Abnormal psy chapter 9 PDF

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abnormal psych chapter 9 ...

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What is suicide? Suicide: A self-inflicted death in which the person acts intentionally, directly, and consciously. 4 kinds of people who commit suicide: ● ● ● ●

Death seeker - one who clearly intends to ends his life with suicide Death initiator - A person who believes that death is around the corner anyway, and he or she is speeding up the process Death darer - Experiences mixed feelings, doesn't care if he or she lives or dies, risky behavior that doesn't necessarily guaranty death Death ignorer - Doesn't recognize that death is the final stage

Subintentional suicide: A death in which the victim plays an indirect, hidden, partial, or unconscious role. (abusing drugs that you now will kill you)

How is it studied? Retrospective analysis: A psychological autopsy in which clinicians piece together information about a person’s suicide from the person’s past. Relatives, friends, and physicians may remember past statements, conversations or behaviors that can that help us study suicide, even letters.

Patterns and statistic -

suicide rate varies from country to country live streaming suicide is on the rise religious people seem less likely to commit suicide women have 3 times as many suicide attempts as men, but men succeed in more than 3 times as many as female

What triggers suicide? (5) Stressful events and situations Suicide more prominent in combat stress and long term stress -

Social isolation serious illness abusive and repressive environment - Environment witch people are unlike to escape from - prisoners of war, concentration camps etc.. occupational stress

Mood and thought changes Not necessarily a mental disorder People who express hopelessness( A pessimistic belief that one’s present circumstances, problems, or mood will not change) are 11 times more likely to die by suicide

Alcohol and other drug use -

Reduces fear of suicide while intoxicated The chosen suicide method is more lethal

Mental disorders -

The vast majority of suicide attempters have a mental disorder In most cases its depression.

Modeling - The contagion of suicide Inspired by others -

Family or friends

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celebrities Other highly publicized cases - media shows a bizarre suicide, people follow. Coworkers and colleagues

What are the underlying causes of suicide? The psychodynamic view -

Many psychodynamic theorists believe that suicide results from depression and from anger at others that is redirected towards oneself. Suicide is thought to be an extreme expression of self-hatred and self-punishment Thanatos(death instinct) opposes life instinct most people learn to redirect their death instinct by aiming it toward others, suicidal people, caught in a web of self-anger, direct it toward themselves.

Durkheim`s sociocultural view -

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According to Durkheim, the probability of suicide is determined by how attached a person is to such social groups as the family, religious institutions, and community. The more you feel you belong = lower risk of suicide 3 categories of suicide:

1. Egoistic: Not concerned with the norms and rules of society 2. Altruistic: Intentionally risk the lives for society’s well being (sacrifice life for other people or cause(Kamikaze)) 3. Anomic suicide: Social environments fail to provide stable structures, such as family and religion

The interpersonal view -

A theory that asserts that people with perceived burdensomeness(feeling like a burden to others), thwarted belongingness(not feeling like you belong), and a psychological capability to carry out suicide are the most likely to attempt suicide

Biological view

Is suicide linked to age? -

Increases with age up until middle age, then decrease at the early stages of old age, then increasing again at age 75

Children -

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One out of every million individuals kills themselves. That rate rises to two per 100,000 among children aged 11 to 14 years and 8 per 100,000 among teens aged 15 to 19 years Researchers have found that suicide attempts by the very young are commonly preceded by such behavioral patterns as running away from home; accidentproneness; aggressive acting out; temper tantrums; self-criticism; social withdrawal and loneliness; extreme sensitivity to criticism by others; low tolerance of frustration; sleep problems; dark fantasies, daydreams, or hallucinations; marked personality change; and overwhelming interest in death and suicide

Adolescents -

8 of every 100,000 teenagers (age 14 to 18) end their lives in the United States each year Around 19 percent of all adolescent deaths are the result of suicide anti-depressant slightly increase the chance of committing suicide in some individuals(2%) (black- box warnings) prescribed fell 22%, suicide rose 14% teens who commit suicide often under great stress. far more suicide attempts in teens then actual suicide Half of attempted suicide try again in the future

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American Indians have the highest suicide rate, double the rate of non-Hispanic white American teenagers and triple that of other minority teenagers

The elderly -

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More than 16 of every 100,000 people between the ages of 65 and 74 years in the United States kill themselves, a rate that rises to 21.4 per 100,000 among people over the age of 74 years The reason is that as people grow old they often become ill, lose close friends and relatives, lose control over their lives, and lose status in society. success rate is much higher

Treatment and suicide Falls into two categories: treatment after a suicide attempt and suicide prevention

What treatments are used after suicide attempts? -

Cognitive-behavioral therapy is particularly helpful, focuses largely on painful thoughts. Using becks CBT may help client's asses, challenge and change many of their negative attributes and illogical thinking Using mindfulness-based CBT may helpt clients become more aware of the painful thoughts and feelings rather than to try to eliminate them Using therapy exercises like homework, and other CBT tools. (dialectical behavior therapy(DBT))

What is suicide prevention? A program that tries to identify people who are at risk of killing themselves and to offer them crisis intervention -

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Suicide hotlines - 24/7 hour telephone service The services offer crisis intervention - A treatment approach that tries to help people in a psychological crisis to view their situation more accurately, make better decisions, act more constructively, and overcome the crisis. Also, there is a crisis text line The counselor has several tasks:

1. Establishing a positive relationship 2. Understanding and clarify the problem 3. Assess suicide potential

4. Asses and mobilize the caller's resources 5. Formulate a plan

Do suicide prevention programs work? -

Difficult measuring the effectiveness of suicide prevention programs Apparently only a small % of suicidal people contact prevention centers.

Summary Chapter 10- Disorders Featuring Somatic Symptoms Factitious Disorder- A disorder in which a person feigns or induces physical symptoms, typically for the purpose of assuming the role of a sick person. Factitious Disorder Imposed on Self 1. False creation of physical psychological symptoms, or deceptive production of injury or disease, even without external rewards for such aliments. 2. Presentation of oneself as ill, damaged, or hurt. Factitious Disorder Imposed on Another -Also popularly known as Munchausen syndrome by proxy 1. False creation of physical or psychological symptomes, or deceptive production of injury or disease, in another person, even without external rewards for such aliments. 2. Presentation of another person (victim) as ill, damaged, or hurt. Typically for this is parents or caretakers make up or produce physical illnesses in their children. -Between 6 and 30% of the victims of Munchausen syndrome by proxy die as a result of their symptoms, 8 percent of those who survive are permanently disfigured or physically impaired.

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People with factitious disorder often research their supposed ailments and are impressively knowledgeable about medicine.

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People with factitious disorder eagerly undergo painful testing or treatment, even surgery. When they are confronted with evidence that their symptoms are factitious,

they typically deny charges and leave the hospital; they may enter another hospital the same day. -

Clinical researchers have had a hard time determining the prevalence of factious disorder, since the patients with the disorder hide the true nature of their problem. Overall the pattern appears to be more common in women than men. Many men however often have severe cases. Disorder usually begins during early adulthood.

Factitious disorder seems to be particularly common among people who (1) received extensive treatment for a medical problem as children, (2) carry a grudge against the medical profession, or (3) have worked as a nurse, laboratory technician, or medical aide. A number have poor social support, few enduring social relationships, and little family life. -The causes of factitious disorder are not understood, but clinical reports have pointed to factors such as depression, unsupportive parental relationships during childhood, and extreme needs for attention and/or social support that are not otherwise available. -Clinicians have nor been able to develop dependably effective treatments for this disorder. Conversion Disorder A disorder in which a person’s bodily symptoms affect his or her voluntary motor and sensory functions, but the symptoms are inconsistent with known medical diseases. Conversion Disorder Checklist 1. Presence of at least one symptom or deficit that affects voulntary or sensory function. 2. Symptoms are found to be inconsistent with known neurological or medical disease. 3. Significant distress or impairment. -

It is often hard even for physicians to distinguish from a genuine medical problem. It is always possible that a diagnosis of conversion disorder is a mistake and that the patients problem has han undetected neurological or other medical cause.

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Physicians sometimes rely on oddities in the patient’s medical picture to help distinguish the two.

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Unlike people with factitious disorder, those with conversion disorder do not consciously want or purposely produce their symptoms.

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People with factitious disorder almost always believe that their problems are genuinely medical.

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Conversion disorder usually begins between late childhood and young adulthood

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It is diagnosed at least twice as often in women as in men

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It often appears suddenly, at times of extreme stress

Somatic Symptom Disorder A disorder in which people become excessively distressed, concerned, and anxious about

bodily symptoms they are experiencing, and their lives are disproportionately disrupted by the symptoms. -

Symptoms last longer but are less dramatic than those found in conversion disorder

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In some cases the somatic symptoms have no known cause; in others, the cause can be identified.

Somatic Symptom Disorder Checklist 1. Person experiences at least one upsetting or repeatedly disruptive physical (somatic) symptoms. 2. Person experiences an unreasonable number of thoughts, feelings, and behavior regarding the nature or implications of the physical symptoms, including one of the following: a) Repeated, excessive thoughts about their seriousness. b) Continual high anxiety about their nature or health implications. c) Disproportionate am 3. ounts of time and energy spent on the symptoms or their health implications. 4. Physical symptoms usually continue to some degree for more than 6 months.

*Two patterns of somatic symptom disorder have received particular attention Somatization Pattern; the individual experiences a large and varied number of bodily symptoms. -

Experience many long-lasting physical ailments—ailments that typically have little or no physical basis.

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Often includes symptoms as; Headaches, chest pain, nausea, diarrhea, menstrual difficulties, vision, paralysis.

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Goes from doctor to doctor, searching for relief. Describe their many symptoms in dramatic terms.

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Feel anxious and depressed.

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Typically lasts for years.

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4% of all people in the US may experience a somatization pattern in any given year, women much more commonly than men.

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Begin between adolescence and young adults. Runs in family. 20% of the close female relatives of women with the pattern also develop it.

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Victims of childhood or recent sexual abuse are more likely than nonvictims to develop this pattern in adulthood.

Predominant Pain Pattern; the person’s primary bodily problem is the experience of pain. -

the primary feature of somatic symptom disorder is pain, the person is said to have a predominant pain pattern.

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It may begin at any age, women seem more likely than men to experience it.

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Often develops after an accident or during an illness that has caused genuine pain, which then takes on a life of its own.

What causes conversion and somatic symptom disorders? - For many years referred to as hysterical disorders.

Psychodynamic view: “Hysterical disorders represented a conversion of underlying emotional conflicts into physical symptoms and concerns” primary gain; In psychodynamic theory, the gain people derive when their somatic symptoms keep their internal conflicts out of awareness. secondary gain; In psychodynamic theory, the gain people derive when their somatic symptoms elicit kindness from others or provide an excuse to avoid unpleasant activities.

The Cognitive-Behavioral View Cognitive-behavioral theorists point to rewards and communication skills to help explain conversion and somatic symptom disorders. -

Theorists from this point of view propose that the physical symptoms of these disorders yield important benefits to sufferers.

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Perhaps the symptoms remove the individuals from an unpleasant relationship or perhaps the symptoms bring attention from other people

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The theorists also hold that people who are familiar with an illness will more readily adopt its physical symptoms

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Many studies find that many sufferers develop their bodily symptoms after they or their close relatives or friends have had similar medical problems.

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This focus on the role of rewards is similar to the psychodynamic notion of secondary gain. The key difference: psychodynamic theorists view the gains as indeed secondary— Cognitive-behavioral theorists view them as the primary cause of the development of the disorders.

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The Cognitive-behavioral view has as the psychodynamic view received little research support.

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Some cognitive-behavioral theorists propose that conversion and somatic symptom disorders are forms of self-expression, to reveal emotions that would otherwise be difficult for them to convey

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They suggest, that the purpose of the conversion is not to defend against anxiety but to communicate extreme feelings—anger, fear, depression, guilt, jealousy—in a “physical language” that is familiar and comfortable for the person with the disorder.

The multicultural view Most Western clinicians believe that it is inappropriate to produce or focus excessively on somatic symptoms in response to personal distress. That is a part of why CD and SSD are included in DSM-5. -

Some theorists believe, however, that this position reflects a Western bias—a bias that sees somatic reactions as an inferior way of dealing with emotions

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The transformation of personal distress into somatic complaints is the norm in many non-Western cultures

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In such cultures the formation of such complaints is viewed as a socially and medically correct—and less stigmatizing—reaction to life’s stressors.

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In many non-Western cultures the transformation of personal distress into somatic complaints is the norm. It is viewed as more socially and medically correct- less stigmatized - reaction to life’s stressors.

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Studies have found very high rates of stress-caused bodily symptoms in nonWestern medical settings throughout the world, including those in China, Japan, and Arab countries.

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People throughout Latin America seem to display the most somatic reactions. Even within the United States, Hispanic Americans display more somatic reactions in the face of stress than do other populations. - What we see from this, once again is that both bodily and psychological reactions to life events are often influenced by one’s culture. How Are Conversion and Somatic Symptom Disorder Treated? ●

People with these disorders usually seek psychotherapy only as a last resort. Because they believe that their problems are completely medical.

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When a physician tells them that their symptoms a psychological dimension, they often go to another physician.

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Eventually many patients with these disorders do consent to psychotherapy, psychotropic drug therapy, or both.

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Many therapists focus on the causes of these disorders (the trauma or anxiety tied to the physical symptoms) and apply insight, exposure, and drug therapies.

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Psychodynamic therapists try to help those with somatic symptoms become conscious of and resolve their underlying fears, thus eliminating the need to convert anxiety into physical symptoms.

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Cognitive-behavioral therapists alternaly use exposure treatments by exposing the client to features of the horrific event(s) that first triggered their physical symptoms.

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And biological therapists most often use antidepressant drugs to help reduce anxiety and depression in patients with these disorders....