Dissociative disorders Overview Involve serve alterations of sense of reality or detachments from reality.

Can affect sense of identity, memory, or the continuity of consciousness About 50% of the general pop. Will have at least one translent dissociative experienceDepersonalization- distortion of sense of ones own reality or feeling disconnected from ones body. derealization-???????? Types of DSM IV TR dissociative disorders Depersonalization disorder: Overview and defining features. Primary symptom:serve and frightening feelings of unreality and detachment Feelings dominate and interfere with life functioning Must rule out schizophrenia, current drug use, neurological disorder, and certain personality disorders. Facts and statistics Affects 0.8% -2% of gen. Pop. Same prevalence for males and females. High co-morbidity w anxiety disorders 64% and mood disorders 73% Onset is typically around age 16 Usually runs a chronic lifelong course. Causes neurophysiology testing indicates cognitive deficits in attention, short term memory, spatial reasoning. 3d images appear flat...misjudge size and distance of objects Treatment Little is known: usually antidepressants are prescribed Dissociative amnesia Includes several forms of psychogenic (psychologically caused) memory loss, especially for personal info Two types: generalized unable to remember anything including who they r Localized or selective type: unable to remember specific events. Dissociative fugue Fugue= flight Loss of memory of the past, including ones own identity Also sudden travel to a new location (with no awareness of how they arrived.) Dissociative amnesia and fugue: causes Statistics Onset in adulthood Show rapid onset and dissipation Occur most often in females Causes Little is known Trauma and stress can serve as triggers Treatment most get better without treatment Most remember what they had forgotten Dissociative identity disorder Clinical description Formerly known as multiple personality disorder Defining features Dissociation of personality or identity (multiple identities w own traits)

Extensive memory lapses Not due to drug use or medical condition Multiple identikits vary from as few as 2 to as many as 100 Identities have unique behaviors voice postures and even handwriting Terminology of DID Alters (short for alter egos) different personalities Host the identity that keeps other personalities together Switch quick translation from one personality to another Statistics Dsm provides no estimates of incidence. Best current source estimates 1.5% in community samples Ratio of females to males is high 9:1 Onset is almost always in childhood.- after age 9 development is rare High co-morbidity rates with other disorders, especially personality disorders. Most DID have 7 other diagnoses Lifelong chronic course with out treatment Causes 97% cases, histories of horrible unspeakable child abuse Believed to be a complex mechanism to escape from the impact of this early trauma Treatment no controlled research Some case studies have been presented usually long term talking treatment Focus is on facing early early trauma( imaginable exposure) and reintegration of personality Success rates not encouraging; 20-25% recover Faking DID Malingering to avoid legal sanctions Kenneth balanchi murdered 10 women in los angeles area in late 1970s Plea not guilty by reason of insanity Alter: "steve walker" Martin orne (phd, md) discovered malingering No outside corroboration of symptoms Library of psych. Books found in his library DID is a controversial diagnosis One third of psychiatrists believe DID should not have been included in DSM IV Sociocognitive model of DID: DID is latrogenic, caused by treatment. Symptoms are reinforced by overly eager therapists DID people are often highly suggestible, creative and hyponoizable, so easily influenced by therapists. Hypnotize Epidemic of DID, Book Sybil (1974_ film 1976: shirley mason at least 16 personalities); treated by Cornelia wilber MD for 11 years beginning in 1954 Diagnosis greatly increased following this book and the subsequent film 200 cases in 1980 20,000 in 1980-1990 Does DID exist? Yes, many people do present with the symptoms of DID described by dsm --------------------------------------------------------------------------------------------------Chapter 6

mood disorders ' Gross deviations from normal mood ranging from elavation to severe depression Major depressive episode Defining features Extremely depressed mood lasting at least 2 weeks Cognitive symptoms-feelings of worthlessness, guilt indecisiveness, thoughts of death, suicidial indeation Somatic or vegetative symptoms, disturbed physical functioning Fatigue/low energy Insomnia, hypersomnia Weight loss or gain Agitation or psychomotor retardation Anhedonia- loss pleasure/ interest in usual activities If untreated, generally lasts 4-9 months CESD: Cut off score =16 for "at risk" (sometimes 19 for seniors) Manic episode Abnormally elevated euphoric or irritable mood lasting at least one week. And may include Inflated self esteem, grandiosity (often delusional) Excessive or extraordinary goal directed activity. Flight of ideas Rapid speech Disteracbity Decrease need for speech. If left untreated, will last for 3-6 months Mixed episode For one week the person meets the criteria 4 both manic and major depressive episode nearly ever day Hypomanic episodes Hypo= below-less severe than full manic episode Must last 4 days Change must be clearly observable by others may not disrupt daily functioning to a significant degree An overview of mood disorders Either classified as depressive disorders or bipolar disorders Depressive disorders -major depressive disorder Dysthmyic disorder Double depression Bipolar disorders bipolar I Bipolar II Cyclothymic disorder

Major depressive disorder

At least one major depressive disorder and The absence of the manic or hypomanic episodes before or during the disorder Categorized as either single episode- highly unusual Recurrent- more common Onset and prevalence Rare until teens Mean age= 30 yrs Rates of depression are increasing across the globe, and onset getting younger and younger In US, people born by 1900, 1% became depressed by age 75, people born since 1955, 6% became depressed by age 24 About 16% lifetime prevalence worldwide. Sex differences- rate twice as high for females across all cultures. Sex differences decline with age and disappear by the 60s Often difficult to diagnose in middle age. Major depression and suicide About 12% will attempt suicide (people with major depression) About 3.5% successfully kill themselves Females attempt suicide 3 times as often as males Males successfully kill themselves 4-5 times the rate of females Males use more violent means, guns and hanging Females more slower: poisoning overdose and cutting Grief and depression Depression does follow the death of a loved one. 6.2% meet criteria for major depressive episode after death of a loved one. Usually not considered a disorder unless psychotic features or suicidal ideas are present or symptoms still present after 2 months since loss. If symptoms are serve with in 2 months indicate pathological grief reaction. Some "specifiers" With postpartum onset -occurs within 4 weeks of giving birth -10% of new mothers have this With seasonal pattern -aka seasonal affective disorder(SAD) -seasonal onset usually winter and remission (usually spring) -Not accounted for by yearly stressors like school or seasonal unemployment. -Has occurred for two years - those with SAD are sensitive to light and show seasonal variation in how much melatonin( sleep inducing secretion hormone from pineal gland in brain. Non-SAD people are constant in melatonin over the seasons 2% pop. In Florida...10% in new Hampshire Treatment with 2 hrs of bright light in morning effect begins 3-4 days and complete remission after 1-2 weeks) Dysthymic disorder Defining features Chronic, long lasting form of depression Symptoms are milder than major depression Symptoms present for most days for at least 2 yrs, No more than 2 months symptom free. No manic or hypomanic episodes

People with dysthymia are at higher risk for major depression than others (22%) Symptoms can persist unchanged for over long periods more than 20 years Double depression Defining features Major depressive episodes and dysthymic disorder Dysthmic disorder usually develops first Bipolar 1 Defining features Alternations between full manic episodes and major depressive episodes Facts and statistics Average onset 18 yrs Males and females same prevalence Suicide attempts are even more common in bipolar 1 than for unipolar depression Bipolar 2 disorder Defining features Alternations between major depressive and hypo-manic episodes Facts and statistics Average age of onset is 22 yrs 10 to 13% of cases progress to bipolar 1 Same prevalence between males and females Suicide attempts are more frequent than for bipolar 1 and unipolar depression. Cyclothymic disorder Defining features Chronic, milder version of bipolar disorder Manic and depressive moods are less severe, but persist for long periods Must last for at least 2 years - 1 year for children and adolescents Facts Average age of onset is 12 to 14 yrs Most are female Tends to be life long and chronic High risk at developing bipolar 1 or 2 Dsm When first mentioning the dsm write full title in italics, followed by abbreviation also in italics in parentheses After that use abrration in italics In apa format, the names of mental disorders are not capitalized Criteria/criterion Criteria is plural...criterion is singular. Who vs. That Who= people That=things, processes, animals Periods and commas always go inside the quotation marks Colons and semicolons, always outside the quotation marks Inside if the question or exclamation is part of the quotation Outside if question is not part of the quotation. Never use two punctuation marks together even when asking a question about a Paragraphs Don't use both indent and space after paragraph The elements of style....by William strunk and e.b white

Anything with "for dummies" Grammar for writers....**** Tex works Mood disorders :genetic influences Twin studies -concordance rates are high in identical twins: if a twin has a mood disorder, the other is likely to have one too Twins usually 80% have the polarity of the other twin Neurobiological influences Neurotransmistter systems 3 implicated in mood disorders serotonin norepinephrine dopamine Mood disorders are related to low levels of serotonin One serotonin is to regulate other neurotransmitters(especially dopamine and norepinephrine) Permissive hypothesis:when serotonin is low other neurotransmitters are not regulated. This dysregulation leads to the emotional instability found in mood disorders. Drop in norepinephrine and dopamine causes low energy negative mood lack of reinforcement and goal seeking Increase in them causes mania The endocrine system...elevated cortisol levels(stress hormone) are found in depression. Cortisol can shut down neurogenisis(production of new neurons) in the brain- except hippocampus Neurogenesis is associated with improved memory and info processing New neurons are more excitable than older neurons and promote cognitive flexibly Depressed people seem to be cognitively stuck cant move forward. Stressful life events Stress related to mood disorders Depression often follows stressful events such as divorce unemployment childbirth graduating from school starting new career. Meaning and mood It is not the objective event that predicts depression, but the meaning of the event for the person For some, divorce may be experienced as liberating or loss of job an opportunity for something better A behavioral theory Peter lewinsohns behavioral theory of depression Depressed people have low levels of positive experiences from their environments Intital trauma(loss defeat) disrupts their usual behavior making them less successful in receiving reinforcements They stay isolated and confined, often in an impoverished environment After depressed, people avoid them(they become aversive to others, eg. Smell bad sigh and complain Psychological dimensions (learned helplessness) The learned helplessness theory of depression Martin seligman: original model was a behavioral model based on animal learning studies..(escape learning) Dogs and other animals who are shocked with no means of escape simply cease trying Seilgman(1974) Dogs subjected to inescapable electric shocks later failed to escape from shocks even when it was possible to do so So depression caused by ans experiences over which one has no control If person learns that behavior make no difference to their negative environment, they may stop trying to

escape aversive stimuli when it is possible Psychological dimensions Reformulated( learned helplessness) Seilgman later modified his theory on a cognitive direction: it is how one interprets negative events that predicts depression Depressive attributional style- how you explain the events Internal attribution- negative outcomes are ones own fault Stable attributions believing future negative outcomes will be ones own fault Global attribution. Believing negative events will disrupt many life activites All three domains contribute to a sense of hopelessness Psychological dimensions (cognitive theory) Aaron beck Formerly a psychoanalyst Negative coping styles: depressed people distort daily life in negative way The depressive cognitive triad, self world future Cognitive errors Arbitrary inference: drawing negative conclusions on the basis of insufficient evidence or the lack of evidence at all Overgeneralztion drawing on overall sweeping conclusion on the basis of a single event Social and cultural dimensions Social support: network of family and friends who can be counted on to provide emotional financial and instrumental support Lack of social support predicts late onset depression Substantial social support predicts recovery from depression when it does occur Interpersonal relations are altered in depression Depressed people can elicit rejection from others Low in social skills, seek reassurance others but this reassurance is temporarily. Marital relations Marital dissatisfaction is strongly related to depression This relation is particularly strong in males Among people who had no history of depression 14% became depressed following divorce; only 5% of women became depressed Treatment of mood disorders: tricyclic meds Widely used -block re uptake of norepinephrine and to a lesser extent other neurotransmitters such as serotonin Therapeutic effects can take 2 to 8 weeks Negative side effects are common Dry mouth,, blurred vision, constipation, weight gain. Up to 40% stop taking them May be lethal in excessive doses Over 100 studies up to 50% improve. Monoamine oxidase (MAO) inhibitors Monoamine oxidase breaks down serotonin/norepinephrine So by blocking MAO, serotonin and norepinephrine remain active in the system Slightly more effective than tricyclics but Eating foods with tyramine (cheese red wine, beer) and taking many common drugs can be dangerous and even fatal when interacting Selective serotonergenic re uptake inhibitors Specifically block re uptake of serotonin. Prozac most popular

Recall SSRI's indirectly affect norepinephrine and other neurotransmitters Ssri's have similar levels of effectiveness as tricyclics and MAO inhibitors SSRI's pose no unique risk of suicide or violence in adults FDA cautions possible risk in adolescents. Negative side effects are common, especially sexual dysfunction, but seem preferable to side effects of other anti depressants. Treatment of mood disorders:lithium Lithium carbonate(a common salt) is an antidepressant, but it also effectively reduces and prevents manic episodes..sometimes called mood stabilizer Now the primary drug of choice for bipolar disorders 50% respond well Dosage must be monitored well because of risk for poisoning Electroconvulsive therapy (ect) ECT: is effective for cases of severe depression not responding to other treatments Usually 6 to 10 out patient treatments are required Few side effects 50% effectiveness rate High relapse rate tho. Psycho-social treatments Cognitive therapy Addresses cognitive errors in thinking Also includes behavioral components (such as encouraging exercise and social activity) Research suggests that the behavioral component might be the most active ingredient Interpersonal psychotherapy Focuses on current problematic interpersonal relationships and development of new relationships Teach conflict management social skills assertiveness Psychosocial treatments Outcomes - cognitive and interpersonal treatments are empirically validated. Produce effects comparable or slightly better than medications. They increase serotonin and improve neurogenisis Research does suggest that combined treatment of meds and psychosocial might be better than just doing one alone Chapter 8 Eating and sleep disorders Anorexia nervous and bulimia nervous Both involve both fear and apprehension of gaining weight Both involve serve disruptions in eating behavior due to drive for thinness Both increased dramatically since the 1960s in western cultures In both, the strongest etiology seems to be sociocultural rather than psychological or biological Both are potentially deadly: the mortality rates for eating disorders are higher than any other disorder including depression. Bulimia Recurrent episodes of binge eating and compensatory actions Binge eating -eating excessively within a 2 hr period, with a sense of lack of control over the eating. Compensary activity to prevent weight gain: Vomiting -misuse of laxative- diuretics-fasting-excessive exercise- stimulant drugsBinge/compensation cycle at least twice a week for 3 months to be diagnosed Excessive preoccupation with body shape and weight Two subtypes Purging subtype-most common subtype...vomiting laxatives direutics Nonpruging subtype- exercise fasting or both

No differences in the subtypes in terms of serverty of pathology, frequency of binges or prevalence of co morbid disorders(anxiety or mood disorders) Associated features Most are within 10% of target body weight Purging methods can result in Erosion of dental enamel Enlarge salivary glands Calluses on hands and fingers Laxative abuse can lead to intestinal problems and permanent colon damage Electrolyte imbalance Kidney failure Cardiac arrhythmia Seizures Bulimia nervous: associated psychological features Most have comorbid psychological disorders 80% have anxiety disorders at some point in their life 50-70% mood disorder during course of eating disorder 33% have substance abuse prob. Depression usually follows eating disorders and is a response to eating disorder Bulimia Majority are female (90-95%) Onset 16-19 yrs Lifetime prevalence is about 1.1% for females and .0 for males 6-8% of college women suffer from bulimia Tends to be chronic if left untreated anorexia nervosia Successful weight loss-hallmark of anorexia Refusal to maintain body weight at or above expected weight At least 15% below normal weight. Intense fear of obesity and losing control over eating Show a relentless pursuit of thinness Amenorrhea (lack of menstruation) Often starts with just dieting, but becomes an obsessive pursuit Subtype of anorexia Restricting subtype- limit caloric intake via dieting and fasting Binge-eating-purging subtype- about 50% of anorexics Smaller amounts of food than bulimics, but more constisant purging(often after every meal or snack) Over half of restricting subtypes will begin purging Subtypes may be stages Difference- anorexics are successful at keeping weight down, bulimics ashamed at their condition, anorexics proud of their achievements and sense of control Most are comorbid for other psychological disorders OCD higher in anorexia than bulimia Medical consequences Dry skin brittle hair or nails Sensitivity to cold temp. Lanugo...downy hair on face chest back or limbs Low blood pressure Anorexia majority are white and female Very rare in black girls

From middle to upper middle class families Onset age 13 or early adolescence Most anorexics 25-30% underweight by the time they seek treatment. Causes of bulimia and anorexia Biological considerations Little is well established in terms of genetics Evidence for low serotonin associated with binge eating Psychological considerations Low sense of personal control and self confidence Perfectionist attitudes Distorted body image Mood intolerance :at least a subset of eating disordered patients have difficulty toralating negative emotions Media and cultural considerations Cultural imperative for thinness where food is plentiful Being thin...= success, happiness Translates into dieting (often trigger for eating disorder) Womans magazines 10.5 times more weight lost ads and articles than mens Media standards of the ideal are difficult to achieve Westernization Nassar, 1988 60 Egyptian women at universities in Cairo Egypt, 0 eating disorders 50 Egyptian woman at universities in London: 12% had eating disorders Becker at al., 2002 TV introduced at 1995... self induced vomiting increased from 0 to 11% Treatment of bumliuma ner. Antidepressants -can help reduce binging and purging -not too effective in the long term Psychosocial treatments Cognitive-behavioral therapy(cbt) The treatment of choice Change eating habits(behavioral) and attitudes (cognitive) about food and weight Interpersonal psychotherapy Social skills, conflict management Results in long term gains similar to CBT Goals of psychological treatment of anorexia neroxsa General goals and strategies Weight restoration -first and easiest goal to achieve Frequent smaller meals (5-6x a day) 400-500 calories per meal Average gain 1/2 lb per day Behavioral and cognitive interventions Target attitudes about food weight, body image, thought and emotion Treatment often involves family Long term prognosis for anorexia is poorer than for bulimia Binge eating disorder In appendix for dsm 4 Further research suggested

Chapter 8 Sleep disorders We spend a 1/3 of our lives asleep recurrent state of unconsciousness and sensory-motor inactivity All mammals and birds and most reptiles, fish and amphibians Sleep essential to survival in most species Purpose of sleep Research findings Production of growth hormones Increase on serotonin Higher immune functioning Increase in wound healing Increased memory functions Repair and production of brain cells In short, sleep seems to be a period of repair and restoration of biological and psychological processes People who do not sleep enough have more health problems Infants need 16-20 hrs Toddlers 12-14 Preschool 11-13 School age 10-11 Teens 9.5-10 Most adults need 7 1/2 -8 hrs to function well...about 10% require more or less sleep Biology of sleep Cell clusters in the hypothalamus called superchiasmtic nuclei (SCN) receive info about light from the retina When dark the SCN stimulates the pineal gland to secrete the hormone melention which induces drowsiness Light inhibits the production of melatonin Sleep patterns 5 stages of sleep during a normal night Stages 1-4 or non-REM and REM During non rem sleep, many of the restorative functions of sleep occur(esp. In stages 3 and 4, slow wave sleep) During REM sleep, memories and thoughts from the day are processed. Stages progress cyclically 1-4, then REM, restart back at stage 1 One complete cycle takes about 90-110 min First cycle have relatively short REM sleeps REM sleep time increases in cycles REM sleep stage Brain waves increase to the awake level Most dreams occur during this stage Physical changes during REM -increase heart rate, blood pressure, breathing rate -Eyes jerk rapidly Limb muscles temperality paralyzed Some loss of temperature regulation Men may experience erections

Most people have 3-5 intervals of REM each night Infants spend 50% of time in REM Adults spend 20% in REM Sleep disorders: an overview Two major types of DSM-IV TR sleep disorders Dysomias Difficulties in amount, quality, or timing of sleep Insomnia, hypersomia, narcolepsy, breathing related disorders circadian rhythm disorders Parasomias, abnormal behavioral and physiological events during sleep, nightmare disorder, sleep terror disorder, sleepwalking disorder Assessment of disordered sleep: Polysomnographic (PSG) evaluation Electroencephalograph (EEG) -brain wave activity Electrooculograph (EOG) -eye movements Electromygraphy(EMG) muscle movements Detailed history, assessment of sleep efficiency)percent time sleeping, of total time trying to sleep 85-90% is good Insomnia and primary insomnia Problems intimating or maintain sleep, and/or non restorative sleep Insomnia is one of the most common sleep disorders (40% in a yr report symptoms) Primary insomnia: unrelated to any other medical condition, psych disorder or substance use Facts and statistics Often associated with medical conditions (pain, respiratory problems) and or psychological conditions(depression, bipolar, and anxiety disorder) Affects females twice as much as males Some causal factors Worry and rumination Worry about sleep can disrupt sleep Bed and bedroom can become classically conditioned to anxiety (and p

Defining features of hypersomia Hypersomia and primary hyposomia Excessive sleepiness for at least 1 month Sleeping too much at night or daytime sleep episodes Experience excessive sleeping as distressing or impairing functioning facts and statistics About 39% have a family history of hypersomia Often associated with medical and or psychological conditions A significant subgroup of people with hypersomia have been exposed to viral infections such as mononucleosis, hepatitis, or vivral pneumonia causes of this is unclear