ere de%ression is ma'or depressi"e episode# An

extremey de%ressed mood state that asts at east t!o !eeks and inc'des co"niti(e sym%toms

;feein"s of !orthessness and indecisi(eness< and dist'r&ed %hysica f'nctions ;atered see%in"

%atterns+ chan"es in a%%etite/!ei"ht+ oss of ener"y< to the %oint that e(en the si"htest acti(ity or

mo(ement reH'ires an o(er!hemin" effort# 0y%icay accom%anied &y a marked "enera oss of

interest and of the a&iity to ex%erience any %eas're from ife# A(era"e d'ration of an 'ntreated

e%isode is months#

Anhedonia is the term 'sed to descri&e the ina&iity to ex%erience %eas're#

n mania+ indi(id'as find extreme %eas're in e(ery acti(ityI in fact+ some %atients com%are

their daiy ex%erience of mania !ith a contin'o's sex'a or"asm# A flight of ideas is

characteristic# A manic e%isode reH'ires a d'ration of one !eek+ ess if the e%isode is se(ere

eno'"h to reH'ire hos%itai6ation# rrita&iity is often %art+ near the end# A(era"e d'ration of an

'ntreated e%isode is 2 to months#

A hypomanic episode does not ca'se marked im%airment in socia or occ'%ationa f'nctionin"

and needs ony ast days#

;nipolar mood disorder B ex%eriencin" either de%ression or mania aone# Mania &y itsef

seems rare#

5ixed features in(o(es ex%eriencin" manic sym%toms &'t at the same time fein" some!hat

de%ressed or anxio's+ or &ein" de%ressed !ith a fe! sym%toms of mania#

Manic e%isodes are characteri6ed &y dysphoric ;anxio's or de%ressi(e< feat'res#


22/24

Full remission B reco(erin" for at east t!o months &et!een e%isodes#

Partial remission B ony %artiay reco(erin" and retainin" some sym%toms#

ecurrent B t!o or more ma:or de%ressi(e e%isodes occ'r and are se%arated &y at east 2 months

d'rin" !hich the indi(id'a !as not de%ressed# 85F of sin"e e%isode cases ex%erience a ater

e%isode#

Persistent depressi"e disorder (dysthymia) is constant# De%ressed mood that contin'es for at

east 2 years ;, year for chidren/adoescents< d'rin" !hich the %atient cannot &e sym%tom free

for more than 2 months at a time#

ouble depression B s'fferin" from &oth dysthymia ;%ersistent de%ression !ith fe!er

sym%toms< and e(ent'ay ec%erincin" a ma:or de%ressi(e e%isode# 4ack and forth rotation#

*i"ht s%ecifiers to descri&e de%ressi(e disorders9 ,< %sychotic feat'res 2< anxio's distress 1re %aced# May &e an end state? reaction to feein"s of imminent doom#

Aty%ica B reactin" !ith %eas're to some thin"s#

#ntegrated grief B finaity of death and its conseH'ences are ackno!ed"ed and the indi(id'a

ad:'sts to the oss#

Premenstr'a dys%horic disorder (P5) B 2 to 5F of !omen !ho s'ffer from se(ere and

sometimes inca%acitatin" emotiona reactions d'rin" the %remenstr'a %eriod# Different from

PM7#

isrupti"e mood regulation disorder B a from of &i%oar disorder NO7 in chidren and

adoescents# No e(idence of mania#

Bipolar ## disorderE ma:or de%ressi(e e%isodes aternate !ith hy%omanic e%isodes rather than

f' manic e%isodes#


23/24

Bipolar # disorder B the indi(id'a ex%eriences f' manic e%isodes# M'st &e a sym%tom-free

%eriod of at east 2 months#

D'rin" manic or hy%omanic e%isodes+ %atients often deny they ha(e a %ro&em#

Cyclothymic disorder is a chronic ateration of mood ee(ation and de%ression that does not

reach the se(erity of manic or ma:or de%ressi(e e%isodes# 0end to &e in one mood state or the

other for many years !ith reati(ey fe! %eriods of ne'tra ;e'thymic< mood# 0his %attern m'st

ast for at east t!o years ;one in chidren


24/24

Notes on Modern Psychopathology

Documents