Understanding Psychopathology > A psychological disorder is (1) a psychological dysfunction within, an individual that is (2) associated with distress or impairment in {functioning and (3) a response that e not typical or culturally ex- pected All three basic aiteria must be met: no one criterion alone thas yet been identified that defines the essence of abnormality. > ‘he field of psychopathology is concerned with the scientific study of psychologteal disorders. Trained mental health professionals range from clinical and counseling psychologists to psychiatrists and psychiatric social workers and nurses, Each profession. roquites a specific ype of traning. Using scientific methods, mental health professionals can function. as scientist practitioners Uhey not only keep up with the latest findings but also use scientific data to evaluate their own work, and they often conduct research within their clinics or hospitals. > Research about psychological disorders falls into three basic ‘eategories: description, causation, and treatment and outcomes. The Supernatural, Biological, and Psychological Traditions Historically, there have been three prominent approaches to abnormal behavior. In the supernatural tradition, abnormal, Dbchavior ie attributed to agents oxtside our bodies or socal environment, such as demons, spirits, oF the influence ofthe ‘moon and stars: although sil alive, this tradition has been largely replaced by biological and psychological perspectives In the biological tradition, disorders are attributed to disease or biochemical imbalances in the psychological tradition, abnor. -mal behavior i attributed to faulty psychological development and to socal context. Each tradition has its ovmn way of trating individuals who suder ‘rom paychological disorders, Supernatural treatments include 28 cHaPTER exorcism to rid the body ofthe supernatural spirits. Biological ‘treatments typically emphasize physical care and the search for medical cures, especialy drugs. Psychological approaches use psy- hosocial treatments, beginning with moral therapy and including modern psychotherapy > Sigmund Freud, the founder of psychoanalytic therapy, oered an claborate conception ofthe unconscious ming, much of which isstill conjecture. In therapy, Freud focused on tapping into the systeries of the unconscious through such techniquet as athar- sis, fre association, and dream analysis. Although Freud’sfollow- xs veered from his path in many ways, Freuds influence can sill be felt today. ‘One outgrowth of Freudian therapy is humanistic psychology, which focasee more on human potential and eelf-actuaizing than ‘on psychological ditorders, Therapy that has evolved from dhe sp- proach i known ae person-centered therapy; the therapist shows Almost unconditional positive regard forthe clients feclings and thoughts ‘The behavioral model moved psychology into the realm of science. Both esearch and therapy focus on things that are measurable, including euch techniques as systematic desensitization reinforce ‘ment, and shaping. The Present: The Scientific Method and an Integrative Approach > With the increasing sophistication of our scientific tools, and new knowledge from cognitive science, behavioral science, and neu roscience, we now realize that no contribution to psychological disorders ever occurs i isolation. Our behavior, both normal and abnormal, sa product ofa continual interaction of psychological, biological, and social insluencs. ABNORMAL BEHAVIOR IN HISTORICAL CONTEXT copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Key Terms psychological disorder, 3 phobia, 4 abnormal behavior, 4 peychopathology, 6 scientst-prastitioner,7 presenting problem, 7 slinieal deeription, 7 prevalence, 7 incidence,7, course, 8 prognosis, 8 ctiology,€ exorcism, 10 pychosocial treatment, 16 ‘moral therapy, 16 ‘mental hygiene movement, 17 psychoanalysis, 18 bbehaviorism, 18 unconscious, 18 catharsis, 18, psychoanalytic model, 19 id19 g0,20 superego, 20 intrapsychic conflicts, 20 defense mechanisms, 20, Answers to Concept Checks aychosexual stages of 441 12 development, 21 Part Le 2a 3b ‘astration anxiety, 21 Rae ncurosis (plural neuroses) 22 13 Part B Bedi 4G Sa E76 Bb Lb 26 3d da object relations, 22 ‘collective unconscious, 2 free association, 22, ‘dream analysis, 22 eychoanalyet, 22 twansference,23 eychodynamic person-centered therapy, 24 ‘unconditional positive regard, 24, ‘behavioral model, 24 classical conditioning, 24 ‘extinction, 25, introspection, 25, systematic desensitization, 25 ‘behavior therapy, 26 reinforcement, 26 shaping. 26 suMMaRy copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203 29Timeline of Significant Events 400 B.c.-1875 q a 18008: Superstition runs rar pant and mental isoders are 1400-1800: Bloodletting ard Blamed on dewars and wiches; leeches a0 used 'o the fxorcims are performed to id body of unhestny Node and 1798: Phillpe Pinel nro es moral therapy and makes French mental stations 400 sc: Hippoorates sug {gests tha psychological disor Sere have Bot Bolog-cal anc psychological causes, ‘ests of ev spies restore chemi! balance ‘more human, Core 1300s eo EES 200 ci: Galen suggests that 1400s: Enlightened ew that 1500s: Paracelaus suggests 1625-1875: Syphilis sat- ‘otmal ar sbrormal Beha Tore ae related fo “our boty fads, or hums. 1890: sun shock therapy. lectic shock treatments, and bran surgery cegin tobe used to treat psyehopathology. 1090: B. F. Skinner publishes The Behavior of Organisms limich deserbes te principe of operant cordtionng. iw Insanity $ caused by mertal ‘oremational stess gas ‘omentum, and depression ‘and anvioty are aga rogared {hat the moan andthe tas, rot possession by he dev, ‘ect people's psychological ‘nctoning, fevered ‘rom other pes of payonosisinthat tis caused by a pect Bacterur: ut ‘ately: peicln is found to 1043: The Minnesota Mutiphasic Personality Inventory is published by some 2s clsocers. 1080: Th fat efective drugs {or severe psychotic isorders Be developed. Humaniste Dsychologytbased on ideas ‘tal Jungs Aled Aer ‘and Car Rogers) gains some secoplance. cure syphilis. 1258: Josep Wlpe efectiely ‘veatspaions with phobias Ung systematic desensilog- ‘on based on arnciples of behavioral slonce, 1946; Anna Freud publishes Ego and the Mechanisms of Defense, 1952: The fst etion of tne Diagnoste and Statsvea! ‘Manual DS-)ispubl shed. 1968: DSI is pubtshed copy 2018 Cengage Learang. Al igh Reserved May nl be coped, Scomed upstate pa, WEN 022002081848-1920 448: Doretnea Dix suecess- 1870: Lou's Pastaur develops ci fuly campaigns for more his germ theory of disease, 1900: Sigmund Freud pub humane testment nS. Uwrich helps density the bac- shes Tho Infrgrtation of mental instutons {erum that causes syphilis Dreams nT 1904: an Pavlov receives the Nobel Priv for nis work on ‘he physielogy of cigeston. ‘which lead nin to ent ‘onaltloned reflexes in dos. era 4.854: John P. Grey, hea of Now Yors Utica Hospital betevos tat inary the result of prysicl causes, tus e-orphastang psychological treatments 1870 1895: set Srouer teats the “hystoreal” Asn 0, leading to Fteva's development of psychoanalytic theory. 1990s: Inceasinalysophist- sted esearch methods 30 Seveloped: noone iviuence Bilogea or envrormental—is ‘ound to cause psychological eordere in lation trom ine 1980: DSA is pushed. other 2000: DSM-IV-TR Is pushed. 1887: DSMIER is publishes. 1984: DSM-IV is published. 1015: Emi Krsepatnclassfas \arous peychologel dsarcers ftom a Bologea pont of view Sha publanes wore on diagnos 1920 1920: John Watson exper= rents with coneitoned earn ie alber using a white rat 2019: DSHS ie published copy 2018 Cengage Learang. Al igh Reserved May nl be coped, Scomed upstate pa, WEN 02200208One-Dimensional versus Multidimensional Models > ‘The causes of sbnormal behavior are complex and fascinating. Psychological disorders are caused by a complex interplay of nature (biology) and nurture (psychosocial factor). To dentify the causes of psychological disorder in a given per 4s0n we must consider the interaction of ll relevant dimensions genetic contributions, the role ofthe nervous syster, behavioral and cognitive processes, emotional influences, social and inter personal influences, and developmental factors. Thus, we have arrived ata mulidimensional integrative approach othe causes ‘of psychological disorders Genetic Contributions to Psychopathology > “the genetic influence on much of our development and most of| ‘our behavior personality, and even 1Q score is polygenie—that is, iniuenced by many gens. This is assumed tobe the casein abnormal behavior as well although research is beginning to identify specific smal groups of genes that relate to some major psychological disorders > In studying causal relationships in psychopathology, researchers look a the interactions of genetic and environmental elfect, In the diathesis-stress model, individuals ae assumed to inherit cer- ‘sin vulnerabilities that make them susceptible to a disorder when the right kind of stressor comes along, In the gene-environment cortelation or reciprocal gene-environment model, the in viduals genetic vulnerability oward a certain disorder may make itmore likely thatthe person will experience the stressor that, ‘turn, riggers the genetic vulnerability and thus the disorder. Inepigenctics, the immediate effects of the environment (such as caly stressful experiences) inluence cells that turn certain ‘genes on of ff. hie ffect may be passed dow through several ‘generations. Neuroscience and Its Contributions to Psychopathology Brain science and the field of neuroscience promise much as ‘we ty to unravel the mysteries of poychopathology. Within the nervous eystem, levels of neurotransmitter and neuroendocrine activity interact in complex ways to modulate and regulate emo- ‘ons and behavior and contribute to psychological disorders. > Critical to our understanding of psychopathology are the neu rolranstntter currents called brain crete. Of the newrotrans- siters that may play akey roe, we investigated live: serotonin, .gamma-aminebutyric acid (GABA), glutamate, norepinephrine, snd dopamine. Behavioral and Cognitive Science > “The relatively new Geld of cognitive science provides avalusble perspective on how behavioral and cognitive infuencesalfect ‘the learning and adaptation each of us experience throughout life. Clearly, such influences not only contribute to psychologi- cal disorders but also may directly modify brain functioning, brain structure, and even genetic expression, We examined some research in this field by looking a learned helplessness, modeling, prepared earning, and implicit memory. Emotions > Emotions havea direct and dramatic impact on our function- ing and play a central role in many mental disorders. Mood, & pefsistent period of emotionality, soften evident in psychological Aisordere. Cultural, Social, and Interpersonal Factors > ‘Social and interpersonal inluences profoundly allect both peycho- logical disorders and biology. Life-Span Development > tn considering a multidimensional integrative approach to psychopathology iti important to remember the principle of quiinality, which reminds us that we must consider the various paths toa particular outcome, not just the resul 72 CHAPTER? AN INTEGRATIVE APPROACH TO PSYCHOFATHOLOGY copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Key Terms multidimensional integrative approach, 33 genes, 36 diathesie-stress model, 38 ‘vulnerability, 38 ‘gene-environment correlation ‘model, 40, epigenetics, 2 neuroscience, 2 neuron, 43 action potentials 43 terminal button, 43, synaptic clef, 48 neurotransmitters, 43 excitatory, 43 inhibitory, 43 hormone, 47 brain cireits, 49 agonist, 50, antagonist, 0 inverse agonist, 50 reuptake, $0 glutamate, 50 gamma-aminobutyric acid (GABA), 50 serotonin, 51 norepinephrine (also noradrenaline), 52 dopamine, 53 ‘cognitive science, 58 learned helplessness, 59 modeling (also observational learning), 60 prepared learning, 60 implicit memory, 61 flight or fight response, 62 emotion, 62 mood, 63 alee, 63 ‘ircumplex model, 63 ‘equifinality, 70, Answers to Concept Checks 24 Lb, 2a (best answer) ore 3.6; 4a linia), © (maintenance) 2.2 1. F (Gast 2 pairs): 2.7 3.7, 4. (reciprocal gene ‘environment model) 5. (complex interaction of, both nature and nurture) 23 Lb 2e 34g Sd 67 hba 24 Lib; 2a: 3d; he 25 1 fear, 2 gender; 3. soca, contacts; 4 age: 5. cquifinality summaay 73 copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Assessing Psychological Disorders > Clinical absessment isthe systematic evaluation and measurement of pycholgicl,biclogia, and soil factor in an indvidal vith a possible pychologicl disorder; agnosis the process of determining that hose factors meet ll criteria for a specie peychological disorder. > Relisbiity, validity, and standardization are important compo- nents in determining the value of «psychological assessment » To assess various aspects of psychological disorders, clinicians ‘may first interview and take an informal mental status exam of | the patient, More systematic observations of behavior are called ‘behavioral assessment > A varity of peychological tests can be red during assessment, including projective tests, in which the patient responds to am- biguous stimuli by projecting unconscious thoughts personality inventories, in which the patient takes a self-report questionnaire designed to assess personal rats and intligence testing, which ‘provides a score known as an intligence quotient (1Q), Biological aspects of psychological disorders may be assessed ‘rough neuropeychological testing designed to dently possible Key Terms clinical aeessent 75 slecroencephalogram lingua 75 (EEG), 50 reliably, 7 iingrapic eteatogy 92 alii, 77 nomethetic strategy, 92 Standardization, 77 ‘lasfcation, 92 tment ttus eam, 78 taxonomy, 92 Iehavioralatesment, 80. nosology 92 stb monitoring #3 nomenclature, 92 projective teste 84 Clascal (or pe) categorical Pertonalityiweatories, 85 sprroach 93 intelligence quotient 1Q), 88 dimensional approach 93 Tareropeycholopla te 88 pectoypial approuch, 93 false postive, 9 asia ippregetiend false negative, 89 comorbicity, 98 Eeosteesieg © labeling. 99 paychophysiologial ssesment, 90 areas ofbrain dysfunction. Neuroimaging can be used more dizecty toidentify brain structure and function, Finally, psychophysiclog- ‘al assessment refers to measurable changes in the nervous system, reflecting emotional or psychological events that might he relevant toa psychological disorder, Diagnosing Psychological Disorders The term classification refers to any effort to construct groups ‘or categories and to asign objects or people tothe categories ‘on the basis oftheir shared attributes or relations. Methods of Anxiety is a fature-oriented state characterized by negative alect {in which a person focuses on the possibility of uncontrollable danger or misfortune; in contrast, fear isa present-oriented state characterized by strong escapist tendencies nd a surge in the sympathetic branch ofthe autonomic nervous system in response to current danger > Apanicattack represents the alarm response of rel fea, but there ‘sno actual danger Panic attacks may be (1) unexpected (without warning), o (2) ex pected (ahraye occurring in a specific situation) Panic and anxiety combine to crest different anxiety and related disorders. Several disorders are grouped under the heading Anxiety Disorders. Generalized Anxiety Disorder In generalized anxiety disorder (GAD), aniety focuses on minor, everyday events and not on one major worry or concern, » Both genetic and psychological vulnerabilities seem to contribute to the development of GAD, Although drug and psychological eatments may be elective in the short term, drug treatments are no more effective inthe long. ‘term than placeho treatments, Successful treatment may help individual with GAD focus on what is really threatening to them in theirlives, Panic Disorder and Agoraphobia » Inpanic disorder, which may or may not be accompanied by agoraphobia (a fear and avoidance of situations considered to be “unsafe’) anxiety is focused on the next panic attack, For some ‘people, agoraphobia develops in the absence of panic attacks or panic ike symptoms. > Weallhave some genetic vulnerability to stress, and many of us Ihave had a neurobiological overzeaction to some szesfal event — that isa pante attack Individuals who develop pani disorder and then develop anxiety over the possibilty ofhaving another panic attack. > Both drug and psychological treatments have proved succesful in the treatment of panic disorder. One psychological method, panic ‘contol treatment, concentrates on exposing patients to clusters of sensations that remind them oftheir panic allacks. For agorapho- bia, therapeutically supervised exposure to feared situations is most effective. Specific Phobia > in phobic disorders, the individual avoids situations that pro- duce severe anxiety, panic, or both, In specific phobia, the fea is focused on a particular objector situation. 180 CHAPTERS. ANXIETY, TRAUMA: AND STRESSOR-RELATED, AND OBSESSIVE-COMPULSIVE AND RELATE > Phobias can be acquired by experiencing some traumatic event they ean also be learned vicariously or even be taught > Treatment of phobias is rather straightforward, with afocus on structured and consistent exporure-based exercises. Social Anxiety Disorder (Social Phobia) > Social anxiety disorder isa fear of being around others, particu lnsly in situations that call for some kindof performance" in front of other people > Although the causes of social anxity disorder are simile to those of specifi phobias, treatment as a different focus that includes rehearsing or role-playing socially phobic situations. In addition, drug treatments have been effective Several ditorders ae also grouped under the heading Trauma ‘and Stressor-Related Disorders, Posttraumatic Stress Disorder > Posttraumatic stress disorder (PTSD) focuses on avoiding houghte or images of pas traumatic experiences > “The precipitating cause of PTSD is obvious—a traumatic experi- ence, But mere exposure to trauma is nat enough, The intensity ofthe experience seems to e a factor in whether an individual develops PTSD: biological vulnerabilities, as well as social and cultural factors, appear to play aroe as well ‘Treatment involves rexposing the victim tothe trauma and reestab- lishing a sense of aety to overcome the debilitating effects of PTSD. Adjustment Disorders > Adjustment disorder is the development of anxiety or depression in response to stressful, but not traumatic, ie evens > Individual prone to anxiety or depression generally may experi- ence increases during etressal life events Attachment > Children experiencing inadequate, abusive, or absent caregiving in early childhood fl to develop normal tachment relationships ‘with caregivers, esuting in two different disorders. isorders Reactive attachment disorder describes children who are inhibited and emotionally withdrawn and unable to form attachment with caregivers. > Disinhibited socal engagement disorder describes children who {inappropriately approach all strangers, behaving asif hey had always had strong loving relationships with them. » Several disorders are grouped under the heading of Obsesive- Compulsive and Related Disorders. bisonoers copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203‘order Obsessive-Compulsive » Obsessive-compulsve disorder (OCD) focuses on avoiding frightening or epulsive intrusive thoughts (obsessions) or neutralizing these thoughts through the use of ritualistic behavior (compulsions), > Aswith all anxiety disorders, biological and peychologicl vulner- abies seem tobe involved in the development of OCD. Drug trestment seems to be only modestly suecestfilin treating (OCD. The most effective treatment approsch ea psychological treatment called exposure and ritual prevention (ERP). Body Dysmorphic Disorder » Inbody dyemorphic disorder (BD), a person who looks normal 4s obsessively preoccupied with some imagined defect in appea ance (imagined ugliness) These patients typically have more Insight into ther problem and may seek ou plastic surgery asa Key Terms nae, 127 social anaety ditorder fear 128 (SAD), 154 panic, 128 social phobia, 154 panic attack, 128 pevttrnmatc ress disardet tchavioralinhibition system" (PTSD), 160 (BIS), 130 acute stress disorder, 161 fight/flight system (FFS), 130 adjustment disorders, 167 senerlied anxiety disorder attachment dvorder, 167 (GAD), 134 reactive attachment panic disorder (PD), 139, vorder, 168 Broraphobia, 139 iinbited social engagement panic control treatment ivorder, 168 cn, us cheatcv-comptlere specific phobia, 147, blood-injection-injury disorder (OCD), 168, obsessions, 168 phobia, 19 compulsions, 168 situational phobia, 149, body dysmorphic disorder natural environment (BDD),173 phobia, 149 Uwichotillomania, 177 Animal phobia, 149 ‘excoriation, 177 separation anxiety disorder, 153, remedy, Peychologicl treatment approaches are alzo similar to ‘hose for OCD and are approximately equally ssceesful, Hoarding Disorder Hoarding disorder is characterize by excessive acquisition of things, Individuals with somatic symptom and related disorders are patho- logically concerned with th functioning of their bodies and bring ‘these concerns to the attention of health professionals, who usualy find no identifiable medical basis forthe physical complains There ate several types of somatic symptom disorders. Somatic ‘symplom disorder is characterized bya focus on one or more ‘physical symptoms accompanied by marked distress focused on. the eymptom that disproportionate to the nature or severity of| the physical symptoms. ie condition may dominate the indi- viduals life and interpersonal relationships. llness anxiety dior- deri a condition in which individuals believe they axe seriously land become anxious over this possibility, even though they ate not experiencing any notable physical symptoms atthe ime In conversion disorder, there is physical malfunctioning, such as paralysis, without any apparent physical problems. Distinguishing. among conversion reactions, real physical disorders, and ovtright _malingering, ot faking, is sometimes dificult. Even more puzzling ‘canbe facttious disorder, in which the persons symptoms are {feigned and under voluntary control, as with malingering, but for ‘no apparent reason. The eauss of somatic symptom disorder are not well understood, Patients with this disorder are often preoccupied with physical ‘symptoms that significantly distress or interfere with their lives. In the case ofillness anxiety disorder (formerly known as hypochon. riass), the person experiences significant anxiety about having ‘or developing a serious medical disease. Ihe latter diagnosis e similar to an anxiety disorder 'Iretment of tomatic symptom disorders ranges from basic techniques of reassurance and social 212 carters support to interventions meant to reduce stress and remave any secondary gun for the behavior. Recently, specifically talored cognitive behavioral therapy has proved succesful with these conditions Dissociative Disorders > Dissociative disorders are characterized by alterations in percep. dons: 2 sense of detachment from one's own sel, rom the world, or rom memories. > Dissociative disorders include depersonalzstion-derealization disorder, in which the individuals sence of personal reality is ‘temporarily lost (depersonaization), a isthe realty ofthe exter ‘al world (dereaization)-Tn dissociative amnesia, the individual maybe unable to remember important personal information In generalized amnesia, the individval i unable to remember anything: more commonly, the individual is unable to recall. specific evens that accur during a speci period (localized oF selective amnesia). In dissociative fugue, a subtype of dissociative amnesia, memory los is combined with an unexpected trip (or trips). In the extreme, new identities, o alters, may be formed, as, in dissociative identity disorder (DID). The causes of dissociative disorders are not well understood but afen seem related tothe tendency to escape psychologically from sess ot memories of toaumatic evens, > Treatment of dissociative disorders involves helping the paient oexperience the aumatic events in a controlled therapeutic manner to develop better coping ski In the case of DID, therapy is often long term. Particulaly essential with this disorder isa sense of rust between therapist and patient SOMATIC SYMPTOM AND RELATED DISORDERS AND DISSOCIATIVE DISORDERS copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Key Terms somatic symptom epertonaliation-dreazation disorder 185 Sivorder 199, isoctive vod 185 dicncatrs amnesia, 200 coreg fpeecicelcemet a disorder, 186 fetes ines ansiety disorder, 187 amnesia, 201 psychological factors affecting dissociative fugue, 201 Imedical condition, 192 dissociative trance, 203 conversion diorder, 193 aller, 203 toalingsring. 193 Alieocativedeniy disorder faciious disorder, 194 (1D), 203 derelization, 199, Answers to Concept Checks 61 62 La 2b: de Le 2d 3b 4a Se CONTINUUM VIDEO PROJECT or erat Piste er Us like living with 13 roommates... and your responsibility is to make sure everyone's needs get met” ‘Access the Continuum Video Project MindTap at mera cengagebreincom summary 213 copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Exploring Somatic Symptom and Dissociative Disorders These two sets of disorders share some common features and are strongly linked historically as “hysterical neuroses.” Both are relatively rare and not yet well understood. ‘SOMATIC SYMPTOM AND RELATED DISORDERS Characterized by a pathological concern with physical functioning or appearance ed Characteristics eatment Fouty 1 Sovere awit over physi problems 1 Psychatnerany to crallonge less Person ‘hat ae medical urcetctabie perceptions ‘Otprvscal 1 Alects women and men equaly 1 Counealng ansfer support groupe hhereased Sensations 1 May emerge at any age ‘provide reassurance aniety 1 Lvidetin diverse culties Causes invonstind focus on seneatons 1 Ropors of mip ysl srmotoms 1 Hardt reat vitro a edie! bars 1 Cognit boavioral eran (87) renal sec Sanaa = Runs nares prov herable bass to povde eassurance, eaice ‘staion Cota oy © Rare—mest roan amang umaerad Stoss, and mnimze als emer ot amen Mow socioeconome ups benavors canes 1 Onset usualy acoescence, aon 1 Therap o broaden basis for rlatng ports ino ot 298 ‘oothers site sme anc attonion Cee eene Ceca Treatment 1 Severe phys dystuctoning 6, 1 Same a or sorte symptom Sociatintuences paras an lees) witout iso, with emohasisonrsoking (ays ames Lie sressescr __ eatesperdng physcal pathology tie stessorcontet and ediong from oosenig ral PSS” x ected pool are genuine vnanare he-seokeg boars ihess or 9) pogo thatthe can neon noma Causes 1 May corse ih other preales, fespmcaly sate smpiom dsorser 1 Most pevabnt no socioeconomic (yexps, women, and men unser — frireme ses e.g sales) hreapactatng simpioms copy 2018 Cengage Learang. Al Rights Reserved May nl be coped Scomed upstate pa, WEN 02200208DISSOCIATIVE DISORDERS: Characterized by detachment from the self (depersonalization) and objective reality (derealization) Severe aouso curing chikthood 1 Fantasy es he nl "escape" Process becomes automate ‘to hen invlumary Sm etobay to postraumatc ss disorder Causes beacts wth DBilgeal vue eed Dissociative Identity = Disorder (01D) Depersonalization” = Derealization Disorder igh suggestonty apossbietat ee ‘Aocted person ado new deities, o” ars, hat Coax smataneoush; the alters may oe come and tlstret personals of on par incependert ‘Average numberof aersis 15 CChithood enso: afc rer womon than men Ptonts ton sue om char psychological srders smutaneoush Fare outsce of Weston cures Severe and tghtering fstngs of detachment deminats ‘he person’ site 1 Artec perso fees ko an outside obser of his or her Dissociative Amnesia ‘own mental or body processes (Causes sigcart lsress oF rpaimentinfuctionng. especialy emotona expression and Gets in perception Some symploms ie ers to hose of pane digo Fare, onset usualy nadolescence Gonerazec nay 0 remember anything, netuclng ‘cent, comparatively aro Ulcalzed: nay o remember pect events (usualy ‘reuse Yoquonty occurs var More comenon than general ames Usual aut onset or bot joes Dissociative Fugue Subtype: Memory loss i accompanied by purposetutravelor beniered wandering ‘The scionife community e iced vor ho queston oF whathormitisle Identtes ae a genure experence Or faked, Stole have shown nat “lea memaree" canbe crested (ilar) by therapists. Other {ests contr that varus ater are Physobgialy distinct oa 1 Long.tom psychotherapy may rongyat sopaateporsoralls in 25% of patents 1 Teatro ssocate trauma str to postraumatc erase order Heng Condon wihout weatmont 1 Psychological estments imi to those forpanc oisorcer may be help f= Stossos assoc wih onsht of Seorder shoul adresses ss Tend tobe eng 1 Usual sot-corectng when cunt te stros is roschod 1 Frneeded,therany focuses on reeving lost formion copy 2018 Cengage Learang. Al Rights Reserved May nl be coped Scomed upstate pa, WEN 02200208Understanding and Defining Mood Disorders > Mood dizorders are among the most common psychologic dis orders, and the isk of developing them i inceasing worldwide, partcalaty in younger people ‘Two fondamental experiences can contribute either singly or in ‘combination to all specific mood disorders: a major depressive ‘episode and mania. lese severe episode of mania that does not cause impairment in social or occupational functioning is known asa hypomanic episode. An episode of mania coupled with anxiety or depression is known as mixed episode or mixed state, An individual who suffers from episodes of depression only is said tohave a unipolar disorder. An individual who alternates between {depression and mania has a bipolar disorder, > Major depressive disorder may be a single episode or recurrent, but it ie always time-limited, in another form of depression, persistent depressive disorder (dysthymia), the symptoms ae often some- ‘what milder bat remain relatively unchanged over lng periods {mn some eases, fewer symptoms are observed than in a major depressive episode, but they pesit for at least wo years (persistent depressive disorder) (dysthymia);in other cases, a major depres- «sive epizode wil last atleast wo years (chronic major depressive ‘episode)-tn cass of double depression, aform of persistent de- pressive disorder, an individual experiences both major depressive episodes and persistent depressive disorder (dysthymia) Approximately 20% of bereaved individuals may experience a complicated grief reaction in which the normal grief response develops into a fll-blown mood disorder. ‘The key identifying feature ofbipolar disorders isan alternation ‘of manic epirodes and major depressive episodes. Cyclothymic “disorder isa milder but more chronic version of bipolar disorder. » Pattern of additonal features that sometimes accompany mood disorders, called specifiers, may predict the course ox patient response to treatment, as does the temporal patterning or course of mood disorders, One pattern, seasonal affective disorder, most olen oecurs in winter Prevalence of Mood Disorders > Mood disorders in child disorders in adults, are fndamentally similar to mood 268 CHAPTER 7 MOOD DISORDERS AND SUICIDE > Symptoms of depression are increasing dramatically in our elderly population. > “The experience of anxiety across cultures varies, and it ean be Aificult to make comaparisons—especially, for example, when we attempt to compare subjective felings of depression, Causes of Mood Disorders > The causes of mood disorders le in a complex interaction of biological, psychological, nd social factors. From a biologi cal perspective, researchers are particularly interested in the stress hypothesis and the role of neurohormones. Paychologt- cal theories of depression focus on learned helplessness and the depressive cognitive schemas, as well as interpersonal disruptions, Treatment of Mood Disorders > A variety of treatments, both biological and psychological, have proved effective for the mooil disorders, at leat in the short term. For those individvals who do not respond to antidepressant druge or psychosocial treatments, amore dramatic physical treatment, clectracomulsive therapy is sometimes used. Two peychological ‘reatments—cognitive therapy and interpersonal psychotherspy— seam effective in treating depressive disorders [Relapse and recurrence of mood disorders are common in the long term, and treatment effort must focus on maintenance treat- ‘ment, that is, on preventing relapse or recurrence Sui > Suicide is often asoctated with mood disorders but can accur in their absence or in the presence of other disorders Cis the 10th leading cause of death among all people inthe United States, but among adolescents, itis the 3rd leading cause of death, > In understanding suicidal hebavior, three indices ae important Suildal ideation (serious thoughts about commiting suicide), suicidal plans (a detailed method for killing oneself), and suicidal altempts (that are not successful) Important, to, in learning about risk factors for suicides the psychological atopy, which the peychological profile of an individval who has commit ted suicide reconstructed and examined for cluct. copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Key Terms mood disorders, 218 ‘major depressive episode, 218 mania, 219 hypomanic episode, 219 mixed features, 219 major depressive disorder, 220 recurrent, 220 persistent depressive disorder (ysthymia), 221 double depression, 221 hallucinations, 222, delusion, 223 catalepsy, 223 seazonal affective disorder (SAD), 225, integrated grief, 228 ‘complicated grief, 28 premenstrual dysphoric disorder, 229 isruptive mood dysregulation, disorder, 229 Dipolar It disorder, 231 Dipolar I disorder, 231 ‘eyelothymic disorder, 232 ‘neurohormones, 241 earned helplessness theory of depression, 245, Aepressive cognitive triad, 245 mood stabilizing drug, 254 lectroconvulsive therapy (ect), 254 ‘cognitive therapy, 255, interpersonal psychotherapy (PT), 256 ‘maintenance treatment, 259 suicidal ideation, 262 suicidal plans, 262 suicidal attempts, 262 ‘psychological autopsy, 263, Answers to Concept Checks 71 tia, a sense of uncontrollably; Le 2a 36 4d 5b 3, mania dissaisacton, sender, few social supports 72 1.1, 2.F (t does not require Ife experience) 3.1. 4.T 74 1. eleetroconvulsive therapy: 2. cognitive therapy; 73 3. antidepressants; 4 lithium; 5.interpersonal psyches genetics, neurotransmitter § sintenance treatment system abnormalities, endo- ‘rine system, circadian or sleep thythms, neurohormones 2. sessfl life events learned hhlplssness, depressive cognitive 75 Le 2d, a; 4b CONTINUUM VIDEO PROJECT Een ro “When I'm fecling the wore, my brain tells ‘me that Lam worthless, thatthe kids would be better off without me... T'm just drain” ‘Acces the Continuum Video Project in MindTap at sora cengageboin.com summary 269 copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Exploring Mood Disorders People with mood disorders experience one or both of the following: 1 Mania: A frantic “high” with extreme overconfidence and energy, often leading to reckless behavior 1 Depression: A devastating “low” with extreme lack of energy, interest, confidence, and enjoyment of life 1 Nogatve er pote Ve changes aeatn ‘fn ore, promotion, et) 1 Prysloat mess Biological intluencs ' lnhered voerabiy | = Atoroenovrotransitlers an neueohor ‘ronal systems 1 Step depron = Crcedianrytnm dsturoances SS Behavioral Influences 1 Woman and minoriis—socialinquelty anc oppression and a ominshea sense of conta causes 1 Seca support can reduce eymcioms 1 Lack of social support can aggravate Depression 1 Ganeral sling down 1 Nogletofresponsibitios Lact senate vm 1m Fetabilty; complaints aout rato meme wen ipechy ro ae Bereta ee eet j ray oe pom : Inasty to concentate Fopolessnoss anor bared rebiseress 1 Loss of sexual ste Loss ot warm feng fr fait send Mons 1 Exaggerated se-Hame gult 1 Overgenralzaton = Poor memory Loss of soosteom Suicidal thoughts or actors Mania = raggeatedfeolngs of euproia and aceon copy 2018 Cengage Learang. Al Rights Reserved May nl be coped Scomed upstate pa, WEN 02200208TYPES OF MOOD DISORDERS ‘Major Depressive Disorder Syrptoms of maor depress cucrd: begin suction fen tigger bya crs, change, ores Longer unchanging symptoms of mit Save extremely sevre,inirterng wih normal sectonng depression, sormatmes sing 29 t0 20. ‘oan belong term, using months or years untested years untestad, Daly enctonng nt Some people have anyone eso, but the patton wsualy 35 severe aiecte, bul over ine invohes repeated apsedes or sting symptoms. Impaler is cursive. People whe have a bipolar disorder Dusing the Depressive Phase, he person may: During the Manfe Phase, th person may lve on an unending emotional roller slosealliniavest i lessurable scutes and tends steel extreme plasize ana oy fom avery acti ‘coastor feat wortbss hess ac hopeless be exraorinany cine, ahanng excessive Shave rutle cnestating aly actitios ‘Types of Bipolar Disorders ose gain weigh wihout tying = shop el itnout get trea = Bipolar: rsordooresson anc ful mania shave rouble sleeping or logo Tore than usual selon grancose plans leaing to eckess "Bipolar: mace doprosson and miki meal trod all ho to bbohavow untested buying sarees, sox. ana 1 eal physical aches and pans that have no Irescretons, folsh buses restmons 1 Gyelothymia: mid depression wih mld" medial cause shave racing though” ar akon anc on ‘mana, chon ae ng erm thine about ath or atom suse "be easy tated an asracted ‘TREATMENT OF MOOD DISORDERS ‘Treatment for mood disorders is most effective and easiest when it's started early. Most people are treated with a combination of these methods. Medication “ies of Eat paeeseeert ere 1 Nene ena nor MAO nbs: Nar Part MAO : rr andre totam Ihbsa cane ane Se foc, epee wn coe i ton eta ere eta pea H ee peter teers + Sthote secon regia roto of Soe Prost, 2 re rower 3 sada oor ae ese an Weer Wwe «Linum so prone dg fo opal corsersde ects con be 2 eter eee ieee! Cognitive-Behavioral Therapy « leanscshcnesive ders hogs an Fae crete pear obuton whe poste on 1 Smo nro fact con brave an ls Interpersonal Paychotherapy = fs one ssa an prone ag for tle depresses peo Ccorston chasm xr a oe) 1 dette tress Fierce ar bu res Electroconvulsive Therapy (ECT) «= For sover dapresson, ECT is used when other treatments have been nace usualy nas Temporary sdb oct, such as amor oss and rary. In some patents, cera itlbctual anslor ‘memary futons may be permanent ost Light Therapy 1 For seasonal rece csorder Copyright 2018 Cengage Learn, Al Rags Reserves My na ecole, sanned er aupeauen whale ein par WEN 62-200-203> The prevalence of eating disorders has increased rapidly over the past half century. Asa result they were inluded forthe fist time asa separate group of disorders in DSMIV. Bulimia Nervosa, Binge-Eating Disorder, and Anorexia Nervosa ‘There ate thre prevalent eating disorders. In bulimia nervosa, dieting results in out-of-control binge-eting episodes that are often followed by purging the food through vomiting or other -means. In binge-eating disorder, a pattern of binge eating isnot followed by purging. Anorexia nervosa in which food intake is ‘cut dramatically reells in substantial weight loss and sometimes dangerously low body weight Statistics and Course for Eating Disorders Bulimia nervoss and anorexia nervosa are largely confined to ‘young women in developed countries who ae pursuing thin body shape that is culturally mandated and biologically inappro- priate, making it extemely dificult to achiev. Without treatment, eating disorders hecome chronic and ean, on ‘occasion, result death Causes of Eating Disorders In addition to sociocultural pressures, causal factors include pos- sible biological and genetic vulnerabilities (the disorders tend to run in families), psychological factors (low self-esteem), social anxiety (eas of rejection) and distorted body image (relatively ‘normal-weight individuals view themselves as ft and gly). Treatment of Eating Disorders > Several psychosocial eatments are elective, including cogative- ‘behavioral approaches commined with fay therapy ad interpersonal poyehotberapy Drug treatments are less effective a the current time, Obesity » Obesiys nota disorder in DSM bt sone ofthe more dangerous epi- demice confronting the world today Culturl norms that encourage 318 CHAPTER 8 EATING AND SLEEP-WAKE DISORDERS ‘ating high-fat foods combine with genetic and ther factors to cause obesity, which i diel to reat, Professionally directed behavior modification programs emphasizing et and exercise are moderately succesful bul prevention ello in the form of changesin government policy on nurion sem the mos promising Sleep-Wake Disorders > Sloep-wake disorders are highly prevalent in the general popula lion and are of to types: dyssominia (disturbances of deep) and ‘parasomnias (abnormal events such as nightmares and sleepwalk in that occur during sleep. ‘Of the dyssomnias, the most common disorder, insomnia disorder, involves the inability to initiate sleep, problems maintaining sleep, or failure to fel refreshed after a fll nights seep. Other dyssom: nia inlude hypersomnolence excessive sleep), narcolepsy (sudden and irresistible lep attack), circadian rhythm sleep disorders (sleepiness or insemnia caused by the body’ inability to synchronize its sleep patterns with day and night), and breathing- related sleep disorders (disruptions that have a physical origin, such a sleep apnea, that leads to excessive slepiness or insamni). “The formal assessment of slep disorders, a polysomnographic evaluation, is typically done by monitoring the heact, muscles, respiration, brain waves, and other functions of sleeping client in the lb. In addition to such monitoring, iis helpfl to deter ‘mine the individuals seep eciency, a percentage based on the time the individual actually sleeps as opposed to time spent in bed toying to sleep Benzodiazepine medications have been helpfl or short-term, treatment of many of the dyssomnias, but they mast be wsed ‘aefully or they might cause rebound insomnia, a withdrawal ex perience that can cause worse sleep problems after the medication is topped. Any long-term treatment of sleep probleme should include peychological interventions euch ae timlus control and sleep hygiene > Parasomniae such ae nightmares occur during rapid eye move- ‘ment (or dream) sleep, and sleep terrors and sleepwalking occur Aduing nonrapid eye movement sleep. copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Key Terms bulimia nervosa, 273, binge, 273 anorexia nervoss, 273 binge-cating disorder GBED),273, ety, 274 purging techniques, 276 night eating syndrome, 296 bariatric surgery, 299 rapid eye movement (REM) sleep, 302 dyssomnias, 302 parasomniae, 302 polysomnographic (PSG) evaluation, 302, actigraph, 302 sleep efficiency (SE), 302 microsleeps, 303, insomnia disorder, 303, sleep apnea, 307 narcolepsy, 308 Dreathing/related sleep Aisorders, 308 ‘circadian rhythm sleep disorders, 310 nightmares, 315, disorder of erousal, 315 tleep terrors, 315 sleepwalking. (Gomnambulism), 316 Answers to Concept Checks a4 a4 Le 2a da 4b Lh 2636 46: 5d 6b 82 85 1.7; 2.7; 3.P(females finda prt smaller size more atsactive than 4c. 2.b; 3.a do men); 4.F (Whey help with boalimia nervora, not PartB anoreaia), 5.7, 6. 4. scheduled awakenings 5. benuodiazepiness 83 6 sleep hygiene 1; 2.F (ts atleast one tied ormore); 3.F 4. CONTINUUM VIDEO PROJECT “The refrigerator became my confidante, ‘Access the Continuum Video Project MindTap at ‘mora cengagebrain.com summary 319) copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Exploring Eating Disorders Individuals with eating disorders: = Feelarelentless, all-encompassing drive Maliaaisbaa Aad eee eee tobe thin Drinshed sense of personal contel ‘Cutura and soci emphasis on slender cea leasing fo boos Clssatstacton and preoccupation ‘ath food an eating, ane sf-con'donce, essing bw Are overwhelmingly young females from —_SStcastoom, Distant ba mage midale- to upper-class families, who live in socially competitive environments = Lived only in Western countries until recently Causes Ses Posse genetic endoncy o poor Impuso contol, motional instill, ana pertecionisi rats EATING DISORDERS. Cee) oan Bulimia» Out-otcontol consumption of excessive amounts of mostly nor-nutous food within» Drag teste, suchas ricopres Nervosa | 2:70%tine ‘ants 1 Elminaicn of food through setinduced voting andor abuse of lates or dureics _» Shor-term cognltve-behavra therapy 1 To compensate or oges, some bulics exercise excessively or as between bges__ (C3) fo access behav” snd tudes 1 Vorntng may ons salary glares fusing achuboy face, red dora evar ‘on eating ac oy shapo and cause olocvo}te mbalae rsuling i carciac fal or kidney problems 1 Interpersonal psychotherapy (PT) 0 = Wecys usualy win 10% of normal Impeow rorpersonel nctionng = Age of erst ypcaly 18 10 21 yous of age, sthough can be as ent as 10 1 Tend tobe cone fe untested Anorexia» Inions (ear of obesity ard porsistont purcut ofthis; porpeual dsasfacton with a Hospitalation [at 75% below normal Nervosa eiahi bss woh 1 Sowte calorie esticton, eon vith excess exercise and sometimes with pug, Outpt! tostment to rstorewoight {othe point of som-stavaton and covect dystunctonalattudes on 1 SoveralyImitng calor iiake may cause cessation of menstruation, dowry hairon feaing and body shape limos andcheoks, dy skin, bts har onal, sonst tocol, ard danger ofcxze = Far therapy care ory are 1 Tonal tobe cron 1 untested: 1 Weight alleas 15% alow normal re rit to eat nan Bula = Average agp of ans i teen 18 anc 21 years of 299, wih youngor cases tending to begn at 15 Binge- «Similar to butriavwith ou-o-conta food binges, bulro atom to purge the food x Shorten CBT to achoss boravor Eating (vomiing, laces, cisoics) or componsal or axcossiointako and ates on eating and body seapo 1 Marked physcal and ertional sess some sufeers bnge to alevate bad moods Binge eaters share som coscers about egh and body shape a nals th nore and bala 1 Tends to atect mere clder people than eter bulma cr ancrxia = IPT to mprove reerpersonalfuncionng = Drag weatmants that reduce featngs of hunger 1 Selene aporoaches enn Social influences utd) ‘arancing echnobay | Obesity — = Upto 70% ofS. aduts wo .over- « Sottatoctod weight pect pulse conta Seas, wight and ovr 85% ave chose hes programs fittudes and motivation Hest ana = Wolds proto eeased rak a Commercalsel-reb area sang” ane consirption of Inwean‘ather than rl setings programs, such as resporskoness the igh ft ood. 1 Two forms of maooapive eateg Weight Watonors rare Causes patoms associated wit abesty— a Professionaly drcted Great. behavior madison progr, whieh are Binge estng andright exing syrasome fs Inoeaans rk ofeariovascuhy Ina most efectve Sseaso,dabetes, hypertension, Yeatme eT Stroke, and oher physical 1 Surgery 9s st ological Influences ‘sity igs probloms resort ‘Genes influence annua’ arb of fal cal, endoncy owas fat storage, anc actly iv copy 2018 Cengage Learang. Al Rights Reserved May nl be coped Scone plated, whale emp, WEN 02200208Exploring Sleep—Wake Disorders Characterized by extreme disruption in the everyday lives of affected individuals, and are an important factor in many psychological disorders, SLEEP-WAKE DISORDERS ‘A polsormnograohie (PSC) evaluation assesses an indhicals sogp as vith various electronic tests to measize alow, brah acy, eye movements, muscle movements, and heat sot. Resuts are woghed wih s measure 0! seep eticency {Su the perconiage of te spent sooo. Dyssomnias Disturbances in the timing, amount, or quality of sleep rd Coe ties Insomnia Disorder = Characteristics med cc inating ‘Seep ceuty martaring sep. 0° romestorave soe, Narcolepsy 1 Characteristics nol sdon daytime conte! of REM seep combined vith talon, a raid bs of muscle tne ‘hatean be gut itor esut in comple calls, Orton accomparied by slep paras anc nypnagogic patios. Hypersomnotence = Charscoristis nchiie abnormally Disorder excessive sep and sears, and invohatry dayne sling, Classtiod as aGsordor any when's subjectively orcad as drut. Breathing-Related «Characins nol turbos shop Sleep Disorders and dayne fague ruling rom Frypovetlaton fabored breathing) or ‘pep aonea (suspended breathing Circadian Rhythm = Characteristics mold sopinass or Sloop-Wake irsomni. Disorders Parasomnias ‘Abnormal behaviors that occur during sleep or = Causes ncluce pai insutcient exercise, rg use, envronmenia Influences, anit, respraicry problems, anc bokgcal vulneabiy. 1 Causes are aly obo gona 1 Causes may ivohe genetic Ink andlor excess sertonn 1 Causes may nc narrow or ‘obstructed arway,obesty, and Increasing ap 1 Caused by inal to syncrvnzo slop pators wth current pate of cay and Fight duo jag, shit wor delayed “lkep or advance sleep igang to bed eer ran noma beater} Seed 1 Treatment may be medical {enzocizepnes or psyerobogicl {arnt rector, Improved sleep ygine, comaned aperach ie aval most att 1 Treatments medial stmulont rugs sTrsstmantis usual mecoal {stmt drugs) 1 Treatmont using continuous postive air ressur [CPA machines she {gold standara, weght loss ako Sten prescribed ‘Treatment includes phase dolys to acs becne and right ght te rwadust ieegeal cock. ‘Ocexr cing no-REM froncreaing) le ‘and most commrany at chien, Sloop hid sears, ces, sweats, soreimos waks, ‘nas apis hertoal, and carrot easly be wacenec or comiorea. More common i boys ‘than gis, and posse gontc Ink since they td tun fas, May subse wits ime ‘Geouts atest once curing ron-AEM slees In 159% f0 30% ot ehron snr ago 15. {Causes may ince exter fag, sloop depron, scale cr hypo rugs, and stress, Ait sleepwalking s usual associated wih other psycholbgeal (dsorcers, May havea gant. copy 2018 Cengage Learang. Al Rights Reserved May nl be coped Scomed upstate pa, WEN 02200208mortality rates over a period of 40 years, These results show that ‘mounting an effort like this is worthwhile to individuals, to the ‘community, and to public health oficials because many lives will be saved and disability leave willbe decreased to an extent that will more than cover the original cost of the program. Unfortunately {implementation of these types of programs is sil not widespread Perhaps the faisly recently instituted Affordable Care Act and the expansion of Medicare and Medicaid might bring about a sea change by focusing on preventing rather treating disouders. Qe (Check your understanding of psychosocial eatment by ‘matching the treatments to the correct scenarios or statements: (a) biofeedback, (b) meditation and relaxation, (c) cognitive coping procedures, () denial, (e) modify behaviors to promote Inalth, and (f) Stanford Taree Community Study. 1. Marys often upset by stupid things other people are always doing, Her doctor wants her to realize her exag ‘eration ofthese events and suggests ‘Tyrone cant seem to focus on anything at work. He feels too stressed. He needs ‘away of mini sizing intruding thoughts that he can do at workin a short amount of time. Harry's blood pressure soars when he feels stressed “is doctor showed him how to become aware of hi body process o control them better by using ‘Ata world conference, leaders met to discuss how to reduce the risk of childhood injuries, AIDS risks, and the number of smoking related diseases, Professionals suggested programs involving teaching individuals howto Initially, strong, can help a patent endure the shock of bad news; however, later it can inhibit or prevent the healing process. ‘The fs one ofthe best-known efforts o reduce community disease risk factors Psychological and Social Factors That Influence Health » Paychological and social factors play a major role in developing and maintaining a numberof physical disorders ‘wo fields of study have emerged asa reslt ofa growing interest in peychological factors contributing to illness. Behavioral medi- cine involves the application of behavioral science techniques to preven, diagnose, and treat medical problems. Health psychology isa subfield that focuses on psychological factors involved in the promotion of health and wellbeing. » Peychological and social factors may contribute directly to illness and diseate through the peychological effets of stress om the im- mune system and other physical functioning. [the immune system is compromised it may no longer be ale to attack and eliminate antigens from the body effectively, or it may even begin to attack the body's normal tissue instead, a process known a autosmmine disease, Growing awareness of the many connections between the nervous system and the immune system has resulted in afield of study called paychoneuroimmunclgy. Diseases that may be partly related tothe effects of stress on the immune system include AIDS, cardiovascular disease, and 356 cHaPTER Psychosocial Effects on Physical Disorders > Long standing patteras of behavior or lifestyle may put people atrsk for developing certain physical disorders. For example, unhealthy sexual practices can lead to AIDS and othe sexually twansmited discaes, and unhealthy behavioral patterns, suchas ‘poor eating habits, lack of exercise, or type A behavior pattern, may contribute to cardiovascular diseases suchas stroke, byper- tension, and coronary heat disease ‘Of the 10 leading causes of death inthe United States, fully 50% of deaths canbe taced to lifestyle behaviors Psychological and social factors also contribute to chronic pa, ‘The brain inhibits pain through naturally occurring endogenous opioids, which may also be implicated in a variety of paychelogt- cal disorders. ‘Chronic fatigue syndrome is a relatively new disorder that is attributed a least parily to stress but may also have an as yet undiscovered vial or immune system dysfunction ‘component. Psychosocial Treatment of Physical Disorders > A variety of psychosocial ueatments have been developed with the teal of either treating or preventing physical divorders. Among these are biofeedback andthe relation response PHYSICAL DISORDERS AND HEALTH FSYCHOLOGY copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Comprehensive strest- and pain-reduction programs include not only relaxation and related techniques but also new meth fds to encourage effective coping, including stress manage- ‘ment, realistic appraisals, and improved atitudes through, cognitive therapy > Comprehensive programs are generally more effective than individual components delivered singly. Key Terms behavioral medicine 324 strohnferebral vascular heath poychology, 324 ‘cident (CVA), 336 rl ae tenderer petenan (GAS) 395 ec bypertneien 336) stress 325, Seeerietaeeed selheticacy 328 (CHD), 338 immune system, 328 type A behavior pattern, 340 antigens, 329 (ype B behavior pattern, 340 ‘utolmmune disease. 230 acute pn, 342 ‘heumatoid arthritis 330 chronic pin, 342 Popchanetioinencleyy ecdogsnots Cantera opioids, (ND, 330 Mt AIDS-related complex esse ages aes (ARC), 331 (CES), 346 cance, 334 biofeedback, 348 peychoncology, 334, ‘cardiovascular disease, 336 relaxation response, 349 » Other interventions sim to modify euch bchaviors as unsafe sexual practices, smoking, and unhealthy dietary habits, Such efforts hhave been made in variety of areas, incleding injury contol, AIDS prevention, smoking cessation campaigns, and programs tw reduce risk factors for diseases such as CHD. Answers to Concept Checks 91 impatient), type B (relaxed, Ld; 2a 3.6 4b; 5.6 6.¢ — lessconcerned); 5. chronic tected 9.2 eee et eee Acrype A (hard driving 93 Le 2b date 5d 6f summary 357 copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Exploring Physical Disorders and Health Psychology Psychological and behavioral factors are major contributors to iliness and death. 1 Behavioral medicine applies behavioral science to medical problems. = Health psychology focuses on psychological influences on health and improving health care. PSYCHOLOGICAL AND SOCIAL FACTORS INFLUENCE BIOLOGY Responses ta threats ang chalengos may proc the aft of sees the mune ayer, Causes : ‘Sense of control or abity to cope ‘More contr Depression Weakened immune system/ compromised nervous system ILLNESS i 5 i Cardiovascular Problems en ‘The human immunccefseney vrs AM) ‘= Tre heart and tbod vesels canbe damaged by stacks the iemune system and Stroke: Blockage or rupture of bod vessels in ‘pporunste nections develop the bran rorirlatiy. Hypertension: Gonstton of lcod vessel at 1 Psychological restments focus on storgtnering tho mero systom and ‘garing a senso of con 1 Aough drug therapy may contol he vus, ‘heres 30 fa no biological means of prevention and he signee i tl alae ala ‘xgans and entrees pus extra pressure on ‘ho heat which eventuay woakons Coronary heart lane: Blockage of aeios ‘sunphing blood tothe heart '= Bobsgcal psycrologeal and social actors conte foal hes concone an are akrested in osimont ed 1 May bogin wih an acute episede but doos not, ciminsy when uy heals. = Tyoleatyivctios ants, muscles, and Iondons: ay rsul fom enlarged blood vossals,tesue degeneration, o” cancerous 1 Psyenoogical anc socal ntuences may cause and maintan chon pao 8 sna! degree "= Aonormal ct growth produces malgnant tanors Pyehococa retmonts may prolong ie, albvate ‘ympioms, and reduce depression and pai 1 Dieront cancers have trent rates af ecovery andmotally, 1 Paychoncclgy isthe study of psychosocial factors Invohed nthe course and weatment of cancer. copy 2018 Cengage Learing. Al Rights Reserved May al be ope. ceed, dle, nal in par. WEN 62200209,PSYCHOSOCIAL TREATMENTS FOR PHYSICAL DISORDERS ‘The stress reaction associated with pain may reduce the number of natural killer cells in the immune system, Ce reese or tf Extreme jsease or Pan "= Fstrone montors make shyla responses Ennanced Disease such as heartbeat vse on a computer screen, orinuy 1 Paiont loams to ncrease or docrease to response, Causes “hereby improving tuncienng deereasng enc) = Developing 2 sense of cone may be therapeu Stress Relaxation and Meditation ' Progressive muscle relaxation: Porson loans to beats physical lonsion ans ta counteract by relaxing a specie muscie group 1 Meditation: P2csning stanton ans epe%%s\530) por orovees or con an arming thought or image; some ‘ors, ecuseg ona singe Sent epeaie! yale ran “ers” the mint Mediation accompaniog by sow, regu broathing “Meatatng daly fra ast 10% 20 mnates imparts caln and relaxation by reducing cen neuvansmters ancl stress hormones and nereasing a sons of conto BEHAVIOR MODIFICATION TO PROMOTE HEALTH Many injuries and diseases can be prevented or controlled through lifestyle changes involving diet, substance use, exercise, and safety precautions, ken ' Injures are th oatng caus of 1 Changing highsisk behavior trough ath fr pacnle age 1 10 45, ‘hil and commurtyesucaton isthe especialy chien ‘only tec saty, 1 Mos people conse jie to = Etrinateunssie sau practos through bo out of ho conta cogaive-enavirlsemanagernt “hareore co not change highs traning and social suppor networks. benavore ~ Show dug abusers how to clean neces In chioren, oreventon focuses on and make safe ctor, oscacing es 1 Target meortis and women, groups that do ~crossngsteets not percave themselves 66s sk = sng ca seats, seat bos, da coverage focuses on gay whe ard Boye halos abs estas = Mere women are infect trough heteasenualintracions than tough Inravonous rug vse, Copyright 2018 Cengage Learn, Al Rags Reserves My na ecole, sanned er aupeauen whale ein par WEN 62-200-203What Is Normal Sexuality? » Patterns of sexual behavior, oth heterosexual and homosexual, ‘ary around the world in terms ofboth behavior and risks. Ap- proximately 20% of individuals who have been surveyed engage in sex with aumerous partners, which puts them ars for sexually ‘transmitted diseases such as AIDS, Recent surveys also suggest that as many as 60% of US, college females practice unsafe sex by not using condoms Two ypes of disorders are associated with sexal functioning — sexual dysfunctions and paraphilie disorders. Gender dysphor isnot specially a sexual disorder, but rather a mazked incon- _gruence between one’ natal (biological) sex and the gender one txperiences or identifies with, An Overview of Sexual Dysfunctions » Sexual dysfunction includes a varety of disorders in which people find it dificult to function adequately duving sexual lations. > Specific sexual dysfunctions include disorders of sexual deste (hypoactve sexual deste disorder in males and female sexual {nteresVarousal disorder) in which interest in sexual relations is ‘extremely low or nonexistent, disorders of sexual arousal erectile ‘disorder and female sexual interest/arousal disorder) in which achieving or maintaining adequate penile erection or sexsal ‘excitement and vaginal lubrication is problematic, and orgasmic disorders (female orgasmic disorder and delayed ox premature sjactlation in males) in which orgasm occurs too quickly or not tall The most common disorder in this category is prematuce| ejaculation, which occu in males: snubited orgasm is commonly soon in females Sexual pain disorder, specially genito-pelvic pain/penctration ‘disorder in women, in which unbearable pain is associated with sevual relations, including vaginismus in which the pelvic muscles in the outer third ofthe vagina undergo involuntary spasms when Intercourse is attempted, Assessing Sexual Behavior > ‘The three components of asessment ae interviews, 2 complete ‘medical evaluation, and psychophysiological assessment, Causes and Treatment of Sexual Dysfun Sexual dysfunction is associated with socially transmitted negative arttudes about sex, current relationship difficulties, and anxiety focused on sexual activity Peychosocial treatment of sexual dysfunctions is generally suc- cessful bu not ready available. In recent years, varios medical approaches have become available, including the drug Viagra and similar drugs. ‘hese treatments focus moslly on erect dysfunction 400 carter 10 and ate efective and satisfying for about one third of patients who try them, Some preliminary evidence exists on a new drug, Aibanserin, asa possible treatment for hypoactive sexual desice in ‘omen, but mare research i needed, Paraphilic Disorders: Cli > Parapila is sexual attraction to inappropriate people such as children, o to inappropriate objects, such as articles of dating, Paraphiia becomes a parapilic disorder when the sexual altrac- tion causes significant distes or impairment tothe individual causes harm or the rik of harm to other. al Descriptions > “The paraphilic disorders include fetishistic disorder, in which sexual arousal occurs almost exclusively inthe context of nap- propriate objects or individuals exhibitionist disorder, in which sexual gratification i attained by exposing one’ genitals to un- suspecting strangers voyeuristic disorder, in which sexual arousal 4s derived from observing unsuspecting individvals undressing or naked; transvestic disorder, in which individuals ae sexually aroused by wearing clothing ofthe opposite sex; sexual sadism. disorder, in which sexual arousal is associated with inflicting ‘Pain or humiliation; sexual masochism disorder, in which sexual arousal is associated with experiencing pain or humiliation; and pedophilic disorder, in which there isa strong sexual altraction toward children. Incest i type of pedophilia in which the victim ss rated, often ason or daughter > “the development of paraphilic disorders is associated with, deficiencies in consensual adult sexual arousal, deficiencies in consensual adlt socal sills, deviant sexval fantasies that may develop before or during puberty, and attempts by the individual to suppress thoughts associated with these arousal patterns Assessing and Treating Paraphilic Disorders > Poychosocial treatments ofthese disorders are only modestly eflective at best among individuals who are incarcerated, but somewhat more sucessful in les severe outpatients Gender Dysphoria > Gener dysphoria is a dissatisfaction wth ones natal (biologi- cal) sexandthe sens that one is realy the opposite gener (for «example, a woman trapped in a man’ bods). A person develops a sense of gender or gender identity between 18 months and 3 years of age, and it seems that both congruent gender identity and incongrvent gender identity have biological roots influenced by learning > “Treatment for adults with matked gender incongruence (rans sexuaism) may include sex reassignment surgery integrated with psychological approaches, SEXUAL DYSFUNCTIONS, PARAPHILIC DISORDERS, AND GENDER DYSPHORIA copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Key Terms heterosercal behavior 362 otteurstic disordes 389 homoserual bchvion 362 fetish isrdes, 383 ermal dpcfenction 366 veystriiediordec 384 feate ly pomclire evan dare forties ives disorden, 368 feeretcnenmestl cae! teas disorder, 368 fexual masochism, 386 sreciledsorder, 369 pedophilia, 387 delayed ejaculation, 370 incest, 387 female orgasmic disorder, 370 covert sensitization, 30 premature ecalation, 371 orguume reconditining, 391 geclirpelricpeinlpenctcation gender dyin $93 disordey 372 pecieracncentarnlly 6 eer IP paraphilic disorders, 383 CONTINUUM VIDEO PROJECT Dean Gender Identity Disorder “The more Tred to bea gic itjust wast right” ‘Access the Continuum Video Project in MindTop at rccengagebein.com Answers to Concept Checks 10.1 Lardscsa 10.2 1. 2.¥ (sometimes increases arousal); 3.1 4.1; 5.8 (pom: ‘demand pleasuring, squeeze technique, and soon); 6,7 103 Ld 2e Sa 4b: Sa &e 10.4 1. More men masturbate and doit more often; men are more permissive about casual sex: ‘women want more intimacy ‘from sex. and so on. 2, Both heterosexuality and homosexuality are normal: genetics appear to play some role in the development of sexual preference, 3, Gender dysphoria 4, Abnormal hormone levels during development; socal or parental inuencee 5. Sex reassignment surgery: psychosocial treatment to adjust to expressed or desired ender summary 401 copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Exploring Sexual Disorders and Gender Dysphoria '= Sexual behavior is considered normal in our culture unless it is associated with one of three kinds of impaired functioning—gender dysphoria, sexual dysfunction, or paraphilic disorders. © Sexual orientation probably has a strong biological basis that is influenced by environmental and social factors. GENDER DYSPHORIA ty hates ware” se ta hi or er Frits eonea ct peeoral (Goo: orth sndoponcere ‘owiaarocalpaome| Aer gical Influences Not yt contmed, although keto Invoke pronatalexpostre to hormone “Hormonal atatons may be natural ‘orresu om medication Sones = Gnd dey develop aetween 12 and 3 yours of age ="Masculno” banaviors ings anc “mine behavors In boys evoke cieret responses ciflrest ‘oevles Causes 1 Sex eessignmant suger: moval of boas or penis ‘gontalrocansition Requires rgorous psychological preparaton and franca land sci saniy 1 Pejchosocal ntenenton ta change gendo ientity PARAPHILIC DISORDERS. Sexual arousal occurs almost exclusively in the context of inappropriate objects or individuals, ia 1 Fetishiste dsorder: Sexsst stration to nonting = Transvestic deorder: Seal oral Yom Wearing 1 Sexual sadism disorder: Soxal sous associated objects Voyeurs etsorder: Sexual arcusl achoves by viewng unsuspecting person undressing or nae Exhibitoniste isorder Sexal yatliation tom ‘sparing one's gente o neuspectng strangers opposite-sex clatng rose-cnssng) ‘wih ifictng pan or uilaion ‘Serual masochism aisorder Sexal asa assoratn wh experioseng pan or humiaion Pedophile aisorder: Song saxualatvacton to cnken Incest: Sexual atacton ofamiy ng Us unsiccnestl xcept as temporary rele intl gery oo ee = Preexisting deiencos =e of area with ‘oneenel ais Im consensval act sooal sas = Covert sentation: Repeated mera coos nage aeaceltone wth Gebaie 1 Raapee preventon Trapt preperson tor capng ih fz stuatone 1 Organi recratong Patra aporopte ‘Shrl win master tees pose ‘rovsalpatmne + Meceat brag hal ec estostorone 0 ‘iporse coal ste farts ad aol ‘etn when dss ae stopped Treatment rcojod rom as masturbation Extomel strong sox civ combined wth uncortralso ‘thought processes Copyright 2018 Cengage Learn, Al Rags Reserves My na ecole, sanned er aupeauen whale ein par WEN 62-200-203‘SEXUAL DYSFUNCTIONS See ifelong: Presort curing erzre sexual htory we ube pat 1 Aequired: Virus nrval somal pater Fassia opt eas aa Goneralzed: Peson» eer encower = Male ypoactve sexual desir disorder: Acparot hos nosn sows 1 Situational: oso onl wih cotan parors cr at Satan eras Sey ‘Sexual Arousal Disorders 1 Erectile disorder: curing na ty © asneve or maiian ase. econ ‘The Human Sexual Response Cycle = Female sexual interestfarousal disorder: ocr rab 2 erie oe [Adystincbonis on mparmentn one ol ne sexual response stages,” martun aoc honeston ‘orgasm Disorders Desi = Female orgasmic disorder: batty achswscrgesm cesote acute Raselton costo ad atousal 1 Premature ejaculation: Sscusion bof tis det, wih minal somucr Sexual Pain Disorders "= Genito-pelve painpenetration dsorder Ni pn sey, an oon ‘arouse 2MU°9 ‘assoolsod wih reroute fr wen hoo na medoal uso: Yager. {lp michrnany masol paeme nthe tort ha vaghathat pve or Pore orgasm vith inercouse, occurs females Plateau Santis = Dstracion 1 Undetesinatas of rout 1 Nogatve thought processes Enver hone SS = Acombnaton af nences is amost = Ertophoba causes by formative ‘vaya present causes expences of eoual cus as Specie nll predspostion and same psjenalogalacore may prsuce 9 = Neguve sxperence, sich a Patou csc Seer ~ = Deteroration of rlatonsie rs 1 Nourclegeal er cher neous system problems f= Vacca icnaca Psychosocial Te aca asi ee = Ps erapaut program ofacikate Sa emmunkaton, prove sonal ehuaten, ad ofaese cheng strana srw. Beh panos paripat fy = Maseat Anos alitventons cus on le erocle disor, nung crags, prostoses, Sr sing Veal teatran combine th oul econ anthro achive recur bert Copyright 2018 Cengage Learn, Al Rags Reserves My na ecole, sanned er aupeauen whale ein par WEN 62-200-203‘Match the following disorders with thee corzesponding symptoms: (2) gambling disorder (6) intermitent explosive isonet (€) Meptomania, and (¢) pyromania, 1. Thissarcly diagnosed ditorder is characterized by episodes of aggresive impulses and can sometimes he ‘ueated with cognitive behavioral interventions, drug Uwcatments, or both “This disorder begins with the person feeling a sense of tension that is released and followed with pleasure after he has committed a robbery. ‘his disorder afets somewhere between 386 and 5% ‘ofthe adult American population ands characterized by the need vo gamble A, Individuals with this disorder ae preoccupied with fires and the equipment involved in setting and putting outires, Erne Opretecanas oss tacit concern among some in the eld of substance related dsorders was dropping ‘he ditinction beoween dependence on A substance and abuse of tha substance (6.keiwards, 2012; Hasin 2012; Schuck, 2012). Although there is general agreement wa than was necessary, ‘hat abusing a substance eg. binge drinking) and being dependent an that substance (eg, increasing tolerance to alcohol and go ing through withdrawal symptoms if drinking is stopped) are cliferene processes, esearch shows tat practically speaking they cend ogo together In other words, someone is routinely abusing a drug hat person wil ikely become dependent on it (O'Brien, 2011), From a scientific pone of vew, therefore, ‘here isan obvious diference between abuse ane dependence, but from clinical perspec tive (which i the main function of the OS!) the argument was made chat having these as separate diagnoses was more complicated In addition, a second major change adeition of Adele in specifi, gambling disorder—to the substancecreated disorders section, Hete again the science suggests that ‘the phenomena are quite similar with both substance-telated disorders and ‘gambling disorder showing pacceens of dependence, cravings, and working on similar brain pathways (Ashley & Boehlke, 2012), However, this potentially opens up the category forthe inclusion of many diffrent kinds of “addictions” Other Peete problems that cause real dysfunction among some people include the new M5 disorder under further study internet gaming disorder") (Block, 2008 Yan Rooil, Schoenmakers, Vemulst, Var Den Eljnden & Van De Meer, 2011) and even "tanning addiction’ (Poorsattar & Hornung, 2010), and they are being taken seriously as similar types of problems {cis likely thac many activities have the potential for causing dependence because Je Disorder” they activate the reward systems in our brains in much the same way asthe substances deserved. Te diference in whether or not they constitute a disorder” ray come back to whether or not they ‘cause the harmful distress that is part of most psychological diagnoses. Perspectives on Substance-Related Disorders » In DSM-S, substance-related and addictive disorders include problems with the use of depressants (alcohol, barbiturates, and benzodiazepines), stimulants (amphetamines, cocaine, nicotine, and caffeine), opiates (heroin, codeine, and morphine), and hallucinogens (cannabis and LSD) as well as gambling, > Specific diagnoses ae further categorized as substance intoxica tion and substance withdrawal > Nonmedical drug ure in the United States has declined in recent times, although it continues to cost billions of dollars and seriously impairs the lives of millions of people each yest 444° cHapteR 11 Depressants, Stimulants, Opioids, and Hallucinogens > Depressants area group of drugs that decrease central nervous system activity The primary effect isto reduce ou level of physiological arousal and help us relax Included inthis group are alcohol and sedative, hypnotic, and anxiolytic drugs, such as those prescribed fr insomnia. > Stimulants, the most commonly consumed psychoactive drugs, include caffeine (in coffe, chocolate, and many sft drinks), nicotine (in tebacco products suchas cigarettes), amphetamines, and cocaine, In contrast to the depressant drugs, stimulants make uusmore alert and energetic: SUASTANCE-AELATED, ADDICTIVE, AND IVPULSE-CONTROL DISORDERS copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203> Opiates include opium, morphine, codeine, and heroin; they have ‘narcotic effect—seieving pain and inducing seep The broader term opioids i used to refer tothe family of substances that includes ‘these opiates and synthetic variations created by chemists (eg, ‘methadone) and the simiacly acting substances that occur naturally ‘in our brains (enkephalns, beta-endorphins, and dynorphins). > Hallucinogens essentially change the way the user perceives the world. Sight, sound, feelings, and even smell are distorted, some- times in dramatic ways in a person under the induence of druge such ae cannabis and LSD. Causes and Treatment of Substance-Related Disorders > Most psychotropic drugs seem to produce positive fects by act ting directly or indirectly on the dopazsinergic mesolimbic system (che pleasure pathway). In addition, psychosocial factor such aveapectations, stress, and culteral practices interact with the biological factors to iniuence drug use Key Terms substance related and addictive barbiturates, 414 Aisorders, 403 benzodiazepines, 414 Ampulse-control disorders, 405 amphetamines, 416 alcohol use disorder, 405 amphetamine use piychosctive substance,406 disorders, 417 sabstance ws, 407 ‘cocaine use disorders, 418 substance intoxication, 407 substance use disorders, 407 physiological dependence, 407 tobacco-related disorders, 420 ‘affeine-related disorders, 421 opivid-related disorders, 422 tolerance, 407 Cannabis (Cannabis sativa) withdrawal, 408, (marijuana), 423 substance dependence, 408 cannabis use disorders, 424 substance abuse, 408 LSD (d-tysergic acid depressants, 409 diethylamide), 425 simolants, 409 hallucinogen use opiates, 409) disorders, 426 hallucinogens, 09 agonist substitution, 436 other drugs of abuse, 409, aicotine, 436 gambling disorder, 409 nicotine patch, 437 alcohol, 409 antagonist drugs, 437 alcohol-related disorders, 409 controlled drinking, 38 ‘withdrawal delirium (delirium tremens/DIs), 411 relapse prevention, 439 gambling disorder, 441 Wernicke-Korsakof intermittent explosive ‘syndrome, 411 disorder, 442 fetal alcohol syndrome eptomania, 443, (as), 411 pyromania, 443 alcohol dehydrogenase (ApH), 412 » Substance dependence is treated succesfully only in a minority ofthose affected, and the hes results reflect the motivation of| the drug user and a combination of biological and peychosocial treatments Programs aimed at preventing drug use may have the greatest cance of significantly affecting the drug problem, Gambling Disorder » Problem gamblers display the same types of cravings and depen- dence at persons who have substance elated disordert Similar brain systems appear tobe involved with those addicted to gambling a: secn in persons with substance related disorders. Impulse-Control Disorders In DSM-5, impulse-control disorders include three separate disorders intermittent explosive disorder, leptomania, and pyromania, Answers to Concept Checks W4 13 Part A PartA Le 2b 3d 4a LE 26 3d da Se 6b Part B Sic: 6d: 7b: Be Part B 7.0; 8.7, 9.F (llhavean effect); 10.F (they would stil 12 act uninhibited); 11.77 1. False (he use of crack by pregnant mothersadversdly 11.4 aifects only some babies); LE 2G dd di Sh 2. True; 3. True; 4. False (can nabis produces the most variable reactionsin people); 5.False {amphetamines are produced in Jabs); 6. True; 7. False (stimu: lant occur nateally) 6.8 7b, Be: by 1a 115 Lb te saad That's what drugs are, they ate your sav but also they ate also thereto kil, maim, and Aestroy you. Is awesome, but true i ; ‘Access the Continuum Video Projet in MindTap at wnscengogerain.com summary 445 copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Exploring Substance Use Disorders 1 Many kinds of problems can develop when people use and abuse substances that alter the way they think, feel, and behave. 1m Once seen as due to personal weakness, drug abuse and dependence are now thought influenced by both biological and psychosocial factors. Se 1 Expose to dhugs— though med, peers, parents oF lack "paver motoring vers no exposure fo drugs 1 Social expectations and cual norms for use 1 FamiyZcuture/socty and peers flor sore) suoportve versus unsuppartve of ug use loo Not to use: 1 Foarot ofects of drug uso = Decision not to use arugs rte causes aot + organo oe ts a me 1 Dr we er eas; aston wth “lg (ood poste eicramen 1 Drag ue to avo pahandescape uplasan Biological Influences Tees tnereng cut heoahisae caren 1 Fedig of tang cate 1 rte ganstivabeabyatets: 1 Ponte expeciatorages stout what cig Body's sostvty ocr ADH goo) ooo Boo sity o metabolize ug resece of Pata aera speckcesymes ne See 1 Drug aciate atrlrovarc cone esse ad than ro RSet treet Ce eetieeetateed ‘TREATMENT: BEST TO USE MULTIPLE APPROACHES Paychosocial Treatments Biological Treatments 1 Aros beryl crs nogate associations wih Ant suoettvton Chagoo wn cen, ageing rasa th esac ore a wn asm one fretacne oho tne gu acd was mens gees 1 Contngeney management change behaviors by 1 Potagonttsubstnen renaraing chosen eras ang on d's fst wt acter dg ralexone er ope and oho 1 Nohotcs Anno ants ations = hurav toarets ieee ee eee eee = lng erg toa very nes osng Arabs, when cavee nae ad Conta ue ‘ening wan med ih alco ota slehoter) onmunty renxcement 1 Drugs fo hovering pre dal in hana symptoms ore for 1 Pape preverton pate weherana seabes br oo ee) ‘TYPES OF DRUGS Depressants ‘Acoho, Eases odes: Anya Secanal Neral, Dereatod centr rene sytem actaty tanzodazrpins arta Valm Xara, cn) Pedicad bre of dy woud sown staanis eee eee = boreaed psa oul Users mov at srl eneaete opiates Heron, marphnecodene 1 Narote—tedice pan andindice deep and eharia byminonng opts he bran fedrphra ee} Cannabis. 59, Eosisy 1 Atsred manta arc emotional perception 1 Distortonftometinescramatt of sensory percptons copy 2018 Cengage Learang. Al Rights Reserved May nl be coped Scone plated, whale emp, WEN 02200208Exploring Impulse-Control Disorders Characterized by inability to resist acting on a drive or temptation. Sufferers often perceived by society as having ‘a problem simply due to a lack of "will." ‘TYPES OF IMPULSE-CONTROL DISORDERS: See Intormittent 1 Acting on aggressive impulses that Explosive : rosifin assets. dost of property ‘Curent eteern i focused on hot rnevrlvarmiers and istesterone bol inract wth psychosocial iuonces ire, parening shes) Kleptomania Recurring fire to est ge to sSealunneeded ters Feotng tons st oto se High comorbdy th mood a= ‘orcas anh to alesse doy, wih ‘lostanes abusaldependence i i Pyromania rosso urge to set es Feeing aroused ror oseting re then asense of gratiicaton or ret nie thee ums Fare; agnosod infos han 4% of ‘worse ‘Treatment Cogetive-behavoralinterentonsfhl>- Ing person dently and avo tgers for agessve outbuss\ and aporoaches ‘medi afer drug trealmants appear most eects {eravralintevantons or antiapessant rmecealton Cogative-behavortitonventon ftping person ini signal tiggering urges, {and teaching coping statages io resst sting fre} Copyright 2018 Cengage Learn, Al Rags Reserves My na ecole, sanned er aupeauen whale ein par WEN 62-200-203An Overview of Personality Disorders The personality disorders represent long standing and ingrained ‘wayeof thinking, feeling, and behaving tha ean cause sgn ‘cant distress. Because people may display two or more ofthese maladaptive ways of interacting with the world, considerable disagreement remains ver how to categorize the personality disorders. > DSM-S includes 10 personality disorders that are divided into three clusters: Cluster A (odd or eccentric) includes paranoid ‘schizoid, and schizotypal personality disorders; Custer 3 (Gramati, emotional, o erratic) includes antisocial, borderline, bistionic, and narcissistic personality disorders and Cluster C (anxious or fearful) includes avoidant, dependent, and obsessve- compulsive personality disorders Cluster A Personality Disorders » People with paranoid personality disorder are excessively mi trustful and suspicious of other people, without any justification “They tend not to confide in others and expect other people to do (hem harm. » People with schizoid personality disorder show a pattern of detachment from social relationships and a limited range of emotions i interpersonal situations. They seem aloof, cold, and indifferent to other people » People with schizotypal personality disorder are typically socially ‘goTated and behave in ways that would seem unusual (o most of us. In addition, they tend tobe suspicious and have odd beliefs about the world. Cluster B Personality Disorders » People with antisocial personality disorder havea history ofuiling ‘to comply with social norms. They perform actions most of us ‘would find unacceptable, suchas stealing from fiends and family “They also tend tobe iresponsible, impulsive, and deceit > In contrast to the DSM-5 eriteria for antisocial personality, which focus almost entirely on observable behaviors (for example, 480 CHAPTER 17 PERSONALITY DISORDERS impulsively and repeatedly changing employment, residence, or sexual partners), the related concept of psychopathy primarily re- fects underlying personality traits (for example, sel-centeredness for manipulativeness) People with borderline personality disorder lack stabi in their ‘moods and in ther relationships with other people, and they taually hve poor self-esteem, These individual often feel empty and are at gret risk of suicide > Individuals wit histrionic personality disorder tend to be overly dramatic ang often appear almost to be acting. People with narcissistic personality disorder think highly of themselves—beyond their real abilities, They consider them: selves somchow diferent from others and deserving of special weatment Cluster C Personality Disorders » People with avoidant personality disorder are extremely sensitive to the opinions of othere and therefore avoid social relationships. ‘heir extremely low self ester, coupled witha fear of rejection, causes them to reject the attention of others > Individual with dependent personality disorder rely on others to the extent of letting them make everyay decisions, as well as ma- jor ones; this results in an unzeasonable fear of being abandoned, People who have obsessive-compulsive personaly disorder are characterized by a fiation on things being done “the right way” “This preoccupation with details prevent them fom completing such of snything, > “Treating people with personality disorders is often dificult be- cause they usually do not see that their dificlties ar a result of| ‘the way they relate to others, Personality disorders are important forthe clinician to consider because they may interfere with ears to treat more speciic problems such as anxiety depression, or substance abuse. Un orvunately, the presence of one or more personality disorder ie associated with a poor treatment outcome and a generally negs- tive prognosis. copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Key Terms personality disorder, 449 paranoid personality disorder, 455, schizoid personality disorder, 457 schizotypal personality disorder, 459 antisocial personality disorder, 461 psychopathy, 462 borderline personality disorder, 469, dialectical behavior therapy, (oer), 472 histrionic personality disorder, 472 natciststic personality disorder, 474 avoidant personality, disorder, 476, dependent personality disorder, 477 obsessive-compulsive personality disorder, 478 Answers to Concept Checks 12.4 123 comorbidity; 2.Cluster A, 1. borderline; 2. antisocial, (Cluster, Cluster C; 3. catego: 3. narcissistic histionie tes: 4 chronic; 5. bias 24 122 1. obsessve-compulsive A.paranoid; 2schizotypa 2. dependent; 3. avoidant 3. schizoid CONTINUUM VIDEO PROJECT Borderline Personality Disorder “Tiinda get high off of making people as uncomfortable as they make me, I's almost my ‘way of relly connecting with myself ‘Acces the Continuum Video Project In MindTap at orncengagebaincom summary 481 copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Exploring Personality Disorders | People with personality disorders think and behave in ways that cause distress to themselves and/or the people who care about them. 1m There are three main groups, or clusters, of personality disorders, which usually begin in childhood. CLUSTER A Odd or Eccentric | } = Though that popte aro mallicus, decoptve, and Createring = Behavior based on mistsxen eee sssimpions about others social isolation Eas Causes Very tito range of erotons ss Agpareny col anc \assennactd ‘May be aseocated in sUatcted ty praise oF boner dnsty of cites dopamine recor: 1 Outsiders” may be susceptible because of wieve experiences prisoners, etugees, people wth hearing ropamonts, athe ele sParers arty teaching may nluence Causes 1 Learning valu ot Ss saan 1 Social scaring rence or sc sohton “with role playing i se ace a eesti close rebtorships inching romantic ‘reemual ene ee See oe susecion ees ‘= Possbip but unclear Ik ‘wih sonzoohrena = ist bocauso ot let's mistust {nd suspecn Cognito work to crange thoughts = Lon succ0ss rato Unusual belefs, behavior, or ‘Schizotypal a reer i salto eo ee are peas Biologie cLusTER Receeen a ee Dependent fee ace pen sar coveunesiy, | (Emma eal ‘depressive disorcier tor echizophvenia but Cee soars eam 1 Emly “oss” of cartaker cusses Srmameen | “teehee foo pees — s Tera an poss 1 Teaching soil te Scars a SS ao etree ec [eksroees ] Beer ere err ee reduce ideas of ‘Lenk of octal lle avoiding confit eae Sr aah aegeey ceo oo Leciire cen oe Song ae eee Avodons than = Deponcens lng Copyrah 2018 Cengage Learn Al Rais Vary ite resoarcn Appser as ies) cons = Subrisshenoss gatas inden: sence at cope, sane, apes n whole erin pan WEN 62-200-203CLUSTER B Dramatic, Emotional, or Erratic . Narcissistic re) excessive interest monet say bento by ek ot = Peet moseegotomosty — ee alitertistmances tents ity to ize with others: Unclear how biology: ‘yooh hohe nar how i causes ‘ister 1 Changos n societal roms that emphasize shorter redone. nck, competiveness, nd that are ataratie and acest erat Borderline tumultuous instability Eee 'Famlal nto mood dsordrs 1 Suelal += Possioyinherted tendencies Grate moods Gauges THULIN oFvolaity, 1 Irouliny f= Dabticalbohavor therapy 287) Medien: eye annpressans ss Exly aura, especialy ‘serualipyscal abuse = Pariccutal changes immigration ~ Minor trans ray gge plore =m Avoidant inmotion Insts character. ase iste may cause = ctor sensitity fas 1 Pecerbes socal os propa ‘Irsuicont parental atecton = Bonaveralrerventon eernques someimes suecessta = gyelorati coconsizaion = benaviralrahessal = Ingroverens Usually modest 1 Teaching coaching statis ‘o use ne Cenersy 90 "= Dependent on routes 1 Prorastnaing| Antisocial 4 Violation of thers’ rights oo Biological influences it "= Genetic vherbity eens Fara ed mame = hrstoron 0 Roomy cates comarscichers sign ear troshots Causes * Cogntve heracy to fous onthe dayo-cay pleasurable xpereces 1 Seloor succosstl See China| 1 Siressiexposure trauma, ewceration 1 constr’ paontal scp stead) 1 Sosceconome seaovarsage 1 Parent ‘raining problmsare caught omy 1 Prevention trough preschool programs Histrionic Psychological Influences dauaabe dulisaia eee Enero Ea eon = Posse lk 0 antisocial Sisgieeanpercie = Sina: shy dyeg Semen itn ‘yutenon i Causes Lite evcence of ee res wards anc nes 1 Ovely dramatic behavior tacts Focus on attenon| Inerpersonal sSedwcine reltions sApprvalsockng Obsessive-Compulsive os Distant elton to OCD = Probable weok gentile = precisposton to stucture combined ‘wih parentalrenforcerent = Lit incrmaton = Therapy aac tears bend nee Fimloxaton or dataction Techniques rooreet campus fo ore ‘uation on detals Causes EEN sory woofer Poarnierprsonalatnshos copyatt 2018 Cengage Learang. Al igh Reserved May nl Be coped, Scomed of pated, whale emp, WEN 02200203Perspectives on Schizophrenia » Schizophrenia is complex syndrome that has been recognized for many years. Perhaps the earliest and best description of his disorder was published in 1809 by John Haslam in his book Observations on Madnes and Melancholy > A.number of historic figures during the 19% and early 20% century contributed tothe evolving definitions and possible causes of this spectrum of disorders. Clinical Description, Symptoms, and Subtypes Schizophrenia is characterized by a broad spectrum of cognitive an emotional dysfunctions that include delusions and hlluc. ‘nations, disorganized speech and behavior, and inappropriate > he symptoms of schizophrenia can be divided into posi- tive, negative, and disorganized. Positive symptoms are active manifestations of abnormal behavior, oF an excess or distortion of normal behavior, and include delusions and hallucinations "Negative symptoms involve deficit in normal behavior on such dimensions as affect, speech, and motivation. Disorganized ‘symptoms include rambling speech, erratic behavior, and inap. propriate afc. Peychotic behaviors, suchas hallucinations and delusions, char acterize several other disorders; these include schizophreniform disorder (which includes people who experience the symptoms of schizophrenia for les than 6 months); schizoaffective disorder (oehich includes people who have symptoms of schizophrenia and who exhibi the characteristics of mood disorders, such a depres sion and bipolar affective disorder) delusional disorder (which includes people with a persistent bli that e contrary to reality, in the absence ofthe other characteristics of schizophrenia) and brie psychotic disorder (which includes people with one or more positive symptoms, such as delusions, hallucinations, or dsorga- nized speech or behavior over the course ofess than a month). > A proposed new disarder—attenuated peychosissyndrome— ‘hich includes one or more ofthe symptoms of schizophrenia such as hallucinations or delusions, but the individual is aware that there are unusual experiences and are not sypical for a healthy person. Thisis included inthe Appendix of DSM-S asa disorder in need of further study Prevalence and Causes of Schizophrenia > A numberof causative factors have been implicated for schizo- pphrenia, including genetic influences, neurotransmiterimbal- ances, structural damage tothe bran caused by a prenatal viral infection or birth injury, and psychelogieal stressors. [Relapse appears to be triggered by hostile and critical family ene ronments characterized by high expressed emotion. Treatment of Schizophrenia > Successful treatment for people with schizophrenia rarely includes complete recovery. The qualiyof if for these individuals ean ‘be meaningfully lected, however, by combining antipsychotic ‘medications with paychosocial approaches, employment support, and community-based and family interventions > Treatment typically involves antipsychotic drugs that are usually aulministered with a variely of peychosocial treatments, with {he goal of reducing relapse and improving skill in deficits and compliance in taking the medications. The effectiveness of treatment is limited, because echizophenta is typically a chronic disorder. 516 CHAPTER 13. SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Key Terms schizophrenia, 485 catatonia, 486 hhebephrenia, 486 paranoia, 486 dementia praccox, 486 associative spliting, 486 psychotic behavior, 88 positive symptoms, 488 delusion, 488 hallucination, 490 negative symptoms, 491 volition, 491 alogia, 91 anhedonia, 492 flat afect, 492 disorganized speech, 192 {inappropriate affect, 493 catatonic immobility, 493, schizophreniform disorder, 498 schizoaffective disorder, 494 delusional disorder, 494 shared peychotic disorder (folie deus), 495 substance-induced peychotic disorder, 196 psychotic disorder associated ‘with another medical condition, 496 brief psychotic disorder, 496 attenuated prychosis syndrome, 496 schizotypal personality disorder, 496 prodromal stage, 498 schizophrenogenic mother, 507 double bind communication, 507 ‘expressed emotion (EE), 507 (oken economy, 511 Answers to Concept Checks 13.4 132 Part Liha Daa di 1. disorganized: 2. Schizo phreniform disorder; 133 3, Delusional disorders LG 2h Sig Ade A.catatonis 5, Attenuated, Era pychosis syndrome PartB 6c 7b Ba 9d CONTINUUM VIDEO PROJECT “rbelieve that ather people are pathological i liars, and 'm not So why should T even have to listen to them?” ‘Acces the Continuum Video Project in MindTap at orcengagebroin.com summary 517 copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Exploring Schizophrenia "= Schizophrenia disrupts perception of the world, thought, speech, movement, and almost every other aspect of daily functioning 1m Usually chronic with a high relapse rate; complete recovery from schizophrenia is rare. sa rr as i eee pete om nares As oa eu peer ieee cases 1 Envtonmont eal fail ‘experences} can trgger onsot Causes aa ae aed these tone hlvchaton, toate, Go deoginand qpech oxbedy ipeheneene heen movements, or catatonia) agave stems Fatale ecko onotonal , oxen ) frelon facto, pay) moti “Agia fltesbeneem ercunk 7 Ceonees ‘orcontent of spe6ch) 1 itrcten ss et 90 gh Gan holy, a enter creme a pra cod TREATMENT OF SCHIZOPHRENIA Individual, Group, and Family Therapy ‘= Can help patent and family wndrstand the hse anc symetom tigers. 1 [eachos lames communication sail 1 Provides resources or dealing wih ematonal and practical chalerges. Social Skills Training ‘Gan occur hospital or communty stings 1 Teaches the person wih schzophrena scl seltsare, and vooatonl sil Medications ' Tokng neurlepic maceations may heb people weh schzopheniao lary ting and pereptons of ealty Reduce nalucnations soc deisons 1 Drugiteatment must be canisent fo be eect. consistent dosage may aggravate ektng syrotoms or creat new ores, copy 2018 Cengage Learang. Al Rights Reserved May nl be coped Scomed upstate pa, WEN 02200208‘SYMPTOMS OF SCHIZOPHRENIA People with schizophrenia do not all show the same kinds of symptoms, ‘Symptoms vary from person to person and may be cyclical. Common symptoms include: ‘Unrate and bizare beats not sated by others in he cute 1 May be delusions a grand at you are eal Mther Teresa or Napokor ‘olisions of porsecuion the cys who oeloved her compet wor sabotaging er by puting paboes ithe ra) 1 Sensory events thal arn't based on any external event faring voces, seeing ‘eotte who have dec. 1 Mary have autor halusinations David hears his dead uncl taking oi) Hallucinations Disorganized Speech = Jumping tom top to te 1 Taking gical fot answerng drect questions going oon tangon's) ‘Spang Fringe words an cenlancee Behavioral Problems 1 Pacing ota, wll agitation Fpappropraie cross {coats nth summer, shorts inthe winter Ipappropriat tect © Ignoring personal hygiene rant Withdrawal = Lack of ematonal esponse fat speech. Ite change in fala expressions) ‘pay fl rest n cay-to-cy acts Dead and nit responses in conversation Less of eroyment in pleasurable aces eating, scialng, sx) en a Copyright 2018 Cengage Learn, Al Rags Reserves My na ecole, sanned er aupeauen whale ein par WEN 62-200-203Overview of Neurodevelopmental Disorders Developmental psychopathology isthe study of how disorders arise and change wit time, These changes usvallyfllow a pattern, with ‘he child masering one sil efore acquiring the next. This aspect of development i important because it implies that any disruption fn the acquisition of eary sale vl bythe very nature ofthe devel ‘opmental process, also disrupt the development of later sil Attention-Deficit/Hyperactivity Disorder > “the primary characterises of people with attention-deiit hyperactivity disorder ae a patter of natention (suchas not paying attention to school- or work-related tasks) impulsivity, andlor hyperactivity. These deficit ean sgnficany disrupt academic efforts and socal relationships Specific Learning Disorder SMES describes specic learning disorder a academic perfor smance that is substanially below what would be expected given the pesos ag intelignce quotient (10) score and education. These problems canbe seen as diculis with reading, mathematics, ad! cx veiten expression, All are defined by performance that lls far ther of expectations based on inteligence and schoo preparation > Communication and motor disorders seem closely related to specific learning disorder ‘hey include childhood speech fency disorder (titering), a disturbance in speech fluency; language disorder, im- sted speech nll situations but without the types of cognitive deficits ‘hat Tead to language problems in people with intellectual disability ‘or one ofthe pervasive developmental disorders; and Touret dis- ‘order, which chads involuntary motor movements such as head ‘ssitching and vocalizations such ae grunts that occur suddenly in rapid succession, and in idiosyncratic or stereotyped ways. Key Terms neurodevelopmental joint stention, 535 disorders, 521 prosody, 535 attention-deficitvhyperactvity, disorder (ADHD), 522 naturalistic teaching, strategies, 539 ‘Tourette's disorder, 523 intellectual disability copy number variants, 527 aD), 540 specific learning disorder, 530 phenylketonuria (PKU), 544 childhood—onset fluency _Letch-Nyhan syndrome, 544 disorder (stuttering), 532 language disorder, 532 Down syndrome, 544 amniocentesis, 545 autism spectrum disorder chorionic villus sampling (ASD), 534 (CVS), $45, childhood disintegrative fragileX syndrome, $45, disorder, 534 ‘cultural-familial intellectual Rett disorder, 534 disability 546 pervasive developmental disorder—not otherwice specified, 534 Autism Spectrum Disorder People with ASD all experience trouble progressing in lan. guage socialization, and cognition. This s nota relatively minor problem (ike specific earning disorder) buts a condition that significantly affects how individvals lve ad interact with others. Aussie spectrum disorder ea childhood disorder characterized by significant impairment in social communication sills and restricted, repetitive paterns of behavior, interests, or activites ‘This disorder does not have a single cause; instead, a number of biological conditions may contribute, and these, n combination with psychosocial influences, result in the unusual behaviors displayed by people with ASD. > Impressive advances have been made in improving outcomes for many young chile with ASD using eazy intervention pro- grams, Ifesiment for older children involves behavioral nter- ‘ventions focused on their social communication deficits and the restricted, repetitive paterns of behavior, interests, or activites Intellectual Disability The definition of intellectual disability has three parts significantly subaverage intellects unesoning, emcurrent defor mpirments fm present adapuve functioning, and an onset before the age of 18, » Dov syndrome ea type of intellectual disability caused by the presence of an extra 21st chromosome. tis possible to detect the presence of Down syndrome ina fetus through a process known asamniocentesi » Two other type of ntellectual disability ate commons fragile X syn Alzheimer's disease isthe leading cause of neurocognitive disor. er, affecting approximately 4 million people in the United States; can be caused by brain trauma, intoxication by drugs or poisons, surgery, anda variety of other stressful conditions, especially, among alder adults, Major and Mild Neurocognitive Disorders » Neurocognitive disorder isa progressive and degenerative condi- tion marked by gradual deterioration of range of cognitive abilities including memory, language, and planning organizing, sequencing, and abstracting information 1 Mild neurocognitive disorder i a condition in which there are early signs of cognitive decline such tat itegins to interfere with activities of daily living, thereis currently no knawn cause or cure. To dat, there sno effective treatment forthe ireversible neuro cognitive disorder caused by Alzheimer’ disease, Lewy bodies, vascular disease, Parkinson's disease, Huntingtons disease, and various les common conditions that produce progressive cogni- ive impairment, Treatment oflen focuses on helping patients cope swith the continwing lose of cognitive sills and helping caregivers eal with the stres of caring for afected individuals, summary 575 copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Key Terms delirium, 554 ‘major neurocognitive disorder (dementia), 356 mild neurocognitive disorder, 356 agnosia, $58 facial agnosia, 958 Alzheimer’s disease, 559 neurocognitive disorder due to Alzheimer's disease, 559 vyatcular neurocognitive disorder, 562 head trauma, 563, frontotemporal neurocognitive disorder, 563, Pick’s disease, 563, ‘traumatic brain injury (TBN, 563 neurocognitive disorder ‘due to traumatic brain injury, 563, 576 CHAPTER 15. NEUROCOGNITIVE DISORDERS neurocognitive disorder due to Lewy body disease, 563 neurocognitive disorder due to Parkinsons disease, 563 Parkinsons disease, 563 ‘human immunodeficiency ‘virus type 1 (HIV-1), 364 neurocognitive disorder due to HIV infection, 364 aphasia, 565 Huntington’ disease, 565 neurocognitive disorder ‘due to Huntington’ disease, 566 neurological disorder duc to rion diseat, 566 ‘Creutafeldt-Jakob disease, 566 substance/medication- induced neurocognitive disorder, 567 deterministic, 568 susceptibility, 568 copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203Answers to Concept Checks 15.1 Le 2b da de 5.6 6d 152 Lb de sa 4. substance induced neurocognitive disorder; 5. vascular neuro- cognitive disorder: 6, neurocognitive disorder due to Alzheimers disease CONTINUUM VIDEO PROJECT (neces “'m going to forget their names. I'm going to forget who they are. Alzheimer’s Is eating ‘away at my brain” ‘Acces the Continuum Video Project in MindTap at ccengagebrincom suMMaRy copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203 577Exploring Neurocognitive Disorders = When the brain is damaged, the effects are reversible, accumulating until learning, memory, or consciousness are obviously impaired. | Neurocognitive disorders develop much later than intellectual disability and other learning disorders, which are believed to be present at birth. TYPES OF NEUROCOGNITIVE DISORDERS eee Causes (subtypes) Treatment frosted consciousness = Deleumduotoa nd comnton for several (genoralmaccat hours or days condtion “confusion, dsorenation, m Substancecnduced Inably focus sara = Most prevalnt among Delran ce to ‘lier adults, people wth multe etclges AIDS, anc patents en = Dalrum not cherie mediation spected copy 2018 Cengage Learang. Al Rights Reserved May nl be coped Scomed upstate pa, WEN 02200208Major and Mild Neurocognitive Disorders "= Gradual deterioration of brain functioning that affects judgment, memory, language, and other advanced cognitive processes = Caused by medical condition or drug abuse 1m Some forms are irreversible; some are resolved by treatment of primary condition, ‘TYPES OF NEUROCOGNITIVE DISORDERS ue rd pra 1 iereasng merory 1 Progressive brain 1 No cure so far, but Impaimont ane ther damage, evident in hope ies genes ‘uttele behavioral ane evottilay’tangles and research ana amyloid ogni defi. afecing _neurie pague, confirmed Tangvage. motor uncton- by alopsy but assessed ing, aly ta recognize by simpli’ moni Deople or hings, andlor status xam notes heb marian bisnsng 1 Involves mutisle ones ‘rintator, 1 Most revalnt 1 New mectatons that ewocognibe csorcer pretent acetyholne = Subect of ost resnaren boakdown andar thorapycalay bt do not stop progression of Seclne Substance- 1 Caused by brain camage cue io prolonged chug use, especially combination with Induced poor dot, 38 » alcahol dopendor thor substances may nelude abn, a Neurecegnitive ‘he seca hyonotc, and arscyic dug Dicerdee 1 Treatmeet focuses en prevention, Vascular 1 Permanent deterioration de to blocked or damaged load vessel the bain (stoke Nourocognitive 1 Symplors include decines 1 spood o formation procesing and axecul function: Disorder ig, cree eter mn aay ho ce rotons ws ak na 1 Treatment foevses on coping. Nourocogni- 1 Simarn acto other cognve csorrs, but caused by {ive Disorders head trauma Due to Other Lewy bods, HV, Parkinson's, Huntnglon's, Picks Coutzl- Jako dsoase Medical “nyeboepnais,hipohyodsm, bran tumor, sn vtemin B12 detoency Sars 1 Treatmect of prerarycondtion ssomatines possible. Copyright 2018 Cengage Learn, Al Rags Reserves My na ecole, sanned er aupeauen whale ein par WEN 62-200-203Perspectives on Mental Health Law Societal views of people with mental illness change with time often as "responses to perceived problems with and as intended improvements ‘ofrelevan laws, According to researchers, a "ibeal ea” between 1960 and 1980 the United States was characterized by a commit ‘ment to individual rights and faimess; the “neoconservative era that {allowed focuses on majority concerns and on law and order Civil Commitment Civil commitment laws determine the conditions under which a person may he certified legally to have a mental illness and therefore tobe placed in a hospital, sometimes in conflict with the persis own wishes, Historically states have permitted commitment when several Having a mental iliness does not seem lo increase the likelihood ‘of dangeraseness, hate that a person will commit violent acts the future, athough having symptoms of hallucinations and del sions does seem to indicate mote rick for behaving violensly. » ‘The combination of the lack of success with deinstittionalzation, ‘which has resulted instead in transinstitutionalization; the rise in homelessness and the criminalization of people with severe ‘mental illnes ed to a backlash agains the perceived causes of these factors, including the strict ev commstment laws. Criminal Commitment Criminal commitments the proces by which people are held for one ‘of two reasons: (1) They have been accused of committing a crime and ate detained in a mental heath facility unl they can be deter- ‘mined fi or unfit to participate in leal proceedings agunst them, or (2) theyhave been found not guilty ofa crime by reason of insanity “The incanity defense is defined by a number of legal rulings: The MINaghten rule states that people are not responsible for criminal Ibchavio f they do.not know what they ae doin, of they do Key Terms iil commitment laws, $81 ‘mental illness, 583 dangerousness, 583 Aeinutitutionalization, 584 ‘ransinstitutionalzation, 585 «criminal commitment, 387 diminished capacity, 588 competence, 591 dy to warn, 591 expert witnesses, 591 linical efficacy axis, 395, clinical utility axis, 595 ‘know and they doit know tis wrong The Dusham rule broadened the criteria for responsibilty from knowledge of right or wrong to the presence of “mental disease or defect” The American Law Institute criteria concluded that people were not responsible for ther criminal behavior if because oftheir mental illness, they lacked ether the cognitive ability to recognize the inappropriaeness ‘oftheir behavior or the ability to contol their behavior “The concept of diminished capacity holds that people's ability to ‘understand the nature oftheir behavior and therefore their erm nal intent could be lestened by their mental iliness A determination of competence must be made before sn individ- val canbe tried for a criminal offense: To stand trial, people must bbe competent—able to understand the charges agsinet them and toasts with their own defence, Duty to warn ea standard that sets forth the responsibilty of the therapist to warn potential victims that a dient may attempt to Inu or Kall them, Individuals who have specialized knowledge and who assist judges and juries in making decisions, especially about such issues as competence and malingering, ae called expert witnesses, Patients’ Rights and Clinical Practice Guidelines One ofthe more fundamental ights of patients in mental health faces thelr ght to weatment bat they have legal ight to sme sort of ongoing effort to both define and tie toward tecatment goal, By contrat «great dal of controversy existe over wether al patients ae capable of making a decision to refuse treatment, This ian eepciallydfcl emma inthe cate of atipeychotic medications that may improve patent’ symptom but bring with them severe negative side eect. Subjects who participate in any research study must be filly informed, ‘ofthe risks and benefits and formally give their informed consent 0 Indicate they have been fally informed. > Clinical practice guidelines can playa major role in providing in formation about types of interventions tha are likely tobe effective for a specific disorder, hereby setting tne stage for evidence based practice, Crcal to such adeterminaion are measures of clinical flcacy (internal validity) and clinical utility (external validity; in other words, the former is a measure of whether a treatment works, and the later i a measure of whether the treatment i elective in a variety of settings and can be implemented in those settings Answers to Concept Checks 16.4 16.2 A.mental disorder; 2.danger Lea; 2.6) 3.6: 4h; 5.b; us; 3. grave disability, gi 7d 4. legal; 5. deinstitutionaiza- lion; 6.transinsttutionalization 16.3 26 3a de 5b summary 597 copy 2018 Cengage Learang. Al Rights Reserved May nl Be coped, Scomed of uplsted, whale em pa, WEN 02200203