Reviewer 1

• Disorder types

  • Biological/Evolutionary
  • Psychological Psychodynamic
  • Behavioral
  • Cognitive
  • Sociocultural
  • Humanistic
• GAD


  Generalized anxiety disorder
• Biological vulnerability in GAD


  • Inherited tendency to be tense, uptight, & anxious
  • Low GABA
  • Low serotonin
  • High cortisol & norepinephrine
• Psychological vulnerability in GAD

  • Generalized: from early experience (ex: learned from/taught by parents); sense of control or the lack of it
  • Specific: learned later on (ex: "physical sensations are potentially dangerous")
• Psychodynamic factors in GAD

  • High levels of neurotic or moral anxiety
  • Defense mechanisms are inadequate because of overprotective parents: children had little opportunity to develop effective DMs
  • Due to basic irrational assumptions (Albert Ellis)
  • They hold silent assumptions that imply that they are in imminent danger (Aaron Beck)
  • Implicitly hold both positive & negative beliefs about worrying and engages in metaworrying (metacognitive theory)
  • Cannot tolerate that negative events may occur so they keep on worrying in efforts to find correct solutions and to restore certainty (intolerance of uncertainty theory)
  • Have greater bodily arousal & they worry repeatedly to reduce or avoid this arousal (avoidance theory)
• Panic disorder


  • High norepinephrine activity
  • A brain circuit that is composed of amygdala, hippocampus, ventromedial nucleus of the hypothalamus, central gray matter, & locus coreleus probably malfunctions
• Psychological factors in panic disorder

  • Early object loss and/or separation anxiety might predispose someone to develop the condition as an adult
  • They interpret normal physical sensations in catastrophic ways (David Clark)
• Specific phobia


  • Learned preparedness: humans are theoretically prepared to acquire some phobias & not others (ex: snakes, heights)
  • Can be acquired by: direct experience, experiencing a false alarm (panic attack) in a specific situation), observing someone else experiencing severe fear, or through information transmission
  • Learned through classical conditioning & operant conditioning (Mowler's 2-factor model)
  • Learned through modeling (observation & imitation)
  • In most societies, it is almost unacceptable form males to express fears or phobias, thus majority of the reported SP occur in women
• Social anxiety disorder


  • Evolutionarily, we inherited the tendency to fear angry, critical, or rejecting people
  • Excessive behavioral inhibition is a risk
  • They hold social beliefs & expectations that consistently work against them and causes them to anticipate social disasters
  • Traumatic social experiences in childhood or early adolescence
• PTSD


  • Family history of anxiety
  • 2 short alleles of serotonin transporter gene
  • Damage in hippocampus
  • Generalized psychological vulnerability: family instability may instill a sense that the world is an uncontrollable, potentially dangerous place
  • Lack of support group is a risk
• OCD


  • Damage in caudate nucleus (causes the obsessions & compulsions)
  • Low serotonin
  • Dysregulated glutamate
  • Specific psychological vulnerability: early experience taught them that some thoughts are dangerous and unacceptable because what they're thinking might happen & they would be responsible (thought-action fusion)
  • Battle between anxiety-provoking impulses & anxiety-reducing DM is played out in overt thoughts & actions
  • ID: obsessions

  DMs: compulsions

  3 DM common: isolation, undoing, reaction formation

  • Compulsions are learned randomly through random associations
  • Negative reinforcement happens (thus the repeated compulsions)
  • Unlike normal people, they blame themselves for their intrusive thoughts & expect that terrible things will happen. they try to neutralize the thoughts which then becomes compulsions
  • Have exceptionally high standards of moral & conduct & inflated sense of responsibility
  • Believe that they should have perfect control over all of their thoughts & behaviors
• Body dysmorphic disorder (BDD)


  • Displacement: an underlying unconscious conflict would be too anxiety provoking to admit into consciousness so the person displaces it onto a body part
• Somatic symptom disorder & intermittent explosive disorder (IED)


  • Runs in families; there is a modest genetic distribution
  • Possibly a tendency to over respond to stress
  • Hyperresponsivity might combine with a tendency to view negative life events as unpredictable & uncontrollable and therefore to be guarded at all times
  • Specific psychological vulnerability: learned from their family members to focus their anxiety on specific physical conditions and illness
  • Seem to develop in the context of a stressful life event
  • Disproportionate incidence of disease in their family when they were children
  • Important social & interpersonal influence
• Conversion disorder

  • Biological vulnerability to develop CD when under stress, but this seem less important than the overriding influence of interpersonal factors
  • Freud: conversion of underlying emotional conflict into physical symptoms & concerns
  • Most theorists: sufferers have unconscious conflicts carried forth from childhood, which arouse anxiety , and they convert it into "more tolerable" physical symptoms

  Primary gain – to relieve anxiety; to keep their internal conflicts out of awareness

  Secondary gain – to avoid unpleasant activities or to receive sympathy from others

  • Operational conditioning: physical symptoms of the disorder bring rewards to sufferers
  • Propose that this disorder is a form of communication providing a means for people to express emotions that would otherwise be difficult to convey
  • Western: see somatic symptoms as an inferior way of dealing with emotions

  Non-western: transformation of personal distress into somatic complaints is the norm, it is socially & medically correct reaction to stress

  • Risk: less educated & lower socioeconomic group where knowledge about disease and medical illness is not well developed
• Dissociative identity disorder (DID)


  • Smaller hippocampal & amygdala volume
  • Autohypnotic model: people who are highly suggestible may be able to use dissociation as a defense against extreme trauma

  Note: those who are less suggestible may develop PTSD

  • Self-hypnosis model: dissociative disorders may be a form of self-hypnosis, they hypnotize themselves to forget unpleasant events (hypnotic amnesia)
  • Thought to result from a lifetime of excessive repression. this continuous repression is motivated by traumatic childhood events
  • Whenever they experience bad thoughts or impulses, they unconsciously disown and deny them by assigning them to other personalities
  • Hold that dissociation is a response learned through operant conditioning. as people find relief from terrifying experiences when their minds drifts to other subjects, momentary forgetting increases the likelihood of future forgetting
  • State dependent learning: different arousal levels may produce entirely different group of memories, thoughts and abilities, that is, different personalities
  • Social cognitive theory: DID is a form role playing acquired through observational learning & reinforcement
  • Abused as a child

  Lack of social support during or after abuse
• Dissociative amnesia

  • Autohypnotic model: people who are highly suggestible may be able to use dissociation as a defense against extreme trauma

  Note: those who are less suggestible may develop PTSD

  • Self-hypnosis model: dissociative disorders may be a form of self-hypnosis, they hypnotize themselves to forget unpleasant events (hypnotic amnesia)
  • Repression: it is a single episode massive repression

  Note: escape behavior

  • Hold that dissociation is a response learned through operant conditioning. as people find relief from terrifying experiences when their minds drifts to other subjects, momentary forgetting increases the likelihood of future forgetting
  • State dependent learning: when such people are calm (unlike what they felt during the trauma), they may forget what happened during stressful times

  SDL – if people learn something when they are in a particular situation or state of mind, they are likely to remember it best when they are again in that situation

  • Social cognitive theory: DA and fugue are learned responses
• Depersonalization derealization disorder


  • Disruption of the sleep-wake cycle
  • Autohypnotic model: people who are highly suggestible may be able to use dissociation as a defense against extreme trauma
• Depression


  • Heritable/genetics: Women - 40% bio, Men - 20% bio, Identical twins - 80% risk
  • Low serotonin, dopamine, & norepinephrine

  High dopamine IF with psychotic features or atypical

  • Permissive hypothesis: when serotonin levels are low, other neurotransmitters are permitted to range more widely, become dysregulated, and contribute to mood irregularities
  • Stress hypothesis: over activity of the HPA axis that produces cortisol (high cortisol levels)
  • Smaller hippocampus (with suppressed neurogenesis)
• Psychological factors in depression

  • Stress & trauma - what matters is the context of the event and the meaning it has for the individual

  Humiliation, loss, & social rejection – most potent stressful life events likely to lead to depression

  • Due to real or symbolic/imagined loss they regress to the oral stage. they then merge their own identity with that of the person they have lost, that is introjection. they direct all their feeling for the loved one, including sadness & anger toward themselves. introjection should be temporary. if the grief worsens over time it will lead to depression

  Prone to depression: needs were not met during the oral stage

  • Depression results from significant changes in number of rewards and punishments people receive in their lives

  Peter Lewinson suggested that positive rewards in life dwindle for some people leading them to perform fewer & fewer constructive behaviors

  Note: social rewards are particularly important

  • Learned helplessness theory: people become depressed when they decide that they have no control over the stress in their lives

  Attribution – helplessness theory: Internal, global, & stable

  Theory of negative thinking (Aaron Beck) – maladaptive attitudes, cognitive triad (self, world, future), errors in thinking (arbitrary inferences, magnification, minimizing, overgeneralization), automatic thoughts

  Children are at high risk because of a depressed mother showed depressive cognitive styles when under minor stress

  • Strongly influenced by interpersonal stress, esp marital dissatisfaction

  Risk of people who live alone is almost 80% higher

  Family social perspective: depressed people often display weak social skills & communicate poorly. due to other people feeling uncomfortable & avoiding interactions
• Helplessness theory


  Internal, global, & stable
• Theory of negative thinking (Aaron Beck)


  Maladaptive attitudes, cognitive triad (self, world, future), errors in thinking (arbitrary inferences, magnification, minimizing, overgeneralization), automatic thoughts
• Children are at high risk because of a depressed mother


  They showed depressive cognitive styles when under minor stress
• Depressed people are strongly influenced by interpersonal stress, especially marital dissatisfaction
• The risk of people who live alone is almost 80% higher
• Family social perspective

  Depressed people often display weak social skills & communicate poorly, due to other people feeling uncomfortable & avoiding interactions
• Stress hypothesis


  Over activity of the HPA axis that produces cortisol (high cortisol levels)
• Smaller hippocampus


  • With suppressed neurogenesis
• Object relations

  Depression happens when their relationships leave them feeling unsafe & insecure
• People whose parents pushed them toward excessive dependence or excessive self-reliance are more likely to be depressed when they lose important relationships
• Theories for gender (women) differences in depression

  • Artifact theory
  • Hormone explanation
  • Life stress theory
  • Body dissatisfaction explanation
  • Lack of control theory
  • Rumination theory
• Bipolar disorder


  • Elevated left frontal EEG activity
• Mania


  Stressful life event: more positive set
• Bipolar disorder is strongly influenced by interpersonal stress, especially marital dissatisfaction
• Anorexia nervosa


  • Runs in families, have a genetic component (50%)
  • Traits such as emotional instability, poor impulse control, & perfectionism
  • Hypothalamus is affected
  • Low serotonin levels
• Emotional eating behavior & binge eating frequencies peaked in the post ovulatory phase of the menstrual cycle
• Anorexia nervosa


  Diminished senses of personal control & confidence in their own talents and abilities (low self-esteem)
• Factors contributing to anorexia nervosa


  • Cultural imperative for thinness
  • Exposure to media images depicting thin-ideal body & body images concern in women
  • Mother with anorexia may restrict food intake of their children, sometimes to the detriment of their child's health
  • Mothers of girls with ED seemed to act as society's messengers in wanting their daughters to be thin
• Bulimia nervosa


  • Runs in families, have a genetic component (50%)
  • Traits such as emotional instability, poor impulse control, & perfectionism
  • Hypothalamus is affected
• Factors contributing to bulimia nervosa

  • Cultural imperative for thinness
  • Exposure to media images depicting thin-ideal body & body images concern in women
  • Mothers of girls with ED seemed to act as society's messengers in wanting their daughters to be thin
• Insomnia


  • Due to accompanying medical and/or psychological disorder
  • Problems with biological clock
  • Delayed temperature rhythm: body temp doesn't drop & they don't become drowsy until later night