Psychopathology 2 Midterm 1

Complete loss of air flow, 10 seconds to minutes. Can also happen many times during sleep

• Less severe than apnea
• Overly shallow breathing, or abnormally low respiratory rate
• Result in decreases amount of air movement onto the lungs
• Due to a partial obstruction to the upper airway
• Can still get a full night sleep, but a lack in oxygen which disrupt the stages of sleep

Broad class of sleep disorders in regards to the amount, quality, and timing of sleep

Abnormal movements, perceptions, or dreams while falling asleep

• Sudden episode of muscle weakness, accompanied by full awareness
• Usually triggered by an emotional state: big laugh or fear

Between sleep and wakefulness

• theta wave activity
• harder to awaken sleeper

• slow wave/delta wave sleep
• sleeper less responsive to environment
• Initiated in the pre-optic area of the brain

• Rapid eye movement sleep; most muscles paralyzed
• also called paradoxal sleep
• Lack of REM sleep ☛ harder to learn complex tasks
• Adult reaches REM approx. every 90 mins

No, people will bounce around between stages

yes

• Insomnia Disorder
• Hypersomnolence Disorder
• Narcolepsy

• Obstructive Sleep Apnea Hypopnean
• Central Sleep ApneanSleep-Related
• Hypoventilationn
• Circadian Rhythm Sleep-Wake Disorders

• Non-Rapid Eye Movement Sleep Arousal Disordersn
• Nightmare Disordern
• Rapid Eye Movement Sleep Behavior Disordern
• Restless Legs Syndrome

• Difficulty initiating sleep
• Difficulty maintaining sleep
• Early morning awakening with inability to return to sleep
• At least 3 nights/week for at least 3 months
• Difficulty occurs despite adequate opportunity for sleep
• Causes clinically significant distress or impairment in social, occupation, or other
• Not better explained by (and does not occur exclusively during course of another sleep-wake disorder)
• Not attributable to physiological effects of a substance/medication
• Co-existing mental disorders and medical conditions do not adequately explain complaint

• short-term drugs
• Physical exercise
• Manipulate the persons sleep environment, diet and timing of persons meals
• Might also use biofeedback, deep muscle relaxation

• Recurrent periods of/lapses into sleep within the same day
• Prolonged main sleep episode of more than 9 hours per day—nonrestorative
• Difficulty being fully awake after abrupt awakening
• Occurs at least 3 times/week for at least 3 months
• Accompanied by significant distress or impairment in cognitive, social occupational, or other important areas
• Not better explained by and does not occur exclusively during the course of another sleep disorder
• Not attributable to physiological effects of a substance/medication
• Coexisting mental and medical disorders do not adequately explain complaint

• behavioral changes
• avoiding alcohol or caffeine
• limits naps to 1 per day at 45 mins.

• Recurrent periods of irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day
• Episodes of cataplexy:  strong emotion or laughter causes a person to suffer sudden physical collapse though remaining conscious.

• At least 5 obstructive sleep apneas or hypopneas per hour of sleep
• Nocturnal breathing disturbances
• Daytime sleepiness, fatigue, or unrefreshing sleep despite adequate opportunities to sleep
• A quarter of men, 1-10 women have it
• linked to heart disease

• Evidence from sleep study of 5+ sleep apneas per hour of sleep
• linked to heart and kidney failure

Sleep study shows episodes of decreased respiration associated with elevated CO2 levels

• Recurrent pattern of sleep disruption—primarily due to alteration of the circadian system misalignment between endogenous circadian rhythm and the sleep-wake schedule required by an individual’s physical environment
• Leads to excessive sleepiness or insomnia, or both
• Clinically significant distress or impairment
• This is typically seen with jet lag

• Recurrent episodes of incomplete awakening from sleep accompanied by either–Sleepwalking–Sleep terrors
• Little or no dream imagery is recalled
• Amnesia for the episodes is present

• Recurrent extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity
• Upon awakening, individual rapidly becomes oriented and alert
• could be PTSD if other symptoms are present

• Repeated arousal during sleep associated with vocalization and/or complex motor behaviors
• Occur during REM sleep—more than 90 minutes into sleep cycle; more frequent during later portions of cycle; uncommon during daytime naps
• Upon awakening, individual is completely awake, alert, and not confused or disoriented

• Urge to move legs, usually accompanied by or in response to uncomfortable and unpleasant sensations in the legs
• At least 3X/week for at least 3 months

• One or more somatic symptoms that are distressing or disrupt daily life significantly
• At least one of the following:

• Disproportionate, persistent thoughts re: seriousness of one’s symptoms
• High level of anxiety about health or symptoms
• Excessive time and energy devoted to these symptoms or health concerns

• Preoccupation with having/acquiring a serious illness
• Somatic symptoms not present (or very mild); if medical condition is present or if predisposition exists, preoccupation is clearly excessive
• High level of anxiety about health
• Person performs excessive health-related behaviors or exhibits maladaptive avoidance
• Preoccupation present for at least 6 months
• basically afraid of getting sick

• One or more symptoms of altered voluntary motor or sensory function
• Clinical findings show incompatibility between symptom and recognized neurological or medical conditions
• “La belle indifference”–Symbolic meaning of symptoms
• Primary and secondary gain
• usually there is an acute psychological trigger

• a strange non-concern about a newly developed symptom 
• person will talk about it, but not be overly concerned about it

A symptom protects a person from experiencing a difficult or painful situation

a person receives gratification because of the way people respond to a symptom which in turn reinforces the symptom

• Falsification of physical/psychological signs or symptoms or induction of injury or disease—associated with identified deception
• Individual presents self as ill, impaired, or injured
• Deceptive behavior is evident even without obvious external rewards
• Previously known as Munchausen Disorder

• Falsification of physical/psychological signs or symptoms or induction of injury or disease in another—associated with identified deception
• Individual presents another person as ill, impaired, or injured
• Deceptive behavior is evident even without obvious external rewards
• Previously known as Munchausen by Proxy Disorder

• Recurrent behavioral outbursts; failure to control aggressive impulses 
• verbal aggression w/o damage 2x/week for 3 months
• 3 outbursts involving damage during 12 month period 
• out of proportion reaction to event 
• not premeditated 
• not really effective treatments

• deliberate recurrent fire setting
• tension or affective arousal prior to act 
• fascination/attraction to fire
• pleasure when setting fire or witnessing aftermath
• not performed for monetary gain 
• most common in males

• recurrent failure to resist impulses to steal unneeded objects
• increased tension immediately before theft
• pleasure/relief when committing theft
• not expression of anger
• more common in women and must watch for comorbid personality disorder

• physical
• sexual
• psychological/emotional
• destruction of property
• verbal
• economic
• violence to pets

• women are the majority targets
• occurs frequently in marriages
• leaving the abuse can be dangerous
• often involves alcohol/drugs
• 60% are pregnant women
• sometimes murder of the husband

• phase 1: tension building 
• phase 2: acute battering incident
• phase 3: contrite loving behavior (hardest to intervene)

• low self-esteem
• fear of intimacy but often dependent on victim
• high power/control needs
• high levels of anger/hostility
• depression
• low stress tolerance 
• defensive
• denial/minimization

• possessive/suspicious/jealous
• poor communication
• guarded
• difficulty expressing affection
• verbally aggressive
• negative attitude towards women

• violence in family of origin 
• alcohol/drug abuse 
• un/under employment
• child abuse

• divorce or separation
• custody battle
• recent violence
• threats
• isolation from support

• does not deserve abuse
• conflicting emotions between love and anger
• isolated, submissive, feels powerless
• trapped/frightened
• needs information
• may have been abused as a child

• frequently abused also
• emotional trauma
• at risk for similar relationships

• history of relationship violence
• violence in family origin
• type of violence
• stages/frequency
• substance abuse
• level of danger

acute, situationally reactive violence directed to partner only

perp:

• alarmed by loss of control 
• feels guilt
• able to verbalize guilt without retaliation 

Victim:

• respond in a protective manner
• feels appropriate outrage
• express a lack of tolerance 
• couples therapy is appropriate and often effective

cyclical violent affective storms directed to partner and family

perp:

• violence is egosyntonic
• limited acceptance of responsibility
• might be temporary remorse instead of guilt
• suffers from chronic dysphoric angry/depressive states
• violence is chronic and targeted at family members
• increased level of danger 

victim:

• not fundamentally outraged at the violence
• stays attached to the perp
• relationship fluctuates between symbiotic and disconnected 
• perp can benefit from anger management 
• if treatment is voluntary it is usually because the women left and not effective 
• treatment can be effective if man commits to anger management and woman commits to safety

• habitual instrumental violence directed to partner and others
• therapy not effective
• violence is used for control
• violent towards anyone frustrating 
• characterized by exploitation 
• history of criminal behavior 
• victim should be assisted with safe withdrawal

• acute or chronic secondary violence directed to partner and others
• perp might have a mental disorder
• couples therapy is not recommended 
• violence is impulsive and might not have anything to do with relationship dynamic

• marked delay in ejaculation
• marked infrequency or absence of ejaculation 
• 75-100% of the time 
• minimum of 6 months

1-3 of the first 3 items

• difficulty obtaining erection 
• difficulty maintaining erection
• decrease in erectile rigidity
• 6 months

• delay, infrequency, or absence of orgasm 
• reduced intensity of orgasm 
• 6 months

at least three of the following

• absent/reduced interest in sex
• absent/reduced sexual/erotic thoughts or fantasies 
• no/reduced initiation of sexual activity and unreceptive 
• absent/reduced sexual excitement/pleasure from sex
• absent/reduced sexual interest/arousal in response to cues
• absent/reduced genital or non genital sensations during sex
• 6 months

pain or fear/anxiety during sex

• lack of desire for sex or thoughts of sex
• 6 months

• ejaculation in less than 1 minute
• 6 months

• incongruence between assigned and expressed gender
• incongruence between assigned and expressed sex characteristics 
• strong desire to be rid of primary and/or secondary sex characteristics 
• strong desire for opposite sex characteristics
• strong desire to be the other gender and/or treated as other gender

• living as desired gender
• hormone therapy
• sex reassignment therapy

• arousal from observing an unsuspected person who is naked
• person as acted on urges with non-consenting person

• Arousal of exposing genitals to an unsuspecting person 
• person has acted on urges to expose

• Arousal from touching/rubbing against non-consenting people
• acted on urges

Arousal from being humiliated, beaten, bound, or otherwise made to suffer

• Arousal from the physical or psychological suffering of another person 
• acted on urges with a non-consenting person

• Arousal from fantasies, urges, or behaviors involving children
• acted on urges
• person is at least 16 and at least 5 years older than child

arousal from nonliving objects or highly specific focus on nongenital body parts

arousal from cross-dressing

• Detachment: depersonalization and derealization
• compartmentalization

• a partial or total failure to deliberately control processes and take actions that ordinarily would be influenced by an act of will
• wanting to recall something but cannot

• Formerly known as multiple personalities 
• two or more identities 
• marked discontinuity in sense of self and sense of agency/capability  
• alterations in affect, behavior, consciousness, memory, etc...
• recurrent gaps in recall

• Sudden inability to recall important personal information that is inconsistent with ordinary forgetting
• no personality changes as seen with DID

• intentional travel or wondering that is associated with amnesia
• the amnesia is about who they are or other autobiographical information

experiences of unreality, detachment, or being an outside observer with regard to ones thoughts, feelings, sensations, body, or actions

experiences of unreality or detachment regarding ones surroundings

presence of persistent or recurrent experiences of depersonalization and/or derealization

• Unable to remember things after the event (anterograde)
• memory loss tends to be total, not partial or spotty as seen with concussions 
• retain their precious skills and may show some secondary gain

look for a history of drinking without completing recovery

usually happens within 4 weeks of the vent and lasts only about 4 weeks

• Chacterized by DID, reactive emotions, low self-esteem, impulsive, substance issues, identity confusion, suicide attempts, etc...
• 70% of DID diagnoses also have borderline 
• the difference is the abrupt personality changes

lying or feigning about a disorder for a real external purpose

• Lack of interest in food or eating
• avoidance of food due to sensory characteristics
• no distortion in body image

• Severe food restriction leading to very low body weight 
• intense fear of gaining weight
• disturbance in the way one views their body, weight, shape
• persistent lack of recognition of the seriousness of low body weight

• Recurrent episodes of binge eating with a sense of lack of control while eating 
• recurrent inappropriate compensatory behaviors in order to prevent weight gain 
• occurs at least once a week for 3 months 
• depression is commonly comorbid 
• does not have the extreme low body weight like anorexia or the extreme control over food

same binge eating as Bulima without the compensatory behavior

anorexia

• greater rigidity in family functioning with possible high levels of pressure
• restrictive behavior begins early in life
• family pressure to be thin

Still being researched

• media plays a large role
• school settings and peer pressure can contribute

loss of loved ones, sexual abuse, traumatic events can all contribute

different cultures have different views about food