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Chapter 13 Notes
Anxiety Disorders:
Normally our fear is caused by something appropriate and identifiable and it passes
with time.
Anxiety disorders: don’t know why he/she is afraid or the anxiety is inappropriate to the
circumstances.
This the most common of any mental disorder
Specific phobia: intense, paralyzing fear of something that perhaps should be feared, but
the fear is excessive and unreasonable. It interferes with the persons life functioning and
causes them to create adaptive activities.
About 1 in 10 people in the US suffer from a least one specific phobia
Social phobia – excessive inappropriate fears connected with social situations or
performances in front of other people.
Intense fear of public speaking is a common form of social phobia.
Agoraphobia – fear of the market place. Typically involves multiple, intense fear,
perhaps being alone, being in public places from which escape might be difficult, tunnels,
bridges, etc.
Interferes greatly with life functioning. It affects about 3 % of the population.
Women more likely than men to suffer from agoraphobia.
Panic disorder – characterized by recurrent panic attacks
A panic attack: a sudden, unpredictable and overwhelming experience of intense fear or
terror without any reasonable cause.
Symptoms: impending doom, chest pain, dizziness or fainting, searing, difficulty
breathy and fear of losing control or dying.
Attacks usually last only a few minutes, but may recur for no apparent reason.
The dread of having another can also lead to agoraphobia.
Generalized anxiety disorder is defined by prolonged vague, but intense fears that are
not attached to any particularly object or circumstance.
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Symptoms: inability to relax, constantly feeling restless or keyed up, muscle tension,
rapid heart beat, apprehensiveness about the future, hyper vigilance, and sleeping
difficulties.
Closest thing to a neurotic.
Obsessive-compulsive disorder
Obsessions are involuntary thoughts or ideas that keep recurring. May not perform the
behaviors.
Thoughts are often of a frightening nature.
Compulsions are the behaviors people feel driven to perform. Often take the form of
washing or cleaning or checking behaviors.
To be a disorder the actions and thoughts are very debilitating. They are considered an
anxiety disorder, because if they do not perform them they experience severe anxiety.
Acute stress disorder is anxiety related to a highly stressful event.
Counseling after the Northridge earthquake.
If the anxious reaction occurs long after the event, it is post-traumatic stress
This is characterized by hyperarousal, avoidance of situations that recall the trauma and
“reliving” the traumatic event in detail.
Two common kinds are military combat exposure and rape or sexual abuse.
Causes of anxiety disorders:
*
Learned from one fearful event
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Some believe phobias are prepared responses that evolution has made us
biologically predisposed to. We see to be “hard-wired” to associate certain
stimuli with intense fears.
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Sometimes realistic fears or cautions are transformed into a phobia.
*
People who feel they are not in control of stressful events in their lives are more
likely to experience anxiety than those who believe they have control over such
events. (Internal vs. external locus of control)
African Americans who live in high crime areas have a higher incidence of anxiety
disorders than other Americans do.
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Why do some people develop phobias and others do not?
A predisposition to anxiety disorders may be inherited. – Evidence shows they may run
in some families.
Internal psychological conflicts - Psychoanalytic people feel these unacceptable impulses
or thoughts may overwhelm the ego and break through into full consciousness.
Freudian defense mechanism protects the conscious mind against such threats, but at a
cost in anxiety.
It is too unacceptable to have these thoughts about my parent, sister etc, so I will become
afraid of spider.
Psychosomatic Disorders:
It is a misnomer that the conditions are “only in your head”.
They are reasonable physical illnesses. It is just that they are brought on by
psychological factors such as stress sand anxiety.
Relaxation techniques are taught as medicine.
Modern medicine is leaning toward the idea that all physical ailments are to some extent
“psychosomatic” because stress, anxiety, and various states o emotional arousal alter
body chemistry and the functioning of bodily organs, and the body’s immune system.
Stress and psychological strains also alter health behavior like eating properly, smoking,
alcohol consumptions etc.
Some diseases that particularly related to psychosomatic factors:
Headaches, allergies, asthma, and high blood pressure. However, not infectious
diseases.
Somatoform disorders:
These are characterized by physical symptoms without any identifiable physical cause.
There is no evidence of physical illness. Symptoms are real to them, they are not faked
or under voluntary control.
Somatization disorder:
Experiences vague, recurring physical symptoms for which medical attention has been
sought repeatedly but no organic cause found.
Common complaints: back pain, dizziness, partial paralysis, abdominal pains, and
sometimes anxiety and depression.
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Conversion disorders -- also somatoform disorders in which a specific disability has
no physical cause, but instead seems related to psychological problems.
Hypochondriasis – interpretation of insignificant symptoms as signs of serious illness in
the absence of any organic evidence of such an illness
Body dysmorphic disorder – imagined ugliness that causes marked impairment in
normal functioning.
Somatoform disorders present a challenge for psychological theorists. They seem to
involve some kind of unconscious processes.
Psychoanalytic approach:
Freud believes physical symptoms were often related to traumatic experience buried in
patients past.
Primary gain: prevention from acting out forbidden desires or repeating forbidden
behavior.
Secondary gain: allow person to avoid an unpleasant activity, person, or situation.
Cognitive Behavioral theories – focus on Secondary gains– ways in which
The symptomatic behavior is being rewarded.
Learning the past aches, pains, and so forth can be used to avoid unpleasant situations.
Biological perspective: some somatoform disorders were real physical illnesses that
were overlooked or misdiagnosed. However, these are only a few exceptions.
Dissociative Disorders
Means that part of an individual’s personality is separated or dissociated from the rest,
and for some reason the person cannot reassemble the pieces.
Usually involves memory loss and a complete – but temporary – change in identity.
Loss of memory without organic causes may be a reaction to intolerable experiences.
Dissociative amnesia – not being able to recall your name, family etc.
Dissociative fugue – leaving home and assuming an entirely new identity. (Note: very
unusual)
Total amnesia is quite rare.
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Dissociative identity disorder - aka multiple personality disorder.
Most feel it develops out of severe childhood abuse. Child learns to cope with abuse by
dissociation. When the person is an adult one of the personalities is usually a child.
Others think it is an elaborate kind of role-playing.
But in some cases the two personalities have different blood pressures and brain waves.
Difficult to fake
Depersonalization disorder: people who feel “outside” of themselves. Often in a dream
like way.
Dissociative disorders seem also to involve some kind of unconscious processes.
Loss of memory in amnesia, fugue and mpd is real. Patient often lacks awareness of
memory loss.
Biological factors play a role in memory impairments commonly dissociated with aging
and disorders such as Alzheimer’s disease. Some Dissociative experiences are a
consequence of drugs like LSD. Trauma is a psychological factor that is of importance at
the onset of amnesia and fugue as well as did.
SEXUAL DISORDERS:
Sexual dysfunction
Erectile disorder
Female sexual arousal disorder
Sexual desire disorders
Sexual arousal disorder
Orgasmic disorders
Premature ejaculation
Vaginismus
Paraphilias
Fetishism
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Voyeurism
Gender identity disorders
Fetishism
Voyeurism
Exhibitionism
Transvestic fetishism – almost always heterosexuals – dressing up tied to arousal
Sexual sadism – pleasure tied to aggression
Masochism – pleasure tied to pain
Pedophilia – fantasies, urges or behaviors involving sexual activity with a prepubescent
child.
Pedophiles:
Men under age of 40
Cannot adjust to sex role of an adult male
Turn to children as sexual objects in response to stress in adult relationships
Records of unstable social adjustment. Commit acts against children in response to stress
in adult relationships in which they feel inadequate.
Have histories of sexual frustration and failure. Are dependent, unassertive lonely and
insecure.
Gender-identity Disorders:
Involves the desire to become – or the insistence that one really is – a member of the
other sex.
Most begin in childhood, some develop normal gender identities in adult life others do
not.
Sexual reassignment surgery is one possible and controversial option for adults.
Causes not known / suspect. Prenatal hormonal imbalances. Also possibly: family
dynamics and learning experiences.
Schizophrenia:
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A psychotic disorder in which a person loses contact with reality, experiencing grossly
irrational ideas or distorted perceptions.
Typically, strikes as young people are maturing into adulthood. Affects males and
females about equally.
Symptoms:
Literally means “split mind” refers to a split from reality. It manifests itself in
disorganized thinking, disturbed perceptions, and inappropriate emotions and actions.
Thinking is fragmented, bizarre, and distorted by false beliefs, called delusions.
Many psychologists believe disorganized thoughts result from a breakdown in selective
attention. Schizophrenics cannot filter out the conversations. Have difficulty clearing
their working memory of distracting information.
Disturbed perceptions:
Hallucinations (sensory experiences without sensory stimulation) usually auditory.
Inappropriate Emotions and actions: flat affect – zombie like state or inappropriate affect.
Perform senseless compulsive acts – rocking, rubbing an arm.
Catatonics remain motionless for hours on end
Such symptoms can profoundly disrupt social relationships.
Types of Schizophrenia:
Positive symptoms indicate the presence of inappropriate behaviors and negative
symptoms are the absence of appropriate behaviors.
When schizophrenia is a slow developing process recovery is doubtful.
Rapid onset – recovery more likely.
Outlook is better for those with positive symptoms than with withdrawal.
Understanding Schizophrenia:
Most dreaded psychological disorder, linked with brain abnormalities and genetic
predispositions. Disease of the brain exhibited in symptoms of the mind
Brain abnormalities
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Story of the Mad Hatters – licked the brim of mercury laden felt hats.
Dopamine over activity– excess of receptors for dopamine – Such a high level may
intensify brain signals in schizophrenia, creating positive symptoms. Drugs that block
dopamine receptors often lessen the symptoms
Drugs that increase dopamine levels such as amphetamines and cocaine sometimes
intensity them. You can get a psychotic induced experience from amphetamines.
Dopamine over activity may underlie patients’ overreacting to irrelevant external and
internal stimuli.
Brain anatomy:
Many people with chronic schizophrenia have abnormal brain activity. Some have low
activity in the frontal lobes.
Thalamus is smaller than normal, not a single brain abnormality, but problems with
several brain regions and their interconnections.
What causes these abnormalities?
A prenatal problem. Low birth weight and birth complications are known risk factors for
schizophrenia. Mid pregnancy viral infection might cause.
Genetic factors:
Evidence strongly suggests that we can inherit a predisposition to certain brain
abnormalities.
1 – 100 in general population
1 in 10 among those who have an afflicted sibling or parent,
1 in 2 among those who have an afflicted identical twin.
May be a prenatal environmental component. If twins shared same placenta greater
chance than if, they had separate placentas.
Genetics alone does not guarantee the disease: other factors with it include nutritional
deprivation, prenatal viruses, and oxygen deprivation at birth
Psychological Factors:
No environmental causes have been discovered
Can stresses trigger schizophrenia? Can family difficulties contribute?
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Maybe… young people with schizophrenia tend to have unusually disturbed
communications with their parents. But this could be a causes or a result of their
disorder.
Psychologists have developed a list of “high-risk” children:
A mother whose schizophrenia was long and severe
Birth complications often involving oxygen deprivation and low birth weight
Separation from parents
Short attention span and poor muscle coordination
Disruptive or withdrawn behavior
Emotional unpredictability
Poor peer relations
Subtypes of schizophrenia:
Paranoid:
delusions or hallucinations
Disorganized disorganized speech or behavior, or flat or inappropriate emotion
Catatonic:
immobility then excessively excited
Undifferentiated:
Residual:
many and varied symptoms
withdrawal after hallucinations and delusions have disappeared.