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Psychology (Universiteit Stellenbosch)
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Summary 2019
Psychology 314
Rebecca JvR (19980329)
Week 1: Introduction
Lecture 1:
Psyche = mind or soul, Pathology = sickness or illness
Psychopathology = Abnormal behaviour / Mental illness / Psychological disorder
- Pain, distress, vulnerability. How we defend against it or cope with it.
How to Diagnose:
- List the signs and symptoms
o Signs = clinician’s objective findings and observations
o Symptoms = subjective experiences described by patient
- Evaluate information
- Differential diagnosis
o List of possible diagnoses to be considered in decreasing order of likelihood
- Working diagnosis
o Principal diagnosis
o Non-principal diagnosis
o Provisional diagnosis
o Diagnosis deferred
o Ruled-out diagnosis
- Double check DSM exclusion criteria
Example: Case of Dora
- List symptoms
- List signs
- Can you come up with a diagnosis?
- What are the advantages of diagnosis?
- What are the disadvantages of diagnosis?
Theoretical issues surrounding diagnosis and DSM-5
- Concept of abnormal / normal is subjective and interpretive
- Criteria for abnormal:
o Unusual = statistical – behaviours that deviate from the average
o Non-conformist = societal norms violated (can lead to relativism)
o Impairment (work and love) = interruption / restriction of daily life
o Distressing for others
o Distressing for self (sometimes it is appropriate to be sad or anxious)
- Factors to take into account when diagnosing:
o Age (developmental factors), Gender, Culture, What happened before (recent
trauma), Pattern / once-off, Explanation, How it affects others, Medical
factors, Context.
- History of DSM-5
o Sydenham (1624-1689) – ‘English Hippocrates’
 Classification in medicine
 Syndromes are:
 Recognisable clusters/patterns of Symptoms and signs that run
together in an evolving clinical history
 Helped to isolate distinct diseases with distinct causes
 Allowed specific treatments
 Allowed prediction of course.
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Summary 2019
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Psychology 314
Rebecca JvR (19980329)
o 18th and 19th century
 3 groups of mental illness
 Madness
 Disorders of mood
 Psychoses based on brain injury
 The many different classification systems that have developed differ in
their relative emphasis on phenomenology, aetiology and course as
defining features, as well as their number of diagnostic categories.
They differ in their principal objective being for use in a clinical /
research / administrative setting.
o Kraeplin (1917)
 Introduced Sydenham’s syndromal approach
 Collected life histories
 Three clusters of illnesses
o Freud
 Emphasis on dynamic unconscious (motives, wishes, memories,
fantasies)
 Sexual and aggressive
 Techniques: hypnosis, free association, dream interpretation
 Psychoanalysis dominates American Psychiatry
o DSM (1952)
 Very psychoanalytic, 108 categories, 8 headings
o DSM-II (1968)
 Revised to match ICD, Little interrater reliability, Diagnostic error
o DSM-III (1980)
 Goal: to make diagnosis more reliable, not based on clinical consensus
but on scientific evidence, no aetiology, claims that it is a-theoretical
and useful to clinicians from different theoretical backgrounds, not in
prose form, multi-axial, 265 mental disorders
o DSM-IV
DSM-5 Critique
o Categorical (between disorders, abnormal/normal, axes)
o Focused on the individual
o Clinical judgement still there
o Ignore strengths/resilience
o Danger of labelling
o Culturally specific
o Euro-American outlook
o Male perspective
o Symptom orientated
o No analysis of explanation (like naturalist’s field guide to birds)
o Situate problem in individual
o Context not taken into account (psychological response to adverse situation)
o False positives: level of impairment not correlated with symptom counts
(stems from individual and cultural factors)
o Neurophysiological bias vs importance of social-psychological variables
o Reductionist
o Medicalisation of human nature
o Drug companies
o Instruments of social control
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Summary 2019
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Psychology 314
Rebecca JvR (19980329)
o Political problems – Paraphilias, Hypoactive Sexual Desire Disorder.
DSM-5 advantages
o Communication
o Treatment and prevention
o 3rd party reimbursements
o Legal proceedings
o Predicting course / patterns of disease
o Advise to families
o Classify disorders not people
o Decision-making
o Prognostic implications
o Consumer protection
o Communication of empathy
o Forestalling flights from treatment
o Other
Lecture 2: Aetiological Models
Aetiology = study of origination or causation
Provides a framework for understanding symptoms and making decisions regarding diagnosis
and treatment.
Due to the complex and dynamic nature of disorders, aetiology does not provide direct
answers about causes.
No aetiological model is better than others
Strong focus on a cross-cultural, Southern African view of abnormal behaviour
- Biomedical perspectives
o The biomedical model claims that all mental illnesses have a biological cause
o Factors like social pressures, type of parenting, or other environmental factors
seen as secondary in the precipitation of mental disorders
o Biological abnormalities are understood to occur in four different areas:
 Genetic predisposition
 Abnormal functioning of neurotransmitters
 Endocrine dysregulation
 Structural abnormalities in the brain
- Psychological perspectives
o Psychodynamic approaches:
 Derived from Freud’s theory of psychoanalysis
 Behaviour is largely influenced by internal forces that exist outside
consciousness
 Psychological disorders emerge from conflict between the id, ego and
superego, as well as deficiencies in the ego
 Defence mechanisms are used to ward off excessive psychological
pain
 Contemporary approaches include the work of
 Melanie Klein – object relations
 John Bowlby – attachment theory
 Heinz Kohut – self psychology
 Donald Winnicott – the independents
 Intersubjective psychoanalysis and relational psychanalysis
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Psychology 314
Rebecca JvR (19980329)
o Behavioural / learning perspectives
 Based on the experiments of Pavlov, Watson & Skinner
 Behaviour is learned through processes and mechanisms like:
 Habituation – gradual adaption
 Sensitisation – extreme response to a stimulus
 Classical conditioning – association
 Operant conditioning – reinforcement
 Modelling (Bandura) – observation
 Dysfunctional behaviour develops because an individual learns
ineffective or dysfunctional responses or fails to learn appropriate,
adaptive behaviour.
o Cognitive-behavioural perspective
 Mental disorders are caused by aspects of the content of thoughts as
well as information-processing factors.
 Different perspectives, for example:
 Theory of helplessness (Seligman)
 Theory of hopelessness (Beck)
 Rational-emotive theory (Ellis)
 Beck’s cognitive theory of depression suggests that negative automatic
thoughts trigger a negative process of cognition, affect, and behaviour
o Humanistic and existential perspectives
 Emerged as a third force in psychology, opposing the determinism of
the psychodynamic and behaviourist approaches
 The humanistic approach (Rogers & Maslow) believes in a person’s
free will and ability to choose how to act.
 The existential approach (May & Laing) emphasises the uniqueness of
each individual and the quest for values and meaning.
Social perspectives
o Community psychology perspective
 Community psychology is ‘psychology of, with, and for the people’
 Focus is on preventing dysfunction, rather than just treating it.
 Broad social factors, e.g. social, political, and cultural context need to
be considered to fully understand development of psychological
problems
 Community psychologists in South Africa see their role as extending
beyond the traditional consulting room to include such diverse
practices as consciousness-raising, advocacy, and social upliftment.
o Importance of the socio-political context
 Socio-political factors impact on our mental health
 Role of apartheid:
 Impact of racist attitudes & policies
 Mental health system as inaccessible & discriminatory
 Mainly white psychologists and psychiatrists
 Historical discrimination in psychological testing (based on
racial groups) – lack of locally appropriate measures
 Training based on American-European models
(individual/therapy rather than collective)
 Cross-cultural challenges in diagnosis
 Limited mental health services in rural areas
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Summary 2019
Psychology 314
Rebecca JvR (19980329)
Cultural and cross-cultural perspectives
o Culture
 The way in which behaviour is shared, learned behaviour is transmitted
across generations
o Cultural psychology
 Began as the study of behaviour of people in diverse and unfamiliar
cultures that were conspicuously different from the investigator’s own
culture
 Recognises the cultural specificity of all human behaviour.
 Cultural handicaps can emerge when an individual moves out of his or
her original culture and tries to function, compete or succeed within
another culture.
Integrated perspectives
- Psychological disorders are most often caused by multiple factors acting in complex
& dynamic ways
- Biopsychosocial and diathesis-stress models provide broad theoretical frameworks,
demonstrating the multi-dimensional nature of psychopathology
- Biopsychosocial model
o Psychological disorders are caused by multiple biological, psychological and
social factors in interaction with each other
- Diathesis-stress model
o A diathesis (biological predisposition) interacts with a stressor, which together
cause a disorder to develop
Multidimensional models of abnormal behaviour
- Major influences
o Biological
o Behavioural
o Emotional
o Social and cultural
o Developmental
o Environmental
The role of emotion in psychopathology
- The nature of emotion
- To elicit or evoke action
- Action tendency different from affect and mood
- Components of emotion
- Behaviour, physiology and cognition
- Example of fear: Anxious thoughts, elevated heart rate, tendency to flee
Emotion has 3 important and overlapping components
- Emotion and Behaviour
o Basic patterns of emotional behaviour (freeze, escape, approach, attack) that
differ in fundamental ways
o Emotional behaviour is a means of communication
- Cognitive aspects of emotion
o Appraisals, attributions, and other ways of processing the world around you
that are fundamental to emotional experience
- Physiology of emotion
-
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Summary 2019
Psychology 314
Rebecca JvR (19980329)
o Emotion is a brain function involving (generally) the more primitive brain
areas
o Direct connection between these areas and the eyes may allow emotional
processing to bypass the influence of higher cognitive processes
Emotions and psychopathology
- Suppressing negative emotions increases sympathetic nervous system activity
- Dysregulated emotions are key features of many mental disorders
- Example: Panic attack = fear occurring at the wrong time
- Note: Main types of psychopathology are maintained by problematic reactions to our
own emotions. For example, people with social anxiety do not like the way they feel
in social situations, so they attempt to avoid these situations in order not to feel that
uncomfortable emotion
Culture, Gender, Social and Interpersonal Factors in psychopathology
- Cultural factors
- Influence the form and expression of behaviour
- Example: Children raised to be autonomous are less fearful
- Example: Culturally bound fears
- Susto (Latin America): symptoms of anxiety occurring when an individual believes
(s)he has been struck by black magic
- Gender effects
- Men and women may differ in emotional experience and expression
- Examples:
o 90% of insect-phobia sufferers are female
o Most bulimia sufferers are female
o Alcohol-use disorders are more common in men
o May be related to gender roles: Certain ways of coping with emotion are more
acceptable for men or women
- Effect of social support
- Low social support related to mortality, disease, and psychopathology
- Frequency and quality important
- Social support especially important in the elderly
Social stigma of psychopathology
- Culturally, socially and interpersonally situated
- Problems with social stigma
- May limit the degree to which people express mental health problems
- E.g. concealing feelings of depression – unable to receive support from friends
- May discourage treatment-seeking
Global incidence of psychological disorders
- Mental health accounts for 13% of the world’s disease burden
- Mental health care very limited in developing countries
- Sub-Saharan Africa: only one psychiatrist per 2 million people
- Even in the USA, only 1 in 3 people with a mental disorder has received any
treatment
Conclusion
- Psychological disorders are complex and most often caused by multiple factors acting
in complex and dynamic ways
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Summary 2019
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Psychology 314
Rebecca JvR (19980329)
In South Africa, we need to adopt a more critical and holistic understanding of
psychosocial dysfunction
Need to consider the broader social context to fully understand the development of
psychological problems
Psychologists should be familiar with traditional African beliefs and practices
Lecture 3:
Important factors
- Affect, Intersubjective space, Defences, History, Context, Discourse, Body,
Emotional convictions, Self, Language
Contextual factors to take into account
- Age (developmental factors), gender, culture, what happened before: recent trauma,
Pattern or once-off, Explanation, How it affects others, Medical factors, class
Psychological disorder
- Psychological dysfunction within an individual associated with distress or impairment
in functioning and a response to this that deviates from that individual’s culture
Psychiatric diagnosis
- Practitioners of the latter approach categorise patients according to common
behavioural and phenomenological features. They develop symptom checklists that
allow them to classify patients according to similar clusters of symptoms. The
patient’s subjective experience is peripheral to the essence of psychiatric diagnosis
and treatment, which must be based on observable behaviour….the descriptive
psychiatrist is primarily interested in how a patient is similar to rather than different
from other patients with congruent features.
History
- The pre-scientific era
o Initial belief that abnormal behaviour was caused by supernatural forces
o Hippocrates – first biological view
 Brain is the centre of wisdom, consciousness, intelligence and emotion
 Changes in behaviour = changes in the brain
 Abnormal behaviour = result of physical disease
o Galen: humours of the brain
o Galenic-Hippocratic tradition
 Linked abnormality with brain chemical imbalances
 Foreshadowed modern views
o Middle Ages: Move away from biological views – mental illness considered
punishment for sin (thus people had to be exorcised)
 Some still believe this today (e.g. HIV/AIDS)
 Institutionalisation on the increase – inhumane treatment in asylums
 Around 1800: reforms in treatment of the mentally ill
- The scientific era
o Shift back to a biological approach
o Noted that syphilis produced the same symptoms as a mental disorder but the
cause is biological (bacterial micro-organism)
 Supported the view that mental illness = physical illness
 Provided a biological basis for madness
- 18th and 19th century
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Summary 2019
Psychology 314
Rebecca JvR (19980329)
o 3 groups of mental illness
 Madness, Disorders of mood, Psychoses based on brain injury
- Kraeplin (1917)
o Used biological tradition to classify psychopathology
o Reduced complex psychiatric taxonomies of the 19th century
o Believed brain pathology is the cause
o Divided into 2 classes
 Manic depressive psychosis (Bipolar)
 Dementia Praecox (Schizophrenia)
- Freud
o Emphasis on dynamic unconscious (motives, wishes, memories, fantasies)
o Sexual and aggressive
o Techniques: hypnosis, free association, dream interpretation
o The importance of defence mechanisms
o Psychoanalysis dominates American psychiatry
- Behavioural theory
o John Watson, Pavlov, Skinner
o Disorder is the result of learned behaviour
- The 1950s
o Medications becoming increasingly available
o Included neuroleptics (antipsychotics, e.g. reserpine) and major tranquillizers
Classification of mental illness
- International classification of diseases (ICD)
o Published by WHO
o Includes a section on psychiatric conditions
- The Diagnostic and Statistical Manual of mental disorders (DSM)
o Published by APA
o Solely focused on mental health disorders
- Aim of the manuals
o Develop replicable and clinical useful categories and criteria
o Facilitate consensus and agreed standards
- DSM-IV
o DSM-IV (1994) & DSM-IV (Text revision 2000)
o Number of disorders grew to 400
o Minimum number of symptoms from a list determines the presence or absence
of the disorder
o Multi-axial diagnostic system
o Based on biomedical model
o Signs and symptoms grouped together to identify the pathological cause or
syndrome
- DSM-IV-TR: Multi-axial diagnostic system
o Axis 1: Clinical disorders
o Axis 2: Personality disorders, Mental retardation
o Axis 3: General Medical Conditions
o Axis 4: Social functioning and impact of symptoms
o Axis 5: Global assessment of functioning
- DSM-5
o Also attempts to address the structural problems of previous editions
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Summary 2019
Psychology 314
Rebecca JvR (19980329)
o In answer to the criticism levelled at the large number of narrow diagnostic
categories in the previous editions, DSM-5 makes use of scientific indicators
to inform new groupings of related disorders within the existing categorical
framework
o Ongoing revisions of DSM-5 will make it a living document, adaptable to
future discoveries in neurobiology, genetics and epidemiology.
o DSM-5 is organised on developmental and lifespan considerations, beginning
with disorders that first manifest in early childhood, followed by disorders that
manifest in adolescence and early adulthood, and ending with disorders
relevant to adulthood and later life
o In contrast to previous editions that made use of a multi-axial system of
diagnosis, DSM-5 utilises a non-axial documentation of diagnosis (previously
axes 1, 2 and 3)
o Allows separate notations for key psychosocial and contextual factors
(previously axis 4) and disability (previously axis 5)
o This addresses the criticism that previous editions implied that medical
conditions were unrelated to behavioural and psychosocial factors
DSM-IV categories
ICD-10 categories
Neurodevelopmental Disorders
(Childhood emotional disorders are incorporated under
Depressive Disorders, Anxiety Disorders, ObsessiveCompulsive Disorders, Trauma and Stressor Related
Disorders, Feeding and Eating, Elimination and Disruptive,
Impulse Control and Conduct Disorders)
Behavioural and emotional
disorders with onset usually
occurring in childhood and
adolescence
Mental retardation
Disorders of psychological
development
Neurocognitive Disorders
Organic, including
symptomatic, mental
disorders
Substance-related and Addictive Disorders
Mental and behavioural
disorders due to
psychoactive substance use
Schizophrenia Spectrum and other psychotic disorders
Schizophrenia, schizotypal,
and delusional disorders
Bipolar and Related Disorders
Depressive Disorders
Mood (affective) disorders
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Summary 2019
Psychology 314
Rebecca JvR (19980329)
Anxiety disorders
Obsessive-Compulsive and Related Disorders
Trauma- and Stressor Related Disorders
Somatic Symptom Disorders
Dissociative disorders
Neurotic, stress-related, and
somatoform disorders
Feeding and Eating Disorders
Sleep – Wake Disorders
Sexual Dysfunction
Gender Dysphoria
Behavioural syndromes
associated with
physiological disturbances
and physical factors
Personality disorders
Disruptive, Impulse Control and Conduct Disorders
Disorders of adult
personality and behaviour
Clinical assessment and diagnosis
- Clinical assessment
o The evaluation and measurement of psychological, biological and social
factors in individuals who present with possible psychological disorders
- Diagnosis = process whereby:
o A clinician determines whether the particular problem with which the
individual presents meets all criteria for psychological disorder as described in
the DSM-IV-TR or ICD-10
- Clinician begins with collecting a wide range of information
- First step: ask patient what is wrong (establish presenting problem)
- If more than one, rank problems from most important to least
- Take full history and record other relevant facts
- Note observable signs (e.g. fidgeting, eye contact etc.)
- Identify any evidence of a medical condition that could explain the problem before
diagnosis of psychological disorder
- May need to do neurological examination
- Determine individual’s mental condition (state)
o Orientation to time/place/person
o Attention span, concentration, and memory
o Helps make provisional diagnosis
- From list of possible (differential) diagnoses, diagnostician identifies most likely
diagnosis, based on symptoms (subjective) and signs (objective)
- The clinical interview
o 1st step of process
 Allows the diagnostician to obtain
 Detailed description of the presenting problem
 History of patient’s life, current situation, and social history
 Info about attitudes, emotions and current and past behaviour
 Family history
 Info about when problem started, significant events around that
time
- Mental status examination (MSE)
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Psychology 314
Rebecca JvR (19980329)
o Involves systematic observation of patient’s behaviour
o Structured and detailed (but quite quick)
o 5 categories:
 Appearance and behaviour (e.g. dress, posture, appearance)
 Thought processes (e.g. conversation, rate/flow of speech)
 Mood and affect (mood is subjective, affect is what the clinician
observes)
 Intellectual functioning (abstractions, understanding of metaphors,
memory)
 Sensorium (awareness of surroundings: orientation –
time/person/place)
o Enables diagnostician to establish which areas of patient’s behaviour and
condition should be assessed in more detail
Behavioural assessment (observe, measure, systematically evaluate in actual setting)
Medical assessment (vitals, ENT)
Psychological testing
o Projective testing
(ambiguous content reveal
unconscious conflict)
o Structured tests (MMPI,
JSAIS, SAIS)
Neuropsychological assessment
(Bender visuo motor)
Collateral information 
Arriving at a diagnosis: The use of
diagnostic classification systems
- Ultimate goal of assessment: Arrive
at a dimensional diagnosis
- Need: minimum number and
duration of symptoms
- There is often overlap between
symptoms in disorders
- Differential diagnosis: List all
possible disorders, often includes comorbid disorders
- Final diagnosis communicates information to other professionals about patient,
treatment and prognosis
Summary
- Assessment and diagnosis involves complex and time-consuming procedures
- Requires:
o Investigative and deductive reasoning
o Technical skills
o Sensitivity to person’s cultural background
- Thus, training (and experience) are essential to avoid misdiagnosis
- Diagnosis
o Provides guide to treatment
o Helps understand prognosis
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Summary 2019
Psychology 314
Rebecca JvR (19980329)
Week 2: Anxiety, Trauma, Stressor-related and Obsessive-Compulsive
disorders
Anxiety disorders
This is a large group of disorders that share common elements – the role of anxiety and fear.
These are some of the most common types of mental disorders. We will discuss specific ones
in more detail as we progress through the chapter. In the past, all of the disorders in these
chapters were called ‘anxiety’. Now they have been divided into categories that have their
own focus. Anxiety and fear, like all emotions, are useful and adaptive in moderation. They
become psychological disorders when they are out of proportion to the actual situations a
person is encountering.
Anxiety, fear and panic: some definitions
- Fear
o Immediate, present-oriented
o Sympathetic nervous system activation in response to current danger
o Example = Jumping out of the way if you see a snake approaching
o Strong escapist tendencies
- Anxiety
o Apprehensive, future-oriented, no actual danger
o Somatic symptoms: Muscle tension, restlessness, elevated heart rate
o Example = worrying about encountering snakes on an upcoming hike (worry
about the possibility of uncontrollable danger or misfortune
- Both = negative effect
- Panic attack – abrupt experience of intense fear
o Alarm response of fear, but no actual danger
o Physical symptoms: Heart palpitations, chest pain, dizziness, sweating, chills
or heat sensation etc.
o Cognitive symptoms: Fear of losing control, dying or going crazy
o Two types
 Expected (situation-specific)
 Unexpected (without warning)
o Panic attacks come on suddenly, they typically reach a peak within ten
minutes and they are accompanied by uncomfortable physical sensations and
catastrophic thoughts. People may also experience ‘limited symptom
episodes’, or panic attacks that have only a few symptoms (less than four in
total). Panic attacks are very common. Most people have at least one panic
attack in their lives. People with severe anxiety may have multiple panic
attacks every day. Unexpected attacks occur out of the blue – they could come
up when you’re just watching TV at home. Expected attacks may be cued by
certain situations (e.g. public speaking), especially in places where a person
has had an attack in the past (e.g. while driving in the location of a previous
panic attack).
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Summary 2019
Psychology 314
Rebecca JvR (19980329)
Diagnostic criteria for panic attack
An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes
and during which time four (or more) of the following symptoms occur:
1. Palpitations, pounding heart or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, light-headed or faint
9. Chills or heat sensations
10. Paraesthesias (numbness or tingling sensations)
11. Derealisation (feelings of unreality)
12. Depersonalisation (being detached from oneself)
13. Fear of losing control or going crazy
14. Fear of dying
Biological contributions to anxiety
- Increased physiological vulnerability
o Polygenetic influences
 Corticotropin-releasing factor (CRF)
 Important because it activates the hypothalamic-pituitaryadrenocortical (HPA) axis which impacts anxiety
o Brain circuits and neurotransmitters
 GABA (Gamma-Aminobutyric Acid)
 Lower levels of GABA are associated with more anxiety
 Noradrenergic
 Serotonergic systems
 The above 2 refer to the release of the neurotransmitters
noradrenaline (also called norepinephrine) and serotonin.
Deficits in noradrenaline and serotonin are linked to greater
anxiety
o Limbic system
 Mediates between the brainstem (lower order structure) and cortex
(higher order structure); the brainstem senses changes in bodily
function and communicates danger signals via the limbic system to the
more cognitive cortex
 Behavioural inhibition system (BIS)
 Part of the limbic system. It is activated by signals from the
brainstem about unexpected events and signals from the cortex
about perceived danger, which travel to the septal-hippocampal
system
 Fight/flight (FFS) system
 Panic circuit
 Alarm and escape response
o Brain circuits are shaped by environment
 Example: teenage cigarette smoking – teenage smoking is linked to
increased risk of developing anxiety and panic
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Psychology 314
Rebecca JvR (19980329)
 Interactive relationship with somatic symptoms
Psychological contributions
- Freud
o Anxiety = psychic reaction to danger
o Reactivation of infantile fear situation
- Behaviourists
o Classical and operant conditioning – symptoms are a result of learnt
associations
o Modelling – anxious or avoidance behaviour has been modelled and learned
- Beliefs about control over the environment
- Early life experiences give us a sense of greater or lesser control over the
environment, leading to less or more anxiety
- Emotional and cognitive influences
o Heightened sensitivity to situations or people perceived as threats
o Unconscious feeling that physical symptoms of panic are catastrophic
(intensifies physical reactions)
Social contributions
- Biological vulnerabilities triggered by stressful life events
o Family
o Interpersonal
o Occupational
o Educational
- Social support reduces intensity of physical and emotional reactions to triggers or
stress – lack of social support intensifies symptoms
An integrated model
- Triple vulnerability
o The 3 vulnerabilities that contribute to the development of anxiety disorder
after experiencing a stressful situation
o Generalised biological vulnerability
 Diathesis
 Heritable contribution to negative affect
 Glass is half empty, irritable, driven
o Generalised psychological vulnerability
 Beliefs / perceptions
 Sense that events are uncontrollable/unpredictable
 Tendency towards lack of self-confidence, low self-esteem, inability to
cope
o Specific psychological vulnerability
 Learning / modelling
 E.g. physical sensations are potentially dangerous
 Anxiety about health, nonclinical panic
Comorbidity of anxiety and related disorders
- High rates of comorbidity
o 55% to 76%
- Commonalities
o Features & Vulnerabilities
- Links with physical disorders
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Summary 2019
Psychology 314
Rebecca JvR (19980329)
Comorbidity = meeting diagnostic criteria for multiple disorders at the same time. In
people with anxiety, major depression is the most common additional disorder. People
are more likely to have anxiety if they have GI conditions, migraines, arthritis and
allergies
Suicide
- Suicide attempt rates
o Similar to major depression
o 20% of panic patients attempt suicide
- Increases for all anxiety disorders
- Comorbidity with depression
Treatment principles for anxiety disorders
- Cognitive-Behavioural Therapy
o Systematic exposure to anxiety-provoking situations and thoughts
o Learning to substitute positive behaviours and thoughts for negative ones
o Learning new coping skills: Relaxation, controlled breathing etc.
- Medicinal
o Reduces the symptoms of anxiety by modifying neurotransmission
 Antidepressants
 Benzodiazepines (limited to symptomatic relief)
- Other
o Managing stress through a healthy lifestyle: rest, exercise, nutrition, social
support and moderate alcohol or other substance intake
Specific anxiety disorders
- Generalised anxiety disorder
-
Diagnostic criteria for generalised anxiety disorder
A. Excessive anxiety and worry (apprehensive expectation) about a number of events or
activities (such as work or school performance) occurring on more days than not for at
least 6 months
B. The individual finds it difficult to control the worry
C. The anxiety and worry are associated with at least three (or more) of the following 6
symptoms: (with at least some symptoms present for more days than not for the past 6
months – only one item is required in children)
1.
2.
3.
4.
5.
6.
Restlessness or feeling keyed up or on edge
Being easily fatigued
Difficulty concentrating or mind going blank
Irritability
Muscle tension
Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)
D. The anxiety, worry or physical symptoms cause clinically significant distress or
impairment in social, occupational or other important areas of functioning.
E. The disturbance is not due to the direct physiological effects of a substance (such as a
drug of abuse, a medication) or a general medical condition (such as hyperthyroidism)
F. The disturbance is not better explained by another mental disorder (such as anxiety or
worry about having panic attacks in PD, negative evaluation in SAD)
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o Clinical description
 Shift from possible crisis to crisis
 Uncontrollable unproductive worrying about everyday events
 Worry about minor, everyday concerns (unable to stop the worry)
 Job, family, chores, appointments
 Leads to behaviours such as procrastination, over-preparation
o GAD in children
 Needs only one physical symptom
 Worry (academic, social, athletic performance)
o Statistics
 3.1% meet criteria during any one-year period
 5.7% meet criteria at some point during lifetime
 Similar rates worldwide
 Insidious onset (comes on slowly, no obvious symptoms at first)
 Early adulthood
 Chronic course
o GAD in the elderly
 Worry about failing health, loss
 Up to 10% prevalence
 Use of minor tranquillisers: 17-50%
 Sometimes prescribed from medical problems or sleep
problems
 Increase risk of falls and cognitive impairments
o Causes
 Inherited tendency to become anxious
 Neuroticism - Tendency to experience more frequent and more intense
negative affect and to react to this affect with avoidant coping.
Cognitive activity in the
left frontal lobe serves to
avoid distressing worry
images that would
otherwise be activated in
the right frontal lobe
 Less responsiveness
 Autonomic
restrictors – natural
responses to
improve bodily
situation during
stress
 Threat sensitivity
 Frontal lobe activation
 Left vs right
 Both genetic and
psychological
vulnerabilities
o Summary of causes 
o Management
 Pharmacological
 Benzodiazepines
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o Provide fast-acting relief, but there is limited support
for long-term use and they lead to minor cognitive and
motor impairment
o Risks vs benefits
 Antidepressants
 No more effective than placebo in the long term
 Psychological
 Similar benefits as drugs and better long-term results
 Cognitive-behavioural
o Exposure to worry process
o Confronting anxiety-provoking images
o Coping strategies
 Acceptance
 Meditation
 Successful treatment may help individuals focus on what is
really threatening to them in their lives
Panic disorder and agoraphobia – anxiety focused on the next panic attack
o Clinical description
 Were previously coupled together
 Unexpected panic attacks
 Anxiety, worry or fear of another attack
 Persists for one month or more
 Agoraphobia
 Fear or avoidance of situations/events where it would be unsafe
to have a panic attack (Can in the extreme be inability to leave
a room or the house)
 Concern about being unable to escape or get help in the event
of panic symptoms or other unpleasant physical symptoms (e.g.
incontinence, vomiting, falling)
 Can continue for years even if no other attacks happen. Can
develop in the absence of panic attacks or panic-like symptoms.
 Avoidance can be persistent
 Use and abuse of drugs and alcohol
 Interoceptive avoidance - Avoiding activities that might bring on
physical sensations reminiscent of panic (e.g. exercise, sex, caffeine,
anger, exhilarating movies, amusement park rides)
o Statistics
 2.7% meet criteria during any one-year period
 4.7% meet criteria at some point during lifetime
 Female/male ratio = 2:1
 Acute onset, most common in young adulthood (e.g. ages 20-24)
o Special populations
 Children
 Hyperventilation is a common symptom
 Earlier cognitive development leads to fewer cognitive
symptoms (e.g. less fear of dying)
 Elderly
 Health focus is more common
 Changes in prevalence – decreases with age
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Diagnostic criteria for panic disorder
A. Recurrent unexpected panic attacks are present
B. At least one of the attacks has been followed by one month or more of one or both of
the following: (a) persistent concern or worry about additional panic attacks or their
consequences (e.g. losing control, having a heart attack, going crazy) or (b) A
significant maladaptive change in behaviour related to the attacks (e.g. behaviours
designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar
situations)
C. The disturbance is not attributable to the physiological effects of a substance (e.g. a
drug of abuse, a medication) or another medical condition (e.g. hyperthyroidism,
cardiopulmonary disorders)
D. The disturbance is not better explained by another mental disorder (e.g. the panic
attacks do not occur only in response to feared social situations, as in SAD)
Diagnostic criteria for agoraphobia
A. Marked fear or anxiety about 2 or more of the following 5 situations: public
transportation, open spaces, enclosed places, standing in line or being in a crowd, being
outside the home alone
B. The individual fears or avoids these situations due to thoughts that escape might be
difficult or help might not be available in the event of developing panic-like symptoms
or other incapacitating or embarrassing symptoms (e.g. fear of falling in the elderly,
fear of incontinence)
C. The agoraphobic situations almost always provoke fear or anxiety
D. The agoraphobic situations are actively avoided, require the presence of a companion or
are endured with intense fear or anxiety
E. The fear or anxiety is not proportionate to the actual danger posed by the agoraphobic
situations or to the sociocultural context
F. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more
G. The fear, anxiety or avoidance causes clinically significant distress or impairment in
social, occupational or other important areas of functioning
H. If another medical condition is present (e.g. inflammatory bowel disease, Parkinson’s
disease) the fear, anxiety or avoidance is clearly excessive
I. The fear, anxiety or avoidance is not better explained by the symptoms of another
mental disorder, e.g. The symptoms are not confined to specific phobia, situational
type; do not involve only social situations (as in SAD) and are not related exclusively to
obsessions (as in obsessive-compulsive disorder (OCD)), perceived deficits or flaws in
physical appearance (as in body dysmorphic disorder (BDD)), reminders of traumatic
events (as in PTSD), or fear of separation (as in separation anxiety disorder).
o Social/gender roles
 More than 75% of those with agoraphobia are female
o Cultural factors
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Similar prevalence rates across cultures
Variable symptom expression
 In developing countries somatic symptoms are more
emphasised than emotional symptoms
o Cultural influences
 Susto – Spanish, Individual suffering from fright that is thought to
have caused the soul to leave the body, which causes the psychological
and physical symptoms
 Ataque de nervios – Latino-specific, intense emotional upset, acute
anxiety, anger, grief. Screaming and shouting uncontrollably, crying,
trembling, heat sensations etc.
 Kyol goeu – “Wind overload” – found among Khmer refugees in the
US. Fainting syndrome that leads to panic and constant anxious
scanning of the body
o Nocturnal Panic
 60% with panic disorder experience nocturnal attacks
 Occur in non-REM sleep and during delta/slow-wave sleep
 Caused by deep relaxation
 Sensations of letting go are anxiety provoking to people who
experience panic attacks
 Sleep terrors
 Childhood condition of intense fear in the middle of the night,
often involves screaming and getting out of bed, but the
children don’t wake up and don’t remember it the next day
 Isolated sleep paralysis
 Temporarily unable to move when transitioning from sleep to
wake, accompanied by surge of terror and occasional
hallucination
o Causes
 Generalised biological
vulnerability
 Alarm reaction to
stress – genetic
vulnerability to
stress
 Cues get associated with
situations and
conditioning occurs
 Generalised psychological
vulnerability
 Anxiety about
future attacks
 Hypervigilance
 Increase interoceptive awareness
o Management
 Medications
 Multiple systems affected by medication
o Serotonergic
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o Noradrenergic
o GABA
 Benzodiazepines (e.g. Ativan)
 SSRIs (e.g. Prozac and Paxil)
 High relapse rates after discontinuation of medication
 Psychological intervention
 Exposure-based
 Reality testing
o Testing patient’s hypothesis that they can’t handle an
anxiety-provoking situation by entering the situation
and discovering that it is survivable
 Relaxation and breathing skills
 Example: Panic control treatment (PCT)
o Exposure to interoceptive cues (cluster of sensations
that remind them of their panic attacks)
o Cognitive therapy
o Relaxation/breathing
o High degree of efficacy
 Combined psychological and drug treatments
 No better than CBT or drugs alone
 CBT is better in long term
Specific phobia
o Clinical description
 Extreme and irrational fear of a specific object or situation that triggers
an attack
 Feared situation almost always provokes anxiety
 Significant impairment or distress
Diagnostic criteria for specific phobia
A. Marked fear or anxiety about a specific object or situation (e.g. flying, heights, animals,
receiving an injection, seeing blood)
B. The phobic object or situation almost always provokes immediate fear or anxiety. Note:
in children, the anxiety may be expressed by crying, tantrums, freezing or clinging.
C. The phobic object or situation is actively avoided or endured with intense fear or anxiety
D. The fear or anxiety is out of proportion to the actual danger posed by the specific object
or situation, and to the sociocultural context
E. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more
F. The fear, anxiety or avoidance causes clinically significant distress or impairment in
social, occupational or other important areas of functioning
G. The disturbance is not better explained by the symptoms of another mental disorder,
including fear, anxiety and avoidance of: situations associated with panic-like symptoms
or other incapacitating symptoms (as in agoraphobia), objects or situations related to
obsessions (as in OCD), reminders of traumatic events (as in PTSD), separation from
home or attachment figures (as in separation anxiety disorder) or social situations (as in
SAD)
Specify type: Animal, Natural Environment, Blood-injection-injury, situational
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Specific type
 Animal
o Dogs, snakes, mice, insects
o May be associated with real dangers
o Onset – usually in childhood
 Natural environment (e.g. heights, storms, water)
o May cluster together
o Associated with real dangers
o Onset – usually in childhood
 Blood-injection-injury
o Decreased heart rate and blood pressure when seeing
blood, injections or injury
o Fainting
o Inherited vasovagal response
o Onset – usually in childhood
 Situational (e.g. planes, elevators, enclosed places)
o No uncued panic attacks
o Fear centres around risks of the situation rather than
having a panic attack
o Onset is usually early- to mid-20s
 Other (e.g. phobic avoidance of situations that may lead to
choking, vomiting or contracting an illness, or in children –
avoidance of loud sounds or costumed characters)
o Statistics
 8.7% meet criteria during any
one-year period
 12.5% meet criteria at some
point during lifetime
 Female/male ratio = 4:1
 Chronic course
 Onset – most often in
childhood

o Causes
 Direct experience
 Vicarious experience – seeing someone else encounter a feared object
 Information transmission – learning about a situation/object being
dangerous
 ‘Preparedness’
 It is easier for us to acquire phobia of things that would have
been for our ancestors to fear (e.g. more likely to fear spiders
and snakes than buses, although the latter are more dangerous)
in other words, through natural selection, we have been
prepared to fear certain things more than others
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o Management
 Cognitive-behaviour therapies
 Exposure
o Graduated
o Structured
o Systematic progression through hierarchy of feared
situations related to phobia. E.g. someone who fears
spiders would first look at pictures of spiders, then
watch videos of spiders, then be in a room with a spider
in a cage, then approach the cage, then touch the spider
etc. Each level of hierarchy may be repeated until the
person’s anxiety decreases
 Relaxation – used to be practised more, but now often not a
part of empirically supported treatment
Social anxiety disorder (social phobia)
o Clinical description
 Extreme/irrational concern about being negatively evaluated by other
people
 Sometimes (not always) manifests as shyness
 Leads to significant impairment and/or distress
 Avoidance of feared situations, or endurance with extreme distress
 Subtype
 Performance only: anxiety only in performance situations (e.g.
public speaking)
o Tends to be less interfering because individuals are able
to function in most social situations without a problem.
Both subtypes are often associated with
professional/educational impairment (e.g. not speaking
up at meetings, avoiding classes that require
presentations)
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Diagnostic criteria for social phobia (anxiety) disorder
A. Marked fear or anxiety about one or more social situations in which the person is
exposed to possible scrutiny by others. Examples include social interactions (e.g.
having a conversation, meeting unfamiliar people), being observed (e.g. eating or
drinking) or performing in front of others (e.g. giving a speech) Note: in children, the
anxiety must occur in peer settings and not just in interactions with adults
B. The individual fears that he or she will act in a way, or show anxiety symptoms, that
will be negatively evaluated (i.e. will be humiliating, embarrassing, lead to rejection or
offend others)
C. The social situations almost always provoke fear or anxiety. Note: in children, the fear
or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking or failing
to speak in social situations
D. The social situations are avoided, or endured with intense fear or anxiety
E. The fear or anxiety is out of proportion to the actual threat posed by the social situation,
and to the sociocultural context
F. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more
G. The fear, anxiety or avoidance causes clinically significant distress or impairment in
social, occupational or other important areas of functioning
H. The fear, anxiety or avoidance is not attributable to the effects of a substance (e.g. a
drug of abuse, a medication) or another medical condition
I. The fear, anxiety or avoidance is not better explained by the symptoms of another
mental disorder, such as PD (e.g. anxiety about having a panic attack) or separation
anxiety disorder (e.g. fear of being away from home or a close relative)
J. If another medical condition (e.g. stuttering, Parkinson’s disease, obesity, disfigurement
from burns or injury) is present, the fear, anxiety or avoidance is clearly unrelated or is
excessive
K. Specify if performance only – if the fear is restricted to speaking or performing in
public
o Statistics
 6.8% meet criteria during any one-year period
 12.1% meet criteria at some point during lifetime
 Female/male ratio = 1:1
 Onset – usually adolescence
 Peak age of onset – 13
 More common in people who are young (18-29 years), undereducated,
single and of low socioeconomic class
 13.6% prevalence in ages 18 - 29
 6.6% prevalence in ages 60+
o Across cultures
 Japan – taijin kyofusho
 Fear of offending others or making them uncomfortable
 Concern about aspects of personal appearance (e.g. stuttering,
blushing, body odour)
 More common in males
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o Causes
 Generalised psychological vulnerability
 E.g. belief that threatening events are uncontrollable
 Generalised biological vulnerability
 E.g. propensity for anxiety
 Just as we are prepared to fear dangerous animals, we are also prepared
to fear angry or rejecting people. It’s evolutionarily useful to worry
about
social
rejection,
because
we are
more
likely to
survive if
we are
socially
accepted
o Medications
 Benzodiazepines
 More commonly prescribed for performance-only social
anxiety
 SSRIs (Paxil, Zoloft and Effexor)
 More commonly prescribed for generalised social anxiety
 D-cycloserine (DCS)
 An antibiotic
originally used to
treat tuberculosis. It
is a cognitive
enhancer that
improves extinction
learning (the learning
that occurs when
someone is engaged
in exposure therapy,
learning about their
ability to cope with feared situations. Some studies have shown
that DCS improves outcomes when given to social anxiety
patients doing exposures
 Psychological
 Cognitive-behavioural
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o Challenging of anxious thoughts about the
consequences of social judgement
o Exposure to anxiety-provoking situations
o Rehearsal
o Role-play
 Highly effective
- Separation anxiety disorder (new)
o Clinical description
 Characterised by unrealistic and persistent worry that something will
happen to self or loved ones when apart (e.g. kidnapping, accident) as
well as anxiety about leaving loved ones
 4.1% of children meet criteria, 6.6% of adults
 Used to diagnose children only, but now may be diagnosed in adults.
Loved one from whom separation is feared usually has some
caretaking responsibility for affected individual (e.g. spouse, parent). It
is not common to see parents fearing separation from their children, for
example. If a parent has pathological worry about harm coming to their
child, it would more likely be diagnosed as part of GAD.
- Selective mutism (new)
o Clinical description
 Rare childhood disorder characterised by a lack of speech
 Must occur for more than one month and cannot be limited to the first
month of school
 High comorbidity with SAD
 Management
 CBT most effective, similar to management of SAD
General: Phobias (avoid situations that produce severe anxiety and/or panic) = Agoraphobia,
Specific Phobia, Social Anxiety (social phobia).
Trauma- and Stressor-related disorders and Obsessive-Compulsive disorders
-
Posttraumatic stress disorder
o Clinical description
 Trauma exposure
 Continued re-experiencing
 E.g. memories, nightmares, flashbacks
 Avoidance of thoughts or images of past traumatic experiences
 Emotional numbing
 Reckless or self-destructive behaviour
 Interpersonal problems
 Refers to problems that persist for more than one month after the
trauma
 Acute stress disorder assigned for post-traumatic symptoms
lasting less than a month
 In the DSM, traumatic exposure means experiencing or witnessing an
event in which death, serious injury or sexual violation occurred or was
threatened to the self or someone else OR learning about violent or
accident death or serious injury occurring to a close loved one, OR
extreme aversive exposure to details of a traumatic event (such as a
first responder collecting body parts at the scene of an explosion)
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o Statistics
 3.5% meet criteria during any one-year period
 6.8% meet criteria at some point during lifetime
 Prevalence varies
 Most people who undergo traumatic events do not develop
PTSD
 Type of trauma
o E.g. experiencing repeated sexual assault makes an
individual 2 or 3 times as likely to develop PTSD
 Proximity – more likely to develop PTSD if closer to the
trauma
o Causes
 Trauma intensity – PTSD more likely with severe trauma
 Generalised biological vulnerability
 Twin studies
o When both twins are exposed to trauma (as in combat),
identical twins have higher concordance rates for PTSD
compared to fraternal twins. Certain genes are
associated with greater likelihood of developing PTSD
 Reciprocal gene-environment interactions
 Generalised psychological vulnerability
 Beliefs about uncontrollability and unpredictability of
threatening situations
 Poor social support = greater risk
Diagnostic criteria for Post-Traumatic Stress Disorder
A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or
more) of the following ways:
1. Directly experiencing the traumatic events
2. Witnessing in person the event(s) as they occurred to others
3. Learning that the events occurred to a close relative or close friend. In case of actual
or threatened death of a family member or friend, the event(s) must have been violent or
accidental
4. Experiencing repeated or extreme exposure to aversive details of the traumatic
event(s) (e.g. first responders collecting human remains, police officers repeatedly
exposed to details of child abuse)
Note: Does not apply to exposure through electronic media, television, movies or pictures,
unless this exposure is work-related
B. Presence of one or more of the following intrusion symptoms associated with the
traumatic events, beginning after the traumatic event(s) occurred:
1. Recurrent, involuntary and intrusive distressing memories of the traumatic event(s).
Note: In young children, repetitive play may occur in with themes or aspects of the
traumatic event(s) are expressed
2. Recurrent distressing dreams in which the content and/or affect of the dream are
related to the traumatic event(s). Note: In children, there may be frightening dreams
without recognisable content
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3. Dissociative reactions (e.g. flashbacks) in which the individual feels or acts as if the
traumatic event(s) were recurring (such reactions occur on a continuum, with the most
extreme expression being a complete loss of awareness of present surroundings) Note:
In young children, trauma-specific re-enactment may occur in play
4. Intense or prolonged psychological distress at exposure to internal or external cues
that symbolise or resemble an aspect of the traumatic event(s)
5. Marked physiological reactions to internal or external cues that symbolise or
resemble an aspect of the traumatic event(s)
C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after
the traumatic event(s) occurred, as evidenced by the one or both of the following
1. Avoidance of or efforts to avoid distressing memories, thoughts, feelings, or
conversations about or closely associated with the traumatic event(s)
2. Avoidance of or efforts to avoid external reminders (people, places, conversations,
activities, objects, situations) that arouse distressing memories, thoughts or feelings
about or closely associated with the traumatic event(s)
3. Inability to recall an important aspect of the trauma
4. Markedly diminished interest or participation in significant activities
5. Feeling of detachment or estrangement from others
6. Restricted range of affect (e.g. unable to have loving feelings)
7. Sense of a foreshortened future (e.g. does not expect to have a career, marriage,
children or a normal life span)
D. Negative alterations in cognitions and mood associated with the traumatic event(s),
beginning or worsening after the traumatic event(s) occurred, as evidenced by 2 (or more)
of the following
1. Inability to remember an important aspect of the traumatic event(s) typically due to
dissociative amnesia and not to other factors such as head injury, alcohol or substance
abuse)
2. Persistent and exaggerated negative beliefs or expectations about oneself, others or
the world (e.g. ‘I am bad’, ‘no one can be trusted’, ‘the world is completely dangerous’,
‘My whole nervous system is permanently ruined’)
3. Persistent distorted cognitions about the cause or consequences of the traumatic
event(s) that lead the individual to blame himself/herself or others
4. Persistent negative emotional state (e.g. fear, horror, anger, guilt or shame)
5. Markedly diminished interest or participation in significant activities
6. Feelings of detachment or estrangement from others
7. Persistent inability to experience positive emotions (e.g. inability to experience
happiness, satisfaction or loving feelings)
G. Duration of the disturbance (criteria B, C, D and E) is more than one month
F. The disturbance causes clinically significant distress or impairment in social,
occupational or other important areas of functioning
Specify if:
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With delayed expression: If the diagnostic threshold is not exceeded until at least 6
months after the event (although it is understood that onset and expression of some
symptoms may be immediate)
With dissociative symptoms: the individual’s symptoms meet the criteria for PTSD,
and in addition, in response to the stressor, the individual experiences persistent or
recurrent symptoms of depersonalisation or derealisation
o Causes
 Neurobiological model
 Threatening cues
activate CRF system
 CRF system activates
fear and anxiety areas
o Amygdala
(central
nucleus)
 Increased HPA-axis
activation
o Cortisol
 Summary of causes 
o Management
 Cognitive-behavioural
o Imaginal
exposure to
memories of
traumatic
event
o Graduated or massed
 Increase positive coping skills
 Re-establishing a sense of safety
 Increase social support
 Highly effective
 Psychoanalytic therapy: catharsis – reliving emotional trauma to
relieve suffering
o Treatment
 Medications
 SSRIs can be helpful by relieving heightened anxiety and panic
attacks common to PTSD
Adjustment disorder
o Anxious or depressive reactions to life stress (not necessarily trauma)
o Milder than PTSD/acute stress disorder
o Occur in reaction to life stressors like moving, new job, divorce, etc.
o Clinically significant distress or impairment
Attachment disorders
o Disturbed and developmentally inappropriate behaviours in children
o Child is unable or unwilling to form normal attachment relationships with
caregiving adults
o Occurs as a result of inadequate or neglectful care in early childhood
Reactive attachment disorder
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o Abnormally withdrawn and inhibited behaviour
o Less receptive to support from caregivers
o The child will very seldom seek out a caregiver for protection, support or
nurturing and will seldom respond to offers from caregivers to provide this
kind of care
Disinhibited Social Engagement Disorder
o A pattern of abnormally low inhibition in children
o E.g. inappropriately approaching unfamiliar adults without fear, as if they had
always had strong loving relationships with them
Obsessive-Compulsive Disorder (OCD)
o Clinical description
 Avoiding frightening or repulsive intrusive thoughts (obsessions) or
performing behaviours directed at limiting their occurrence or stress
they cause
 Obsessions
 Intrusive and nonsensical
 Thoughts, images or urges
 Attempts to resist or eliminate
 Examples: doubting (whether you’ve locked the door, done
something correctly), thoughts about contamination, unwanted
sexual/aggressive/religious urges, horrific images popping into
your head, need for symmetry/exactness/doing something until
it feels ‘just right’, thoughts about accidentally hurting other
people
 Compulsions
 Thoughts or actions
 Provide relief from obsessive thoughts
 Examples: Washing, checking, mental rituals, counting
Diagnostic criteria for Obsessive-Compulsive Disorder
A. Presence of obsessions, compulsions or both:
Obsessions are defined by 1 and 2:
1.Recurrent and persistent thoughts, urges or images that are experienced, at some time
during the disturbance, as intrusive and inappropriate and that in most individuals
cause marked anxiety or distress
2. The individual attempts to ignore or suppress such thoughts, impulses or images, or
to neutralise them with some other thought or action.
Compulsions are defined by 1 and 2:
- Repetitive behaviours (e.g. hand washing, ordering, checking) or mental acts (e.g.
praying, counting, repeating words silently) that the individual feels driven to
perform in response to an obsession, or according to rules that must be applied
rigidly
- The behaviours or mental acts are aimed at preventing or reducing distress or
preventing some dreaded event or situation; however, these behaviours or mental
acts either are not connected in a realistic way with what they are designed to
neutralise or prevent or are clearly excessive.
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B. The obsessions or compulsions are time-consuming (e.g. take more than one hour per
day) or cause clinically significant distress or impairment in social, occupational or other
important areas of functioning
C. The disturbance is not due to the direct physiological effects of a substance (e.g. a drug
of abuse, a medication) or another medical condition
D. The disturbance is not better explained by the symptoms of another mental disorder
(e.g. excessive worries, as in generalised anxiety disorder, or preoccupation with
appearance as in BDD)
Specify if:
- With good or fair insight: the individual recognises that OCD beliefs are definitely
or probably not true or that they may not be true
- With poor insight: the individual thinks OCD beliefs are probably true
- With absent insight/delusional: the person is completely convinced that OCD
beliefs are true
Specify if Tic-related – the individual has a current or past history of a tic disorder
o Obsessions
 60% have multiple obsessions
 Need for symmetry
 Forbidden thoughts or actions
 Cleaning and contamination
o Compulsions
 4 Major categories (Not the only options, but they capture many
common compulsions. The function of compulsions is to reduce
discomfort associated with obsessions):
 Checking
 Ordering
 Arranging
 Washing/cleaning
 Association with obsessions
o Tic disorder
 Involuntary movements (e.g. sudden jerking of limbs, movement of
jaw, etc.)
 Often co-occurs in patients with OCD
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Sometimes tics are used as compulsive behaviours – performed to
relieve anxiety associated with obsessions
o Statistics
 1% meet criteria during any one-year period
 1.6%-2.3% meet criteria at some point during lifetime
 Female/male ratio = 1:1
 Chronic
 Onset – childhood to 30s
o Causes
 Similar generalised biological vulnerability to having anxiety in
general
 Specific psychological vulnerability
 Early life experiences and learning
 Thoughts are dangerous/unacceptable
 Thought-action fusion
o Equating having a thought with the specific
outcome/action associated with that thought (e.g. if I
imagine my spouse dying, it means he’s going to die)
o Management
 Medications
 SSRIs
o 60% of patients benefit
o High relapse when discontinued
 Psychosurgery (cingulotomy)
o 30% of patients benefit
 Distraction temporarily reduces anxiety
 Increases frequency of thought
 Cognitive-behavioural therapy
 Exposure and ritual prevention (ERP)
o Exposure to cues that would trigger obsessions, with
prevention of compensatory compulsions. For example:
Patients with fears about contamination who washes her
hands compulsively has to touch every doorknob in her
house and then make dinner without washing her hands
o Most effective
 One study found that 86% of patients benefit
o No added benefit from combined treatment with drugs
Body Dysmorphic Disorder (BDD)
o A preoccupation with some imagined defect in appearance
 Actual defect, if present, appears slight to others
 Comorbid with OCD 10%
 Course of disorder is lifelong
 Onset – early adolescence through 20s
 2 treatments
 SSRIs
 Exposure and response prevention
 Treatment similar to those for OCD and approximately equally
successful
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Examples of concerns in BDD: Ears too big, muscles too small, skin
uneven/blotchy, nose too big
Diagnostic criteria for Body Dysmorphic disorder
A. Preoccupation with one or more defects or flaws in physical appearance that are not
observable or appear slight to others
B. At some point during the course of the disorder, the individual has performed repetitive
behaviours (e.g. mirror checking, excessive grooming, skin picking, reassurance seeking)
or mental acts (e.g. comparing his or her appearance with that of others) in response to the
appearance concerns
C. The preoccupation causes clinically significant distress or impairment in social,
occupational or other important areas of functioning
D. The appearance preoccupation is not better explained by concerns with body fat or
weight in an individual whose symptoms meet diagnostic criteria for an eating disorder
Specify if:
- With good or fair insight: The individual recognises that the BDD beliefs are
definitely or probably not true or that they may or may not be true
- With poor insight: the individual thinks that the BDD beliefs are probably true
- With absent insight/delusional beliefs: The individual is completely convinced that
the BDD beliefs are true
- With muscle dysmorphia: The individual is preoccupied with the idea that his or
her body build is too small or insufficiently muscular. This specifier is used even if
the individual is preoccupied with other body areas, which is often the case
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o Examples of imagined defects (in order of prevalence):
 Skin, Hair, Nose, Stomach, Teeth, Weight, Breasts, Buttocks, Eyes,
Thighs, Eyebrows, Overall appearance of face, Small body build, Legs,
Face size or shape, Chin, Lips, Arms or wrists, Hips, Cheeks, Ears.
o Plastic surgery
 76.4% had sought this type of treatment and 66% were receiving it
 8-25% of all patients who request plastic surgery may have BDD
 Does not make BDD go away – it often intensifies it
Hoarding disorder
o Excessively collecting and keeping items with minimal value, leading to
cluttering and disruption of living space
o Prevalence: between 2% and 5% of the population, (twice as high as the
prevalence of OCD)
 Female/Male ratio is 1:1
 OCD tends to wax and wane, whereas hoarding behaviour can begin
early in life and get worse with each passing decade
o Treatment approaches are similar to those for OCD but are less successful
Trichotillomania (hair pulling disorder)
o The urge to pull out one’s hair from anywhere on the body
o Leads to noticeable hair loss on scalp, eyebrows, arms, pubic region etc.
Excoriation (skin picking disorder) is characterised by repetitive and compulsive
picking of the skin, leading to tissue damage
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1-5% prevalence rate
Behavioural habit reversal training is the most effective treatment
Repetitive and compulsive picking of the skin, leading to tissue damage
Face is a common target for picking
Summary
- Anxiety and related disorders occur when natural and adaptive processes (anxiety,
fear and panic) become disproportionate to the environment
- These disorders occur as a result of generalised biological vulnerabilities, generalised
psychological vulnerabilities and specific vulnerabilities
- Anxiety disorders include:
o Panic disorder
o Agoraphobia
o Generalised anxiety disorder
o Social anxiety disorder
o Specific phobia
o Selective mutism
o Separation anxiety disorder
- Trauma- and stressor-related disorders share a common aetiology: stressful
experiences
- Trauma- and stressor-related disorders include:
o PTSD
o Acute stress disorder
o Adjustment disorders
o Reactive attachment disorder
o Disinhibited social engagement disorder
- Obsessive-compulsive and related disorders share common features: compulsive
behaviours and, sometimes, obsessive thoughts
- Obsessive-compulsive and related disorders include:
o OCD
o Hoarding disorder
o Body dysmorphic disorder
o Trichotillomania
o Excoriation
- The most effective treatment for most anxiety disorders is cognitive-behavioural
therapy
- Medications may also be helpful in treating anxiety disorders
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Week 3: Mood Disorders
Mood Disorders and Suicide:
Mood disorders are among the most common psychological disorders, and the risk of
developing them is increasing world, particularly in younger people.
An overview of Depression and Mania
- Mood disorders = gross deviations in mood
- Composed of different types of mood ‘episodes’
o Periods of depressed or elevated mood lasting days or weeks, including
Diagnostic criteria for a major depressive episode
A. 5 (or more) of the following symptoms have been present during the same 2-week
period an represent a change from previous functioning; at least one of the symptoms is
either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical condition or
mood-incongruent delusions or hallucinations
1. Depressed mood most of the day, nearly every day, as indicated by either subjective
report (e.g. feels sad or empty) or observation made by others (e.g. always appears
tearful). Note: in children and adolescents can be irritable mood.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly every day (as indicate by either subjective account or observation made by
others)
3. Significant weight loss when not dieting or weight gain (e.g. a change of more than
5% of body weight in a month), or decrease or increase in appetite nearly every day.
Note: in children, consider failure to make expected weight gains
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day (observable by others, not
merely subjective feelings of restlessness or being slowed down)
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be
delusional) nearly every day (not merely self-reproach or guilt about being sick)
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either
by subjective account or as observed by others)
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt, or a specific plan for committing suicide
B. The symptoms cause clinically significant distress or impairment in social, occupational
or other important areas of functioning
C. The symptoms are not due to the direct physiological effects of a substance (e.g. a drug
of abuse, a medication) or a general medical condition (e.g. hypothyroidism)
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Diagnostic criteria for a manic episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood
and abnormally and persistently increased goal-directed activity or energy, lasting at least
one week and present most of the day, nearly every day (or any duration if hospitalisation
is necessary)
B. During the period of mood disturbance an increased energy or activity, 3 (or more) of
the following symptoms (four if the mood is only irritable) are present to a significant
degree and represent a noticeable change from usual behaviour:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (e.g. feels rested after only 3 hours of sleep)
3. More talkative than usual or pressure to keep talking
4. Flight of ideas or subjective experience that thoughts are racing
5. Distractibility (i.e. Attention too easily drawn to unimportant or irrelevant external
stimuli), as reported or observed
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or
psychomotor agitation (e.g. purposeless non-goal-directed activity)
7. Excessive involvement in activities that have a high potential for painful
consequences (e.g. engaging in unrestrained buying sprees, sexual indiscretions or
foolish business investments)
C. The mood disturbance is sufficiently severe to cause marked impairment in social or
occupational functioning or to necessitate hospitalisation to prevent harm to self or others,
or there are psychotic features
D. The episode is not attributable to the physiological effects of a substance (e.g. a drug of
abuse, a medication or other treatment ) or to another general medical condition
Note: A full manic episode that emerges during antidepressant treatment (E.g. medication,
electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological
effect of that treatment is sufficient evidence of a manic episode and, therefore, a bipolar 1
diagnosis
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Hypomanic episodes
 Shorter, less severe version of manic episodes
 Lasts at least 4 days
 Has fewer and milder symptoms
 Associated with less impairment than a manic episode (e.g. less
risky behaviour)
 May not be problematic in itself, but usually occurs in the
context of a more problematic mood disorder
 ‘Mixed features’
 Term for a mood episode with some elements reflecting the
opposite valence of mood
o E.g. Depressive episode with some manic features
o E.g. Manic episode with some depressed/anxious
features
The structure of mood disorders
o Unipolar mood disorder: Only one extreme of mood is experienced
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 E.g. only depression or only mania
 Depression alone is much more common than mania alone
o Bipolar mood disorder: Both depressed and elevated moods are experienced
 E.g. some depressive episodes and some manic or hypomanic episodes
DSM-5 (Unipolar) Depressive Disorder
o New to DSM-5
 Premenstrual dysphoric disorder
 Disruptive mood dysregulation disorder
o Major depressive disorder
 Clinical features
 One or more major depressive episodes separated by periods
of remission
 Single episode – highly unusual
 Recurrent episodes – more common
Diagnostic criteria for Major depressive disorder
A. At least one major depressive episode
B. The occurrence of the major depressive episode is not better explained by
schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder or
other specified and unspecified schizophrenia spectrum and other psychotic disorders
C. There has never been a manic episode or hypomanic episode. Note: This exclusion does
not apply if all of the manic-like or hypomanic-like episodes are substance induced or are
attributable to the direct physiological effects of another medical condition.
Specify the clinical status and/or features of the current or most recent major depressive
episode:
- Single episode or recurrent episode; Mild, moderate, severe; with anxious distress;
with mixed features; with melancholic features; with atypical features; with moodcongruent psychotic features; with mood-incongruent psychotic features; with
catatonia; with peri-partum onset; with seasonal pattern (recurrent episode only);
in partial remission, in full remission
(Begin suddenly, often triggered by a crisis, change or loss)
o Persistent depressive disorder (Dysthymia)
 At least 2 years of depressive symptoms
 Depressed mood most of the day on more than 50% of days
 No more than 2 months symptom free
 Symptoms can persist unchanged over long periods (less than
or equal to 20 years)
 Daily functioning is not as severely affected but over time
impairment is cumulative
 May include periods of more severe major depressive
symptoms
o Major depressive symptoms may be intermittent or last
for the majority or entirely of the time period
 Types of PDD
 Mild depressive symptoms without any major depressive
episodes (with pure dysthymic syndrome)
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Mild depressive symptoms with additional major depressive
episodes occurring intermittently (previously called double
depression) (alternating periods of major depression and
dysthymia)
Major depressive episode lasting 2 or more years (with
persistent major depressive episode)
Diagnostic Criteria for Dysthymia
A. Depressed mood for most of the day, for more days than not, as indicated by either
subjective account or observation by others, for at least 2 years. Note: In children and
adolescents, mood can be irritable and duration must be at least one year.
B. Presence, while depressed, of 2 (or more) of the following:
1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration or difficulty making decisions
6. Feelings of hopelessness
C. During the 2-year period (one year for children or adolescents) of disturbance, the
person has never been without the symptoms in criteria A and B for more than 2 months at
a time
D. Criteria for major depressive disorder may be continuously present for 2 years
E. There has never been a manic episode or a hypomanic episode, and criteria have never
been met for cyclothymic disorder
F. The disturbance is not better explained by a persistent schizoaffective disorder,
schizophrenia, delusional disorder or other specified or unspecified schizophrenia spectrum
and other psychotic disorders
G. The symptoms are not attributable to the physiological effects of a substance (e.g. a
drug of abuse or a medication) or another medical condition (e.g. hypothyroidism)
H. The symptoms cause clinically significant distress or impairment in social, occupational
or other important areas of functioning
Specify if: Current severity (Mild, moderate, severe); with anxious distress; with mixed
features; with melancholic features; with atypical features; with mood-congruent psychotic
features; with mood-incongruent psychotic features; with peri-partum onset.
- Early onset: if onset is before age 21 years
- Late onset: If onset is at age 21 years or older;
Specify (for most recent 2 years of dysthymic disorder):
- With pure dysthymic syndrome: if full criteria for a major depressive episode have
not been met in at least the preceding 2-year period
- With persistent major depressive episode: if full criteria for a major depressive
episode have been met throughout the preceding 2-year period
- With intermittent major depressive episodes, with current episode: If full criteria
for a major depressive episode are currently met, but there have been periods of at
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least 8 weeks in at least the preceding 2 years with symptoms below the threshold
for a full major depressive episode
With intermittent major depressive episodes, without current episode: If full
criteria for a major depressive episode are not currently met, but there has been
one or more major depressive episodes in at least the preceding 2 years
In full remission, or in partial remission
o Possible course of depressive disorders 
o Diagnostic specifiers for Depressive Disorders
 Specifier: Additional diagnostic label used by
clinicians to convey extra information about
symptoms
 Specifiers are not mandatory; only assigned if
appropriate
 Psychotic features specifier
 Major depressive episodes which also include some psychotic
features
o Hallucinations: Sensory experience in the absence of
sensory input
o Delusions: Strongly held inaccurate beliefs
 Anxious distress specifier
 Depression is accompanied by several significant symptoms of
anxiety
 Predicts poorer outcome
 Mixed features specifier
 Depressive episodes which also include several manic
symptoms
 Melancholic features specifier
 Major depressive episode accompanied by additional severe
symptoms such as early morning awakenings, lack of reactivity
to positive stimuli
 Catatonic features specifier
 Extremely rare muscular symptoms such as remaining in a still
stupor, ‘waxy’ limbs that remain in place when manipulated,
repetitive or purposeless movement
 Atypical features specifier
 Presence of several symptoms less common in depression,
including oversleeping and overeating
 Peri-partum onset specifier
 Depression occurring around the time of giving birth
 Seasonal pattern specifier
 Depression occurring primarily in certain seasons (usually
winter)
 Sometimes called seasonal affective disorder (SAD)
 May be related to seasonal changes in melatonin
 May be treated effectively with light therapy (but that is not in
South Africa)
o Onset and Duration of depressive disorders
 Rare in childhood
 Risk increases in adolescence and young adulthood
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Mean age of onset = 30
Earlier onset of persistent depression associated with worse outcome
Depressive episodes are variable in length
 Usually last several months untreated, but may last several
years
From Grief to Depression
o In previous editions of the DSM, depression could not be diagnosed during
periods of mourning
o It is now recognised that major depression may occur as part of the grieving
process – Approximately 20% of bereaved individuals may experience a
complicated grief reaction in which the normal grief response develops into a
full-blown mood disorder
o Acute grief: Occurs immediately after loss
o Integrated grief: Eventual coming to terms with meaning of the loss
o Complicated grief: Persistent acute grief and inability to come to terms with
loss
Other Depressive disorders
o Premenstrual dysphoric disorder
 Significant depressive symptoms occurring prior to menses during the
majority of cycles, leading to distress or impairment
 Controversial diagnosis
 Advantage: Legitimises the difficulties some women face when
symptoms are very severe
 Disadvantage: Pathologises an experience many consider to be
normal
Features of premenstrual dysphoric disorder include the following:
In the majority of menstrual cycles, at least 5 symptoms must be present in the final week
before the onset of menses, start to improve within a few days after the onset of menses,
and become minimal or absent in the week post-menses
One (or more) of the following symptoms must be present:
- Marked affective lability (e.g. mood swings),
- Marked irritability or anger
- Marked depressed mood, or
- Marked anxiety and tension
One (or more) of the following symptoms must additionally be present, to reach a total of
5 symptoms when combined with symptoms above:
- Decreased interest in usual activities
- Difficulty in concentration
- Lethargy, fatigability, lack of energy
- Marked change in appetite, overeating, or specific food cravings
- Hypersomnia or insomnia
- A sense of being overwhelmed or out of control, or
- Physical symptoms such as breast tenderness or weight gain
Clinically significant distress or interference with work, school, usual social activities, or
relationships
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Symptoms are not attributable to the effects of a substance (e.g. drug abuse) or another
medical condition
o Disruptive Mood dysregulation Disorder
 Severe temper outbursts occurring frequently, against a backdrop of
angry or irritable mood
 Diagnosed only in children 6-18
 Criteria for manic/hypomanic episodes are not met
 Designed in part to combat over diagnosis of bipolar disorder in youth
Features of disruptive mood dysregulation disorder include the following:
Severe temper outbursts occurring 3 or more times per week for at least one year,
manifested verbally and/or behaviourally that are out of proportion in intensity or duration
to the situation and are inconsistent with developmental level
The mood between temper outbursts is persistently irritable or angry most of the day,
nearly every day, is observable by others in at least 2 of 3 settings (i.e. at home, at school,
with peers), and is severe in at least one of these settings
The diagnosis should not be made for the first time before age 6 years or after age 18 years
There has never been a distinct period lasting more than 1 day during which the full
symptom criteria - except duration - for a manic or hypomanic episode have been met
The symptoms are not attributable to the physiological effects of a substance or to another
medical or neurological condition
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DSM-5 Bipolar Disorders
o Bipolar I disorder
 Alternations between major depressive episodes and manic (or mixed)
episodes
o Bipolar II disorder
 Alternations between major depressive episodes and hypomanic
episodes
Diagnostic criteria for Bipolar II disorder
A. Criteria have been met for at least one hypomanic episode and at least one major
depressive episode. Criteria for a hypomanic episode are identical to those for a manic
episode with the following distinctions: 1) Minimum duration is 4 days; 2) Although the
episode represents a definite change in functioning, it is not severe enough to cause marked
social or occupational impairment or hospitalisation; 3) There are not psychotic features.
B. There has never been a manic episode
C. The occurrence of the hypomanic episode(s) and major depressive episode(s) is not
better explained by schizophreniform disorder, delusional disorder or other specified
schizophrenia spectrum and other psychotic disorder
D. The symptoms of depression or the unpredictability caused by frequent alternation
between periods of depression and hypomania causes clinically significant distress or
impairment in social, occupational or other important areas of functioning
Specify current or most recent episode:
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Hypomanic: If currently (or most recently) in a hypomanic episode
Depressed: If currently (or most recently) in a major depressive episode
Specify if: with anxious distress; with mixed features; with rapid cycling; with moodcongruent psychotic features; with mood-incongruent psychotic features; with catatonia;
with peri-partum onset; with seasonal pattern
Specify course if full criteria for a mood episode are not currently met: in Full remission,
in partial remission
Specify severity if full criteria for a mood episode are currently met: Mild, moderate,
severe
o Cyclothymic disorder
 Alternations between less severe depressive and hypomanic periods
 Chronic version of bipolar disorder
 Alternating between periods of mild depressive symptoms and mild
hypomanic symptoms
 Episodes do not meet criteria for full major depressive episode,
full hypomanic episode or full manic episode
 Hypomanic or depressive mood states may persist for long periods
Diagnostic criteria for Cyclothymic disorder
A. For at least 2 years (at least 1 year in children and adolescents) there have been
numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic
episode and numerous periods with depressive symptoms that do not meet criteria for a
major depressive episode
B. During the above 2-year period (one year in children and adolescents), the hypomanic
and depressive periods have been present at least half the time and the individual has not
been without the symptoms for more than 2 months at a time
C. Criteria for a major depressive, manic or hypomanic episode have never been met
D. The symptoms in criterion A are not better explained by schizoaffective disorder,
schizophrenia, schizophreniform disorder, delusional disorder or other specified or
unspecified schizophrenia spectrum and other psychotic disorders
E. The symptoms are not attributable to the physiological effects of a substance (e.g. a drug
of abuse or a medication) or another medical condition (e.g. hyperthyroidism)
F. The symptoms cause clinically significant distress or impairment in social, occupational
or other important areas of functioning.
Specify if: with anxious distress
o Diagnostic specifiers for Bipolar Disorders
 All of the specifiers for depressive disorders may also apply to bipolar
disorders
 Additional specifier unique to bipolar disorders: Rapid-cycling
specifier
 Moving quickly in and out of mania and depression
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Individual experiences at least 4 manic or depressive episodes
within a year
 Occurs in 20-50% of cases
 Associated with greater severity
Prevalence of Mood Disorders
o Worldwide lifetime prevalence of major depressive disorder = 16% (high)
 6% have experienced major depression in the last year
o Bipolar I disorder much lower at 1%
o Sex differences
 Females are twice as likely to have major depression
 Bipolar disorders affect males and females approximately equally
 Women more likely to experience rapid cycling
 Women more likely to be in a depressive period
o Occurs less often in pre-pubescent children
o Rapid rise in adolescence and adults
o Across cultures
 Similar prevalence among US Subcultures, but experience of
symptoms may vary
 E.g. some cultures are more likely to express depression as a
somatic concern
 Higher prevalence among Native Americans: 4 times the rate of the
general population
Life span developmental influences on Mood Disorders
o 3-month-olds can show depressive symptoms
o Young children typically don’t show classic mania or bipolar symptoms
o Mood disorder may be misdiagnosed as ADHD
o Children are being diagnosed with bipolar disorders at increasingly high rates
o Depression in the elderly between 14% and 42%
 Co-occurrence with anxiety disorders
 Less gender imbalance after 65 years of age
Causes of Mood disorders:
o Trigger – negative or positive life changes (death of a loved one, promotion,
etc.) OR physical illness
o Familial and genetic influences
 Family studies
 Risk is higher if the relative has a mood disorder
 Relatives of bipolar probands are more likely to have unipolar
depression
 Twin studies
 Concordance rates are high in identical twins
o 2 to 3 times more likely to present with mood disorders
than a fraternal twin of a depressed co-twin
 Severe mood disorders have a strong genetic contribution
 Heritability rates are higher for females compared to males
 Some genetic factors confer risk for both anxiety and
depression
o Neurobiological influences
 Neurotransmitter systems
 Serotonin and its relation to other neurotransmitters
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o Serotonin regulates noradrenaline and dopamine
 Mood disorders are related to low levels of serotonin
 Permissive hypothesis: Low serotonin ‘permits’ other
neurotransmitters to vary more widely, increasing vulnerability
to depression
 The endocrine system
 Elevated cortisol
 Stress hormones decrease neurogenesis in the hippocampus, so
it is then less able to make new neurones
 Sleep disturbance
 Hallmark of most mood disorders
 Depressed patients have quicker and more intense REM sleep
 Sleep deprivation may temporarily improve depressive
symptoms in bipolar patients
o Psychological Dimensions (Stress)
 Stressful life events
 Stress is strongly related to
mood disorders
o Poorer response to
treatment
o Longer time before
remission
 Context of life events matters
 Gene-Environment correlation: People who are vulnerable to
depression might be more likely to enter a situation that will
lead to stress
 The relationship between stress and bipolar is also strong
 Learnt helplessness
 The learnt helplessness theory of depression
o Lack of perceived control over life events leads to
decreased attempts to improve own situation
o First demonstrated in research by Martin Seligman
o Negative cognitive styles are a risk factor for depression
 Depressive Attributional style (depressive cognitive schemas)
 Internal attributions
o Negative outcomes are one’s own fault
 Stable attributions
o Believing future negative outcomes will be one’s fault
 Global attribution
o Believing negative events will disrupt many life
activities
 All 3 domains contribute to a sense of hopelessness
 Cognitive theory
 Negative coping styles
o Depressed persons engage in cognitive errors
o Tendency to interpret life events negatively
 Types of cognitive errors
o Arbitrary inference – overemphasise the negative
aspects of a mixed situation
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o Overgeneralisation – negatives apply to all situations
 Cognitive errors and the depressive cognitive triad
o Think negatively about oneself
o Think negatively about the world
o Think negatively about the future
o Social and Cultural Dimensions
 Marital relations
 Marital dissatisfaction is strongly related to depression
 This relation is particularly strong in males after divorce or
separation
 Social support
 Extent of social support is related to depression
 Lack of social support predicts late onset depression
 Substantial social support predicts recovery from depression
Gender differences in Mood disorders
o Women account for seven out of ten cases of major depressive disorder
o Recall that women also have higher rates of anxiety disorders
o Possible explanations for gender disparity
 Women are socialised to have stronger perception of uncontrollability
 Parenting style makes girls less independent
 Women more sensitive to relationship disruptions (e.g. breakups,
tension in friendships)
 Women ruminate more than men
An integrative theory
o Biological and psychological vulnerabilities interact with stressful life events
to cause depression
 Biological vulnerability: E.g. overactive neurobiological response to
stress
 Psychological vulnerability: E.g. depressive cognitive style
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Management of Mood disorders:
o Treatment for mood disorders is most effective and easiest when it is started
early. Most people are treated with a combination of these methods
o Medication
 Antidepressants
 Selective serotonin reuptake inhibitors (SSRIs)
o Specifically block reuptake of serotonin so more
serotonin is available in the brain
 Fluoxetine (Prozac) is the most popular SSRI
o SSRIs pose some risk of suicide, particularly in
teenagers
o Negative side effects are common
 Tricyclic antidepressants
o Include Tofranil
o Negative side effects are common (e.g. Drowsiness,
weight gain)
 Discontinuation is common
o May be lethal in excessive doses
 Monoamine oxidase inhibitors
 Mixed reuptake inhibitors (e.g. serotonin/noradrenaline
reuptake inhibitors)
o Block reuptake of noradrenaline as well as serotonin
o Best known is venlafaxine (Effexor)
o Have similar side effects to SSRIs
 Approximately equally effective
o Only 50% of patients benefit
o Only 25-30% achieve normal functioning
 Choice of antidepressant agents is dictated by patient
characteristics, including response, tolerance of side-effects and
medical risks
 Lithium
 Lithium carbonate = a common salt
 Treatment of choice for bipolar disorder (anti-manic)
 Considered a mood stabiliser because it treats depressive and
manic symptoms
 Toxic in large amounts
o Dose must be carefully monitored
 Effective for 50% of patients
 Why lithium works remains unclear
 Second generation antipsychotic agents used as prophylaxis in bipolar
disorders
o Electroconvulsive therapy (ECT)
 Used for severe depression, when other treatments have been
ineffective
 The nature of ECT
 Brief electrical current applied to the brain
 Results in temporary seizures
 Usually six to ten outpatient treatments are required
 Side effects
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 Short-term memory loss which is usually restored
 Some patients suffer long-term memory loss
 Mechanism is unclear
o Transcranial Magnetic Stimulation
 Uses magnets to generate a precise localised electromagnetic pulse
 Few side effects; occasional headaches
 Less effective than ECT for medication-resistant depression
 May be combined with medication
o Psychological treatments for depression
 Cognitive-Behavioural therapy
 Addresses cognitive errors in thinking and teaches replacing
negative depressive thoughts and attributions with more
positive ones
 Also including behavioural activation (scheduling valued
activities) – develop more effective coping behaviours and
skills
 Interpersonal psychotherapy
 Focus: Improving problematic relationships
 Focus on the social and interpersonal triggers for their
depression (such as loss of a loved one)
 Prevention
 Pre-emptive psychosocial care for people at risk
 Has longer-lasting effectiveness than medication
Preventing relapse
o Research on relapse prevention is relatively less common
o Psychosocial and pharmacological treatments are both used
o Psychosocial interventions are generally more effective at preventing relapse
Treatment of Bipolar disorders
o Medication (usually lithium) is still first line of defence
o Psychotherapy helpful in managing the problems (e.g. interpersonal,
occupational) that accompany bipolar disorder
o Family therapy can be helpful
o Compliance with medications is a veritable management problem in bipolar
disorders
Suicide: Facts and statistics
o Suicide is often associated with mood disorders but can occur in their absence
or in the presence of other disorders.
o It is the eleventh leading cause of death in USA
 Underreported; actual rate may be 2 or 3 times higher
o Gender differences
 Females attempt suicide more often than males
 Males complete more suicides than females
 Disparity is due to males using more lethal methods
 Exception: Suicide more common among women in China
 May reflect cultural acceptability; suicide is seen as an
honourable solution to problems
The Nature of Suicide
o Risk factors
 Suicide in the family
 Low serotonin levels
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 Pre-existing psychological disorder
 Alcohol use and abuse
 Stressful life event, especially humiliation
 Past suicidal behaviour
 Plan and access to lethal methods
o Suicide contagion
 Some research indicates that a person is more likely to commit suicide
after hearing about someone else committing suicide
 Media accounts may worsen the problem by
 Sensationalising / romanticising suicide
 Describing lethal methods of committing suicide
o Suicide prevention
 In professional mental health
 Clinician does risk assessment
o Ideation (serious thoughts), plans (a detailed method),
intent (starting to carry out plans), means (ability to
carry out plans), attempts, etc.
 Clinician and patient develop safety plan (e.g. who to call,
strategies for coping with suicidal thoughts)
 In some cases, sign a no-suicide contract
 Preventative programmes for at-risk groups
 CBT can reduce suicide risk
 Important: Removing access to lethal methods
 If you think someone is at risk, talk to them and ensure they’re getting
needed support
 Talking to someone about suicide is not likely to place them at
greater risk or ‘plant the idea’
 In contrast, the risk of not providing support to someone in
need is huge
Summary of mood disorders
o All mood disorders share:
 Gross deviations in mood
 Common biological and psychological vulnerability
o Occur in children, adults and the elderly
o Onset, maintenance and management are affected by:
 Stressful life events
 Social support
 Differential response to medication
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Week 4: Psychotic disorders
Schizophrenia:
Key terms:
- Psychosis: Gross departure from reality, which may include:
o Hallucinations: Sensory experiences in the absence of sensory input (e.g.
hearing voices)
o Delusions: Strong, inaccurate beliefs that persist in the face of evidence to the
contrary
- Schizophrenia: A pervasive type of psychosis characterised by disrupted perceptions
of the world, disturbed thought, emotion and behaviour
Nature of Schizophrenia and Psychosis: History and Current thinking
- Historical background
o Emil Kraepelin – used the term dementia praecox to describe schizophrenic
syndrome
 Early subtypes of schizophrenia – catatonia, hebephrenia and paranoia
o Eugen Bleuler – introduced the term ‘schizophrenia’= splitting of the mind
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Impact of early ideas on current thinking
o Many of Kraepelin and Bleuler’s ideas are still with us
o Understanding onset and course is considered important
Psychotic behaviour
o May refer only to hallucinations or delusions or to the unusual behaviour (e.g.
inappropriate emotionality, strange actions) accompanying them
Schizophrenia is usually chronic with a high relapse rate. Complete recovery is rare
Trigger = stressful, traumatic life event, high expressed emotion (family criticism,
hostility or intrusion), sometimes no obvious trigger
Diagnostic criteria for schizophrenia
A. 2 (or more) of the following, each present for a significant portion of time during a
one-month period (or less if successfully treated). At least one of these must be (1), (2) or
(3)
1. Delusions
2. Hallucinations
3. Disorganised speech (e.g. frequent derailment or incoherence)
4. Grossly disorganised or catatonic behaviour
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5. Negative symptoms (i.e. Diminished emotional expression or avolition)
B. For a significant portion of the time since the onset of the disturbance, level of
functioning in one or more major areas, such as work, interpersonal relations or self-care,
is markedly below the level achieved prior to the onset (or when the onset is in childhood
or adolescence, there is failure to achieve expected level of interpersonal, academic or
occupational functioning)
C. Continuous signs of the disturbance persist for at least 6 months. This 6-month period
must include at least one month of symptoms (or less if successfully treated) that means
Criterion A (i.e. Active-phase symptoms) and may include periods of prodromal or residual
symptoms. During these prodromal or residual periods, the signs of the disturbance may be
manifested by only negative symptoms or by 2 or more symptoms listed in Criterion A
present in an attenuated form (e.g. odd beliefs, unusual perceptual experiences)
D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have
been ruled out because either
1) no major depressive or manic episodes have occurred concurrently with the activephase symptoms, or
2) if mood episodes have occurred during active-phase symptoms, they have been
present for a minority of the total duration of the active and residual periods of the
illness
E. The disturbance is not attributable to the physiological effects of a substance (e.g. a drug
of abuse or a medication) or another medical condition
F. If there is a history of autistic spectrum disorder or a communication disorder of
childhood onset, the additional diagnosis of schizophrenia is made only if prominent
delusions of hallucinations - in addition to the other required symptoms of schizophrenia are also present for at least one month (or less if successfully treated)
Specify if: With catatonia
Symptoms of Schizophrenia
- ‘positive’ symptoms – “productive”
o Active manifestations of abnormal thinking and behaviour
o Distortions or exaggerations of normal behaviour
o Include delusions and hallucinations
 Delusions: ‘The basic feature of madness’
 Gross misrepresentations of reality
 Fixed false beliefs, unrealistic and bizarre, not shared by others
in the culture, religion or developmental level
 Most common:
o Delusions of grandeur
o Delusions of persecution
 Hallucinations
 Experience of sensory events without environmental input
 Can involve all senses (e.g. tasting something when not eating,
having skin sensations when not being touched)
 Most common: Auditory
o Findings from SPECT studies
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
Neuroimaging shows that the part of the brain most active during
auditory hallucinations in Broca’s area
 Involved in speech production (not comprehension)
- ‘negative’ symptoms – “Deficits”
o Absence or insufficiency of normal behaviour
o Spectrum of negative symptoms
 Avolition (or apathy) – lack of initiation/motivation and persistence
 Alogia – relative absence of speech
 Anhedonia – lack of pleasure, or indifference
 Affective flattening – little expressed emotion
- ‘Disorganised’ symptoms
o Erratic and confused or abnormal speech, emotions and behaviour
o Nature of disorganised speech
 Cognitive slippage – illogical and incoherent speech
 Tangentiality – ‘going off on a tangent’
 Loose associations – conversation in unrelated directions (jump topics)
 Speaking unintelligible words and sentences
o Nature of disorganised affect
 Inappropriate emotional behaviour
o Nature of disorganised behaviour
 Includes a variety of unusual behaviours (pacing, agitation, waxy
flexibility (keeping body parts in the same position when they are
moved by someone else), inappropriate dress, inappropriate silly
affect, ignoring personal hygiene, etc.)
 Catatonia
 May be considered a psychotic spectrum disorder in its own
right or, when occurring in the presence of schizophrenia, a
symptom of schizophrenia
Subtypes of Schizophrenia: A thing of the past
- Schizophrenia as previously divided into subtypes based on content of psychosis:
o Paranoid, catatonic, residual (minor symptoms persist after past episode),
disorganised (many disorganised symptoms) and undifferentiated
- This is no longer the case in the DSM-5, but outdated terms are still in partial use
Other Psychotic Disorders:
Schizophreniform disorder:
- Schizophreniform disorder
o Psychotic symptoms lasting between one and six months ( more than 6 months
= schizophrenia)
o Associated with relatively good functioning
o Most patients resume normal lives
o Lifetime prevalence: Approximately 0.2%
Diagnostic criteria for schizophreniform disorder
A. 2 (or more) of the following, each present for a significant portion of time during a
one-month period (or less if successfully treated). At least one of these must be (1), (2) or
(3):
1. Delusions
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Hallucinations
Disorganised speech (e.g. frequent derailment or incoherence)
Grossly disorganised or catatonic behaviour
Negative symptoms (i.e. Diminished emotional expression or avolition)
B. An episode of the disorder lasts at least one month but less than 6 months. When the
diagnosis must be made without waiting for recovery, it should be qualified as
‘provisional’
C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have
been ruled out because either:
1) no major depressive or manic episodes have occurred concurrently with the activephase symptoms, or
2) if mood episodes have occurred during active-phase symptoms, they have been
present for a minority of the total duration of the active and residual periods of the
illness
D. The disturbance is not attributable to the physiological effects of a substance (e.g. a drug
of abuse or a medication) or another medical condition
Specify if: With good prognostic features:
- This specifier requires the presence of at least 2 of the following features: Onset of
prominent psychotic symptoms within 4 weeks of the first noticeable change in
usual behaviour or functioning; confusion or perplexity; good premorbid social
and occupational functioning; and absence of blunted or flat affect
Specify if: Without good prognostic features
- This specifier is applied if 2 or more of the above features have not been present
Specify if: With catatonia
Schizoaffective Disorder:
- Schizoaffective disorder
o Symptoms of schizophrenia + additional experience of a major mood episode
(depressive or manic)
o Psychotic symptoms must also occur outside of the mood disturbance
o Prognosis is similar for people with schizophrenia
o Such people tend not to get better on their own
Diagnostic criteria for schizoaffective disorder
A. An uninterrupted period of illness during which there is a major mood episode (major
depressive or manic) concurrent with criterion A of schizophrenia
Note: The major depressive episode must include Criterion A1: Depressed mood
B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood
episode (depressive or manic) during the lifetime duration of the illness
C. Symptoms that meet criteria for a major mood episode and present for the majority of
the total duration of the active and residual portions of the illness
D. The disturbance is not attributable to the effects of a substance (e.g. a drug of abuse or a
medication) or another medical condition
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Specify whether:
- Bipolar type: This subtype applies only if a manic episode is part of the
presentation. Major depressive episodes may also occur
- Depressive type: This subtype applies only if only major depressive episodes are
part of the presentation
- With catatonia
Delusional Disorder:
- Key feature: Delusions that are contrary to reality
o Lack other positive and negative symptoms
o Types of delusions include
 Erotomanic – belief that someone or everyone is in love with them
 Grandiose – Over-inflated sense of worth, power, knowledge or
identity
 Jealous – belief that significant other is being unfaithful
 Persecutory – belief they are being persecuted – harm is occurring or
going to occur
 Somatic – belief that bodily functioning, sensation or appearance is
grossly abnormal
o Better prognosis than schizophrenia
- Very rare; affects 24-60 individuals per 100 000
- Later age of onset, ages 35-55
- Somewhat more common in females
o 55% of patients with this disorder are female
Diagnostic criteria for delusional disorder
A. The presence of one (or more) delusions with a duration of one month or longer
B. Criterion A for schizophrenia has never been met
Note: Hallucinations, if present, are not prominent and are related to the delusional theme
(e.g. the sensation of being infested with insects associated with delusions of infestation)
C. Apart from the impact of the delusion(s) or its ramifications, functioning is not
markedly impaired and behaviour is not obviously bizarre or odd
D. If manic or major depressive episodes have occurred, these have been brief relative to
the duration of the delusional periods
E. The disturbance is not attributable to the physiological effects of a substance or another
medical condition and is not better explained by another mental disorder, such as body
dysmorphic disorder or obsessive-compulsive disorder
Specify whether:
- Erotomanic type: This subtype applies when the central theme of the delusion is
that another person is in love with the individual
- Grandiose type: This subtype applies when the central theme of the delusion is the
conviction of having some great (but unrecognised) talent or insight or having
made some important discovery
- Jealous type: This subtype applies when the central theme of the individual’s
delusion is that his or her spouse or lover is unfaithful
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Persecutory type: This subtype applies when the central theme of the delusion
involves the individual’s belief that he or she is being conspired against, cheated,
spied on, followed, poisoned or drugged, maliciously maligned, harassed or
obstructed in the pursuit of long-term goals
Somatic type: This subtype applies when the central theme of the delusion involves
bodily functions or sensations
Mixed type: This subtype applies when no delusional theme predominates
Unspecified type: This subtype applies when the dominant delusional belief cannot
be clearly determined or is not described in the specific types (e.g. referential
delusions without a prominent persecutory or grandiose component)
Catatonia:
- Unusual motor responses, particularly immobility or agitation, and odd mannerisms
- Tends to be severe and quite rare
- May be present in psychotic disorders or diagnosed alone, and may include:
o Stupor, mutism, maintaining the same pose for hours
o Opposition or lack of response to instructions
o Repetitive, meaningless motor behaviours
o Mimicking others’ speech or movement
Diagnostic criteria for catatonia associated with another mental disorder (catatonia
specifier)
A. The clinical picture is dominated by 3 or more of the following symptoms:
1. Stupor (i.e. No psychomotor activity; not actively relating to their environment)
2. Cataplexy (i.e. Passive induction of a posture held against gravity)
3. Waxy flexibility (i.e. Slight, even resistance to positioning by examiner)
4. Mutism (i.e. No, or very little, verbal response [exclude if known appraisal])
5. Negativism (i.e. Opposition or no response to instructions or external stimuli)
6. Posturing (i.e. Spontaneous and active maintenance of a posture against gravity)
7. Mannerism (i.e. Odd, circumstantial caricature of normal actions)
8. Stereotypy (i.e. Repetitive, abnormally frequent, non-goal-directed movements)
9. Agitation, not influenced by external stimuli
10. Grimacing
11. Echolalia (i.e. Mimicking another’s speech)
12. Echopraxia (i.e. Mimicking another’s movements)
Psychotic disorders due to other causes
-
Psychosis may occur as the result of substance use, some medications and some
medical conditions
Knowing these causes is important for treatment
o Address underlying cause
Include:
o Substance / medication-induced psychotic disorder
o Psychotic disorder associated with another medical condition
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Diagnostic criteria for substance/medication-induced psychotic disorder
A. Presence of one or both of the following symptoms:
1) Delusions
2) Hallucinations
B. There is evidence from the history, physical examination or laboratory findings of both
(1) and (2):
1. The symptoms in Criteria A developed during, or soon after, substance intoxication
or withdrawal or after exposure to a medication
2. The involved substance / medication is capable of producing the symptoms in
Criterion A
C. The disturbance is not better explained by a psychotic disorder that is not substance /
medication-induced. Such evidence of an independent psychotic disorder could include the
following:
- The symptoms preceded the onset of substance / medication use; the symptoms persist
for a substantial period of time (e.g. about one month) after the cessation of acute
withdrawal or severe intoxication; or there is other evidence of an independent nonsubstance / medication-induced psychotic disorder (e.g. a history of recurrent nonsubstance / medication-related episodes)
D. The disturbance does not occur exclusively during the course of a delirium
E. The disturbance causes clinically significant distress or impairment in social,
occupational or other important areas of functioning
Note: This diagnosis should be made instead of a diagnosis of substance intoxication or
substance withdrawal only when the symptoms in Criterion A predominate in the clinical
picture and when they are sufficiently severe to warrant clinical attention
Diagnostic criteria for psychotic disorder associated with another medical condition
A. Prominent hallucinations or delusions
B. There is evidence from the history, physical examination or laboratory findings that the
disturbance is the direct pathophysiological consequence of another medical condition
C. The disturbance is not better explained by another mental disorder
D. The disturbance does not occur exclusively during the course of a delirium
Brief Psychotic Disorder
-
Positive symptoms of schizophrenia (e.g. hallucinations or delusions) or disorganised
symptoms
Lasts less than one month
Briefest duration of all psychotic disorders
Typically precipitated by trauma or stress
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Diagnostic criteria for brief psychotic disorder
A. Presence of one (or more) of the following symptoms. At least one of these must be
(1), (2) or (3):
1. Delusions
2. Hallucinations
3. Disorganised speech (e.g. frequent derailment or incoherence)
4. Grossly disorganised or catatonic behaviour
Note: Do not include a symptom if it is a culturally sanctioned response
B. Duration of an episode of the disturbance is at least one day but less than one month,
with eventual full return to premorbid level of functioning
C. The disturbance is not better explained by major depressive or bipolar disorder with
psychotic features, or another psychotic disorder such as schizophrenia or catatonia, and is
not attributable to the physiological effects of a substance (e.g. a drug of abuse or a
medication) or another medical condition
Specify if:
- With marked stressor(s) (brief reactive psychosis): If symptoms occur in response
to events that, singly or together, would be markedly stressful to almost anyone in
similar circumstances in the individual’s culture
- Without marked stressor(s): If symptoms do not occur in response to events that,
singly or together, would be markedly stressful to almost anyone in similar
circumstances in the individual’s culture
- With postpartum onset: If onset is during pregnancy or within four weeks
postpartum
Specify if: With catatonia
Attenuated Psychosis Syndrome
-
Identified as a condition in need of further study in DSM-5
Refers to individuals who are at high risk for developing schizophrenia or beginning
to show signs of schizophrenia
Individual is aware that these hallucinations or delusions are unusual experiences not
typical of a healthy person
Label designed to focus attention on these individuals who could benefit from early
intervention
Tend to have good insight into their own symptoms
More on Schizophrenia:
Schizophrenia: Statistics
- Onset and prevalence of schizophrenia worldwide
o About 0.2-1.5% (or about 1% population)
o Often develops in early adulthood
o Can emerge at any time; childhood cases are extremely rare but not unheard of
- Schizophrenia is generally chronic
o Most suffer with moderate-to-severe lifetime impairment
o Life expectancy is slightly less than average
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 Increased risk for suicide
 Increased risk for accidents
 Self-care may be poorer
- Schizophrenia affects males and females about equally
o Females tend to have a better long-term prognosis
o Onset slightly earlier for males
- Cultural factors
o Psychotic behaviours not always pathologised
o Yet, schizophrenia is found at similar rates in all cultures
Course of Schizophrenia
- Prodromal phase
o 85% experience
o 1-2 years before serious symptoms
o Less severe, yet unusual symptoms
 Ideas of
reference
 Magical thinking
 Illusions
 Isolation
 Marked
impairment in
functioning
 Lack of
initiative, interest
or energy
Causes of Schizophrenia: Findings from genetic research
- Family studies
o Inherit a tendency (multiple genes) for schizophrenia, not specific forms of
schizophrenia
o Risk increases with genetic relatedness
 E.g. having a twin with schizophrenia incurs greater risk than having
an uncle with schizophrenia
- Twin studies
o Monozygotic twins vs fraternal (dizygotic) twins
 At greater risk if your identical twin has schizophrenia
 Supports the role of genes
- Adoption studies
o Adoptee risk for developing schizophrenia remains high if a biological parent
has schizophrenia
o But risk is lower than for children raised by their biological parent with
schizophrenia – a healthy environment is a protective factor
- Search for Genetic and behavioural Markers of schizophrenia
o Genetic markers: Linkage and association studies
 Endophenotypes
 Schizophrenia is likely to involve multiple genes
o Behavioural marker (endophenotype): Smooth-pursuit eye movement
 Schizophrenia patients show reduced ability to track a moving object
with their eyes
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 Relatives of schizophrenic patients also have deficits in this area
Causes of Schizophrenia: Neurobiological influences
- The dopamine hypothesis: Schizophrenia is partially caused by overactive dopamine
o Evidence
 Drugs that increase dopamine (agonists) result in schizophrenic-like
behaviour
 Drugs that decrease dopamine (antagonists) reduce schizophrenic-like
behaviour
 Examples – neuroleptics, L-Dopa for Parkinson’s disease
o Problem: Overly simplistic
 Many neurotransmitters are likely to be involved
- The glutamate system can also be affected
- Some ways drugs affect neurotransmission
Structural and functional abnormalities in the brain
o Enlarged ventricles and reduced tissue volume
o Hypofrontality – less active frontal lobes
 A major dopamine pathway
- Viral infections during early prenatal development (intrauterine viral infection)
o Findings are inconclusive
- Also possible that birth injury affects the child’s brain cells
- Marijuana use also increases the risk for developing schizophrenia in at-risk
individuals
- Conclusions about neurobiology and schizophrenia
o Schizophrenia reflects diffuse neurobiological dysregulation
o Structural and functional brain abnormalities
 Not unique to Schizophrenia
Causes of Schizophrenia: Psychological and Social influences
-
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The role of stress
o May activate underlying vulnerability
o May also increase risk of relapse
- Family interactions
o Unsupported theories
 Schizophrenogenic mother (mother over-protective and rejecting,
causing schizophrenia)
 Double bind communication (receiving 2 or more conflicting messages
that negate each other)
o Interactional styles that are high in criticism, hostility and emotional overinvolvement can trigger a relapse (High Expressed Emotion)
- The role of psychological factors
o May function as the diathesis in a diathesis-stress model
o Exert only a minimal effect in producing schizophrenia
- Cultural influences interpretation of disease/symptoms (hallucinations, delusions)
Relapse appears to be triggered by hostile and critical family environments characterised by
highly expressed emotion
Medical treatment of Schizophrenia
- Historical precursors were generally ineffective and often barbaric
- Development of antipsychotic (neuroleptic) medications
o Often the first-line treatment for schizophrenia
o Began in the 1950s
o Most reduce or eliminate positive symptoms – clarify thinking and perceptions
of reality, reduce hallucinations and delusions
o Primarily affect dopamine system, but also affect serotonergic and glutamate
system
- Acute and permanent side effects are common with first-generation medications
o Parkinson’s-like side effects
o Tardive dyskinesia (stiff, jerky movements of face and body that can’t be
controlled)
o Compliance with medication is often a problem
 Aversion to side effects
 Financial cost
 Poor relationship with doctors
- Must be consistent to be effective, inconsistent dosage can aggravate existing
symptoms or create new ones
Psychosocial Treatment of Schizophrenia
- Historical precursors: Psychodynamic therapy was not effective
- Psychosocial approaches
o Behavioural (i.e. Token economies) on inpatient units: reward adaptive
behaviour
o Community care programmes
o Social and living skills training
o Behavioural family therapy
o Vocational rehabilitation
o Can help patient and family understand the disease and symptom triggers,
teaches family communication skills and provides resources for dealing with
emotional and practical challenges
- Illness management and recovery
-
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o Engages patient as an active participant in care
o Continuous goal setting and tracking
o Modules include: Social skills training (teaches social, self-care ad vocational
skills), stress management, substance use
Cultural considerations
o Take into account cultural factors that influence individuals’ understanding of
their own illness (e.g. supernatural beliefs)
o Involve family and community if possible
Prevention
o Identify at-risk children
 Relatives of individuals with schizophrenia
o Foster supportive, stable environments
o Offer additional treatment at prodromal stages, including social skills training
- Treatment of Schizophrenia: Psychosocial interventions 
Successful treatment for people with schizophrenia rarely includes complete recovery. The
quality of life for these individuals can be meaningfully affected, however, by combining
antipsychotic medications with psychosocial approaches, employment support, and
community-based and family interventions. Treatment effectiveness is limited due to
Schizophrenia being a typically chronic disorder
Summary
- Psychotic disorders: Break from reality resulting in a spectrum of dysfunctions
o Affecting cognitive, emotional and behavioural domains
o Schizophrenia involves positive, negative and disorganised symptom clusters
o Medication is somewhat effective for positive symptoms, but much room for
improvement in treatment
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Week 5: Dissociative and Somatoform disorders
These 2 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 disorders:
Somatic symptom disorders = excessive or maladaptive response to physical
symptoms or health concerns
- Pathological concern with the appearance or functioning of their bodies
- Soma = body
o Preoccupation with health or symptoms
o Physical complaints
o Usually no identifiable medical condition
- Types of disorders:
o Somatic symptoms disorder
 First identified by French doctor who noticed patients coming to him
with numerous complaints with no medical basis
 Formerly called Briquet’s syndrome
 Presence of one or more somatic symptoms
 Symptom is often medically unexplained
 Excessive thoughts, feelings and behaviours related to the symptoms
(e.g. excessive thoughts about seriousness of the symptom, frequent
complaints and requests for help, health-related anxiety, excessive
research)
 Substantial impairment in social or occupational functioning
Diagnostic criteria for somatic symptom disorder
-
A. One or more somatic symptoms that are distressing and/or result in significant
disruption of daily life
B. Excessive thoughts, feelings and behaviours related to the somatic symptoms or
associated health concerns as manifested by at least one of the following
1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms
2. High level of health-related anxiety
3. Excessive time and energy devoted to these symptoms or health concerns
C. Although any one symptom may not be continuously present, the state of being
symptomatic is persistent (typically more than 6 months)
Specify if:
- With predominant pain (previously pain disorder): This specifier is for individuals
whose somatic complaints predominantly involve pain
Specify current severity:
- Mild: Only one of the symptoms in Criterion B is fulfilled
- Moderate: 2 or more of the symptoms specified in Criterion B are fulfilled
- Severe: 2 or more of the symptoms specified in Criterion B are fulfilled, plus there
are multiple somatic complaints (or one very severe somatic symptom)

Statistics
 Relatively rare condition
 Onset usually in adolescence
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
More likely to affect unmarried women from lower
socioeconomic groups
 Runs a chronic course
 Research to date is limited due to recent redefinition of the disorder in
DSM-5
 Causes: Eventual social isolation, continual development of new
symptoms, immediate sympathy and attention
 Runs in families, probable heritable basis
 Treatment: Hard to treat, CBT to provide reassurance / reduce stress /
minimise help-seeking behaviours
o Illness anxiety disorder
 Very similar to DSM-4 hypochondriasis
 Clinical description
 Severe anxiety about the possibility of having or acquiring a
serious disease
 Actual symptoms are either very mild or absent
 Strong disease conviction
 Medical reassurance does not seem to help
Diagnostic criteria for Illness Anxiety Disorder
A. Preoccupation with fears of having or acquiring a serious illness.
B. Somatic symptoms are not present or, if present, are only mild in intensity. If another
medical condition is present or there is a high risk for developing a medical condition (e.g.
strong family history is present), the preoccupation is clearly excessive or disproportionate
C. There is a high level of anxiety about health, and the individual is easily alarmed about
personal health status
D. The individual performs excessive health-related behaviours (e.g. repeatedly checks his
or her body for signs of illness) or exhibits maladaptive avoidance (e.g. avoids doctors’
appointments and hospitals)
E. Illness preoccupation has been present for at least 6 months, but the specific illness that
is feared may change over that period of time
F. The illness-related preoccupation is not better explained by another mental disorder,
such as somatic symptom disorder, generalised anxiety disorder or obsessive-compulsive
disorder
Specify whether: Care-seeking types (medical care, including physician visits or
undergoing tests and procedures, is frequently used); Care-avoidant type (medical care is
rarely used)





Affects approximately 4-6% the general population
Affects all ages approximately equally, as well as both genders equally
Often comorbid with anxiety and mood disorders
Treatment: psychotherapy to challenge illness perceptions, counselling
and/or support groups to provide reassurance
Causes: Increased anxiety, faulty interpretation of physical sensations,
intensified focus on sensations
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Examples: Causes of illness anxiety disorder
o Culturally specific disorders
 Koro = fear in some Asian cultures of genitals retracting into the
abdomen
 Dhat = Symptoms (e.g. dizziness, fatigue) attributed to semen loss in
some Indian cultures
 Kyol goeu = “Wind overload” among Khmer people of Cambodia
 Fear that wind cannot circulate effectively through the body
 Dizziness, weakness, fatigue and trembling are seen as signs of
this illness
Causes of somatic symptom disorders
o Not well understood, but seem closely related to anxiety disorders
o Consistent overreaction to physical signs and sensations
o Cause is unlikely to be found in isolated biological or psychological factors
o Genetic component is present
o May have learnt from family to focus anxiety on physical sensations
o 3 additional factors that may contribute to aetiology
 Stressful life events
 Illness in family during childhood
 Benefits of illness (e.g. sympathy, attention)
Schematic presentation: Somatic symptom disorders
Somatic symptom disorder and Antisocial Personality Disorder
o Findings from family and genetic studies: Link between severe forms of
somatic symptom disorder and antisocial personality disorder
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o Shared features
 Often begin early in life
 Chronic and difficult to treat
 More common in lower socioeconomic group
 Linked to substance abuse and interpersonal problems
o Shared feature: disinhibition / impulsivity
 Individuals with somatic symptom disorder impulsively seek sympathy
and other benefits of illness
o Different manifestations of impulsivity
 Somatic symptom disorder: dependence
 Antisocial personality disorder: aggression
o Gender difference
 ASPD much more common in males
 SSD more common in females
Management of somatic symptom disorders
o Limited research to date
o Mild cases of illness anxiety disorder may benefit from detailed education and
some reassurance from medical professionals
o Cognitive-behavioural therapy can effectively treat illness anxiety disorder
o Antidepressants may be helpful
o ‘Gatekeeper’ physician assigned to limit excessive use of medical services
o Reduce supportive consequences of illness
 E.g. Family members stop providing attention
o Can be basic reassurance or interventions to reduces stress and remove
secondary gain.
Psychological factors affecting medical condition
o Diagnostic label useful for clinicians
o Indicates that psychological variables may be impacting a general medical
issue
o Examples:
 Patient’s concentration difficulties make it difficult to take medication
on time
 Patient fails to comply with medical advice due to being in denial
about diagnosis
Other somatic symptom disorders
o Conversion disorder
 Full name: Conversion disorder (functional neurological symptom
disorder)
 Key feature: altered motor or sensory (physical) function that is
inconsistent with neural/medical conditions and not better explained by
another disorder
 Often suggestive of neurological problem, but no such problem
detected
 Must cause significant distress/impairment
 May display indifferent attitude towards symptoms (la belle
indifference)
 Functioning may be mostly normal
 Not deliberately faking symptoms for the purpose of concrete gains
(malingering)
 Affected people are genuinely unaware that they can function normally
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Diagnostic criteria for Conversion Disorder (functional neurological symptom
disorder)
A. One or more symptoms of altered voluntary motor or sensory function
B. Clinical findings provide evidence of incompatibility between the symptom and
recognised neurological or medical conditions
C. The symptom or deficit is not better explained by another medical or mental disorder
D. The symptom or deficit causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning or warrants medical evaluation



Rare condition, with a chronic intermittent course
Often comorbid with anxiety and mood disorders
Seen primarily in females, most prevalent in low socio-economic
groups, where individuals are under extreme stress
 Onset usually in adolescence
 Common in some cultural and/or religious groups
 Causes
 Not well understood
 Freudian psychodynamic view is still common, though
unsubstantiated
o Past trauma or unconscious conflict is ‘converted’ to a
more acceptable manifestation, i.e. Physical symptoms
 Primary / secondary gains
o Freud thought primary gain was the escape from dealing
with a conflict
o Secondary gains: Attention, sympathy, etc.
 Sociocultural factors
o More common in lower education, lower socioeconomic status
o Patients likely to adopt symptoms with which they are
already familiar – symptoms learned from observing
 Management
 If onset after a trauma, may need to process trauma or treat
posttraumatic symptoms
 Remove sources of secondary gain
 Reduce supportive consequences of talking about physical
symptoms
o Factitious disorder
 Purposely faking physical symptoms
 May actually induce physical symptoms or just pretend to have them
 No obvious external gains
 Only external gain may be the benefits of the ‘sick role’ (e.g.
sympathy)
 Distinguished from malingering, in which physical symptoms
are faked for the purpose of achieving a concrete objective (e.g.
getting paid time off, avoiding military service)
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Diagnostic criteria for factitious disorders
A. Falsification of physical or psychological signs or symptoms, or induction of injury or
disease, associated with identified deception
B. The individual presents himself or herself to others as ill, impaired or injured
C. The deceptive behaviour is evident even in absence of obvious external rewards
D. The behaviour is not better accounted for by another mental disorder such as delusional
belief system or acute psychosis
Specify if:
- Single episode
- Recurrent episode: 2 or more events of falsification of illness and/or induction of
injury
o Factitious Disorder imposed on another
 Formerly known as Munchausen’s syndrome by proxy
 Inducing symptoms in another person
 Typically a caregiver induces symptoms in a dependent (e.g.
child)
 Purpose = receive attention or sympathy
 Atypical child abuse
Dissociative Disorders
-
An overview
o Severe alterations or detachments from reality / own self / memories
o Affect identity, memory or consciousness
o Depersonalisation – distortion in perception of one’s body or experience (e.g.
feeling like your own body isn’t real)
o Derealisation – losing a sense of the external world (e.g. sense of living in a
dream)
o Causes:
 Similar to Posttraumatic stress disorder
 Interacts with biological vulnerability
 High suggestibility of a possible trait
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Severe abuse during childhood, fantasy life is the only escape –
becomes automatic and then involuntary
Types of DSM-5 dissociative disorders
o Depersonalisation-derealisation disorder
 Recurrent episodes in which a person has sensations of unreality of
one’s own body or surroundings – severe and frightening feelings of
detachment dominate their life
 Affected person feels like an outside observer of their own mental or
body processes
 Depersonalisation = sense of personal reality is temporarily lost
 Derealisation = sense of reality of the external world
 Only diagnosed if primary problem involves depersonalisation and
derealisation
 Similar symptoms may occur in the context of other disorders,
including panic disorder and PTSD

-
Diagnostic criteria for Depersonalisation-Derealisation disorder
A. The presence of persistent or recurrent experiences of depersonalisation, derealisation,
or both:
- Depersonalisation: Experiences of unreality, detachment or being an outside observer
with respect to one’s thoughts, feelings, sensations, body or actions (e.g. perceptual
alterations, distorted sense of time, unreal or absent self, emotional and/or physical
numbing)
- Derealisation: Experiences of unreality or detachment with respect to surroundings
(e.g. individuals or objects are experienced as unreal, dreamlike, foggy, lifeless or
visually distorted)
B. During the depersonalisation or derealisation experience, reality testing remains intact
C. The symptoms cause clinically significant distress or impairment in social, occupational
or other important areas of functioning
D. The disturbance is not attributable to the physiological effects of a substance (e.g. a drug
of abuse or medication) or another medical condition (e.g. seizures)
E. The disturbance is not better explained by another mental disorder, such as
schizophrenia or panic disorder

Other features
 Cognitive deficits in attention, short-term memory, spatial
reasoning
 Easily distractible
 Difficulty absorbing new information
 Reduced emotional responding
 May have dysregulation of HPA axis in brain
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Dissociative experiences

Facts and statistics
 High comorbidity with anxiety and mood disorders
 1-3% of the population
 Onset is typically in adolescence
 Usually runs a lifelong chronic course
 Having a history of trauma makes this disorder more likely to
manifest
 Treatment
 Research is very scarce
 No systematic research on psychological treatments
 Trial of antidepressants (fluoxetine) showed no effect above
placebo
 Psychological treatments similar to those for panic disorder
may be helpful
 Stresses associated with onset should be addressed
 Tends to be lifelong
o Dissociative amnesia
 Dissociative amnesia has many forms of psychogenic memory loss
 Consists of localised or selective type
 May involve dissociative fugue
 During the amnestic episode, person travels or wanders,
sometimes assuming a new identity in a different place
 Unable to remember how or why one has ended up in a new
place
Diagnostic criteria for Dissociative Amnesia
A. An inability to recall important autobiographical information, usually of a traumatic
or stressful nature, that is inconsistent with ordinary forgetting
Note: Dissociative amnesia most often consists of localised or selective amnesia for a
specific event or events; or generalised amnesia for identity and life history
B. The symptoms cause clinically significant distress or impairment in social, occupational
or other important areas of functioning
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C. The disturbance is not attributable to the physiological effects of a substance (e.g.
alcohol or other drug of abuse or a medication) or a neurological or other medical
condition (e.g. partial complex seizures, transient global amnesia, sequelae of a closed head
injury / traumatic brain injury or other neurocognitive disorder
D. The disturbance is not better explained by dissociative identity disorder, posttraumatic
stress disorder, acute stress disorder, somatic symptom disorder or major or mild
neurocognitive disorder
Specify if: With dissociative fugue: Apparently purposeful travel or bewildered wandering
that is associated with amnesia for identity or for other important autobiographical
information

Dissociative amnesia and fugue
 Statistics
o Prevalence = 2-7%
o Usually begins in adulthood
o Rarely appears in childhood or late adulthood
o Show rapid onset and dissipation
 Causes
o Little is known
o Trauma and stress can serve as triggers
 Most recover / remember without treatment
 Treatment: Usually self-correcting when a life stress is
resolved, or therapy focused on retrieving lost information
o Dissociative trance disorder
 Presentation varies across cultures
 Nigeria – called vinvusa
 Thailand – called phii pob
 Dissociative symptoms and sudden changes in personality
 Change may be attributed to possession by a spirit
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 Only considered a disorder if it leads to distress or impairment
 Often associated with stress or trauma
 More common in women than in men
 Little is known in terms of treatment
o Dissociative identity disorder (DID)32
 Clinical description
 Formerly known as multiple personality disorder
 Defining feature is dissociation of personality
 Adoption of several new identities (can be as many as 100; may
be just a few; average is 15)
 Identities display unique behaviours, voice and postures. They
can be distinct and complete, or only partly independent
Diagnostic criteria for Dissociative Identity disorder
A. Disruption of identity characterised by 2 or more distinct personality states, which may
be described in some cultures as an experience of possession. The disruption of marked
discontinuity in sense of self and sense of agency, accompanied by related alterations in
affect, behaviour, consciousness, memory, perception, cognition and/or sensory-motor
functioning. These signs and symptoms may be observed by others or reported by the
individual
B. Recurrent gaps in the recall of everyday events, important personal information, and/or
traumatic events that are inconsistent with ordinary forgetting
C. The symptoms cause clinically significant distress or impairment in social, occupational
or other important areas of functioning
D. The disturbance is not a normal part of a broadly accepted cultural or religious practice.
Note: In children, the symptoms are not attributable to imaginary playmates or other
fantasy play.
E. The symptoms are not attributable to the physiological effects of a substance (e.g.
blackouts or chaotic behaviour during alcohol intoxication) or another medical condition
(e.g. complex partial seizures)



Unique aspects of DID
 Alters – different identities or personalities
 Host – the identity that keeps other identities together
 Switch – quick transition from one personality to another
Controversy: Can DID be faked?
 Some patients presenting with DID symptoms are faking
(possibly subconsciously)
o Example: Patients more likely to ‘produce’ a fake alter
when therapist suggests this possibility
 Some DID patients are not faking
o Case studies reveal changes in physiological and brain
function when switching between alters
Statistics
 Prevalence: Not well known, perhaps 1-2%
 More common in females
 Onset is almost always in childhood or adolescence
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 High comorbidity rates with other psychological disorders
 Typically follows lifelong, chronic course
 Causes of Dissociative Identity Disorder
 Typically linked to a history of severe, chronic trauma, often
abuse in childhood
o Risk increases if there is no social support after the
trauma
 Mechanism: Dissociation offers an opportunity to escape from
the impact of trauma
 Closely related to PTSD, possibly an extreme subtype
 Biological vulnerability possible but not well understood;
almost all risk is environmental`
 Treating DID
 Focus is on reintegration of identities
 Identify and neutralise cues/triggers that provoke memories of
trauma / dissociation
 Patient may have to relive and confront the early trauma
o Some achieve this through hypnosis
 Often long-term. Trust between the therapist and patient is
essential
 Long term psychotherapy may reintegrate separate personalities
in 25% of patients
 False memories
 Problem: it’s possible to create / implant false memories of
abuse by the power of suggestion
 Consequence: Some patients think they have repressed
memories of abuse which are later shown to be false, but can be
very damaging to patients and their families
 Conclusion: Therapists need to be well trained in memory
function and careful not to suggest an untrue history by mistake
Causes of Dissociative disorders are not well understood but often seem related to the
tendency to escape psychologically from stress or memories of traumatic events
Management of dissociative disorders involves helping the patient re-experience the
traumatic events in a controlled therapeutic manner to develop better coping skills
Summary of Somatic Symptom Disorders and Dissociative Disorders
-
Features of somatic symptom disorders
o Physical concerns without a clear medical cause
Features of dissociative disorders
o Extreme distortions in perceptions and memory
For both classes of disorders, well established treatments are generally lacking.
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Week 6: Sexual dysfunctions, dysphoria and paraphilic disorders;
Substance-related, addictive, eating and feeding disorders.
Sexual Dysfunctions, Paraphilic Disorders and Gender Dysphoria
-
-
-
-
What is ‘normal’ vs ‘abnormal’ sexual behaviour? Need to consider:
o Normative (i.e. Common, average) facts and statistics
o Cultural considerations
o Gender differences in sexual behaviour and attitudes
o Societies are becoming more tolerant of a variety of sexual expressions
Gender differences
o Masturbation
 Frequency 2.5 times higher in men
 Reason for discrepancy: Male masturbation may be easier, physical
gratification more emphasised for men
o Casual premarital sex
 Men are more permissive, but the gap is shrinking
o Elements of satisfaction
 Women = more likely to seek demonstrations of love, intimacy
 Men = More likely to focus on arousal
o No differences in several domains
 Acceptability of homosexuality
 Acceptability of masturbation
 Importance of sexual satisfaction
o Sexual self-schemas: belief about one’s own sexuality
o Females more likely to value experience of passionate and romantic feelings
 Minority of females hold embarrassed, conservative or self-conscious
views about sex
o Males have fewer negative core beliefs about sex; more likely to emphasise
dominance and aggression
o Summary of sexuality differences
 Men
 Show more sexual desire and arousal
 Self-concept includes power and independence
 Women
 Emphasise context of committed relationship
 Sexual beliefs are more easily shaped by cultural, situational
and social factors
Sex in older adults
o Activity can and does last beyond age 80
o Age 75-85
 M = 38.5% active and F = 16.7% active
o Decrease in sexual activity attributable to physical health changes
Cultural differences
o Views on sexuality in children
 Sambia people (Papua New Guinea) believe receiving semen
contributes to development in children – emphasise homosexual oral
sex between teenage and young boys
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Munda (India) emphasise mild heterosexual activity (e.g. mutual
masturbation) among cohabiting children
o Permissiveness towards casual sex varies
Development of sexual orientation
o The development of sexual orientation
 Interaction of bio-psycho-social influences
 The example of homosexuality
 Only small genetic component: 50% of identical twins raised
together (i.e. Same genes and environment) do not share the
same sexual orientation
Overview of sexual dysfunctions
o Sexual dysfunctions
 Involve desire, arousal and/or orgasm
 Pain associated with sex can lead to additional dysfunction
 Difficulty to function adequately during sexual relations
o Must now be present for more than 6 months in order to make diagnosis
o Must lead to impairment or distress in order to be considered a disorder
o Context of sexual dysfunction
 Desire phase [sexual urges occur in response to sexual cues or
fantasies]
 Arousal stage [A subjective sense of sexual pleasure and physiological
signs of sexual arousal: In males, penile tumescence (increased flow of
blood into the penis); In females, vasocongestion (blood pools in the
pelvic area) leading to vaginal lubrication and breast tumescence (erect
nipples)]
 Plateau phase [Brief period occurs before orgasm]
 Orgasm phase [In males, feelings of the inevitability of ejaculation,
followed by ejaculation; in females, contractions of the walls of the
lower third of the vagina]
 Resolution phase [decrease in arousal occurs after orgasm (particularly
in men)]
o Prevalence
 Sexual difficulties are extremely common and not always distressing
 One study found that 40% of men had some difficulty with
erection/ejaculation and 63% of women had problems with
arousal/orgasm
o Males and females experience parallel versions of most dysfunctions
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o Classification of sexual dysfunctions
 Lifelong vs acquired
 Generalised (every encounter) vs situational (certain partners or times)
 Psychological factors alone
 Psychological factors combined with medical condition
Male Hypoactive Sexual Desire disorder (disorder of desire)
o Little or no interest in any type of sexual activity
o Masturbation, sexual fantasies and intercourse are rare
o Accounts for half of all complaints at sexuality clinics
o Affects 5% of men
Diagnostic criteria for male hypoactive sexual desire disorder
A. Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies
and desire for sexual activity. The judgement of deficiency is made by the clinician, taking
into account factors that affect sexual functioning, such as age and general socio-cultural
contexts of the person’s life
B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6
months
C. The symptoms in Criterion A cause clinically significant distress in the individual
D. The sexual dysfunction is not better explained by a non-sexual mental disorder or as a
consequence of severe relationship distress or other significant stressors and is not
attributable to the effects of a substance / medication or another medical condition
Specify whether:
- Lifelong type
- Acquired type
Specify whether:
- Generalised type
- Situational type
-
Female sexual interest/arousal disorder (disorder of desire / arousal)
o Lack of or significantly reduced sexual interest/arousal
 Typically manifesting in:
 Reduced sexual interest
 Reduced sexual activity
 Fewer sexual thoughts
 Reduced arousal to sexual cues
 Reduced pleasure or sensations during almost all sexual
encounters
Diagnostic criteria for female sexual interest / arousal disorder
A. Lack of, or significantly reduced, sexual interest / arousal, as manifested by at least 3
of the following:
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1. Absent / reduced interest in sexual activity
2. Absent / reduced sexual / erotic thoughts or fantasies
3. No / reduced initiation of sexual activity and typically unreceptive to a partner’s
attempts to initiate
4. Absent / reduced sexual excitement / pleasure during sexual activity in almost all or
all (approximately 75-100%) sexual encounters (in identified situational contexts or, if
generalised, in all contexts)
5. Absent / reduced sexual interest / arousal in response to any internal or external
sexual / erotic cues (e.g. written, verbal, visual).
6. Absent / reduced genital or non-genital sensations during sexual activity in almost all
or all (approximately 75-100%) sexual encounters (in identified situational contexts or,
if generalised, in all contexts)
B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6
months
C. The symptoms in Criterion A cause clinically significant distress in the individual
D. The sexual dysfunction is not better explained by a non-sexual mental disorder or as a
consequence of severe relationship distress or other significant stressors and is not
attributable to the effects of a substance / medication or another medical condition
Specify type:
- Lifelong type
- Acquired type
Specify type:
- Generalised type
- Situational type
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Erectile disorder (disorder of arousal)
o Difficult achieving or maintaining an erection
o Sexual desire is usually intact
o Most common problem for which men seek treatment
o Prevalence increases with age
 60% of men over 60 experience erectile dysfunction
Female orgasmic Disorder (orgasmic disorder)
o Marked delay, absence or decreased intensity of orgasm in almost all sexual
encounters
o Not explained by relationship distress or other significant stressors
o One in four women has significant difficulty achieving orgasm
Diagnostic criteria for female orgasmic disorder
A. Presence of either of the following symptoms and experienced on almost all or all
(approximately 75-100%) occasions of sexual activity (in identified situational contexts or,
if generalised, in all contexts)
1. Marked delay in, marked infrequency of, or absence of, orgasm
2. Markedly reduced intensity of orgasmic sensations
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B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6
months
C. The symptoms in Criterion A cause clinically significant distress in the individual
D. The sexual dysfunction is not better explained by a non-sexual mental disorder or as a
consequence of severe relationship distress or other significant stressors and is not
attributable to the effects of a substance / medication or another medical condition
Specify type:
- Lifelong type
- Acquired type
Specify type:
- Generalised type
- Situation type
Specify: Never experienced an orgasm under any situation
-
Premature ejaculation (orgasmic disorder)
o Ejaculation occurring within approximately one minute of penetration and
before it is desired
o Most prevalent sexual dysfunction in adult males
 Affects 21% of all adult males
 Most common in younger, inexperienced males
o Problem tends to decline with age
Diagnostic criteria for premature ejaculation
A. A persistent or recurrent pattern of ejaculation occurring during partnered sexual
activity within approximately one minute following vaginal penetration and before the
person wishes it.
Note: Although the diagnosis of premature (early) ejaculation may be applied to
individuals engaged in non-vaginal sexual activities, specific duration criteria have not
been established for these activities
B. The symptom in Criterion A must have been present for at least 6 months and must be
experienced on almost all or all (approximately 75-100%) occasions of sexual activity (in
identified situational contexts or, if generalised, in all contexts)
C. The symptoms in Criterion A cause clinically significant distress in the individual
D. The sexual dysfunction is not better explained by a non-sexual mental disorder or as a
consequence of severe relationship distress or other significant stressors and is not
attributable to the effects of a substance / medication or another medical condition
Specify type:
- Lifelong type
- Acquired type
Specify type:
- Generalised type
- Situational type
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Genito-Pelvic Pain / penetration disorder (sexual pain disorder)
o In females, difficulty with vaginal penetration during intercourse, associated
with one or more of the following
 Pain during intercourse or penetration attempts
 Fear/anxiety about pain during sexual activity
 Tensing of pelvic floor muscles in anticipation of sexual activity
Diagnostic criteria for Genito-Pelvic Pain / penetration disorder
A. Persistent or recurrent difficulties with one (or more) of the following:
1. Vaginal penetration during intercourse
2. Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration
attempts
3. Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during,
or as a result of vaginal penetration
4. Marked tensing or tightening of the pelvic floor muscles during attempted vaginal
penetration
B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6
months
C. The symptoms in Criterion A cause clinically significant distress in the individual
D. The sexual dysfunction is not better explained by a non-sexual mental disorder or as a
consequence of severe relationship distress or other significant stressors and is not
attributable to the effects of a substance / medication or another medical condition
Specific type:
- Lifelong type
- Acquired type
-
Assessing sexual behaviour
o Interviews
 Clinician must demonstrate comfort with the topic
 Assess multiple dimensions
 Sexual attitudes
 Behaviours
 Sexual response cycle
 Relationship issues
 Physical health
 Psychological disorder
o Medical evaluation factors
 Medication side effects
 Physical conditions
o Psychophysiological assessment
 Sexual arousal in response to erotic material
 Males – Penile strain gauge (measures erection)
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Females – Vaginal photoplethysmograph (measures blood flow
to vagina)
Causes of sexual dysfunction
o Biological
 Physical disease
 Medical illness (possibly chronic)
 Prescription medications (e.g. antihypertensive medication)
 Alcohol and drugs
 Neurological problems
 Vascular disease
o Psychological contributions
 People with sexual dysfunction are more likely to experience anxiety
and negative thoughts about sexual encounters
 May actively avoid awareness of sexual cues
 Example: Men with PE tend to distract themselves purposefully
to avoid orgasm
 Distraction, underestimates of arousal, negative thought processes
o Effect of anxiety on sexual arousal
 Previously believed to decrease arousal and contribute to sexual
dysfunction
 But in some cases, anxiety (e.g. about getting an electric shock in a
laboratory) increases arousal in response to erotic material
o Distraction often increases arousal and awareness of own sexual response
o Social and cultural contributions
 Erotophobia: Associate sexuality with negative feelings, anxiety or
threat (socially transmitted negative attitudes about sex)
 Unpleasant or traumatic sexual experiences (e.g. rape)
 Poor interpersonal relationships / current relationship difficulties
 Lack of communication
o A combination of influences is almost always present
 Biological predisposition combined with psychological factors
Functional vs dysfunctional sexual arousal:
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Treatment of sexual dysfunction
o Education alone can be surprisingly effective
o Masters and Johnson’s psychosocial intervention
 Education about sexual response, foreplay, etc.
 Sensate focus and non-demand pleasuring
 Sexual activity with the goal of focusing on sensations without
trying to achieve orgasm
 Decreases performance anxiety
o Additional psychosocial procedures
 Generally successful but not readily available
 Squeeze technique – premature ejaculation
 Masturbatory training – female orgasm disorder
 Use of dilators – vaginismus
 Exposure to erotic material – low sexual desire problems
o Medical
 Most focus on erectile dysfunction
 Viagra
o Headache side effects, many discontinue use
 Injection of vasodilating drugs into the penis
 Testosterone
 Penile prosthesis or implants
 Vascular surgery
 Vacuum device therapy
 Few medical procedures exist for female sexual dysfunction
o Combine medical treatment with sexual education and therapy to achieve
maximum benefit
Paraphilic Disorders: Clinical descriptions and causes
o Nature of paraphilic disorders – misplaced sexual attraction and arousal
 Focused on inappropriate people or objects
 Often multiple paraphilic patterns of arousal
 High comorbidity with anxiety, mood and substance-use disorders
o DSM-5 paraphilic disorders
 Fetishistic disorder
 Sexual attraction to nonhuman objects
o Objects can be inanimate and/or tactile
 Examples
o May include rubber, hair, feet, objects such as shoes
Diagnostic criteria for Fetishistic disorder
A. Over a period of at least 6 months, recurrent and intense sexual arousal from the use of
non-living objects or a highly specific focus on non-genital body part(s), as manifested
by fantasies, urges or behaviours
B. The fantasies, sexual urges or behaviours cause clinically significant distress or
impairment in social, occupational or other important areas of functioning
C. The fetish objects are not limited to articles of clothing used in cross-dressing (as in
Transvestic disorder) or devices specifically designed for the purpose of tactile genital
stimulation (e.g. a vibrator)
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Voyeuristic disorder
 Observing an unsuspecting individual undressing, naked or
engaged in sexual activity
 Risk associated with ‘peeping’ may intensify sexual arousal
Exhibitionistic disorder
 Exposure of genitals to unsuspecting strangers
 Element of thrill and risk is necessary for sexual arousal
Diagnostic criteria for Voyeuristic disorder
A. Over a period of at least 6 months, recurrent and intense sexual arousal from
observing an unsuspecting person who is naked, in the process of disrobing or engaging in
sexual activity, as manifested by fantasies, urges or behaviours
B. The person has acted on these sexual urges with a non-consenting person, or the sexual
urges or fantasies cause clinically significant distress or impairment in social, occupational
or other important areas of functioning
C. The individual experiencing the arousal and/or acting on the urges is at least 18 years
of age
Diagnostic criteria for Exhibitionistic disorder
A. Over a period of at least 6 months, recurrent and intense sexual arousal from the
exposure of one’s genitals to an unsuspecting person, as manifested by fantasies, urges or
behaviours
B. The person has acted on these sexual urges with a non-consenting person, or the sexual
urges or fantasies cause clinically significant distress or impairment in social, occupational
or other important areas of functioning

Frotteuristic disorder
 Persistent pattern of seeking sexual gratification from rubbing
up against unwilling others
o Often occurs in crowds and/or confining situations from
which the other person cannot escape
 Examples: Crowded elevator or subway
Diagnostic criteria for Frotteuristic disorder
A. Over a period of at least 6 months, recurrent and intense sexual arousal from touching
or rubbing against a non-consenting person, as manifested by fantasies, urges or
behaviours
B. The person has acted on these sexual urges with a non-consenting person, or the sexual
urges or fantasies cause clinically significant distress or impairment in social, occupational
or other important areas of functioning

Transvestic disorder
 Sexual arousal with the act of cross-dressing
o Males may (rarely) show highly masculine
compensatory behaviours
 Most do not show compensatory behaviours
o Many are married and the behaviour is known to the
spouse
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Not inherently pathological; only considered disordered if it
causes significant distress or impairment
Diagnostic criteria for Transvestic disorder
A. Over a period of at least 6 months, recurrent and intense sexual arousal from crossdressing, as manifested by fantasies, urges or behaviours
B. The fantasies, sexual urges or behaviours cause clinically significant distress or
impairment in social, occupational or other important areas of functioning
Specify if:
- With fetishism
- With autogynaephilia (not arousal associated with clothing itself, but rather with
thoughts or images of oneself as a female)


Sexual sadism disorder
 Inflicting pain or humiliation to attain sexual gratification
Sexual masochism disorder
 Suffering pain or humiliation to attain sexual gratification
Diagnostic criteria for sexual sadism disorder
A. Over a period of at least 6 months, recurrent and intense sexual arousal from the
psychological or physical suffering of another person, as manifested by fantasies, urges or
behaviours
B. The person has acted on these sexual urges with a non-consenting person, or the sexual
urges or fantasies cause clinically significant distress or impairment in social, occupational
or other important areas of functioning
Diagnostic criteria for sexual masochism disorder
A. Over a period of at least 6 months, recurrent and intense sexual arousal from the act of
being humiliated, beaten, bound or otherwise made to suffer, as manifested by fantasies,
urges or behaviours
B. The fantasies, sexual urges or behaviours cause clinically significant distress or
impairment in social, occupational or other important areas of functioning


Sexual sadism, paraphilia and rape
 Some rapists are sadists, but most are not
 Most rapists do not show paraphilic patterns of arousal
 Rapists tend to show sexual arousal to violent sexual and nonsexual material
Paedophilic disorder
 Paedophilia – sexual attraction to prepubescent children
 Vast majority of sufferers are males
o Paedophilia is rare, but not unheard of, in females
 In some cases, paedophilic urges are limited to incest (i.e.
Young members of one’s own family)
 Many sufferers do not act on desires
o Some engage in compensatory moral behaviour
 Paedophilia
o Associated features
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Incestuous males may be aroused by adult
women
 Male paedophiles are usually not aroused by
adult women
 Some rationalise the behaviour
 E.g. consider paedophilic activity to be
an act of affection or a teaching
experience
 Often engage in other moral
compensatory behaviour
Manifest in fantasies, urges, arousal or behaviours
Paraphilia is not always disordered
Only considered disordered when the individual
 Experiences clinically significant
distress or impairment OR
 Acts on urges with a nonconsenting
person
Causes of Paraphilic disorders
 Pre-existing deficiencies
 Difficulty forming ‘normal’
relationships
 Deficits in typical adult
sexual experiences
 Relationship difficulties in
childhood or adolescence
 Deficits in adult social skills
 Early experiences may lead to
sexual associations by chance – then
reinforced through masturbation
 Treatment received from adults
during childhood
 Often have very high sex drive
 Suppressing unwanted fantasies may paradoxically increase
them
Psychosocial interventions / treatment for paraphilic disorders
 Target deviant and inappropriate sexual associations
 Covert sensitisation – repetitive mental reviewing aversive
consequences to form negative associations with deviant (e.g.
paedophilic) behaviour
 Orgasmic reconditioning – pairing masturbation to appropriate (adult)
stimuli to create positive arousal patterns
 Family / marital therapy – address interpersonal problems
 Therapeutic coping preparation and relapse prevention – self-control
and risk management
 Medications that reduce testosterone to suppress sexual desire fantasies and arousal return when medication is stopped
 Efficacy is mixed
 Poorest outcomes = rapists and patients with multiple
Paraphilias
 Incarcerated offenders are difficult to treat
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o Chronic course
o High relapse rates
Outpatient treatment is more successful
Gender Dysphoria
o Clinical overview
 Feeling trapped in the body of the wrong sex
 Often assuming the identity of the desired sex
o Causes are unclear
 Gender identity usually begins between 18 and 36 months of age
 Seems that gender identity (congruent or incongruent) have biological
roots influenced by learning
o Fluid or cross-gender identity is not a disorder unless it causes significant
distress or impairment
o Relatively rare
o Female:Male ratio = 1:2.3 (i.e. More common in males)
o Rates are similar across cultures
 Some cultures revere individuals with non-traditional gender
experience (e.g. biological male adopting a female role seen as a
shaman)
Diagnostic criteria for gender dysphoria
In Children:
A. A marked incongruence between one’s experienced / expressed gender and one’s
assigned gender, of at least 6 months’ duration, as manifested by at least 6 of the
following (one of which must be Criterion A1)
1. A strong desire to be of the other gender or an insistence that one is the other gender
(for some alternative gender different from one’s assigned gender)
2. In boys (assigned gender), a strong preference for cross-dressing or simulating female
attire; or in girls (assigned gender), a strong preferences for wearing only typical
masculine clothing and a strong resistance to the wearing of typical feminine clothing
3. A strong preference for cross-gender roles in make-believe play or fantasy play
4. A strong preference for the toys, games or activities stereotypically used or engaged
in by the other gender
5. A strong preference for playmates of the other gender
6. In boys (assigned gender), a strong rejection of typically masculine toys, games and
activities and a strong avoidance of rough-and-tumble play or in girls (assigned gender),
a strong rejection of typically feminine toys, games and activities
7. A strong dislike of one’s sexual anatomy
8. A strong dislike for the primary and/or secondary sex characteristics that match one’s
experienced gender
B. The condition is associated with clinically significant distress or impairment in social,
school or other important areas of functioning
In Adolescents and adults:
A. A marked incongruence between one’s experienced / expressed gender and one’s
assigned gender, of at least 6 months’ duration, as manifested by at least 2 of the
following:
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1. A marked incongruence between one’s experienced / expressed gender and primary
and/or secondary sex characteristics (or in young adolescents, the anticipated secondary
sex characteristics)
2. A strong desire to be rid of one’s primary and/or secondary sex characteristics
because of a marked incongruence with one’s experienced/expressed gender (or in
young adolescents, a desire to prevent the development of the anticipated secondary sex
characteristics)
3. A strong desire for the primary and/or secondary sex characteristics of the other
gender
4. A strong desire to be of the other gender (or some alternative gender different from
one’s assigned gender)
5. A strong desire to be treated as the other gender (or some alternative gender different
from one’s assigned gender)
6. A strong conviction that one has the typical feelings and reactions of the other gender
(or some alternative gender different from one’s assigned gender)
B. The condition is associated with clinically significant distress or impairment in social,
school or other important areas of functioning
-
o Causes
 No clear biological causes identified, but likely to have genetic
component
 Studies have found that 62-70% of variance in gender
expression is explained by genetics
 Prenatal exposure to certain hormones in the womb (e.g. higher
levels of testosterone may masculinise a female foetus) –
natural or from medication
 Psychological influences
 Gender identity develops between 18 months and 3 years of age
– opposite gender behaviours evoke different responses in
families
o Treating Gender Dysphoria
 Sex reassignment surgery – genital reconstruction
 Must be psychologically / financially / socially stable and live
as desired gender for several years first
 75% report satisfaction with new identity
 Female-to-male conversions adjust better
 Should be integrated with psychological approaches
 Treatment of intersexuality
 Often treated with surgery at birth; subsequent gender
dysphoria may need to be addressed
 Psychosocial intervention to change gender identity – usually
unsuccessful except as temporary relief until surgery
Management of Gender nonconformity in children
o Gender nonconformity is common and may not lead to gender dysphoria
o Gender nonconformity can lead to negative social experiences
o Conflict between affirming child’s identity and encouraging cis-gender
behaviour to improve social adjustment
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o Treatment should be individualised to specific child’s needs and environment
Summary of Sexual and Gender identity disorders
o Sexual dysfunctions are very common
 Problems with desire, arousal and/or orgasm
o Paraphilic disorders represent inappropriate sexual attraction
o Psychosocial and medical treatment options
 Often effective
 Comprehensive assessment and treatment approaches are best
o Gender dysphoria: Feeling trapped in the body of the opposite sex
Substance related, Addictive and Impulse-control Disorders
-
Substance-related and Addictive Disorders
o Perspectives
 The nature of substance-related disorders
 Abuse of psychoactive substances
 Wide-ranging physiological, psychological and behavioural
effects
 Associated with impairment and significant costs
o Once seen as due to personal weakness, now thought to be influenced by both
biological and psychosocial factors
o Non-medical substance use in South Africa has increased in recent times, and
illicit substances have little quality control. Street drugs can contain
adulterants (e.g. baby powder or rat poison) that present a serious public health
concern
o Terms and definitions
 Substance use
 Taking moderate amounts of a substance in a way that does not
interfere with functioning
 Substance intoxication
 Physical reaction to a substance (e.g. being drunk)
 Substance abuse
 Use in a way that is dangerous or causes substantial impairment
(e.g. affecting job or relationships)
 Substance dependence
 May be defined by drug-seeking behaviour (e.g. spending too
much money on substance)
 Tolerance
 Needing more of a substance to get the same effect or reduced
effects from the same amount
 Withdrawal
 Physical symptom reaction when substance is discontinued
after regular use
o Six main categories of substances
 Depressants
 Behavioural sedation (e.g. alcohol, sedative, hypnotic and
anxiolytic drugs)
 Decrease CNS activity, reduce levels of physiological arousal
 Stimulants
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Psychoactive. Increase alertness and elevate mood (e.g.
caffeine, amphetamines, cocaine, nicotine)
 Opioids
 Produce analgesia and euphoria (e.g. opium, heroin, morphine,
codeine)
 Narcotic effect, relieving pain and inducing sleep
 Includes opiates, synthetic derivatives (methadone, pethidine,
fentanyl) and endogenous opioids of the nervous system
(enkephalins, beta-endorphins, dynorphins)
 Cannabinoid
 Reactions to cannabis usually include mood swings, however,
effects tend to vary from person to person
 Hallucinogens
 Alter sensory perception (e.g. LSD, psilocybin)
 Other drugs of abuse
 Include inhalants, anabolic steroids, antihistamines, simple
analgesics (paracetamol and aspirin), and anti-inflammatory
agents (diclofenac)
 Combinations of substances have emerged across the world: nyaope
(methamphetamine, heroin, cannabis and antiretroviral agents) in SA,
and krokodil (codeine phosphate and iodine) in Russia and former
soviet republics
o Substance-related disorders in DSM-5
 Pattern of substance use leading to significant impairment and distress
 Symptoms (need at least 2 within a year)
 Taking more of the substance than intended
 Desire to cut down use
 Excessive time spent using / acquiring / recovering
 Craving for the substance
 Role disruption (e.g. can’t perform at work)
 Interpersonal problems
 Reduction of important activities
 Use in physically hazardous situations (e.g. driving)
 Keep using despite causing physical or psychological problems
 Tolerance
 Withdrawal
 DSM-5 now spells out criteria for:
 Substance intoxication for different types of substances (e.g.
alcohol, stimulants)
 Substance-use disorders for different types of substances
 Withdrawal from different types of substances
The Depressants: Alcohol-Related disorders
o Psychological and physiological effects of alcohol
 Central nervous system depressant
 Influences several neurotransmitter systems
 Specific target is GABA
 Increases inhibitory effects – makes neural cells worse at firing
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Diagnostic criteria for alcohol use disorder
A. A problematic pattern of alcohol use leading to clinically significant impairment or
distress, as manifested by at least 2 of the following, occurring within a 12-month period:
1. Alcohol is often taken in larger amounts or over a longer period than was intended
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or
recover from its effects
4. Craving, or a strong desire or urge to use alcohol
5. Recurrent alcohol use resulting in a failure to fulfil major role obligations at work,
school or home
6. Continued alcohol use despite having persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects of alcohol
7. Important social, occupational or recreational activities are given up or reduced
because of alcohol use
8. Recurrent alcohol use in situations in which it is physically hazardous
9. Alcohol use is continued despite knowledge of having a persistent or recurrent
physical or psychological problem that is likely to have been caused or exacerbated by
alcohol
10. Tolerance, as defined by either or both of the following:
a. A need for markedly increased amounts of alcohol to achieve intoxication or
desired effect
b. A markedly diminished effect with continued use of the same amount of alcohol
11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for alcohol (refer to Criterion A and B of
the criteria set for alcohol withdrawal)
b. Alcohol (or a closely related substance such as benzodiazepine) is taken to relieve
or avoid withdrawal symptoms
Specify current severity:
- Mild: Presence of 2-3 symptoms
- Moderate: Presence of 4-5 symptoms
- Severe: Presence of 6 or more symptoms
o The path travelled by alcohol throughout the body
 1. Ingestion, 2. Stomach, 3. Small intestine, 4. Heart, 5. Liver
o Alcohol-related disorders
 Effects of chronic alcohol use
 Intoxication
 Withdrawal
o Delirium tremens – hallucinations and tremors brought
on by withdrawal from severe alcohol use
 Foetal alcohol syndrome – problems in foetus from alcohol use
during pregnancy
o Impaired growth, cognitive difficulties, behavioural
problems
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Long term heavy alcohol use may lead to:
 Dementia
 Wernicke-Korsakoff syndrome (confusion, lack of coordination, unintelligible speech)
o Statistics on use and abuse
 Alcoholic drinks, especially beer, have a very long history in Africa
 Variation in levels of overall per capita alcohol consumption among
sub-Saharan countries, ranging in 2002 from 18.6L in Uganda to 0.2L
in Guinea
 The population-weighted average per adult capita alcohol consumption
in sub-Saharan Africa was 7.4L, slightly above the global level of
6.2L, and in terms of average consumption per drinker, sub-Saharan
Africa was 19.5L, far above the worldwide estimate of 13.9L
 The eastern and southern Africa regions have the highest consumption
of alcohol per drinker in the world
o Progression of Alcohol-related disorders
 20% are able to stop drinking on their own
 Dependence usually develops over time, but course may be variable
 Individuals for whom alcohol is less sedating are more likely to
become dependent
 Alcohol and violence
 Drinking does not cause violence, but may increase the
likelihood of impulsive behaviour
Sedative, Hypnotic or Anxiolytic Related Disorders: An overview
o The nature of drugs in this class
 Sedatives – calming (e.g. barbiturates)
 Hypnotic – sleep inducing
 Anxiolytic – anxiety reducing (e.g. benzodiazepines)
o Have generally tranquillising effects
o Act on GABA receptors in the brain
o Abusers more likely to be female, white, 35+
o Effects are similar to large doses of alcohol
 Combining such drugs with alcohol is synergistic and dangerous
o DSM-5 criteria for this class of disorders
 Like other substance-use disorders: Use leads to significant
interference or distress and is accompanied by problems such as
reduced activities or tolerance
Diagnostic criteria for sedative-, hypnotic- or anxiolytic-related disorders
A. A problematic pattern of sedative, hypnotic or anxiolytic use leading to clinically
significant impairment or distress, as manifested by at least 2 of the following, occurring
within a 12-month period:
1. Sedative, hypnotics or anxiolytics are often taken in larger amounts or over a longer
period than was intended
2. There is a persistent desire or unsuccessful efforts to cut down or control sedative,
hypnotic or anxiolytic use
3. A great deal of time is spent in activities necessary to obtain the sedative, hypnotic or
anxiolytic, to use the sedative, hypnotic or anxiolytic, or to recover from its effects
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4. Craving, or a strong desire to use the sedative, hypnotic or anxiolytic
5. Recurrent sedative, hypnotic or anxiolytic use resulting in a failure to fulfil major role
obligations at work, school or home (e.g. repeated absences from work or poor work
performance related to sedative, hypnotic or anxiolytic use; sedative-, hypnotic- or
anxiolytic-related absences, suspensions or expulsions from school; neglect of children
or household)
6. Continued sedative, hypnotic or anxiolytic use despite having persistent or recurrent
social or interpersonal problems caused or exacerbated by the effects of sedatives,
hypnotics or anxiolytics (e.g. arguments with a spouse about consequences of
intoxication; physical fights)
7. Important social, occupational or recreational activities are given up or reduced
because of sedative, hypnotic or anxiolytic use
8. Recurrent sedative, hypnotic or anxiolytic use in situations in which it is physically
hazardous (e.g. driving in automobile or operating a machine when impaired by
sedative, hypnotic or anxiolytic)
9. Sedative, hypnotic or anxiolytic use is continued despite knowledge of having a
persistent or recurrent physical or psychological problem that is likely to have been
caused or exacerbated by the sedative, hypnotic or anxiolytic
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of sedative, hypnotic or anxiolytic to
achieve intoxication or desired effect
b. A markedly diminished effect with continued use of the same amount of sedative,
hypnotic or anxiolytics
Note: This criterion is not considered to be met for individuals taking sedatives, hypnotics
or anxiolytics under medical supervision
11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for sedatives, hypnotics or anxiolytics
(refer to Criterion A and B of the criteria set for sedative, hypnotic or anxiolytic
withdrawal)
b. Sedatives, hypnotics or anxiolytics (or closely related substances such as alcohol)
are taken to relieve or avoid withdrawal symptoms
Note: This criterion is not considered to be met for individuals taking sedatives, hypnotics
or anxiolytics under medical supervision
Specify current severity:
- Mild: Presence of 2-3 symptoms
- Moderate: Presence of 4-5 symptoms
- Severe: Presence of 6 or more symptoms
-
Stimulants: An overview
o Increase alertness and energy
o Examples include amphetamines, cocaine, nicotine and caffeine
o DSM-5 criteria for stimulant intoxication: Significant impairment or
psychological changes
 Accompanied by physical changes (e.g. change in HR/BP, dilated
pupils, weight loss, vomiting, weakness, chills)
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o Amphetamine-Use disorders
 Effects of amphetamines
 Produce elation, vigour, reduce fatigue
 Such effects are usually followed by extreme fatigue and
depression
 Amphetamines stimulate CNS by
 Enhancing release of noradrenaline and dopamine
 Reuptake is subsequently blocked
 Some ADHD drugs are mild stimulants
 E.g. Adderall, Ritalin
 Ecstasy (MDMA)
 Amphetamine effects, but without the crash
 Crystal meth
 Purified form of amphetamine
 May cause aggressive tendencies in addition to high
 Extreme risk of dependence
Diagnostic criteria for stimulant use disorder
A. A pattern of amphetamine-type substance, cocaine or other stimulant use leading to
clinically significant impairment or distress, as manifested by at least 2 of the following,
occurring within a 12-month period:
1. The stimulant is often taken in larger amounts or over a longer period than was
intended
2. There is a persistent desire or unsuccessful efforts to cut down or control stimulant
use
3. A great deal of time is spent in activities necessary to obtain the stimulant, use the
stimulant or recover from its effects
4. Craving, or a strong desire or urge to use the stimulant
5. Recurrent stimulant use resulting in a failure to fulfil major role obligations at work,
school or home
6. Continued stimulant use despite having persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects of the stimulant
7. Important social, occupational or recreational activities are given up or reduced
because of stimulant use
8. Recurrent stimulant use in situations in which it is physically hazardous
9. Stimulant use is continued despite knowledge of having a persistent or recurrent
physical or psychological problem that is likely to have been caused or exacerbated by
the stimulant
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of the stimulant to achieve intoxication or
desired effect
b. A markedly diminished effect with continued use of the same amount of the
stimulant
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Note: This criterion is not considered to be met for those taking stimulant medications
solely under appropriate medical supervision, such as medications for attention deficit
hyperactivity disorder (ADHD) or narcolepsy
11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for the stimulant (refer to Criteria A and
B of the criteria set for stimulant withdrawal)
b. The stimulant (or a closely related substance) is taken to relieve or avoid
withdrawal symptoms
Note: This criterion is not considered to be met for those taking stimulant medications
solely under appropriate medical supervision, such as medications for ADHD or
narcolepsy
Specify current severity:
- Mild: Presence of 2-3 symptoms
- Moderate: Presence of 4-5 symptoms
- Severe: Presence of 6 or more symptoms
o Cocaine-related disorders
 Effects of cocaine
 Short-lived sensations of elation, vigour, reduced fatigue
 Effects result from blocking the reuptake of dopamine
 Highly addictive, but addiction develops slowly
 1.9 million report use in USA each year
 Most cycle through patterns of tolerance and withdrawal
 Withdrawal characterised by apathy and boredom > leads to
desire to use again
 Anatomy of cocaine intoxication

Statistics
 Worldwide, almost 5% of adults use at some point
 Since 1994 (after the demise of Apartheid) South Africa has
experienced a drastic increase in the import of cocaine
 Attributed to the influx of immigrants from West and Central
Africa, which is currently in control of the cocaine market, as
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well as the saturation of cocaine on the world market especially
in the United States
o Stimulants: Tobacco-Related Disorders
 Effects of nicotine
 Stimulates nicotinic acetylcholine receptors in CNS
 Results in sensations of relaxation, wellness, pleasure
 Highly addictive
 Relapse rates equal those seen with alcohol and heroin
 Nicotine users dose themselves to maintain a steady level of nicotine
 Smoking has a complex relationship to negative affect
 Appears to help improve mood in short term
 Depression occurs more in those with nicotine dependence
Diagnostic criteria for tobacco use disorder
A problematic pattern of tobacco use leading to clinically significant impairment or
distress, as manifested by at least 2 of the following, occurring within a 12-month period:
1. Tobacco is often taken in larger amounts or over a longer period than was intended
2. There is a persistent desire or unsuccessful efforts to cut down or control tobacco use
3. A great deal of time is spent in activities necessary to obtain or use tobacco
4. Craving, or a strong desire or urge to use tobacco
5. Recurrent tobacco use resulting in a failure to fulfil major role obligations at work,
school or home (e.g. interference with work)
6. Continued tobacco use despite having persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects of tobacco (e.g. arguments with others
about tobacco use)
7. Important social, occupational or recreational activities are given up or reduced
because of tobacco use
8. Recurrent tobacco use in situations in which it is physically hazardous (e.g. smoking
in bed)
9. Tobacco use is continued despite knowledge of having a persistent or recurrent
physical or psychological problem that is likely to have been caused or exacerbated by
tobacco
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of tobacco to achieve the desired effect
b. A markedly diminished effect with continued use of the same amount of tobacco
11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for tobacco (refer to Criteria A and B of
the criteria set for tobacco withdrawal)
b. Tobacco (or a closely related substance such as nicotine) is taken to relieve or
avoid withdrawal symptoms
Specify current severity:
- Mild: Presence of 2-3 symptoms
- Moderate: Presence of 4-5 symptoms
- Severe: Presence of 6 or more symptoms
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DSM-5 Criteria for Tobacco withdrawal
 DSM-5 criteria for tobacco withdrawal
 After several weeks of daily use, unpleasant symptoms
experienced upon stopping or reducing:
o Insomnia, increased appetite, restlessness, trouble
concentrating, anxiety and depression, irritability
 Symptoms lead to clinically significant distress or impairment
o Stimulants: Caffeine-Related Disorders
 Effects of caffeine – the ‘gentle’ stimulant
 Used by over 90% of Americans
 Found in tea, coffee, cola drinks and cocoa products
 Small doses elevate mood and reduce fatigue
 Regular use can result in tolerance and dependence
 Caffeine blocks the reuptake of the neuromodulator adenosine
Diagnostic criteria for caffeine intoxication
A. Recent consumption of caffeine (typically a high dose well in excess of 250mg)
B. 5 (or more) of the following signs or symptoms developing during, or shortly after,
caffeine use:
1. Restlessness
2. Nervousness
3. Excitement
4. Insomnia
5. Flushed face
6. Diuresis
7. Gastrointestinal disturbance
8. Muscle twitching
9. Rambling flow of thought and speech
10. Tachycardia or cardiac arrhythmia
11. Periods of inexhaustibility
12. Psychomotor agitation
C. The signs or symptoms in Criterion B cause clinically significant distress or impairment
in social, occupational or other important areas of functioning
D. The signs or symptoms are not attributable to another medical condition and are not
better explained by another mental disorder, including intoxication with another substance
o Opioids: An overview
 The nature of opiates and opioids
 Opiate – natural chemical in the opium poppy with narcotic
effects
 Opioids – natural and synthetic substances with narcotic effects
 Often referred to as analgesics
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o Analgesic = painkiller
Effects of opioids
 Activate body’s enkephalins and endorphins
 Low doses induce euphoria, drowsiness and slowed breathing
 High doses can result in death
 Withdrawal symptoms can be lasting and severe
Mortality rates are high for opioid addicts
 High risk for HIV infection due to shared needles
Diagnostic criteria for opioid use disorder
A. A problematic pattern of opioid use leading to clinically significant impairment or
distress, as manifested by at least 2 of the following, occurring within a 12-month period:
1. Opioids are often taken in larger amounts or over a longer period than was intended
2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use
3. A great deal of time is spent in activities necessary to obtain the opioid, use the
opioid or recover from its effects
4. Craving, or a strong desire or urge to use opioids
5. Recurrent opioid use resulting in a failure to fulfil major role obligations at work,
school or home
6. Continued opioid use despite having persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects of opioids
7. Important social, occupational or recreational activities are given up or reduced
because of opioid use
8. Recurrent opioid use in situations in which it is physically hazardous
9. Continued opioid use despite knowledge of having a persistent or recurrent physical
or psychological problem that is likely to have been caused or exacerbated by the
substance
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of opioids to achieve intoxication or
desired effects
b. A markedly diminished effect with continued use of the same amount of an opioid
Note: This criterion is not considered to be met for those taking opioids solely under
appropriate medical supervision
11. Withdrawal, as manifested by either of the following:
a. The characteristic opioid withdrawal syndrome (refer to Criteria A and B of the
criteria set for opioid withdrawal
b. Opioids (or a closely related substance) are taken to relieve or avoid withdrawal
symptoms
Note: This criterion is not considered to be met for those taking opioids solely under
appropriate medical supervision
Specify current severity:
- Mild: Presence 2-3 symptoms
- Moderate: Presence of 4-5 symptoms
- Severe: Presence of 6 or more symptoms
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o Cannabis-related disorders
 Marijuana
 Considered a mild hallucinogen
 Most frequently used illegal drug
 Active ingredient: Tetrahydrocannabinol (THC)
 Variable, individual reactions
o May include euphoria, mood swings, paranoia,
hallucinations, reduced concentration
 Dependence and withdrawal are uncommon
Diagnostic criteria for cannabis use disorder
A. A problematic pattern of cannabis use leading to clinically significant impairment or
distress, as manifested by at least 2 of the following, occurring within a 12-month period:
1. Cannabis is often taken in larger amounts or over a longer period than was intended
2. There is a persistent desire or unsuccessful efforts to cut down or control cannabis
use
3. A great deal of time is spent in activities necessary to obtain cannabis or recover from
its effects
4. Craving, or a strong desire or urge to use cannabis
5. Recurrent cannabis use resulting in a failure to fulfil major role obligations at work,
school or home
6. Continued cannabis use despite having persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects of cannabis
7. Important social, occupational or recreational activities are given up or reduced
because of cannabis use
8. Recurrent cannabis use in situations in which it is physically hazardous
9. Cannabis use is continued despite knowledge of having a persistent or recurrent
physical or psychological problem that is likely to have been caused or exacerbated by
cannabis
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of cannabis to achieve intoxication or
desired effect
b. A markedly diminished effect with continued use of the same amount of cannabis
11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for cannabis (refer to Criteria A and B of
the criteria set for cannabis withdrawal)
b. Cannabis (or closely related substance) is taken to relieve or avoid withdrawal
symptoms
Specify current severity:
- Mild: Presence of 2-3 symptoms
- Moderate: Presence of 4-5 symptoms
- Severe: Presence of 6 or more symptoms
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o Hallucinogen-Related disorders
 Hallucinations = altered sensory perceptions (e.g. seeing or hearing
things that are not present)
 Hallucinogens can also produce delusions, paranoia
 Examples of hallucinogens: LSD (most common), psilocybin,
mescaline, PCP (phencyclidine)
 Tolerance builds quickly but resets after brief periods of abstinence
Diagnostic criteria for other hallucinogen use disorder
A. A problematic pattern of hallucinogen (other than phencyclidine) use leading to
clinically significant impairment or distress, as manifested by at least 2 of the following,
occurring within a 12-month period:
1. The hallucinogen is often taken in larger amounts or over a longer period than was
intended
2. There is a persistent desire or unsuccessful efforts to cut down or control
hallucinogen use
3. A great deal of time is spent in activities necessary to obtain the hallucinogen, use the
hallucinogen or recover from its effects
4. Craving, or a strong desire or urge to use the hallucinogen
5. Recurrent hallucinogen use resulting in a failure to fulfil major role obligations at
work, school or home (e.g. repeated absences from work or poor work performance
related to hallucinogen use; hallucinogen-related absences, suspensions or expulsions
from school; neglect of children or household)
6. Continued hallucinogen use despite having persistent or recurrent social or
interpersonal problems caused or exacerbated by the effects of the hallucinogen (e.g.
arguments with a spouse about consequences of intoxication; physical fights)
7. Important social, occupational or recreational activities are given up or reduced
because of hallucinogen use
8. Recurrent hallucinogen use in situations in which it is physically hazardous (e.g.
driving an automobile or operating a machine when impaired by the hallucinogen)
9. Hallucinogen use is continued despite knowledge of having a persistent or recurrent
physical or psychological problem, that is likely to have been caused or exacerbated by
the hallucinogen
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of the hallucinogen to achieve
intoxication or desired effect
b. A markedly diminished effect with continued use of the same amount of the
hallucinogen
Note: Withdrawal symptoms and signs are not established for hallucinogens, and so this
criterion does not apply
Specify current severity:
- Mild: Presence of 2-3 symptoms
- Moderate: Presence of 4-5 symptoms
- Severe: Presence of 6 or more symptoms
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o Other drugs of abuse: Inhalants
 Found in volatile solvents
 Breathed into the lungs directly
 Rapid absorption
 Examples: Spray paint, hair spray, paint thinner, gasoline, nitrous
oxide
 Effects similar to alcohol intoxication
 Produce tolerance and prolonged withdrawal symptoms
 Several negative physiological effects (e.g. organ damage)
Diagnostic criteria for inhalant use disorder
A. A problem pattern of use of a hydrocarbon-based inhalant substance leading to
clinically significant impairment or distress, as manifested by at least 2 of the following,
occurring within a 12-month period:
1. The inhalant substance is often taken in larger amounts or over a longer period than
was intended
2. There is a persistent desire or unsuccessful efforts to cut down or control use of the
inhalant substance
3. A great deal of time is spent in activities necessary to obtain the inhalant, use it, or
recover from its effects
4. Craving, a strong desire or urge to use the inhalant substance
5. Recurrent use of the inhalant substance resulting in a failure to fulfil major role
obligations at work, school or home
6. Continued use of the inhalant substance despite having persistent or recurrent social
or interpersonal problems caused or exacerbated by the effects of its use
7. Important social, occupational or recreational activities are given up or reduced
because of use of the inhalant substance
8. Recurrent use of the inhalant substance in situations in which it is physically
hazardous
9. Use of the inhalant substance is continued despite knowledge of having a persistent
or recurrent physical or psychological problem that is likely to have been caused or
exacerbated by the substance
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of inhalant substance to achieve
intoxication or desired effect
b. A markedly diminished effect with continued use of the same amount of the
inhalant substance
Specify current severity:
- Mild: Presence of 2-3 symptoms
- Moderate: Presence of 4-5 symptoms
- Severe: Presence of 6 or more symptoms
o Other drugs of abuse: Anabolic-Androgenic Steroids
 Derived or synthesised from testosterone
 Used medicinally or to increase body mass
 No associated high
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Dependence involves wanting to maintain the effects of the substance
(i.e. Increased muscle mass)
 May cause long-term mood disturbances
o Other drugs of abuse: Designer drugs
 Drugs were originally produced by pharmaceutical companies to target
diseases; then others began producing for recreational use
 Cause drowsiness, pain relief and dissociative sensations
 Ecstasy
 BDMPEA (Nexus)
 Ketamine (special K)
 Often heighten auditory and visual perception, sense of taste / touch
 Becoming popular in large social recreational gatherings (e.g.
nightclubs, raves)
 Produce tolerance and dependence
Causes of Substance-related disorders
o Psychosocial factors such as expectations, stress and cultural practices interact
with the biological factors to influence substance use
o Family and genetic influences
 Results of family, twin and adoption studies
 Substance abuse has a genetic component
o Example: Certain genes confer risk for heroin abuse in
Hispanic and African American populations
 Much of the focus has been on alcoholism
 Body’s sensitivity to substance (alcohol dehydrogenase gene)
 Body’s ability to metabolise substance (presence of specific
enzymes in the liver) – this impacts which drugs are effective
in treating other substance-use disorders
 Multiple genes are involved in substance abuse
o Neurobiological influences
 Drugs affect the ‘pleasure pathway’ of the brain (i.e. The area that is
active when receiving a reward such as food)
 Believed to include the dopaminergic system in areas of the
midbrain and frontal cortex
 Drugs may inhibit GABA, which turns off the reward-pleasure system
 Drugs inhibit neurotransmitters that produce anxiety / negative affect
 Neuroplasticity increases substance-seeking and relapse
o Psychological dimensions
 Early on, drug use may be seeking a euphoric high (positive
reinforcement) – for pleasure
 Later, drug use will be seeking escape from withdrawal / crash
(negative reinforcement)
 Substance abuse as a means to cope with negative affect (negative
reinforcement)
 Self-medication, tension reduction
 Drugs offer escape from life stressors, avoiding pain
 Want a feeling of being in control
 Opponent-process theory
 Drugs themselves are the easiest way to alleviate feelings of
withdrawal
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Cognitive factors
 Role of expectancy effects: People use drugs when they
anticipate positive effects
 Cravings
 Triggered by cues (mood, environment, availability of drug)
 Presence of other psychological disorders: mood, anxiety, etc.
o Social and Cultural Dimensions
 Exposure to drugs is a prerequisite for use of drugs
 Media, family and peers can influence exposure to drugs
 Parental influence and familial history of substance abuse plays
a significant role in the development of substance-related
disorders
 Societal views about drug abuse
 Sign of moral weakness – failure of self-control
 Sign of a disease – caused by some underlying process
 Family / culture / society and peers supportive vs unsupportive of
substance use
 The role of cultural factors
 Influence the manifestation of substance abuse
 Some cultures expect heavy drinking at certain social occasions
(e.g. Korea)
 Most indigenous African communities continue to believe in
and practise the use of certain substances, including alcohol and
tobacco, for ritualistic purposes
 The extent to which use of mind-altering drugs by indigenous
African communities results in addiction is unknown
 In contemporary Africa, use of psychoactive substances is
increasingly prevalent in the younger generations and mostly
for recreational purposes
An integrative model of substance-related disorders
o Exposure or access to a drug is necessary, but not sufficient
o Drug use depends on:
 Social and cultural expectations
 Positive and negative reinforcement
 Genetic predisposition and biological factors
 Psychosocial stressors
Treatment of
substancerelated
disorders
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Principles of effective treatment for substance Use disorders:
1. No single treatment is appropriate for all individuals
2. Treatment needs to be readily available
3. Effective treatment attends to multiple needs of the individual, not just his or her
substance use
4. An individual’s treatment and services plan must be assessed continually and
modified as necessary to ensure that the plan meets the person’s changing needs
5. Remaining in treatment for an adequate period of time is critical for treatment
effectiveness (i.e. 3 months or longer)
6. Counselling (individual and/or group) and other behavioural therapies are essential
components of effective treatment for substance-related disorders
7. Medications are an important element of treatment for many patients, especially
when combined with counselling and other behavioural therapies
8. Comorbid mental disorders should be sought, identified and managed in an
integrated way with the substance-related disorder
9. Medical detoxification is only the first stage of treatment and by itself does little to
change long-term substance use
10. Treatment does not need to be voluntary to be effective
11. Possible substance use during treatment must be monitored continuously
12. Treatment programmes should provide assessment for HIV, hepatitis B and C,
tuberculosis and other infectious diseases, and counselling to help patients modify
or change behaviours that place themselves or others at risk of infection
13. Recovery from substance dependence can be a long-term process and frequently
requires multiple episodes of treatment
o It is best to use a combination of approaches
o Biological
 Acute management
 Non-specific symptomatic treatment, supportive treatment,
treatment of complications, substance-specific acute treatment
 Maintenance management: Comorbid conditions
 Agonist substitution
 Safe drug with a similar chemical composition as the abused
drug
 Examples include methadone and nicotine gum or patch
 Antagonist treatments
 Drugs that block or counteract the positive effects of substances
 Examples include naltrexone for opiate and alcohol problems
 Aversive treatment
 Drugs that make use of substances extremely unpleasant
 Examples include disulfiram (Antabuse) and silver nitrate
 Efficacy of biological treatment
 Generally ineffective when used alone
 Used to help with withdrawal symptoms
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Medical treatments
Nicotine
Alcohol
Substance treatment goal
Treatment approach
Reduce withdrawal
symptoms and cravings
Alternative nicotine sources
(patch, gum, spray, lozenge,
inhaler)
Nicotine substitution,
varenicline (Champix)
Reduce withdrawal
symptoms and cravings
Bupropin (Zyban)
Reduce reinforcing effects
of alcohol
Naltrexene
Reduce alcohol craving in
abstinent individuals
Acamprosate (Campral)
Maintenance of abstinence,
through aversive
reinforcement
Disulfiram (Antabuse)
Cannabis
No specific medical
interventions, apart from
symptomatic and supportive
measures
Cocaine
No specific medical
interventions, apart from
symptomatic and supportive
measures
Opioids
Maintenance of abstinence
Methadone
Buprenorphine (Suboxone)
o Psychosocial Treatment
 Acute, Rehabilitative
 Inpatient vs outpatient care
 Little difference in effectiveness
 Community support programmes
 Alcoholics Anonymous (AA) and related groups (e.g. NA) may
be helpful
 Balancing treatment goals
 Controlled use vs complete abstinence
 Component treatment
 Incorporate several elements such as psychotherapy and
contingency management
 Comprehensive treatment and prevention programmes
 Individual and group therapy
 Aversion therapy and convert sensitisation
 Contingency management – change behaviours by rewarding
chosen behaviours
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 Community reinforcement
 Relapse prevention
 Preventative efforts
 Recent shift away from education approaches
 Greater enforcement of anti-drug laws
 Example: The 12 steps of Alcoholic Anonymous
 1. We admitted we were powerless over alcohol – that our lives
had become unmanageable
 2. Came to believve that a power greater than ourselves could
restore us to sanity
 3. Made a decision to turn our will and out lives over to the
care of God as we understood Him
 4. Made a searching and fearless moral inventory of ourselves
 5. Admitted to God, to ourselves, and to another human being
the exact nature of our wrongs
 6. Were entirely ready to have God remove all these defects of
character
 7. Humbly ask Him to remove our shortcomings
 8. Made a list of all persons we had harmed, and became
willing to make amends to them all
 9. Made direct amends to such people wherever possible,
except when to do so would injure them or others
 10. Continued to take personal inventory and, when we were
wrong, promptly admitted it
 11. Sought through prayer and meditation to imporove our
conscious contact with God as we understood Him, praying
only for knowledge of His will for us and the power to carry
that out
 12. Having had a spiritual awakening as the result of these
steps, we tried to carry this message to alcoholics and to
practise these principles in all our affairs
o Only a minority are treated successfully, best results reflect the motivation of
the substance user and a combination of biological and psychosocial
treatments
Relapse prevention for substance-related disorders
o Cognitive-behavioural approach to learn habits that make relapse less likely
 Address distorted cognitions
 Identify negative consequences
 Increase motivation to change
 Identify high risk situations
 Reframe relapse
 Failure of coping skills, not person
Preventing substance-related disorders
o Education-based approaches have thus far shown limited efficacy
o Comprehensive community-based skills programmes have promising results
o Cultural changes may prevent substance use (e.g. social perception of smoking
has become less favourable in recent decades)
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Summary
o DSM-5 substance-related disorders cover: Depressants, stimulants, opioids,
cannabinoids, hallucinogens and other drugs of abuse
o Diagnoses include intoxication, withdrawal and substance use disorders
o Most substances activate the dopaminergic pleasure pathway
 Psychosocial factors interact with biological influences
o Treatment of substance abuse disorders
 Variable success
 Highly motivated people do best
 Important to use the comprehensive approach
Gambling disorder
o New disorder in DSM-5
o Same types of cravings and dependence seen in substance-related disorders,
and similar brain systems appear to be involved
o Classified under ‘Addictive Disorders’
o Recurrent gambling leading to clinically significant distress or impairment
o Associated with 4 or more symptoms within a year:
 Difficulty stopping / reducing gambling
 Restlessness / irritability when trying to cut back
 Need to gamble with increasing amounts of money
 Frequent preoccupation
Diagnostic criteria for gambling disorder
A. Persistent and recurrent problematic gambling behaviour leading to clinically significant
impairment of distress, as indicated by the individual exhibiting 4 (or more) of the
following in a 12-month period:
1. Needs to gamble with increasing amounts of money in order to achieve the desired
excitement
2. Is restless or irritable when attempting to cut down or stop gambling
3. Has made repeated unsuccessful efforts to control, cut back or stop gambling
4. Is often preoccupied with gambling (e.g. having persistent thoughts of reliving past
gambling experiences, handicapping or planning the next venture, or thinking of ways
to get money with which to gamble)
5. Often gambles when feeling distressed (e.g. helpless, guilty, anxious, depressed)
6. After losing money gambling, often returns another day to get even (‘chasing’ one’s
losses)
7. Lies to conceal the extent of involvement with gambling
8. Has jeopardised or lost a significant relationship, job or educational or career
opportunity because of gambling
9. Relies on others to provide money to relieve desperate financial situations caused by
gambling
B. The gambling behaviour is not better explained by a manic episode
Specify current severity:
- Mild: 4-5 criteria
- Moderate: 6-7 criteria met
- Severe: 8-9 criteria met
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o Treatment
 Psychosocial treatment similar to that for substance abuse
 Treatment is often ineffective
 Motivation to get better is critical; dropout is high
 Research is limited, but multipart CBT interventions are under
investigation
 Scheduling alternative activities, setting financial limits, relapse
prevention
Other impulse-control disorders
o Each is characterised by:
 Inability to resist acting on a drive or temptation
 Impairment of social and occupational functioning
 May also involve increased tension / anxiety prior to the act,
pleasurable anticipation or a sense of relief following the act
o Include:
 Intermittent explosive disorder
 Rare condition
 Characterised by frequent aggressive outburst
 Leads to injury and / or destruction of property
 Few controlled treatment studies
 Current research is focused on how neurotransmitters and
testosterone levels interact with psychosocial influences (stress,
parenting styles)
 Treatment = CBT to help identify and avoid triggers; treatment
approaches modelled after substance treatments
 Kleptomania
 Failure to resist urge to steal unnecessary items
 Feeling tense just before stealing, followed by feelings of
pleasure or relief when committing the theft
 Seems rare, but it is not well studied
 Highly comorbid with mood disorders
 Also co-occurs with substance-related problems (but less)
 Treatment = behavioural interventions or antidepressant
medication
 Pyromania
 Involves an irresistible urges to set fires
 Feeling aroused prior to setting the fire, then a sense of
gratification or relief while the fire burns
 Diagnosed in only 3% of arsonists (rare)
 There is little aetiological or treatment research
 Treatment usually focuses on identifying urges and practising
incompatible behaviours – CBT to help identify signals
triggering the urge, and teaching coping strategies to resist
setting fires
 Oppositional defiant disorder, Conduct disorder, and Antisocial
disorder
 Behavioural addictions as they tend to have strong aspects of
compulsion, craving, loss of control and hedonistic release
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Compulsive need to engage in behaviours that are harmful to
self and others
Oppositional defiant disorder: Defiant, hostile and disobedient
behaviour (usually directed at authority figures)
Conduct disorder: Repetitive aggression towards others that
may include physical abuse and destruction of property
Antisocial personality disorder: persistent disregard for the
rights, feelings and safety of others
Treatment = parental training, parent behavioural interventions
for oppositional and conduct; Often incarceration for antisocial
Eating and feeding disorders
-
-
Eating disorders: An overview
o Prevalence of these disorders has increased rapidly over the last half century.
They were included in the DSM-4 for the first time as a separate group
o Relentless, all-encompassing drive to be thin
o
o Major types of DSM-5 eating disorders
 Anorexia nervosa and bulimia nervosa
 Severe disruptions in eating behaviour
 Weight and shape have disproportionate influence on selfconcept
 Extreme fear and apprehension about gaining weight
 Strong sociocultural origins – driven by Western emphasis on
thinness
Bulimia nervosa
o Overview and defining features
 Binge-eating – hallmark of bulimia nervosa and binge-eating disorder
 Eating excess amounts of food in a discrete period of time
 Eating is perceived as uncontrollable
 May be associated with guilt, shame or regret
 May hide behaviour from family members
 Foods consumed are often high in sugar, fat or carbohydrates
 Compensatory behaviours – designed to ‘make up for’ binge eating
 Most common = Purging
o Most common purging method: self-induced vomiting
o May also include use of diuretics or laxatives
 Excessive exercise
 Fasting or food restriction
Diagnostic criteria for bulimia nervosa
A. Recurrent episodes of binge eating. An episode of binge eating is characterised by both
of the following:
1. Eating, in a discrete period of time (e.g. within any 2-hour period of time (e.g. within
any 2-hour period), an amount of food that is definitely larger than most people would
eat during a similar period of time and under similar circumstances
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2. A sense of lack of control over eating during the episode (e.g. a feeling that one
cannot stop eating or control what or how much one is eating)
B. Recurrent inappropriate compensatory behaviour in order to prevent weight gain,
such as self-induced vomiting; misuse of laxatives, diuretics or other medications; fasting;
or excessive exercise
C. The binge eating and inappropriate compensatory behaviours both occur, on average, at
least once a week for 3 months
D. Self-evaluation is unduly influenced by body shape and weight
E. The disturbance does not occur exclusively during episodes of anorexia nervosa
-
o Associated features
 Age onset is typically 18 to 21 years of age
 Associated medical features
 Most are within 10% of normal body weight
 Purging methods can result in severe medical problems
o Erosion of dental enamel, electrolyte imbalance
o Salivary glands can become enlarged (from the
vomiting) – causing a chubby face
o Kidney failure, cardiac arrhythmia, seizures, intestinal
problems, permanent colon damage
 Associated psychological features
 Most are overly concerned with body shape
 Fear of gaining weight
 Most have comorbid psychological disorders
o 20% meet criteria for a mood disorder
o 50-70% have met criteria for a mood disorder at some
point
o 80% have met criteria for an anxiety disorder at some
point
o Nearly 2 in 5 abuse substances
 Tend to be chronic if left untreated
Anorexia nervosa
o Overview and defining features
 Extreme weight loss – hallmark of anorexia (at least 15% below
normal)
 Restriction of calorie intake below energy requirements
 Intense fear of weight gain
 Often begins with dieting
 Subtypes
o Restricting: Diet to limit calorie intake
o Binge-eating-purging: Purge to limit calorie intake
Diagnostic criteria for anorexia nervosa
A. Restriction of energy intake relative to requirements, leading to a significantly low
body weight in the context of age, sex, developmental trajectory and physical health.
Significantly low weight is defined as a weight that is less than minimally normal or, for
children and adolescents, less than that minimally expected
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B. Intense fear of gaining weight or of becoming fat, or persistent behaviour that
interferes with weight gain, even though at a significantly low weight
C. Disturbance in the way in which one’s body weight or shape is experienced, undue
influence of body weight or shape on self-evaluation, or persistent lack of recognition of
the seriousness of the current low body weight
Specify type:
- Restricting type: During the last 3 months, the individual has not engaged in
recurrent episodes of binge eating or purging behaviour (i.e. Self-induced vomiting
or the misuse of laxatives, diuretics or enemas). The subtype describes
presentations in which weight loss is accomplished primarily through dieting,
fasting and/or excessive exercise
- Binge-eating / purging type: During the last 3 months, the individual has engaged
in recurrent episodes of binge-eating or purging behaviour (i.e. Self-induced
vomiting or the misuse of laxatives, diuretics or enemas)
-
o Associated features
 Most show marked disturbance in body image
 Most have comorbid psychological disorders
 70% are depressed at some point
 Higher than average rates of substance abuse and OCD
 Starving body borrows energy from internal organs, leading to organ
damage including cardiac damage; can cause heart attack
 Average age of onset is 18 – 21 years old
 Medical consequences
 Amenorrhoea (loss of periods in women)
 Dry skin
 Brittle hair and nails
 Sensitivity to cold temperatures
 Lanugo – fine, soft, thinning hair
 Cardiovascular problems
 Electrolyte imbalance
 Danger of acute cardiac or kidney failure
 It is the most deadly mental disorder due to organ damage
Binge-eating disorder
o Overview and defining features
 New disorder in DSM-5
 Binge eating without associated compensatory behaviours
 Associated with distress and/or functional impairment (e.g. health risk,
feelings of guilt) – some sufferers binge to alleviate bad moods
 Excessive concern with weight or shape may or may not be present
o Associated features
 Approximately 20% of individuals in weight-control programmes
suffer from BED
 Approximately half of candidates for bariatric surgery suffer from
BED
 Better response to treatment than other eating disorders
 Tend to be older than sufferers of anorexia and bulimia
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Higher rates of psychopathology than non-bingeing obese individuals
Diagnostic criteria for binge-eating disorder
A. Recurrent episodes of binge eating. An episode of binge eating is characterised by
both of the following:
1. Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food
that is definitely larger than most people would eat in a similar period of time under
similar circumstances
2. A sense of lack of control over eating during the episode (e.g. a feeling that one
cannot stop eating or control what or how much one is eating)
B. The binge-eating episodes are associated with 3 (or more) of the following:
1. Eating much more rapidly than normal
2. Eating until feeling uncomfortably full
3. Eating large amounts of food when not feeling physically hungry
4. Eating alone because of feeling embarrassed by how much one is eating
5. Feeling disgusted with oneself, depressed or very guilty afterwards
C. Marked distress regarding binge eating is present
D. The binge eating occurs, on average, at least once a week for 3 months
E. The binge eating is not associated with the recurrent use of inappropriate compensatory
behaviour as in bulimia nervosa and does not occur exclusively during the course of
bulimia nervosa or anorexia nervosa
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Bulimia and Anorexia: Facts and Statistics
o Bulimia
 Majority of sufferers are female (90-95%)
 Male sufferers are more likely to be a significant minority
 Lifetime prevalence is about 1.1% for females, 0.1% for males
 6-7% of college women suffer from bulimia at some point
 Onset typically in adolescence
 Tends to be chronic if left untreated
o Anorexia
 Majority of sufferers female and white
 From middle- to upper-class families
 Usually develops in adolescence
 More chronic and resistant than bulimia
o Lifetime prevalence approximately 1% for females
o Cross-cultural factors
 Develop in non-Western women after moving to western countries
 Rare in African-American women
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Causes of eating disorders 
o Low self-esteem,
social anxiety and
fear of rejection,
distorted body image
o Biological – genetic
tendency to poor
impulse control,
emotional instability
and perfectionistic
traits
o Psychological –
diminished sense of
personal control and
self-confidence,
causing low selfesteem. Distorted body image
o An integrative model below:
-
Management of eating disorders
o Drugs – primarily antidepressants
 Generally ineffective for anorexia nervosa
o Psychological treatment – usually cognitive behavioural therapy
 Emphasis on core pathological mechanism: Distorted body image
Medical and Psychological Treatment of Bulimia Nervosa
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o Cognitive-behavioural therapy (CBT) – short term
 Treatment of choice
 Basic components of CBT: identifying maladaptive thinking patterns
and behavioural habits, then gradual practice of new habits
o Medical and drug treatments
 Antidepressants
 Can help reduce bingeing and purging behaviour
 Usually not effective in the long term
o Interpersonal psychotherapy (IPT) to improve interpersonal functioning
Medical and Psychological treatment of binge-eating disorder
o Previously used medications for obesity are now not recommended
o Pharmacological treatments to reduce feelings of hunger
o Psychological treatment
 CBT
 Similar to that used for bulimia, addresses behaviour and
attitudes on eating and body shape
 Appears effective
 Interpersonal psychotherapy
 Equally effective as CBT, to improve interpersonal functioning
 Self-help techniques
 Also appear effective
Treatment of Anorexia Nervosa
o Hospitalisation (at 70% below normal weight)
o Psychological (outpatient)
 General goals and strategies
 Weight restoration
o First and easiest goal to achieve
 Psycho-education
 Behavioural and cognitive interventions
o Target food, weight, body image, thoughts and
emotions
 Treatment often involves the family
o More resistant to treatment than Bulimia
More effective treatments are needed
Preventing eating disorders
o Often focuses on promoting body acceptance in adolescent girls
o Identify specific targets
 Early weight concerns
o Screening for at-risk groups
o Provide education
 Normal weight limits
 Effects of calorie restriction
Obesity
o Cultural norms that encourage eating high-fat and high-sugar foods combine
with genetic and other factors to cause obesity, which is difficult to treat.
o 2 types of maladaptive eating patterns: Binge-eating and night eating
syndrome
o Increased risk of cardiovascular disease, diabetes, hypertension, stroke, etc.
o Treatment:
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Self-directed weight loss problems, commercial self-help programs,
professionally directed behaviour modification programs (most
effective), surgery as a last resort
Prevention programs (e.g. government policy) seem most effective

o Causes
 Psychological – affects impulse control, attitudes and motivation
towards eating, and responsiveness to consequences of eating
 Social – advancing technology promotes sedentary lifestyle and
consumption of high fat foods
 Biological – genes influence an individual’s number of fat cells,
tendency towards fat storage, and activity levels
All eating disorders share
o Gross deviations in eating behaviour
o Heavily influenced by social, cultural and psychological factors
o Most are driven by distorted thinking related to shape and weight
Sleep-Wake disorders
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-
Polysomnographic evaluation (for formal assessment of sleep disorders) – monitoring
the heart, muscle activity, respiration and oxygen concentration, surface
electroencephalogram (EEG) in a sleep laboratory
Sleep efficiency = percentage based on the time the individual actually sleeps as
opposed to time spent in bed trying to sleep
The major Dyssomnias
o The Dyssomnias: disturbances in amount and quality of sleep
 Insomnia disorder
 One of the most common sleep disorders
 Problems initiating / maintaining sleep (e.g. trouble falling
asleep, waking during night, waking too early in the morning)
 35% of adults in the US report daytime sleepiness
 Only diagnosed as a sleep disorder if it is not better explained
by a different condition (e.g. generalised anxiety disorder)
Diagnostic criteria for insomnia disorder
A. A predominant complaint of dissatisfaction with sleep quality or quality associated
with 1 or more of the following symptoms:
1. Difficulty initiating sleep (in children, this may manifest as difficulty initiating sleep
without caregiver intervention)
2. Difficulty maintaining sleep, characterised by frequent awakenings or problem
returning to sleep after awakenings (In children this may manifest as difficulty returning
to sleep without caregiver intervention)
3. Early-morning awakening with inability to return to sleep
B. The sleep disturbance causes clinically significant distress in social, occupational,
educational, academic, behavioural or other important areas of functioning
C. The sleep difficulty occurs at least 3 nights per week
D. The sleep difficulty is present for at least 3 months
E. The sleep difficulty occurs despite adequate opportunity for sleep
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F. The insomnia is not better explained by and does not occur exclusively during the course
of another sleep-wake disorder (e.g. narcolepsy, breathing-related sleep disorder, a
circadian rhythm sleep-wake disorder, a parasomnia)
G. The insomnia is not attributable to the physiological effects of a substance (e.g. a drug
of abuse or a medication)
H. Coexisting mental disorders and medical conditions do not adequately explain the
predominant complaint of insomnia
Specify if:
- Episodic: Symptoms last at least 1 month but less than 3 months
- Persistent: Symptoms last 3 months or longer
- Recurrent: 2 (or more) episodes within the space of 1 year
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Facts and statistics
o Affects females twice as often as males
 Associated features
o Unrealistic expectations about sleep
o Believe lack of sleep will be more disruptive than it
usually is
 Causes
o Pain, physical discomfort, insufficient exercise,
substance use, environmental influences, anxiety,
respiratory problems and biological vulnerability
o Parental effects on
children’s sleep
 Some children
learn to fall
asleep only
with a parent
present
 An integrative model of sleep
disturbance 
Hypersomnolence disorder
 Sleeping too much or
excessive sleep
o May manifest as long
nights of sleep or
frequent napping
 Experience excessive sleepiness as disruptive
Diagnostic criteria for Hypersomnolence disorder
A. Self-reported excessive sleepiness (Hypersomnolence) despite a main sleep period
lasting at least 7 hours, with at least 1 of the following symptoms:
1. Recurrent periods of sleep or lapses into sleep within the same day
2. A prolonged main sleep episode of more than 9 hours per day that is non-restorative
(i.e. Unrefreshing)
3. Difficulty being fully awake after abrupt awakening
B. The Hypersomnolence occurs at least 3 times per week, for at least 3 months
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C. The Hypersomnolence is accompanied by significant distress or impairment in
cognitive, social, occupational or other important areas of functioning
D. The Hypersomnolence is not better explained by and does not occur exclusively during
the course of another sleep disorder (e.g. narcolepsy, breathing-related sleep disorder, a
circadian rhythm sleep-wake disorder, a parasomnia)
E. The Hypersomnolence is not attributable to the physiological effects of a substance (e.g.
a drug of abuse or a medication)
F. Coexisting mental and medical disorders do not adequately explain the predominance
complaint of Hypersomnolence
Specify if:
- Acute: Duration of less than one month
- Subacute: Duration of 1 to 3 months
Specify current severity:
- Specify severity based on degree of difficulty maintaining daytime alertness as
manifested by the occurrence of multiple attacks of irresistible sleepiness within
any given day occurring, for example, while sedentary, driving, visiting friends or
working
- Mild: Difficulty maintaining daytime alertness 1 or 2 days per week
- Moderate: Difficulty maintaining daytime alertness 3 or 4 days per week
- Severe: Difficulty maintaining daytime alertness 5 to 7 days per week


Causes are not well understood due to limited research, but
may involve a genetic link and/or excessive serotonin
 Often associated with other medical and/or psychological
conditions
 Only diagnosed if other conditions do not adequately explain
hypersomnia, which should be the primary complaint
 Associated features
o Complain of sleepiness throughout the day
o Able to sleep through the night
Narcolepsy
Diagnostic criteria for narcolepsy
A. Recurrent periods of irrepressible need for sleep, lapsing into sleep or napping
occurring within the same day. These must have been occurring at least 3 times per week
over the past 3 months
B. The presence of at least one of the following:
1. Episodes of cataplexy defined as either (a) or (b), occurring at least a few times per
month
a. In individuals with long-standing disease, brief (seconds to minutes) episodes of
sudden bilateral loss of muscle tone with maintained consciousness, precipitated by
laughter or joking
b. In children or in individuals within 6 months of onset, spontaneous grimaces or
jaw-opening episodes with tongue thrusting or a global hypotonia (low muscle tone),
without any obvious emotional triggers
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2. Hypocretin deficiency, as measured using cerebrospinal fluid (CSF) hypocretin-1
immuno-reactivity values (less than or equal to one-third of values obtained in healthy
subjects tested using the same assay, or less than or equal to 110 pg/ml). Low CSF
levels of hypocretin-1 must not be observed in the context of acute brain injury,
inflammation or infection
3. Nocturnal sleep polysomnography showing rapid eye movement (REM) sleep latency
less than or equal to 15 minutes, or a multiple sleep latency test showing a mean sleep
latency less than or equal to eight minutes and 2 or more sleep onset REM periods
Specify current severity:
- Mild: Infrequent cataplexy (less than once per week), need for naps only once or
twice per day and less disturbed nocturnal sleep (i.e. Movements, insomnia and
vivid dreaming)



Causes are likely to be genetic
Facts and statistics – rare condition
o Affects about 0.03-0.16% of the population
o Equally distributed between males and females
o Onset during adolescence
o Typically improves over time
Breathing-related sleep disorders
 Include 3 different disorders previously classified as parts of
the same disorder:
o Obstructive sleep apnoea hypopnoea
 Airflow stops, but respiratory system works
o Central sleep apnoea (CSA)
 Respiratory system stops for brief periods
o Sleep-related hypoventilation: Decreased breathing
during sleep not better explained by another sleep
disorder
Diagnostic criteria for obstructive sleep apnoea / hypopnoea
A. Either (1) or (2):
1. Evidence by polysomnography of at least 5 obstructive apnoeas or hypopnoeas per
hour of sleep and either of the following sleep symptoms:
a. Nocturnal breathing disturbances: snoring, snorting / gasping or breathing pauses
during sleep
b. Daytime sleepiness, fatigue or unrefreshing sleep, despite sufficient opportunities
to sleep, that is not better explained by another mental disorder (including a sleep
disorder) and is not attributable to another medical condition
2. Evidence by polysomnography of 15 or more obstructive apnoeas and/or
hypopnoeas per hour of sleep regardless of accompanying symptoms
Specify current severity:
- Mild: Apnoea/hypopnoea index is less than 15
- Moderate: Apnoea/hypopnoea index is 15-30
- Severe: Apnoea/hypopnoea index is greater than 30
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Diagnostic criteria for central sleep apnoea
A. Evidence by polysomnography of 5 or more central apnoeas per hour of sleep
B. The disorder is not better explained by another current sleep disorder
Specify current severity:
- Severity of central sleep apnoea is graded according to the frequency of the
breathing disturbances as well as the extent of associated oxygen desaturation and
sleep fragmentation that occur as a consequence of repetitive respiratory
disturbances
Diagnostic criteria for sleep-related hypoventilation
A. Polysomnography demonstrates episodes of decreased respiration associated with
elevated CO₂ levels. (Note: In the absence of objective measurement of CO₂, persistent
low levels of haemoglobin oxygen saturation unassociated with apnoeic/hyponoeic events
may indicate hypoventilation)
B. The disorder is not better explained by another current sleep disorder
Specify current severity:
- Severity is graded according to the degree of hypoxaemia and hypercarbia present
during sleep and evidence of end-organ impairment due to these abnormalities (e.g.
right-sided heart failure). The presence of blood gas abnormalities during
wakefulness is an indicator of greater severity


Causes may include narrow or obstructed airway, obesity and
increasing age
 Facts and features associated with breathing-related sleep
disorders
o Obstructive sleep apnoea occurs in 10-20% of
population
o More common in males
o Associated with obesity and increasing age
o People are usually minimally aware of apnoea problem
o Often snore, sweat during sleep, wake frequently
o May have morning headaches
o May experience episodes of falling asleep during the
day (due to poor sleep quality at night)
Circadian Rhythm sleep-wake disorders
 Disturbed sleep (e.g. either insomnia or excessive sleepiness)
leading to distress and/or functional impairment (e.g.
significantly decreased productivity at work)
 Specifically due to brain’s inability to synchronise day and
night
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Diagnostic criteria for circadian rhythm sleep-wake disorders
A. A persistent or recurrent pattern of sleep disruption that is primarily due to an alteration
of the circadian system or to a misalignment between the endogenous circadian rhythm
and the sleep-wake schedule required by an individual’s physical environment or social or
professional schedule
B. The sleep disruption leads to excessive sleepiness or insomnia or both
C. The sleep disturbance causes clinically significant distress or impairment in social,
occupational and other important areas of functioning
Specify if:
- Episodic: Symptoms last at least 1 month but less than 3 months
- Persistent: Symptoms last 3 months or longer
- Recurrent: 2 or more episodes occur within the space of one year

Affects suprachiasmatic nucleus, which stimulates melatonin
and regulates sense of night and day
 Examples
o Shift work type – job leads to irregular hours
o Familial type – associated with family history of
dysregulated rhythms
o Delayed or advanced sleep phase type – person’s
biological clock is naturally ‘set’ earlier or later than a
normal bedtime
o Treatments for sleep disorders
 Insomnia
 Benzodiazepines and over-the-counter sleep medications
o Prolonged use can cause rebound insomnia and
dependence
o Best as a short-term solution
 Psychological – anxiety reduction, improved sleep hygiene
 Hypersomnia and narcolepsy
 Stimulants (i.e. Ritalin)
 Catalepsy usually treated with antidepressants
 Breathing-related sleep disorders
 May include medications or weight loss
 Continuous positive air pressure (CPAP) machines are the gold
standard
 Circadian rhythm sleep-wake disorders
 Phase delays
o Moving bedtime later (best approach)
 Phase advances
o Moving bedtime earlier (more difficult)
 Use of very bright light
o Trick the brain’s biological clock
 Cognitive-behavioural therapy for insomnia (CBT-I)
 Psycho-education about sleep
 Changing beliefs about sleep
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 Extensive monitoring using sleep diary
 Practising better sleep-related habits
o Psychological treatments for insomnia
 Cognitive
 Focus on changing sleeper’s unrealistic expectations and
beliefs about sleep by providing information on topics such as
normal amounts of sleep and a person’s ability to compensate
for lost sleep
 Guided imagery relaxation
 Uses meditation or imagery to help with relaxation at bedtime
or after a night waking
 Graduated extinction
 For children who throw tantrums at bedtime or wake up in the
night crying. Instructs the parent to check on the child after
progressively longer periods until the child falls asleep on his
or her own
 Paradoxical intention
 Instructing individuals in the opposite behaviour to the desired
outcome. E.g. telling poor sleepers to lie in bed and try to stay
awake as long as they can to try relieve performance anxiety
surrounding efforts to fall asleep
 Progressive relaxation
 Relaxing the muscles of the body in an effort to induce
drowsiness
 Stimulus control procedures
 Improved sleep hygiene –
bedroom is a place for sleep
 For children – setting a regular
bedtime routine
o Preventing sleep disorders
 Best approach: Practice healthy ‘sleep
hygiene’ (behaviours that lead to
adequate quality and quantity of
sleep)
 Also helpful to educate parents about
good sleep habits for children
 Good sleep hygiene 
The parasomnias: abnormal events during sleep
o Nature and Gender Overview
 Nature of parasomnias
 The problem is not with sleep
itself
 Problem is abnormal events during sleep, or shortly after
waking
 2 classes of parasomnias
 Those that occur during REM (i.e. Dream) sleep - nightmares
 Those that occur during non-REM (i.e. Non-dream) sleep –
sleep terrors and sleepwalking
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o Non-REM sleep arousal disorders
 New DSM-5 diagnosis
Diagnostic criteria for non-rapid eye movement sleep arousal disorders
A. Recurrent episodes of incomplete awakening from sleep usually occurring during the
first third of the major sleep episode, accompanied by either one of the following:
1. Sleepwalking: Repeated episodes of rising from bed during sleep and walking about.
While sleepwalking, the person has a blank, staring face; is relatively unresponsive to
the efforts of others to communicate with him or her; and can be awakened only with
great difficulty
2. Sleep terrors: Recurrent episodes of abrupt terror arousals from sleep, usually
beginning with panicky scream. There is intense fear and signs of autonomic arousal,
such as mydriasis (dilated pupils), tachycardia, rapid breathing and sweating, during
each episode. There is relative unresponsiveness to efforts of others to comfort the
person during the episode
B. No or little (e.g. only a single-visual scene) dream imagery is recalled
C. Amnesia for the episodes is present
D. The episodes cause clinically significant distress or impairment in social, occupational
or other important areas of functioning
E. The disturbance is not attributable to the physiological effects of a substance (e.g. a drug
of abuse or a medication
F. Coexisting mental and medical disorders do not explain the episodes of sleepwalking or
sleep terrors
o More about sleep terrors
 Facts and associated features
 More common in children (about 6%) than adults
 Child cannot be easily awakened during the episode
 Child has little memory of it the next day
 Screams, cries, sweats, walks, has a rapid heartbeat
 More common in boys than girls
 Possible genetic link, may subside with time
o More about sleepwalking
 Occurs at least once during non-REM sleep in 15-30% of children
under 15 years old.
 Causes – extreme fatigue, sleep deprivation, sedative or hypnotic
agents, or stress
 Adult sleepwalking is usually associated with other psychological
disorders
 May have a genetic link
 Sleepwalking disorder – somnambulism
 Usually during first few hours of deep sleep
 Person must leave the bed
 Facts and associated features
 More common in children than adults
 Problem usually resolves on its own without treatment
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 Seems to run in families
 May be accompanied by nocturnal eating
o Nightmare disorder
 Repeated episodes of extended, extremely dysphoric dreams leading to
distress and/or impairment in daily life
 Not adequately explained by other conditions
Diagnostic criteria for nightmare disorder
A. Repeated occurrences of extended, extremely dysphoric and well-remembered dreams
that usually involve efforts to avoid threats to survival, security or physical integrity and
that generally occur during the second half of the major sleep episode
B. On awakening from the dysphoric dreams, the person rapidly becomes oriented and
alert
C. The sleep disturbance causes clinically significant distress or impairment in social,
occupational or other important areas of functioning
D. The nightmare symptoms are not attributable to the physiological effects of a substance
(e.g. a drug of abuse or a medication)
E. Coexisting mental and medical disorders do not adequately explain the predominant
complaint of dysphoric dreams
Specify current severity:
- Severity can be rated by the frequency with which the nightmares occur:
- Mild: less than one episode per week on average
- Moderate: One or more episodes per week but less than nightly
- Severe: Episodes nightly


Causes are unknown, but they tend to decrease with age
Facts and associated features
 10-50% of children and 9 to 30% of adults have nightmares
 Occurs during REM sleep
 Dreams often awaken the sleeper
 Problem is more common in children than adults
o REM sleep behaviour disorder
 New diagnosis in DSM-5
 Repeated episodes of arousal during sleep associated with vocalisation
and/or complex motor behaviours
 Causes impairment or distress
 Often, major problem is injury to self or sleeping partner
o Treatment for parasomnias
 Parasomnias may go away on their own
 Reducing nightmares
 Cognitive behavioural therapy
 Drugs such as amitriptyline may help
 Relaxation may help
 Reducing sleep terrors
 Scheduled awakening: Wake child up before sleep terror
usually occurs, then fade out awakenings over time
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o Rapid eye movement sleep behaviour disorder
Diagnostic criteria for rapid eye movement sleep behaviour disorder
A. Repeated episodes of arousal during sleep associated with vocalisation and/or complex
motor behaviours
B. These behaviours arise during rapid eye movement (REM) sleep and therefore usually
occur greater than 90 minutes after sleep onset, are more frequent during the later phases of
the sleep period, and uncommonly occur during daytime naps
C. Upon awakening from these episodes, the individual is completely awake and alert and
not confused or disoriented
D. Either of the following:
1. REM sleep without atonia (muscle weakness) on polysomnographic recording
2. A history suggestive of REM sleep behaviour disorder and an established
synucleinopathy diagnosis (such as Parkinson’s disease, multiple system atrophy)
E. The behaviours cause clinically significant distress or impairment in social, occupational
or other important areas of functioning (which may include injury to self or the bed
partner)
F. The disturbance is not attributable to the physiological effects of a substance (such as a
drug of abuse or a medication) or another medical condition
G. Coexisting mental and medical disorders do not explain the episodes
Summary of eating and sleep disorders
- All sleep-wake disorders share
o Interference with normal process of sleep
o Interference results in problems during waking
o Heavily influenced by psychological and behavioural factors
- More effective treatments are needed
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Week 7: Personality Disorders
What are Personality Disorders?
- A persistent pattern of emotions, cognitions and behaviour that results in enduring
emotional distress for the person affected and/or for others and may cause difficulties
with work and relationships
Personality disorders: An overview
-
-
-
Enduring, inflexible predispositions (longstanding and ingrained)
Maladaptive, causing distress and/or impairment
High comorbidity with other disorders
Generally poor prognosis
Ego-syntonic: Unlike other disorders, often feel consistent with one’s identity;
patients don’t feel that treatment is necessary
Ten specific personality disorders organised into three clusters
Categorical and Dimensional models
o ‘Kind’ vs ‘Degree’
 Personality disorders have traditionally been assigned as all-or-nothing
categories
 DSM-5 retained categorical model of personality disorders
 Dimensional model: Individuals are rated on the degree to which they
exhibit various personality traits
o Cross-cultural research establishes the universal nature of the 5 dimensions
o 5 factor model of personality (‘Big 5’)
 Openness to experience
 Conscientiousness
 Extraversion
 Agreeableness
 Neuroticism
DSM-5 personality disorder clusters
o Cluster A – odd or eccentric cluster
o Cluster B – dramatic, emotional, erratic cluster
o Cluster C – fearful or anxious cluster
Statistics
o Prevalence of personality disorders
 Affects about 6% of the general population
o Origins and course of personality disorders
 Thought to begin in childhood
 Tend to run a chronic course if untreated
 May transition into a different personality disorder
o Gender distribution and gender bias in diagnosis
 Men more often show traits such as aggression and detachment;
women more often show submission and insecurity
 Antisocial – more often male
 Histrionic – more often female
o Comorbidity is the rule, not the exception
 Often have 2 or more personality disorders or an additional mood or
anxiety disorder
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Cluster A = Odd or Eccentric
-
Paranoid personality disorder
o Overview and clinical features
 Pervasive and unjustified mistrust and suspicion
 Few meaningful relationships, sensitive to criticism
 Poor quality of life
Diagnostic criteria for paranoid personality disorder
A. A pervasive distrust and suspiciousness of others such that their motives are
interpreted as malevolent, beginning by early adulthood and present in a variety of
contexts, as indicated by 4 (or more) of the following:
1. Suspects, without sufficient basis, that others are exploiting, harming or deceiving
him or her
2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends
or associates
3. Is reluctant to confide in others because of unwarranted fear that the information will
be used maliciously against him or her
4. Reads hidden demeaning or threatening meanings into benign remarks or events
5. Persistently bears grudges, i.e. Is unforgiving of insults, injuries or slights
6. Perceives attacks on his or her character or reputation that are not apparent to others
and is quick to react angrily or to counterattack
7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual
partner
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or
depressive disorder with psychotic features, or another psychotic disorder and is not
attributable to the physiological effects of another medical condition
Note: If criteria are met prior to the onset of schizophrenia, add ‘premorbid’ i.e. ‘paranoid
personality disorder (premorbid)’
o Causes
 Not well understood
 Psychological influences
 Thoughts that people are malicious, deceptive and threatening
 Behaviour based on mistaken assumptions about others
 Biological influences
 Possible but unclear link with schizophrenia
 Social / cultural influences
 ‘Outsiders’ susceptible because of unique experiences (e.g.
prisoners, refugees, etc.)
 Parents’ early teaching may influence
o Cultural factors: More often found in people with experiences that lead to
mistrust of others, e.g.
 Prisoners
 Refugees
 People with hearing impairments
 Older adults
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o Treatment options
 Few seek professional help on their own
 Treatment focuses on development of trust
 Cognitive therapy to counter negativistic thinking
 Lack of good outcome studies
 Low success rate
Schizoid personality disorder
o Overview and clinical features
 Pervasive pattern of detachment from social relationships
 Social isolation
 Very limited range of emotions in interpersonal situations
o The causes
 Aetiology is unclear
 Childhood shyness
 Preference for social isolation resembles autism
Diagnostic criteria for schizoid personality disorder
A. A pervasive pattern of detachment from social relationships and a restricted range of
expression of emotions in interpersonal settings, beginning by early adulthood and present
in a variety of contexts, as indicated by 4 (or more) of the following:
1. Neither desires nor enjoys close relationships, including being part of a family
2. Almost always chooses solidarity activities
3. Has little, if any, interest in having sexual experiences with another person
4. Takes pleasure in few, if any, activities
5. Lacks close friends or confidants other than first-degree relatives
6. Appears indifferent to the praise or criticism of others
7. Shows emotional coldness, detachment or flattened affectivity
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or
depressive disorder with psychotic features, another psychotic disorder, or autism spectrum
disorder, and is not attributable to the physiological effects of another medical condition
Note: If criteria are met prior to the onset of schizophrenia, add ‘premorbid’ e.g. ‘schizoid
personality disorder (premorbid)’
o Causes
 Aetiology is unclear due to scarcity of research
 Childhood shyness is usually present
 Some individuals experienced abuse or neglect in childhood
 Preference for social isolation resembles autism
 Psychological influences
 Limited range of emotions, apparently cold and unconnected
 Biological influences
 Associated with lower density of dopamine receptors
 Social/cultural influences
 Preference for social isolation, lack of social skills, lack of
interest in close relationships (including romantic and sexual)
o Treatment options
 Few seek professional help on their own
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 Focus on the value of interpersonal relationships
 Building empathy and social skills (role playing)
 Lack of good outcome studies
Schizotypal personality disorder
o Overview and clinical features
 Behaviour and dress is odd and unusual
 Socially isolated and highly suspicious
 Magical thinking, ideas of reference and illusions
 Many meet criteria for major depression
 Some conceptualise this as resembling a milder form of schizophrenia
Diagnostic criteria for schizotypal personality disorder
A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort
with, and reduced capacity for, close relationships, as well as by cognitive or perceptual
distortions and eccentricities of behaviour, beginning by early adulthood and present in a
variety of contexts, as indicated by 5 (or more) of the following:
1. Ideas of reference (excluding delusions of reference)
2. Odd beliefs or magical thinking that influences behaviour and is inconsistent with
sub-cultural norms (e.g. superstitiousness, belief in clairvoyance, telepathy or ‘sixth
sense’; in children and adolescents - bizarre fantasies or preoccupations)
3. Unusual perceptual experiences, including bodily illusions
4. Odd thinking and speech (e.g. vague, circumstantial, metaphorical, over-elaborate or
stereotyped)
5. Suspiciousness or paranoid ideation
6. Inappropriate or constricted affect
7. Behaviour or appearance that is odd, eccentric or peculiar
8. Lack of close friends or confidants other than first-degree relatives
9. Excessive social anxiety that does not diminish with familiarity and tends to be
associated with paranoid fears rather than negative judgements about self
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or
depressive disorder with psychotic features, another psychotic disorder or autism spectrum
disorder
Note: If criteria are met prior to the onset of schizophrenia, add ‘pre-morbid’ e.g.
‘schizoid personality disorder (premorbid)’
o Causes
 Psychological influences
 Unusual behaviour, beliefs or dress
 Suspiciousness
 Believing insignificant events are personally relevant (‘Ideas of
reference’)
 Expressing little emotion
 Symptoms of major depressive disorder
 Biological influences
 Genetic vulnerability for schizophrenia but without the
biological or environmental stresses present in that disorder
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
-
Social / cultural influences
 Preference for social isolation
 Excessive social anxiety
 Lack of social skills
 May be more likely to develop after childhood maltreatment or trauma,
especially in men
 More generalised brain deficits may be present (e.g. problems with
learning or memory)
o Treatment options
 Address comorbid depression
 30-50% meet criteria for
major depressive
disorder
 Main focus is on developing
social skills
 Reduce isolation and suspicion
 Medical treatment is similar to
that used for schizophrenia
 Treatment prognosis is
generally poor
Grouping cluster A disorders 
Cluster B = Dramatic, emotional or Erratic
-
Antisocial personality disorder
o Overview and clinical features
 Failure to comply with social norms
 Violation of the rights of others
 Irresponsible, impulsive and deceitful
 Lack of a conscience, empathy and remorse
 ‘Sociopathy’, ‘psychopathy’ typically refer to this disorder or very
similar traits
 DSM-5 criteria focuses almost entirely on observable
behaviours (e.g. impulsivity). Related concept of psychopathy
primarily reflects underlying personality traits (e.g. selfcenteredness or manipulation)
 May be very charming, interpersonally manipulative
o Often show early histories of behavioural problems, including conduct
disorder
 ‘Callous-unemotional’ type of conduct disorder more likely to evolve
into antisocial PD
o Families with inconsistent parental discipline and support
o Families often have histories of criminal and violent behaviour
o Neurobiological contributions
 Prevailing neurobiological theories
 Under-arousal hypothesis – cortical arousal is too low
 Cortical immaturity hypothesis – cerebral cortex is not fully
developed
 Fearlessness hypothesis – fail to respond to danger cues
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Gray’s model: inhibition signals are outweighed by reward
signals
o Development
 Genetic influence
 More likely to develop antisocial behaviour if parents have a
history of antisocial behaviour or criminality
 Developmental influences
 High-conflict childhood increases likelihood of APD in at-risk
children
 Impaired fear conditioning
 Children who develop APD may not adequately learn to fear
aversive consequences of negative actions (e.g. punishment for
setting fires) – high fear threshold
 Arousal theory
 People with APD are chronically under-aroused and seek
stimulation from the types of activities that would be too fearful
or aversive for most – abnormally low cortical arousal
 Psychological and social influences
 In research studies, psychopaths are less likely to give up when
the goal becomes unattainable – may explain why they persist
with behaviour (e.g. crime) that is punished
 Difficulty learning to avoid punishment
 Indifferent concerns of others
 APD is the result of multiple interacting factors
 Mutual biological-environmental influence
 Early antisocial behaviour alienates peers who would otherwise
serve as corrective role models
 Antisocial behaviour and family stress mutually increase one
another
 Social / cultural influences
 Criminality
 Stress / exposure to trauma
 Inconsistent parental discipline
 Socio-economic disadvantage
o Treatment
 Few seek treatment on their own
 Antisocial behaviour is predictive of poor prognosis
 Emphasis is placed on prevention and rehabilitation – prevention
through preschool programmes
 Often incarceration is the only viable alternative as treatment is seldom
successful
 May need to focus on practical (or selfish) consequences (e.g. if you
assault someone you’ll go to prison)
 Parent training if problems are caught early
Borderline personality disorder
o Overview and clinical features
 Unstable moods and relationships
 Impulsivity, fear of abandonment, very poor self-image
 Self-mutilation and suicidal gestures
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Comorbidity rates are high with other mental disorders, particularly
mood disorders
Diagnostic criteria for borderline personality disorder
A pervasive pattern of instability of interpersonal relationships, self-image and effects and
marked impulsivity, beginning by early adulthood and present in a variety of contexts, as
indicated by 5 (or more) of the following:
1. Frantic efforts to avoid real or imagined abandonment (note: Do not include suicidal
or self-mutilating behaviour covered in Criterion 5)
2. A pattern of unstable and intense interpersonal relationships characterised by
alternating extremes of idealisation and devaluation
3. Identity disturbance: markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least 2 areas that are potentially self-damaging (e.g. spending, sex,
substance abuse, reckless driving, binge eating) (Note: Do not include suicidal or selfmutilating behaviour covered in criterion 5)
5. Recurrent suicidal behaviour, gestures or threats, or self-mutilating behaviour
6. Affective instability due to a marked reactivity of mood (e.g. intense episodic
dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a
few days)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of
temper, constant anger, recurrent physical fights)
9. Transient, stress-related paranoid ideation or severe dissociative symptoms
o Comorbid disorders
 1 in 5 borderline patients is also depressed
 10% of suicide attempts are successful
 40% meet criteria for bipolar disorder
 67% engage in substance abuse
 Eating disorders
 25% of bulimia patients have borderline personality disorder
o Causes
 Strong genetic component
 Also linked to depression genetically
 High emotional reactivity may be inherited
 May have impaired functioning of the limbic system
 Early trauma / abuse increases risk
 Many BPD patients have high levels of shame and low self-esteem
 Psychological influences
 Suicidal, erratic moods, impulsivity
 Biological influences
 Familial link to mood disorders
 Possibly inherited tendencies (impulsivity or volatility)
 Social / cultural influences
 Early trauma, especially sexual / physical abuse
 Rapid cultural changes (immigration) may trigger symptoms
o ‘Triple vulnerability’ model of anxiety applies to borderline personality too
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Summary 2019
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Psychology 314
Rebecca JvR (19980329)
o Results from the combination of:
 Generalised biological vulnerability (reactivity)
 Generalised psychological vulnerability (lash out when threatened)
 Specific psychological vulnerability (stressors that elicit borderline
behaviour)
o Treatment options – few good outcome studies
 Antidepressant medications provide some short-term relief
 Dialectical behaviour therapy (DBT) is most promising treatment
 Tricyclic antidepressants, second generation antipsychotic
agents, mood stabilising agents
 Focus on dual reality of acceptance of difficulties and need for
change
 Focus on interpersonal effectiveness
 Focus on distress tolerance to decrease reckless / self-harming
behaviour
Histrionic personality disorder
o Overview and clinical features
 Overly dramatic and sensational
 May be sexually provocative
 Often impulsive and need to be the centre of attention
 Thinking and emotions are perceived as shallow
 More commonly diagnosed in females
Diagnostic criteria for histrionic personality disorder
A pervasive pattern of excessive emotionality and attention seeking, beginning by early
adulthood and present in a variety of contexts, as indicated by 5 (or more) of the
following:
1. Is uncomfortable in situations in which he or she is not the centre of attention
2. Interaction with others is often characterised by inappropriate sexually seductive or
provocative behaviour
3. Displays rapidly shifting and shallow expression of emotions
4. Consistently uses physical appearance to draw attention to self
5. Has a style of speech that is excessively impressionistic and lacking in detail
6. Shows self-dramatisation, theatrically and exaggerated expression of emotion
7. Is suggestible (i.e. Easily influenced by others or circumstances)
8. Considers relationships to be more intimate than they actually are
o Causes
 Aetiology unknown due to lack of research
 Often co-occurs with antisocial PD
 Possibly feminine variant of antisocial traits
 Psychological influences
 Vain, self-centred, easily upset if ignored, vague and
hyperbolic, impulsive and difficulty dallying gratification
 Biological influences
 Possible link to antisocial disorder – women histrionic / men
antisocial
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Summary 2019
Psychology 314
Rebecca JvR (19980329)

-
Social / cultural influences
 Overly dramatic behaviour attracts attention, seductive,
approval-seeking
o Treatment options
 Focus on attention-seeking and long-term negative consequences
 Targets may also include problematic interpersonal behaviours
 Little evidence that treatment is effective
 Rewards and fines
 Focus on interpersonal relations
Narcissistic personality disorder
o Overview and clinical features
 Exaggerated and unreasonable sense of self-importance
 Preoccupation with receiving attention – think of themselves deserving
of special treatment
 Lack sensitivity and compassion for other people
 Highly sensitive to criticism, envious, arrogant
Diagnostic criteria for narcissistic personality disorder
A pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration and lack
of empathy, beginning by early adulthood and present in a variety of contexts, as indicated
by 5 (or more) of the following:
1. Has a grandiose sense of self-importance (e.g. exaggerates achievements and talents,
expects to be recognised as superior without matching achievements)
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal
love
3. Believes that he or she is ‘special’ and unique and can only be understood by, or
should associate with, other special or high-status people (or institutions)
4. Requests excessive admiration
5. Has a sense of entitlement (i.e. Unreasonable expectations of especially favourable
treatment or automatic compliance with his or her expectations)
6. Is interpersonally exploitative (i.e. Takes advantage of others to achieve his or her
own ends)
7. Lacks empathy: is unwilling to recognise or identify with the feelings and needs of
others
8. Is often envious of others or believes that others are envious of him or her
9. Shows arrogant, haughty behaviours or attitudes
o Causes are largely unknown
 Failure to learn empathy as a child
 Sociological view – product of the ‘me’ generation
o Treatment options
 Focus on grandiosity, lack of empathy, unrealistic thinking
 Emphasise realistic goals and coping skills for dealing with criticism
 Little evidence that treatment is effective
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Summary 2019
Psychology 314
Rebecca JvR (19980329)
Cluster C = Anxious or fearful
-
Avoidant personality disorder
o Overview and clinical features
 Extreme sensitivity to the opinions of others
 Highly avoidant of most interpersonal relationships
 Interpersonally anxious and fearful of rejection
 Low self-esteem
 Reject attention from others
Diagnostic criteria for avoidant personality disorder
A pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to
negative evaluation, beginning by early adulthood and present in a variety of contexts, as
indicated by 4 (or more) of the following:
1. Avoids occupational activities that involve significant interpersonal contact because
of fears of criticism, disapproval or rejection
2. Is unwilling to get involved with people unless they are certain of being liked
3. Shows restraint within intimate relationships because of the fear of being shamed or
ridiculed
4. Is preoccupied with being criticised or rejected in social situations
5. Is inhibited in new interpersonal situations because of feelings of inadequacy
6. Views self as socially inept, personality unappealing or inferior to others
7. Is usually reluctant to take personal risks or to engage in any new activities because
they may prove embarrassing
-
o Causes
 May be linked to schizophrenia; occurs more often in relatives of
people with schizophrenia
 Experiences of early rejection
 Psychological influences
 Low self-esteem, fear of rejection, criticism leads to fear of
attention, extreme sensitivity, resembles social phobia
 Biological influences
 Innate characteristics may cause rejection
 Social / cultural influences
 Insufficient parental affection
o Treatment
 Similar to treatment for social phobia
 Behavioural intervention techniques sometimes successful
o Systematic desensitisation, behavioural rehearsal
 Focus on social skills, entering anxiety-provoking situations
 Good relationships with therapist is important
Dependent personality disorder
o Overview and clinical features
 Reliance on others to make major and minor life decisions
 Unreasonable fear of abandonment
 Clingy and submissive in interpersonal relationships
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Summary 2019
Psychology 314
Rebecca JvR (19980329)
Diagnostic criteria for dependent personality disorder
A pervasive and excessive need to be taken care of that leads to submissive and clinging
behaviour and fears of separation, beginning by early adulthood and present in a variety of
contexts, as indicated by 5 (or more) of the following:
1. Has difficulty making everyday decisions without an excessive amount of advice and
reassurance from others
2. Needs others to assume responsibility for most major areas of his or her life
3. Has difficulty expressing disagreement with others because of fear of loss of support
or approval (Note: Do not include realistic fears of retribution)
4. Has difficulty initiating projects or doing things on his or her own (because of a lack
of self-confidence in judgement or abilities rather than a lack of motivation or energy)
5. Goes to excessive lengths to obtain nurturance and support from others, to the point
of volunteering to do things that are unpleasant
6. Feels uncomfortable or helplessness when alone because of exaggerated fears of
being unable to take care of him or herself
7. Urgently seeks another relationship as a source of care and support when a close
relationship ends
8. Is unrealistically preoccupied with fears of being left to take care of him or herself
-
o Causes
 Not well understood due to lack of research
 Linked to early disruptions in learning independence
 Psychological influences
 Early ‘loss’ of caretaker (death, rejection or neglect) leads to
fear of abandonment
 Timidity and passivity
 Biological influences
 Each of us born dependent for protection, food and nurturance
 Social / cultural influences
 Agreement for the sake of avoiding conflict
 Similar to avoidant in inadequacy, sensitivity to criticism, need
for reassurance BUT for those same shared reasons Avoidants
withdraw and dependents cling
o Treatment options
 Research on treatment efficacy is lacking
 Therapy typically progresses gradually due to lack of independence
 Treatment targets include skills that foster confidence and
independence
 Appear as ideal clients
 Submissiveness negates independence
Obsessive-compulsive personality disorder
o Overview and clinical features
 Excessive and rigid fixation on doing things the ‘right’ way
 This preoccupation with details prevents them from completing much
of anything
 Highly perfectionistic, orderly and emotionally shallow
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Summary 2019
Psychology 314




Rebecca JvR (19980329)
Unwilling to delegate tasks because others will do them wrong
Difficulty with spontaneity
Often have interpersonal problems
Obsessions and compulsions are rare
Diagnostic criteria for obsessive-compulsive personality disorder
A pervasive pattern of preoccupation with orderliness, perfectionism and mental and
interpersonal control, at the expense of flexibility, openness and efficiency, beginning by
early adulthood and present in a variety of contexts, as indicated by 4 (or more) of the
following:
1. Is preoccupied with details, rules, lists, order, organisation or schedules to the extent
that the major point of the activity is lost
2. Shows perfectionism that interferes with task completion (e.g. is unable to complete a
project because his or her own overly strict standards are not met)
3. Is excessively devoted to work and productivity to the exclusion of leisure activities
and friendships (not accounted for by obvious economic necessity)
4. Is over-conscientious, scrupulous and inflexible about matters of morality, ethics or
values (not accounted for by cultural or religious identification)
5. Is unable to discard worn-out or worthless objects even when they have no
sentimental value
6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his
or her way of doing things
7. Adopts a miserly spending style towards both self and others; money is viewed as
something to be hoarded for future catastrophes
8. Shows rigidity and stubbornness
o Causes are not well known
 Weak genetic contribution
 Psychological influences
 Generally rigid, dependent on routines, procrastinating
 Biological influences
 Distant relation to OCD
 Probable weak genetic role – predisposition to structure
combined with parental reinforcement
 Social / cultural influences
 Very work-oriented
 Poor interpersonal relationships
o Treatment
 Little data on treatment
 Target rumination, procrastination and feelings of inadequacy
 Individual therapy
 Address fears informing need
 Relaxation or distraction techniques redirect compulsions to
order
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Summary 2019
Psychology 314
Rebecca JvR (19980329)
Summary of personality disorders
-
Long-standing patterns of behaviour
Begin early in development and run a chronic course
Disagreement exists over how to categorise personality disorders
o Categorical vs dimensional, or some combination of both
For most, little is known about causes or treatment
Treatment is often difficult because they usually do not see that their difficulties are a
result of the way they relate to others
Personality disorders are important to consider, because they may interfere with
efforts to treat more specific problems, such as anxiety, depression or substanceabuse. The presence of one or more personality disorders is associated with a poor
treatment outcome and a generally negative prognosis
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Student Test Bank 2 - Psychology 314 previous exam
questions and answers
Psychology (Universiteit Stellenbosch)
StuDocu is not sponsored or endorsed by any college or university
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Abnormal psychology: A South African perspective
Student Test Bank
Abnormal psychology
ISBN 978 019 599322 6
This Test bank forms part of the ancillary material accompanying the first edition of the book Abnormal
psychology (ISBN 978 019 598054 7). All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by
any means, without the prior permission in writing of Oxford University Press Southern Africa (Pty) Ltd, or as
expressly permitted by law, or under terms agreed with the appropriate designated reprographics rights
organization.
Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department,
Oxford University Press Southern Africa (Pty) Ltd, at the address below.
Published by Oxford University Press Southern Africa (Pty) Ltd, Vasco Boulevard, Goodwood, Cape Town,
Republic of South Africa, P O Box 12119, N1 City, 7463, Cape Town, Republic of South Africa.
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CHAPTER 1
INTRODUCTION
1. The criterion that a particular behaviour be atypical or not culturally expected is insufficient to
define abnormality because:
a. behaviours vary very little from one culture to another
b. society is less willing to tolerate eccentricity in people who are productive
c. behaviour that occurs infrequently is considered abnormal in every culture
d. many people behave in ways that deviate from the average but this doesn't mean
that they have a disorder
2. The typical profile or prototype of a disorder in the DSM-IV-TR AND ICD-10
reflects the
_____________.
a.
b.
c.
d.
treatments for mental disorders
causes of mental illness
theoretical perspectives on abnormality
diagnostic criteria for psychological disorders
3. The scientific study
a. psychopathology
b. parapsychology
c. pseudoscience
d. psychoanalysis
of psychological disorders is called:
4. The term ‘presenting problem’, as used by
a. the therapist thinks is most severe
b. the patient thinks is most severe
c. has lasted the longest amount of time
d. first brought the individual to therapy
therapists, is used to indicate the problem that:
6. A student began feeling sad and lonely. Although he was still able to go to classes and to work,
he finds himself feeling depressed much of the time and he is concerned about what is happening
to him. Which part of the definition of abnormality applies to this situatio n?
a. personal distress
b. violation of societal norms
c. cultural factors
d. impaired functioning
7. A researcher wants to know how many new cases of Schizophrenia are diagnosed each year.
This figure is referred to as the ___________ of the disord er.
a. recurrence
b. incidence
c. ratio
d. prevalence
8. If
a psychopathology is said to have an acute onset, it means that the symptoms
developed:
a. suddenly
b. following a previous period of recovery
c. atypically
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d. gradually
9. When 21-year-old
Byron was first diagnosed with depression, his family wanted to
know if and how the disorder would progress and how it would affect him in the future.
In medical terms, the family wanted to know Byron's ______________.
a.
b.
c.
d.
pathology
prognosis
psychosocial profile
diagnosis
10. Historically, when trying to understand irrational, problematic behaviour, people focused on
supernatural causes that included all of the following, EXCEPT:
a. demons and evil spirits
b. the moon and stars
c. bodily humours
d. magnetic fields
11. The biological and psychological theories of abnormality were derived originally from
the ancient Greek concept in which the:
a. mind was considered separate from the body
b. movement of the planets influenced human behaviour
c. flow of bodily fluids affected behaviour and personality
d. female reproductive organs were associated with psychopathology
12. During the 14th and 15th centuries, ‘madness’ was
a. religious delusions
b. brain disease
c. toxins in the blood
d. demons and witches
generally attributed to:
13. During the Middle Ages, as well as at other points in history, mentally ill people were
sometimes forced to undergo a religious rite called exorcism in order to:
a.
b.
c.
d.
cure the mental illness by making the individual more religious
prove that the person was not a witch
rid the individual's body of evil spirits
build up muscle strength and make the person healthier
14. The belief held by intolerant people that the ‘sin’ of homosexuality h as resulted in
HIV/AIDS is related to the historical concept of ______________ as a cause of mental
illness.
a.
b.
c.
d.
divine punishment
hysteria
sorcery
faith healing
15. According to the body humour theory espoused by Hippocrates, someone with a ‘choleric’
personality is:
a.
b.
c.
d.
hot-tempered
kind
cheap
easy-going
16. Which
of the following is NOT part of Freud's structural model of the mind?
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a.
b.
c.
d.
ego
psyche
id
superego
17. Even though Freud theorised the libido as the life energy
within the id, some people think
of it as the:
a.
b.
c.
d.
death instinct
sex drive
conscience
Oedipal conflict
18. According to Freud’s psychoanalytic theory, the __________ develops early in life to ensure
that human beings can adapt to the demands of the real world while still finding ways to meet
their basic needs.
a. ego
b. ideal self
c. superego
d. libido
19. In psychoanalytic theory, the id operates on the ‘pleasure principle,’
a. thinks in an unemotional, logical, and rational manner
b. utilises secondary process thinking
c. is sexual, aggressive, selfish, and envious
d. adheres to social rules and regulations
which means that it:
20. The role of the ego in psychoanalytic theory involves:
a.
b.
c.
d.
maximising pleasure and reducing tension
counteracting the aggressive and sexual drives of the id
mediating conflict between the id and the superego
utilising fantasy and primary process thinking
21. According to Freud’s theory, conflicts between the id and the superego often lead to
in
feelings of:
a.
b.
c.
d.
anxiety
depression
anger
desire
22. As used in modern terms to reflect coping styles, defenc e mechanisms:
a. can be either adaptive or maladaptive
b. are never adaptive
c. are always self-defeating
d. are always maladaptive
23. Which of the following is an instance of a self-defeating, maladaptive type of defence
mechanism?
a.
b.
c.
d.
projection
amnesia
sublimation
a hallucinatory experience
24. Which of the following defence mechanisms involves the act of an individual unconsciously
blocking disturbing experiences, thoughts, or wishes from awareness?
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a.
b.
c.
d.
displacement
rationalisation
repression
reaction formation
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25. Behaviourists such as B. F. Skinner and John Watson believed that both animal and human
behaviour is the result of:
a. conditioning
b. self-actualisation
c. sorcery
d. unconscious motivation
26. The continual interaction of biological, psychological, and social influences and their effect on
behaviour is called the _________________ approach.
a. psychobiological/biopsychological
b. systematic
c. socio-cultural
d. multidimensional integrative
27. Within the multidimensional integrative approach to understanding psychopathology, learned
helplessness is considered a ______________ dimension.
a. biological
b. neurological
c. emotional
d. psychological
28. The basis
of the multidimensional integrative approach to understanding
psychopathology is that each dimension (psychological, biological, emotional, etc.):
a.
b.
c.
d.
operates independently
is sufficient to cause pathology
builds on the dimension that precedes it
is influenced by the other dimensions
29. Your uncle spent most of his teen years in a hospital undergoing treatment for a severe
physical illness. As an adult, he is rather shy and withdrawn, particularly around women. He has
been diagnosed with Social Phobia and you believe that it is entirely due to lack of socialis ation
during his teen years. Your theory or model of what caused his phobia is:
a.
b.
c.
d.
multidimensional
integrative
one-dimensional
biological
30. Referring to behaviour and personality as polygenic means that both are:
a. influenced by only a few genes, but each gene has a large effect
b. influenced by many genes, with each individual gene contributing a relatively small
effect
c. influenced by individual genes only rarely
d. a result of our genetic structure only
31. Most psychological disorders appear to be influenced by many individual genes rather than
caused by one single gene, a process referred to as:
a. multigenic
b. polygenic
c. unigenic
d. Morphogenic
32. According to the diathesis-stress model, psychopathology is the result of the:
a. interaction between normal and defective or damaged genes
b. stress level of an individual and how stress is managed in a person's life
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c. family history of an individual
d. interaction of an inherited tendency and events in the person's life
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33. The central nervous system is made
a. brain and spinal cord
b. brain only
c. spinal cord only
d. nerves leading to and from the brain
34. The area between
a. axon terminal
b. Soma
c. synaptic cleft
d. transmission cleft
up of the:
the axon of one neuron and the dendrite of another neuron is the:
35. Neurotransmitters are important because they:
a. allow neurons to send signals to other neurons
b. maintain the oxygenation of the brain
c. prevent the development of psychopathology
d. allow the brain to maintain its structural integrity
36. GABA, dopamine, and norepinephrine are all
a. electrical brain waves
b. Neurons
c. Neurotransmitters
d. areas of the brain
examples of:
37. Most automatic functions, e.g., breathing, sleeping,
and motor coordination are controlled
by the part of the brain called the:
a.
b.
c.
d.
brain stem
Forebrain
Cortex
frontal lobes
38. Functions of the limbic system include control or regulation of:
a. basic body functions such as breathing
b. sleep cycles
c. emotional experiences, expressions, impulse control, and basic drives such as
aggression, sex, hunger, and thirst
d. body posture, coordinated movement, and involuntary responses such as reflexes and
other automatic processes
39. The ability to plan, think, reason,
a. Thalamus
b. Midbrain
c. cerebral cortex
d. brain stem
40. The part of the brain
a. Thalamus
b. Midbrain
c. brain stem
d. cerebral cortex
and create is located in the part of the brain called the:
that makes humans most distinct from other animals is the:
41. The peripheral nervous
a. endocrine system
b. brain stem and cortex
system is made up of the:
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c. somatic and autonomic nervous system
d. brain and spinal cord
42. The major function of the peripheral nervous system is to:
a. carry messages to and from the central nervous system
b. process information received from the central nervous system
c. regulate arousal
d. control hormonal activity
43. The part of the autonomic nervous system primarily responsible for our ‘fight or flight’
response to stress is the:
a.
b.
c.
d.
parasympathetic nervous system
sympathetic nervous system
endocrine system
cortex
44. Balancing the ‘fight or flight’ response to stress and returning the body to a state of ‘normal
arousal’ is a function of the:
a. sympathetic nervous system
b. parasympathetic nervous system
c. endocrine system
d. cortex
45. When those studying the brain
a. electrical pathways in the brain
b. physical brain structures
c. neurotransmitter pathways
d. brain stem activity
speak of brain circuits, they are referring to:
46. The neurotransmitter associated with regulation of mood, behaviou r
and thought processes
is:
a.
b.
c.
d.
GABA
norepinephrine
serotonin
dopamine
47. The neurotransmitter
a. norepinephrine
b. dopamine
c. serotonin
d. GABA
associated with inhibition of anxiety is:
48. The neurotransmitter thought to regulate or moderate certain behavioural tendencies rather
than directly influencing specific patterns of behaviou r or psychological disorders is:
a. norepinephrine
b. GABA
c. dopamine
d. serotonin
49. The neurotransmitter associated with both Schizophrenia and Parkinson's D isease
a. GABA
b. norepinephrine
c. dopamine
d. serotonin
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50. Extremely low activity levels of serotonin are associated
a. depression
b. Schizophrenia
c. anxiety disorders and general feelings of nervousness
d. mania
51. Extremely low levels
a. decreased anxiety
b. increased depression
c. increased anxiety
d. decreased depression
with:
of GABA are associated with:
52. The currently accepted view of the role of neurotransmitters in psychopathology points
out
that:
a. each psychological disorder is caused by a deficit in a specific neurotransmitter
b. chemical imbalances of the brain are the cause of psychopathology
c. simple cause/effect conclusions stating that an individual neurotransmitter
abnormality causes a disorder are incomplete
d. neurotransmitters have very little to do with psychopathology for most individuals but may
be the single cause of disorders for others
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CHAPTER 2
PSYCHOLOGICAL ASSESSMENT AND PSYCHODIAGNOSTICS
and social factors in a person with a
possible psychological disorder is known as clinical ________________.
1. The systematic evaluation of psychological, biological,
a.
b.
c.
d.
assessment
validation
standardisation
interpretation
2. The process of determining
whether a person’s symptoms meet the criteria for a specific
psychopathology is called:
a.
b.
c.
d.
classification
diagnosis
analysis
prognosis
3. The Diagnostic and Statistical Manual of Mental Disorders
a. International Association of Psychologists
b. National Institute of Mental Health
c. American Psychiatric Association
d. World Health Organisation
is published by the:
4. The International Classification of Diseases (10th edition) is
a. International Association of Psychologists
b. National Institute of Mental Health
c. American Psychiatric Association
d. World Health Organisation
5. Which of the following factors form
a. social
b. biological
published by the:
part of a clinical assessment?
c. psychological
d. all of the above
6. One of the goals of clinical assessment is to narrow the focus
a. concentrate on problem areas that seem most relevant
b. concentrate on all problem areas equally
c. consider a broad range of problems
d. cover all possible problems
to:
one of the three concepts that help establish the value of a
psychological assessment procedure?
7. Which of the following is NOT
a.
b.
c.
d.
validity
classification
standardisation
reliability
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8. A person with a well-defined presenting problem receives different diagnoses from different
psychologists. In terms of assessment, this reflects the problem of _____________ with
diagnostic systems.
a. reliability
b. standardisation
c. classification
d. validity
9. In terms of psychological assessment, which of the
following best describes the notion of
validity?
a.
b.
c.
d.
Scores are used as a norm for comparison purposes.
Two or more ‘raters’ get the same answers.
An assessment technique is consistent across different measures.
An assessment technique measures what it is designed to measure .
10. Mrs. P. is a 30-year-old, Zulu-speaking lady who recently emigrated from South Africa to
England. She applies for a job and is given a test. Her score is compared to others who have
taken the test, mostly young university students whose native language is English. Mrs. P.
thinks this is unfair. This is an issue of __________.
a.
b.
c.
d.
validity
reliability
classification
standardisation
the mental health
professional will obtain detailed information about the person's life as part of a:
11. In trying to understand and help a person with a psychological problem,
a.
b.
c.
d.
mental status exam
clinical interview
brain scan
physical exam
12. The primary purpose of a mental status exam is to determine:
a. if a psychological disorder might be present
b. which medication would be most effective
c. whether the individual also has a medical condition
d. what type of treatment should be used
13. In a mental status exam, the term ‘sensorium’ refers to an individual’s:
a. general awareness of his or her surroundings
b. ability to make reasonable judgments
c. impairment in visual or auditory functioning
d. level of emotional sensitivity
14. If a person was laughing during a funeral service, it could be said that his or her affect was:
a. Pervasive
b. Inappropriate
c. Blunted
d. Flat
15. A mental status exam covers all of the following categories,
a. Behaviour
b. Appearance
c. intellectual functioning
d. physical symptoms
EXCEPT:
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16. The term ‘oriented times three’, as used with regard to a mental status exam, refers the
patient’s orientation in terms of:
a. person, place, and time
b. ability to follow directions
c. Space
d. day, month, and year of birth
17. Which of the following is an accurate description of a personality inventory? A personality
inventory:
a. determines the possible contribution of brain damage to the person's condition
b. ascertains the structure and patterns of cognition
c. assesses long-standing patterns of behaviour
d. uses imaging to assess brain structure and/or function
18. Which of the following is an accurate description of an intelligence test? An intelligence test:
a. uses imaging to assess brain structure and/or function
b. assesses long-standing patterns of behaviour
c. determines the possible contribution of brain damage to the person's condition
d. ascertains the structure and patterns of cognition
19. Which of the following is an accurate description of a neuropsychological test? A
neuropsychological test:
a. determines the possible contribution of brain damage to the person's condition
b. uses imaging to assess brain structure and/or function
c. ascertains the structure and patterns of cognition
d. assesses long-standing patterns of behaviour
20. Projective psychological
a. Cognitive
b. Humanistic
c. Behavioural
d. Psychoanalytic
test are based on _____________ theory.
21. When a person describes what they see in the ambiguous stimuli of the Rorschach test, it is
thought that the person's _____________ thoughts are revealed.
a. unconscious
b. preconscious
c. conscious
d. postconscious
22. The Rorschach test has long been considered a controversial assessment tool because of all
of the following concerns, EXCEPT:
a. until recently there were no standardised procedures for administering the test
b. the test is based on psychoanalytic theory
c. the inkblots have been changed many times since the test was developed
d. there is little or no data regarding its reliability or validity
23. The Thematic Apperception Test (TAT)
is different from the Rorschach inkblot test in
that the person taking the TAT is asked to use his or her imagination to:
a.
b.
c.
d.
tell a complete story about a picture
tell a story and draw a picture about it
draw a picture based on a story that is read aloud by the examiner
write down responses after reading a short story
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24. Which of the statements about the Thematic Apperception Test is most accurate?
a. The TAT is used as a diagnostic test because validity is high.
b. Most psychologists interpret responses to the TAT cards in the same way.
c. High inter-rater reliability exists among those administering the test.
d. Many clinicians use the TAT to encourage people to talk more openly about their
lives.
25. Regarding projective tests, the latest research has found that most clinicians:
a. rely on these tests to diagnose psychopathology
b. have their own ways of administering and scoring the tests
c. do not use projective tests
d. use standardised procedures when administering and scoring the tests
26. The
calculation of IQ, previously done by using a child's mental age, is now done by
using a deviation IQ. This means that the child's score is compared to the scores of others:
a.
b.
c.
d.
of the same age
who took the test at the same time
with the same level of intelligence
in the same grade
27. Which of the following statements regarding IQ is NOT true?
a. IQ and intelligence are the same thing.
b. Psychologists have different theories about which skills and abilities constitute intelligence.
c. An IQ test has predictive validity with respect to academic success.
d. IQ tests measure abilities such as attention, memory, reasoning, and perception.
28. Neuropsychological tests are used to determine whethe r
a. be in a depressed state
b. have a brain dysfunction
c. be mentally retarded
d. have had a psychotic episode
or not a person might:
29. Although abnormalities in the functioning and structure of the brain can be detected by neuroimaging techniques, current research is also exploring:
a. a possible association of these abnormalities with psychological disorders
b. preventing psychological disorders with neuro-imaging techniques
c. using brain-imaging techniques as a treatment for psychological disorders
d. changing brain functioning from abnormal to normal
30. Recent
research involving PET scans has revealed that patients with Alzheimer's
disease have:
a.
b.
c.
d.
reduced amino acid production in the frontal lobes
increased dopamine reuptake in the occipital lobes
reduced glucose metabolism in the parietal lobes
increased serotonin levels in the temporal lobes
31. In addition to CT, PET, and MRI, there are other brain-imaging techniques currently in use or
being developed. Which of the following is NOT one of these newer neuro- imaging techniques?
a. SPECT
b. MEG
c. fMRI
d. EEG
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32. A primary
a. EEG
b. GSR
c. ERP
d. DOT
diagnostic technique for identifying seizure disorders is the:
33. One advantage of using classification and diagnostic systems like DSM-IV-TR and ICD-10
is
that knowing an individual’s diagnosis:
a.
b.
c.
d.
helps the therapist to develop a treatment plan and understand the prognosis
allows the therapist to see the patient as an individual
allows patients to fully participate in their own treatment
permits the insurance company to have access to patients' records
34. The dimensional approaches of the DSM-IV-TR and ICD-10 in classification of disorders are
different from the categorical approach in that the dimens ional system provides:
a. information that is used to determine the cause and treatment of the disorder
b. lists of symptoms that are associated with all of the forms of psychopathology that are
currently believed to exist
c. diagnostic labels based on the presence of specific symptoms
d. scales that indicate the degree to which patients are experiencing various
cognitions, moods, and behaviours
35. Most people who are diagnosed with the same disorder, like Generalised Anxiety Disorder, by
means of the DSM-IV-TR or ICD-10 classification systems will:
a. usually have at least some of the same symptoms as others with the disorder
b. usually experience all of the same symptoms
c. typically have very few of the same symptoms
d. none of the above
36. Several clinicians interview a patient using the same diagnostic system and they
independently provide the same diagnosis. We can say that the new diagnostic system is
probably:
a.
b.
c.
d.
reliable
valid
neither reliable nor valid
both reliable and valid
37. A patient's overall level of functioning in life is recorded on DSM-IV-TR Axis
a. I
b. II
c. III
d. V
_________.
38. One of the problems with diagnostic and classification systems like the DSM-IV-TR and the
ICD-10 is that:
a. individuals are often assigned more than one psychological disorder at one time
b. they attempt to maximise validity at the cost of reliability
c. diagnosis is difficult because it is hard to tell how much discomfort a particular symptom is
causing the patient
d. the criteria for many mental disorders are almost identical to each other
39. All of the following are potential dangers of assigning a diagnostic label, EXCEPT:
a. family and friends may see the patient as the disorder rather than an individual
b. the patient's prognosis (future course of the disorder) becomes difficult to predict
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c. health care workers may see the patient as the disorder rather than an individual
d. the patient may lose self-esteem
40. The terms nosology and taxonomy refer to:
a. scientific classification
b. theoretical ideas that cannot be tested objectively
c. the accuracy of a diagnostic system
d. the reliability of a grouping of clinical symptoms
41. A classical categorical approach to diagnosis
a. more useful in psychology than in medicine
b. more useful in medicine than in psychology
c. equally useful in medicine and psychology
d. not appropriate in either medicine or psychology
is:
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CHAPTER 3
COGNITIVE DISORDERS
1. By definition, a cognitive disorder cannot be caused by:
a. a medical disease
b. substance intoxication or withdrawal
c. a psychiatric disorder
d. an infection
2. Cognitive disorders were formerly referred to as:
a. thought disorders
b. organic brain disorders
c. amnestic disorders
d. multi-infarct disorders
3. Which of the following is not
a. amnesia
b. alogia
c. apraxia
d. aphasia
a common deficit that occurs in dementia?
4. In dementia, which of the following terms refers to an inability to recognis e
a. apraxia
b. alogia
c. agnosia
d. aphasia
.
5. The most common cause of dementia is:
a. head injury
b. Alzheimer's disease
c. cerebrovascular disease
d. HIV/AIDS
objects or people?
6. Parkinson's disease results from the death of neurons that produce:
a. Serotonin
b. Acetylcholine
c. Dopamine
d. Norepinephrine
7. Which of the following is not a symptom
a. early memory loss
b. tremors
c. muscle rigidity
d. an inability to initiate movement
of Parkinson's disease?
8. A disturbance of consciousness caused by a medical condition that develops over a very short
period of time and is characterised by a change in cognition (such as a memory deficit or
disorientation) and a reduction in the ability to focus, shift, or sustain attention, is known as:
a. Alzheimer's disease
b. Korsakoff's syndrome
c. delirium
d. HIV-associated dementia
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9. Delirium, dementia, and amnestic disorders
a. as temporary conditions
b. from complications of birth
c. in late adulthood
d. as part of the normal aging process
characteristically develop:
10. The three categories of cognitive disorders are:
a. delirium, dementia, and amnestic disorders
b. Alzheimer's, organic, and amnestic disorders
c. delirium, dementia, and Alzheimer's
d. Alzheimer's, delirium, and amnestic disorders
11. The term ‘organic mental disorders’ is no
longer accurate in describing cognitive
disorders because:
a.
b.
c.
d.
cognitive disorders are actually thought disorders
the term implies that there is no effective treatment
there is nothing ‘organic’ about these disorders
we have found that most psychological disorders have an ‘organic’ component
12. Most cognitive disorders are
a. medication side effects
b. brain dysfunction
c. the normal process of aging
d. alcohol or substances
caused by:
13. Cognitive disorders characteristically cause impairment in all of the following primary abilities,
EXCEPT:
a.
b.
c.
d.
attention
memory
dreaming
perception
14. ‘Impaired consciousness and cognition during the course of several hours or days’
defining characteristics of:
a.
b.
c.
d.
delirium
Amnestic Disorder
dementia
Alzheimer's
15. The symptoms of delirium tend to develop:
a. either very quickly or very slowly, depending on the cause
b. very quickly, over the course of a few hours to a few days
c. very slowly, over the course of several years
d. moderately slowly, over the course of several months
16. The symptoms of delirium tend to subside:
a. very slowly, if they ever subside at all
b. relatively quickly, over the course of a few days or weeks
c. very slowly, over the course of several years
d. moderately slowly, over the course of several months
17. Which of the following is NOT a common cause of delirium?
a. head trauma
b. medical conditions
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c. medication side effects
d. dietary factors
18. Why is substance-related delirium a major problem for the elderly?
a. Their bodies are less able to process and eliminate drugs.
b. Improper use of medication is likely to have serious side effects.
c. They are more likely to take many medications.
d. Because of all the reasons listed in a, b, and c.
19. Which of the following people is most likely to develop delirium?
a. Tony (age 76) takes multiple medications for various medical conditions. Two new
medications have just been prescribed for him and he has already made a mistake
taking the first dose.
b. Leslie (age 40) was in a minor car accident but claims to feel fine.
c. Thembi (age 89) is in good physical and mental health. This morning she has a little bit of
a head cold, but has not yet taken any medication for it.
d. Paul (age 12) woke up with a low-grade fever from the viral infection that has been going
around his class this past week.
20. The gradual deterioration of brain functioning that affects language, memory, judgement, and
other cognitive processes is known as:
a. dementia
b. Mental Retardation
c. delirium
d. Amnestic Disorder
21. One of
the major differences between dementia caused by Alzheimer's disease and
dementia caused by depression is that Alzheimer's type dementia:
a.
b.
c.
d.
involves a slow increase in symptoms
is not reversible
is generally reversible
leads to a rapid decline in abilities
22. Which of the following is NOT a possible cause
a. depression
b. Alzheimer's disease
c. chemical substances (including medications)
d. food additives and preservatives
23. The most common cause of dementia
a. Syphilis
b. Alzheimer's disease
c. a history of substance abuse
d. improper use of prescription drugs
of dementia?
is:
24. One major distinction that is useful in the differential diag nosis
of dementia or delirium is
that:
a. dementia symptoms develop slowly over time and delirium symptoms develop
quickly
b. the symptoms of dementia involve memory but the symptoms of delirium are more likely to
involve expressive language
c. dementia symptoms are usually associated with underlying medical conditions and
delirium is usually the result of other factors
d. the initial symptoms of dementia are generally more severe than the symptoms of delirium
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25. At the age of 50, Robyn has begun to receive quite a bit of teasing from her family about
being ‘absentminded.’ The truth is that Robyn has been hiding the fact that each week she seems
to remember less and less. For the last month, she has been getting lost while driving home from
work. Lately, Robyn has been relying on a hand-drawn map to get home. She has started having
trouble recognising the faces of people at work and frequently forgets why she started to
do something. Robyn appears to be developing:
a.
b.
c.
d.
medically-induced dementia
delirium
dementia
amnestic disorder
26. One of the early signs of dementia is:
a. loss of memory for recent events
b. inability to understand language
c. loss of memory for events from long ago
d. inability to produce language
27. Individuals with
dementia usually suffer from agnosia, which is defined as the inability
to:
a.
b.
c.
d.
remember events and places
use language
recognise and name objects
understand language
28. When a person has dementia, he or she may also experience depression, aggression,
delusions, agitation, and/or apathy, all of which are due to:
a. frustration experienced by these patients as they lose their cognitive abilities
b. progressive deterioration of brain functioning
c. neither of the above
d. both a and b
29. The outcome for patients with dementia due to Alzheimer's
a. death
b. stabilisation at some level of greatly reduced cognitive ability
c. dependent on individual response to treatment
d. slow recovery
30. Alzheimer's type dementia is usually diagnosed
a. psychological and neurological test results
b. ruling out alternative explanations
c. MRI findings
d. functional brain scan
disease is usually:
by:
31. Alzheimer's type dementia is characterised by:
a. multiple cognitive deficits that develop gradually and steadily
b. a few severe cognitive deficits that develop quickly
c. a few severe cognitive deficits that develop gradually and steadily
d. multiple cognitive deficits that develop quickly
32. Which of the following is used for a definitive diagnosis
a. reported observations of the patient by family members
b. psychological testing
c. an autopsy
of Alzheimer's type dementia?
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33. The progression of Alzheimer's type dementia is:
a. slow during early stages and late stages, and rapid during middle stages
b. rapid during early and late stages, and slow during middle stages
c. slow and progressive throughout the individual's life
d. slow in the early stages and rapid during late stages
34. Which of the following
people has the greatest risk of developing Alzheimer's type
dementia?
a.
b.
c.
d.
Nivesh, who is extremely bright but never finished university
Dave, who is wealthy and well educated
Luthando, who completed university although she has an average IQ
Alicia, who dropped out of school when she was very young
35. One hypothetical
explanation of the observed differences in the rate of Alzheimer's
type dementia for people of varying educational level is that:
a. the abilities acquired through formal education help compensate for some of the
deficits of the disorder
b. the type of work that most college graduates pursue is less likely to expose the individual
to the stressors associated with the disorder
c. the type of mental activity associated with formal education places an additional burden on
the brain that makes symptoms worse once a person has the disorder
d. knowledge acquired through formal education helps one avoid exposure to environmental
stimuli that might influence the disorder
36. Regarding dementia, the cognitive reserve hypothesis suggests that:
a. Alzheimer's type dementia is caused by a lack of formal education
b. the more synapses one develops throughout life, the more neuronal death is
required before the person becomes impaired
c. skills acquired through formal education help compensate for the early symptoms of
dementia
d. individuals with Alzheimer's type dementia never had enough reserve neurons
37. ________________ is the most common cause of dementia and ______________ is t he
second most common cause.
a.
b.
c.
d.
Vascular disease; Alzheimer's disease
Alzheimer's disease; head trauma
Alzheimer's disease; vascular disease
Vascular disease; head trauma
38. Why do the symptoms of vascular dementia differ so greatly from pat ient to patient?
a. Patients tend to be elderly and easily confused.
b. The symptoms relate to the area of the brain damaged.
c. It is not known why patients with vascular dementia have different symptoms.
d. The symptoms depend upon the person's other medical conditions.
39. Willem, a 62-year-old
man, has the typical early symptoms of dementia. The fact that he
has abnormalities in walking and weakness in his limbs suggests that his dementia is:
a.
b.
c.
d.
due to multiple influences
the Alzheimer's type
influenced by a medication
the vascular type
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patients with Alzheimer's type dementia, patients with vascular
dementia are more likely to have symptoms such as:
40. In comparison with
a.
b.
c.
d.
abnormalities in walking or muscle weakness during early stages
memory impairment during the late stages
abnormalities in walking or muscle weakness during late stages
memory impairment during the early stages
41. Which of the following statements regarding the different types of dementia is true?
a. Vascular dementia has a more rapid onset and results in fewer deficits than Alzheimer's
type dementia.
b. All forms of dementia have the same onset, symptoms, and course.
c. Vascular dementia has a more rapid onset and patients suffer a much more rapid demise
than with the other forms of dementia.
d. Vascular dementia has a more rapid onset than Alzheimer's type dementia, although
the course and outcome are similar.
42. All of the following are causes of dementia,
a. head trauma
b. HIV
c. pneumonia
d. Vitamin B12 deficiency
EXCEPT:
43. Dementia caused by HIV appears to be due to:
a. the HIV infection itself
b. chemical imbalances in the brain
c. side effects of medications used to treat HIV
d. opportunistic infections that occur in HIV patients
44. The dementia
a. brain stem
b. cortex
c. subcortex
d. hindbrain
45. Dementia
experienced by HIV patients primarily affects areas of the brain in the:
due to HIV is more likely to cause ___________ than Alzheimer's type
dementia.
a.
b.
c.
d.
long term memory loss
death
short term memory loss
severe depression
46. If Zandile's
dementia is caused by a process that has damaged her brain's dopamine
pathways, it can be presumed that this condition is caused by:
a.
b.
c.
d.
Huntington's disease
Parkinson's disease
Alzheimer's type dementia
head trauma
47. The disorder that causes a form of dementia called bovine spongiform encephalopathy (BSE)
or ‘mad cow disease’ is a variation of:
a. Alzheimer's type dementia
b. Huntington's disease
c. Pick's disease
d. Creutzfeldt-Jacob disease
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48. The symptoms of dementia associated with substance dependence are similar
to the
symptoms observed in:
a.
b.
c.
d.
HIV-induced dementia
Alzheimer's type dementia
vascular dementia
Huntington's disease
49. When
symptoms of dementia occur with substance dependence, they are typically
associated with:
a.
b.
c.
d.
poor diet and self-care behaviours
toxic effects of the substances
permanent brain damage
temporary impairment in brain functioning
50. Which disorder
is associated with the formation of amyloid plaques and neurofibrillary
tangles in the brain?
a.
b.
c.
d.
Pick's disease
Creutzfeldt-Jacob disease
Alzheimer's type dementia
Huntington's disease
51. Research into the causes of Alzheimer's type
a. multiple genes
b. high levels of aluminum
c. a single gene
d. environmental toxins
dementia points to the influence of:
52. Genetic research on the causes of Alzheimer's type dementia suggests that there are:
a. one or two forms of Alzheimer's type dementia and each type may have a different genetic
cause
b. many forms of Alzheimer's type dementia and each type may have somewhat
different features and different genetic influences
c. three identifiable forms of Alzheimer's type dementia, each with its own specific genetic
influences
d. too many complex interactions to ever understand the causes of Alzheimer's type
dementia
53. The main deficit of amnestic disorder is an inability
a. transfer information into long-term memory
b. remember one's own name
c. remember significant events from the distant past
d. perform basic mathematical calculations
to:
54. The
characteristic that separates amnestic disorder from dementia is that amnestic
disorder:
a.
b.
c.
d.
is the result of an accident
produces a wider array of cognitive deficits
is caused by brain damage
affects memory but may leave other cognitive abilities intact
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55. Seventy-four-year-old Mrs. Naidoo recently hit her head during a car accident. Ever since
then, she has been unable to remember the most basic things. For example, when shown a pen,
a broom, and a phone, Mrs. Naidoo can name each object, but cannot recall these objects five
minutes later. In all other ways, she appears normal. Mrs. Naidoo’ s diagnosis would probably
be:
a.
b.
c.
d.
organic brain damage
dementia
amnestic disorder
delirium
56. Potential causes of amnestic disorder include all of the following,
a. nicotine
b. head trauma
c. a medical condition
d. alcohol abuse
EXCEPT:
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CHAPTER 4
ANXIETY DISORDERS
1. Which of the following is a characteristic of the mood
a. reduced heart rate
b. muscle relaxation
c. apprehension about the future
d. positive feelings
state known as anxiety?
2. Anxiety is closely related to which of the following psychopathologi es?
a. psychosis
b. depression
c. Schizophrenia
d. dementia
3. The ‘flight or fight’ response is
a. autonomic
b. peripheral
c. somatic
d. parasympathetic
triggered by the ____________ nervous system.
4. ‘I've got to get out of here now, or I might not make it!’
This statement is most likely to be
said by someone in the midst of a(n):
a.
b.
c.
d.
parasympathetic ‘surge’
episode of depression
fear reaction
future-oriented mood state
5. The experience of fear can be described as
a. immediate emotional reaction to danger
b. culturally specific phenomenon
c. type of claustrophobia
d. neurotic response
a(n):
6. Mrs. N has an anxiety disorder in which she has occasional Panic Attacks when shopping at
the mall. This type of Panic Attack is known as:
a. situationally bound
b. situationally predisposed
c. uncued
d. cued
7. Which type of Panic Attack
a. uncued
b. situationally bound
c. situationally predisposed
d. Unexpected
is most closely related to phobic disorders?
8. Which of the following statements about anxiety is the most accurate?
a. An inherited tendency can make us tense or uptight.
b. Stress is a direct cause of panic disorder.
c. A single gene makes us vulnerable to anxiety.
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d. Panic disorder does not ‘run in families.’
9. Which
of the following neurotransmitter systems is associated with both anxiety and
depression?
a.
b.
c.
d.
noradrenergic
serotonergic
GABA-benzodiazepine
corticotropin releasing factor (CRF) system
10. The area of the brain most often associated wit h
a. limbic system
b. corpus callosum
c. reticular activating system
d. occipital lobe
anxiety is the:
11. Which of the following is most associated with Generalised Anxiety D isorder
a. panic
b. emotion
c. worry
d. fear
12. Which of the following is NOT a symptom of Generalised Anxiety D isorder
a. worrying about minor daily events
b. muscle tension
c. mental agitation
d. hypersomnia
13. Research has found that Generalised Anxiety D isorder
(GAD)?
(GAD):
(GAD) is especially prevalent
among:
a.
b.
c.
d.
teenage girls
mid-life males
the elderly
young adult males
14. Which of the following physiological measures distinguishes individuals with Generalised
Anxiety Disorder (GAD) from non-anxious normal people?
a. increased muscle tension
b. decreased EEG beta activity
c. increased heart rate
d. heightened autonomic arousal
15. Agoraphobic avoidance behaviour appears to be determined by:
a. the number of Panic Attacks the person has had in the past
b. the extent to which the person expects another Panic Attack to occur
c. how severe the Panic Attacks have been
d. how recently the last Panic Attack occurred
16. Which of the following statements regarding Panic Disorder With or Without A goraphobia
accurate?
a. Women are more likely than men to cope with Panic Disorder by drinking alcohol.
b. Most individuals with Panic Disorder will also avoid internal sensations that
produce physiological arousal.
c. An individual who suffers through an agoraphobic situation rather than avoiding it entirely
is not considered agoraphobic.
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17. Which of the following is NOT a characteristic of a Specific P hobia?
a. significant attempts by the anxious individual to avoid the phobic situation
b. recognition by the person with the phobia that the anxiety is excessive or unreasonable
c. strong and persistent anxiety related to a specific object or situation
d. decreased arousal of the autonomic nervous system
18. Which of the following is NOT included in the natural environment subtype of Specific
Phobias?
a. storms (including thunder and lightning)
b. deep water
c. heights
d. animals
19. Which of the following
a. fear of public buses
b. fear of flying
c. claustrophobia
d. animal phobia
is NOT an example of a situational phobia?
20. The main difference between situational phobia and Panic Disorder With Agoraphobia (PDA)
is that:
a. people with situational phobia never experience Panic Attacks outside the context
of the phobic situation
b. people with PDA experience Panic Attacks only in specific situations
c. people with PDA experience Panic Attacks only at specific times
d. people with situational phobia experience Panic Attacks when confronted with the phobic
situation as well as at other times
21. You are told about a child who has shown behaviour indicative of ‘separation anxiety’. To
determine whether the child actually has a disorder or whether the behaviou r is normal, you
would first need to know:
a.
b.
c.
d.
the child's age
if other family members have anxiety disorders
how long the child has shown this behaviour
whether the child is a boy or a girl
22. Although
illness phobia resembles hypochondria, it differs in that people with illness
phobias:
a.
b.
c.
d.
are fearful of acquiring a disease
actually have the disease
are fearful that they have contracted a disease
are worried that they may have had the disease and weren't aware of it
23. Which of the following is NOT an example of Social P hobia?
a. a person who can only eat comfortably when alone
b. a student who is reluctant to speak up in a classroom due to fear of embarrassing
themself
c. a male who has difficulty urinating in a public restroom when others are present
d. an individual who cannot travel on public transportation without a family member
present
24. Social Phobia, which involves anxiety about being evaluated or criticis ed,
during:
a. middle age
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b. adolescence
c. childhood
d. young adulthood
25. People suffering from Posttraumatic Stress Disorder (PTSD) may display all of the following
symptoms, EXCEPT:
a. memories and nightmares of the event
b. numbing of emotional responsiveness
c. decreased startle response and chronic underarousal
d. sudden ‘flashbacks’ in which the traumatic event is relived
26. Which of the following is an accurate statement about Posttraumatic Stress D isorder
(PTSD)?
a. Most people diagnosed with Acute Stress Disorder do not eventually develop PTSD.
b. Acute Stress Disorder is diagnosed instead of PTSD if a person's symptoms begin 6
months or more after the traumatic event.
c. PTSD occurs in all individuals who experience a traumatic event.
d. Acute Stress Disorder was included as a DSM-IV diagnosis so that early severe
reactions to trauma could receive health insurance coverage for immediate
treatment.
27. Although the ‘alarm reactions’ experienced in both Panic Disorder and PTSD are similar and
result in conditioned responses, in Panic Disorder the alarm is:
a. false
b. stronger
c. weaker
d. real
28. Obsessive-Compulsive Disorder (OCD) is often accompanied by all of the following,
EXCEPT:
a.
b.
c.
d.
major depression
panic attacks
visual hallucinations
severe generalised anxiety
29. Behaviours, or sometimes thoughts, that an individual with
OCD uses to reduce anxiety are
called:
a.
b.
c.
d.
habits
operants
fixations
rituals
30. The
compulsions that an individual with OCD uses to ward off intrusive thoughts or
suppress disastrous consequences can be either:
a.
b.
c.
d.
behavioural or mental
biological or psychological
autonomic or somatic
positive or negative
31. With regards to OCD, which of the following is NOT an example of a behavioural
compulsion?
a. handwashing
b. counting
c. ordering
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32. Regarding OCD, when the term ‘magical’ is used to refer to compulsive
a. many magicians have been diagnosed with OCD
b. the person with OCD believes he/she is possessed
c. the compulsions have no logical relation to the obsessions
d. compulsive behaviours are similar to superstitions
acts, it means:
33. With regard to the obsessions noted in patients with OCD, the term ‘need for symmetry’
refers to:
a.
b.
c.
d.
putting everything on one's right and nothing on the left
keeping things in perfect order
accumulation of possessions
doing something a number of different ways
40. In OCD, certain types of obsessions lead to certain types of compulsions. Which one of the
following is a correct match between an obsession and its consequent rituals?
a. contamination; ordering
b. symmetry; hoarding
c. sexual obsessions; checking
d. aggression obsessions; cleaning
41. Normal, ordinary individuals who have occasional intrusive thoughts with bizarre, sexual or
aggressive content, would not be considered to have OCD unless they fi nd the thoughts
unacceptable or even dangerous and also:
a.
b.
c.
d.
develop insomnia and nightmares
suffer from either Posttraumatic Stress Disorder or Social Phobia
become anxious about having additional intrusive thoughts
use alcohol or other drugs to reduce anxiety
42. Sipho has thoughts about hating his younger brother and wishing he would die. He becomes
very anxious about these thoughts because he has developed the idea that if anything happened
to his brother, it would be his fault. For no explainable reason, Sipho starts mentally counting by
odd numbers each time he walks past his brother's room and discovers that this activity helps
decrease his anxiety. Sipho’s behaviour can be described as:
a. an attempt to be better at maths than his brother, to gain parental acceptance
b. a mental compulsion developed to neutralise his bad thoughts
c. a compulsive ritual designed to make him like his brother more
d. a phobia of going into his brother's room because he is afraid his hatred will actually hurt
him
43. What happens when people with OCD attempt to neutralis e
or suppress disturbing,
intrusive thoughts?
a.
b.
c.
d.
Other kinds of obsessive thinking starts to occur.
The frequency of the obsessive thoughts increases.
This strategy has no effect on the obsessive thoughts.
The obsessive thoughts disappear.
44. The model of the aetiology of Obsessive-Compulsive Disorder
suggests that in order for an
individual to develop OCD, __________ must be present.
a.
b.
c.
d.
neither biological nor psychological vulnerabilities
biological vulnerability
both biological and psychological vulnerabilities
psychological vulnerability
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CASE STUDY QUESTIONS
You are the Clinical Psychologist responsible for acute disorders in a Psychiatric Hospital.
You have to conduct group therapy with some of the patients in your ward. At the moment,
you have the following patients in your group:
Amy, age 38, is a worrier. She is restless, irritable and has difficulty concentrating. She worries
that she worries so much and isn't always sure what it is that she is worried about. She can't let
her husband or children leave the house without making them call her regularly to reassure her
that they are okay. Her husband is growing weary of her fretting. Her children can't understand
what all the fuss is about. Their impatience with her only makes her worry more. GAD, Separation
anxiety disorder
Annie is a 20-year-old student at a local community college. On several occasions recently, she
has experienced sudden, absolute panic. During these episodes, her heart pounds, she trembles,
her mouth gets dry, and it feels as if the walls are caving in. The feelings only last a few minutes
but, when they occur, the only thing that seems to relieve her fear is walking around her
apartment and reminding herself that she is in control. She won't ride in cars any more unless she
is driving so she is sure that she can stop if necessary. She will only go to class if she can find an
aisle seat in the back row so that she can leave quietly should she have another attack. She
avoids any situation in which she might feel out of control or embarrassed by her own terror.
Panic Disorder, Agoraphobia
Hannah, age 55, was in a major car accident 20 years ago during a cross-country trip. Ever
since, she has been unable to drive on major highways. Although she does drive, she goes to
great lengths to travel only on back roads and scenic routes. She is able to go where she wants
to go but it often takes much longer to get there than it should. PTSD
Bert is 40 years old and works on an assembly line in a brush factory. He is terribly afraid of
being contaminated by germs. He avoids shaking hands with others. He won't eat in the cafeteria.
He has trouble leaving the bathroom because he isn't sure he has washed his hands well
enough. Specific phobia-other
Two weeks ago, Leo, age 25, was hunting with his best friend when his friend tripped over a root
and accidentally shot himself to death. He doesn't remember exactly how he got himself and his
friend's body out of the woods. Every night he has nightmares about not being able to save him,
making it almost impossible to sleep. He can't concentrate or stay focused during conversations.
Most of the time, he says he feels numb. But when asked to talk about what happened, he gets
very upset. PTSD
Joanne, age 32, is involved with the first man who really counts in her life. As the couple has
become more intimate, Joanne has started to have flashbacks about an uncle who touched her
sexually when she was only eight. She is distressed to find that she is shutting down feelings
about her boyfriend and distancing herself from him. Although she has been sexual with other
men, she says she can't stand to let herself be sexual with someone she loves and trusts. She
startles easily and reports a general increase in anxiety. She is very angry that she has to deal
with the feelings about the incidents with her uncle that happened so long ago. She says that she
thought she had gotten beyond all that. PTSD
At the weekly ward round you have to report back to the rest of the psychiatric team, and you
report back as follows:
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QUESTION 1
The group session begins with all the patients stating that, in one way or another, they experience
the following feeling: ‘I've got to get out of here right now, or I may not make it!’ You react by
saying that this statement is most likely to be said by someone experiencing a(n):
a.
b.
c.
d.
episode of depression
future-oriented mood state
fear reaction
parasympathetic ‘surge’
QUESTION 2
Annie seems to have an anxiety disorder in which she has occasional Panic Attacks when driving
on a highway. This type of Panic Attack is referred to as:
a.
b.
c.
d.
uncued
situationally predisposed
cued
situationally bound
QUESTION 3
If we assume that all your patients are suffering from some type of anxiety disorder, which one of
the following statements would apply to them?
a.
b.
c.
d.
An inherited tendency can make us tense or uptight.
A single gene makes us vulnerable to anxiety.
Panic disorder does not ‘run in families.’
Stress is a direct cause of panic disorder.
QUESTION 4
Whilst facilitating the group, you are also keeping a number of theories about anxiety disorders in
the back of your mind. One of these theories is that of Jeffrey Gray, a British neuropsychologist,
who said that the behavioural inhibition system (BIS) is activated by danger signals
_________________, resulting in the experience of anxiety.
a.
b.
c.
d.
ascending from the brain stem
descending from the cortex
arising from both the brain stem and the cortex
within the amygdala only
QUESTION 5
Recent research by Barlow (2002) and others indicates that the members of your group have a
vulnerability to developing anxiety disorders which is related to:
a.
b.
c.
d.
their sense of control over environmental events
the number of unexpected occurrences in their lives
the number of siblings in their families
genetic or biological factors only
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QUESTION 6
In attempting to formulate a developmental model for Amy’s disorder, you combine findings from
cognitive science with biological data. Your developmental model for Amy’s disorder would
include all of the following, EXCEPT:
a.
b.
c.
d.
an inherited tendency to be tense
a sense of control over life events
stress leading to apprehension and vigilance
an autonomic restriction
QUESTION 7
In Annie’s case, which of the following is an accurate statement about Panic Disorder With or
Without Agoraphobia?
a. An individual who suffers through an agoraphobic situation rather than avoiding it entirely is
not considered agoraphobic.
b. Most individuals with Panic Disorder will also avoid internal sensations that produce
physiological arousal.
c. Approximately 75% of those with Agoraphobia are male.
d. Women are more likely than men to cope with Panic Disorder by drinking alcohol.
QUESTION 8
Annie has recently been isolating herself more and more. She was sitting in her room feeling very
depressed. To cheer her up, a friend suggested that they both go to an exercise class. Shortly
after the warm-up started, however, she had another Panic Attack. What is the best explanation
for this occurrence?
a. She was angry with the friend for insisting that she go out.
b. The medication that had been prescribed for her was only treating the depression, not the
anxiety.
c. The physical sensations experienced during exercise had become an internal cue for
panic to occur.
d. The exercise class was an unconditioned stimulus that resulted in a Panic Attack.
QUESTION 9
Hannah has developed a specific phobia. All of the following are characteristics common to
specific phobias, EXCEPT:
a.
b.
c.
d.
strong and persistent anxiety related to a specific object or situation
significant attempts by the anxious individual to avoid the phobic situation
recognition by the person with the phobia that the anxiety is excessive or unreasonable
decreased arousal of the autonomic nervous system
QUESTION 10
The main difference between Hannah’s disorder and Annie’s disorder is:
a. people with a situational phobia never experience Panic Attacks outside the context of
the phobic situation
b. people with situational phobia experience Panic Attacks when confronted with the phobic
situation as well as at other times
c. people with PDA experience panic attacks only in specific situations
d. people with PDA experience panic attacks only at specific times
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QUESTION 11
In order for Joanne to have developed her disorder there had to have been an experience
accompanied by a triad of feelings, including all of the following, EXCEPT:
a.
b.
c.
d.
horror
paranoia
helplessness
fear
QUESTION 12
Bert is most likely to comorbidly experience all of the following, EXCEPT:
a.
b.
c.
d.
severe generalised anxiety
major depression
visual hallucinations
panic attacks
QUESTION 13
Which of the following would Bert not experience with regards to his disorder because it is not an
example of a behavioural compulsion?
a.
b.
c.
d.
checking
counting
handwashing
ordering
QUESTION 14
One cannot use the term ‘magical’ in regard to Bert’s disorder because when the term ‘magical’ is
used to refer to compulsive acts, it means:
a.
b.
c.
d.
the person with OCD believes he/she is possessed
compulsive behaviours are similar to superstitions
the compulsions have no logical relation to the obsessions
many magicians have been diagnosed with OCD
QUESTION 15
In a 1986 study by Jenike et al., it was found that the most common obsessions in a group of 100
patients were related to:
a.
b.
c.
d.
aggression
sex
contamination
symmetry
QUESTION 16
In OCD, certain types of obsessions lead to certain types of compulsions. From the following
choose the one that is a correct match between an obsession and its consequent rituals.
a.
b.
c.
d.
aggression obsessions; cleaning
contamination; ordering
sexual obsessions; checking
symmetry; hoarding
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QUESTION 17
What would happen if Bert attempted to neutralise or suppress his disturbing, intrusive thoughts?
a.
b.
c.
d.
The obsessive thoughts disappear.
The frequency of the obsessive thoughts increases.
Other kinds of obsessive thinking starts to occur.
This strategy has no effect on the obsessive thoughts.
QUESTION 18
The model of the aetiology of Obsessive-Compulsive Disorder suggests that in order for Bert to
have developed OCD, __________ had to have been present.
a.
b.
c.
d.
biological vulnerability
psychological vulnerability
both biological and psychological vulnerabilities
neither biological nor psychological vulnerabilities
QUESTION 19
In the integrative model of the causes of Bert’s disorder (displayed as a diagram in the textbook),
anxious apprehension:
a.
b.
c.
d.
is focused on recurring thoughts
becomes associated with unacceptable thoughts
leads to learned alarms
results from biological vulnerability only
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CHAPTER 5
MOOD DISORDERS
1. Anhedonia, one of the symptoms of a mood disorder, is defined as:
a.
b.
c.
d.
an altered pattern of sleep
Indecisiveness
a feeling of worthlessness
an inability to experience pleasure
2. Mood disorders exist along a continuum from mild to severe; the most severe type of
depression is called:
a.
b.
c.
d.
Major Depressive Disorder
Dysthymia
Profound Depression
Cyclothymia
3. Most episodes of major depression are time-limited, i.e., lasting up to ___________,
although about 10% may last as long as two years.
a.
b.
c.
d.
3 months
6 months
9 months
1 year
4. Which of the following is a symptom of mania?
a.
b.
c.
d.
hypoactive behaviour
fatigue
clear, coherent speech
grandiosity
5. With regards to mood disorders, the term ‘flight of ideas’ means:
a. repression of all creative ideas
b. rapid speech expressing many exciting ideas at once
c. anxiety about airplane travel
d. limited imagination reflected in a slow way of speaking
6. Which of the following statements comparing the length of untreated depressive
episodes and untreated manic episodes is accurate?
a.
b.
c.
d.
Depressive episodes generally last longer.
This comparison cannot be made because depressive episodes are always treated.
Manic episodes generally last longer.
Both types of episodes typically last about the same amount of time.
7. The somatic or physical symptoms of a Major Depressive Disorder
a. changes in appetite or weight
b. increased energy
c. orgasmic feelings
d. decreased ability to concentrate
8. Which of the following symptoms characteris e a manic
a. feelings of guilt
b. irritability
include:
episode?
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c. anhedonia
d. loss of energy
9. A 38-year-old man named Jonathan has recently formulated an elaborate plan to cure cancer
with vitamin therapy. In order to fund this cause, he has withdrawn all the money from his bank
account and purchased thousands of jars of vitamins and small boxes in which to put them. When
he appeared at a hospital emergency room loudly demanding names of patients with cancer, he
was hospitalised for psychiatric observation. What is a likely diagnosis for Jonathan ?
a. Postpartum Psychosis
b. Hypomanic Episode
c. Manic Episode
d. Major Depressive Episode
10. With regard to mood disorders, which of the following statements is accurate?
a. An individual experiencing manic symptoms can also be depressed or anxious.
b. An individual who has experienced only manic episodes in the past is unlikely to ever
become depressed.
c. Neither manic nor depressive symptoms remit on their own without treatment.
d. Unipolar mania is more common than unipolar depression.
11. Dysphoric mania refers to a type of mood disorder
a. very mild
b. related to a medical condition
c. accompanied by depression or anxiety
d. extremely severe
in which manic episodes are:
12. A significant difference between ‘Major Depressive Disorder, recurrent’ and ‘Major Depressive
Disorder, single episode’ is:
a. the single episode type is more common
b. single episode symptoms are more severe
c. recurrent symptoms are more severe
d. the recurrent type is more common
13. Most people who experience a single episode of Major Depressive Diso rder
a. most likely have just one more episode
b. later have a manic episode
c. probably have several episodes throughout their lives
d. never have another episode
will:
14. Dysthymic Disorder differs from Major Depressive Disorder because people diagnosed with
Dysthymia have symptoms of depression that are:
a. more severe
b. longer-lasting
c. episodic
d. temporary
15. Carlos has experienced recurrent episodes of Major Depressive Disorder. In the time between
the episodes, he does not return to ‘normal.’ In fact, during those periods, he has been diagnosed
as Dysthymic. Carlos’ condition is referred to as:
a. Double Depression
b. Atypical Depression
c. Dysfunctional Dysthymia
d. Bipolar Disorder
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16. The chance that a person will recover from a Major Depressive E pisode within
5 years
approaches 90% in:
a.
b.
c.
d.
all cases
double depression only
mild cases only
severe cases only
17. In severe cases of depression, where the episode lasts 5 years or longer, how many suffers
can be expected to recover?
a. all
b. none
c. approximately one-third
d. about half
18. In severe cases of Major Depressive Disorder, where the depressive episode has lasted 5
years or more, all of the following statements are accurate, EXCEPT:
a. The likelihood of a subsequent episode is high.
b. Subsequent episodes may be associated with incomplete inter-episode recovery.
c. The next episode is likely to be manic, rather than depressive.
d. The episode may not entirely clear up, leaving some residual symptoms.
19. In comparison to later age of onset, early onset of Dysthymia (before age 21) is associated
with all of the following characteristics, EXCEPT:
a. genetic influence
b. greater chronicity
c. poorer response to treatment
d. better prognosis
20. Symptoms
of severe depression are usually NOT considered a psychological disorder
when they are associated with:
a.
b.
c.
d.
a grief reaction
thoughts of suicide
a manic episode
anxiety
21. Although grieving is considered a normal process, it does sometime s escalate into
psychopathology. Which of the following cases would NOT be diagnosed as a
pathological grief reaction?
a. Dr. Q's wife died a few months ago. Recently, in addition to his depressive symptoms, he
has been having paranoid delusions in which he believes that certain unnamed individuals
are planning to remove his wife's body from the grave.
b. Mr. T experienced a death in his family. In addition to symptoms of depression, he has
been having auditory hallucinations in which he hears other deceased people talking to
him.
c. Mrs. F's dog recently died. Three weeks later, her friends suggest that she get
another dog ‘to help her get over the loss.’ Mrs. F. refuses and says she just isn't
ready to get another dog and besides, it would be impossible to replace her beloved
‘Fifi’.
d. Miss N. has experienced the death of a close friend. She is so depressed that she has no
appetite, no energy, and is suicidal.
22. Regarding mood disorders, Cyclothymic is to D ysthymic
a. Bipolar is to Major Depressive
b. Major Depressive is to Bipolar
as:
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c. Bipolar I is to Bipolar II
d. manic is to hypomanic
23. Thandiwe is diagnosed with Bipolar II D isorder. You
a. both manic and hypomanic episodes
b. hypomanic episodes
c. neither manic nor hypomanic episodes
d. full manic episodes
can expect that she will experience:
24. Manic episodes alternate with depressive episodes in the disorder called:
a.
b.
c.
d.
Bipolar Disorder
Pathological Grief Reaction
Postpartum Psychosis
Major Depressive Disorder
25. When referring to the mood disorders called Cyclothymia and Dysthymia, it would be correct
to say that a person with Cyclothymia probably:
a. would be considered ‘moody’
b. has more depressive episodes
c. has full manic episodes
d. cannot function normally at all
26. One of the problems psychiatrists who prescribe medication for patients with Bipolar Di sorder
encounter is that patients often:
a.
b.
c.
d.
overdose on the medication during a severe manic state
stop taking the medication in order to bring on a manic state
become addicted to the medication during a severe manic state
stop taking the medication in order to bring on a depressive state
27. All of the following words relate to the manic mood state,
a. energetic
b. elated
c. expansive
d. exhausted
EXCEPT:
28. At various times, Michelle, a 21-year-old college student, has been considered by her friends
and/or family to be high-strung, moody, hyperactive, or explosive. Taking the criteria for mood
disorders into consideration, what would be a likely diagnosis for Michelle?
a. Dysthymia
b. Panic Disorder
c. Major Depressive Disorder
d. Cyclothymia
29. Which of the following is NOT included in the melancholic specifiers for depressive disorders?
a. loss of libido (sex drive)
b. anhedonia
c. sleeping late and hypersomnia
d. weight loss
30. Karmini has received a diagnosis of Major Depressive Disorder. Most recently she has been
lying immobile for long periods of time. If someone moves one of her arms to a different position,
it just stays there. Karmini has stopped speaking and does not appear to hear what is being said
to her. What specifier would you apply to her diagnosis of Major Depressive D isorder?
a. Melancholic
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b. Catatonic
c. Chronic
d. Atypical
31. Although catatonic symptoms can occur in Major Depressive D isorders,
they are most
frequently associated with:
a.
b.
c.
d.
Somatoform Disorders
Dissociative Identity Disorder
phobias
Schizophrenia
32. Patients whose Bipolar diagnosis includes a psychotic features specifier h ave hallucinations
and/or delusions:
a.
b.
c.
d.
during inter-episode intervals only
only in the manic state
when they are either manic or depressed
only in the depressed state
33. The postpartum onset specifier is used to define a severe manic or dep ressive episode
with
psychotic features that occurs in a woman following:
a.
b.
c.
d.
childbirth
rape
menopause
a hysterectomy
34. In regard to mood disorders, there are criteria called specifiers that are used to determine
prognosis and length of treatment. Which of the following is a longitudinal course
specifier?
a.
b.
c.
d.
catalepsy
postpartum onset
anhedonia
inter-episode recovery
35. Which of the following is NOT a longitudinal course specifier for recurrent mania or
depression?
a.
b.
c.
d.
full recovery between manic and depressive episodes
presence of psychotic features
previous history of Dysthymia
previous history of Cyclothymia
36. Which of the following statements about the prevalence of mood disorders in children and
adolescents is FALSE?
a. Major Depressive Disorder in adolescents is primarily a female disorder.
b. Adolescents with Bipolar Disorder may become aggressive, impulsive, sexually
provocative, and accident-prone.
c. Rates of attempted suicide decrease during adolescence.
d. Bipolar Disorder in children is often misdiagnosed as Attention-Deficit/Hyperactivity
Disorder (ADHD).
37. The
presence of symptoms of dementia or medical illnesses can make the diagnosis of
depression difficult in:
a. menopausal women
b. highly creative individuals
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38. Which
of the following statements regarding the relationship between anxiety and
depression is accurate?
a. Almost all depressed patients are anxious, but not every anxious patient is
depressed.
b. Anxiety is often preceded by an episode of major depression.
c. Cognitive content is more negative in anxious patients than in those with depression.
d. A core symptom of anxiety is the inability to experience pleasure.
39. The most recent research into neurotransmitter systems has produced the ‘permissive’
hypothesis which means that:
a. the absolute levels of neurotransmitters are more significant in mood regulation than the
overall balance of the various neurotransmitters
b. low levels of serotonin are sufficient to explain the aetiology of mood disorders
c. when serotonin levels are low, other neurotransmitter systems become
dysregulated and contribute to mood irregularities
d. the norepinephrine system regulates serotonin levels; if norepinephrine is low, depression
will occur
40. Regarding the relationship between stress and depression, all of the following statements are
true, EXCEPT:
a. an individual's current mood state might distort earlier memories of stressful life events
that precipitated the depression
b. stressful life events are strongly related to the onset of mood disorders
c. the context of the life event, as well as its meaning to the individual, are more important
than the nature of the event itself
d. recurrent episodes of depression, but not initial episodes, are strongly predicted by
major life stress
41. When people who are biologically vulnerable to depression place themselves in high risk
stressful environments, this is called:
a. a stress-depression linkage effect
b. humoural theory
c. the reciprocal gene-environment model
d. the cognitive-behavioural model
42. A person who usually says, “It's all my fault,” when anything goes wrong is demonstrating the
_________ characteristic of the depressive attributiona l style.
a. stable
b. external
c. internal
d. global
43.
Martin Seligman's theory that people become anxious and depressed because they
believe that they have no control over the stress in their lives, is called:
a.
b.
c.
d.
the learned helplessness model
humanistic/existential theory
the control theory of depression
cognitive-behavioural theory
44. In Aaron Beck's depressive cognitive triad, people have negative thoughts about all of the
following, EXCEPT:
a. their future
b. themselves
c. their past
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d. their immediate world
CASE STUDY QUESTIONS
William, a 32-year-old client has typically been described as ‘moody’. He can be very sad and
depressed at times, and extremely light-hearted and happy at other times. During his ‘down’
times, he would feel tired and sleep a lot. He would lose his appetite and not eat. During his
‘happy’ times, he has a remarkable amount of energy, parties a lot, and is able to get by with very
little sleep. He frequently thinks of new ideas and inventions that he is sure will have a major
impact on the world. He did very well in school, and graduated with an M.Com degree. He is
employed as an executive for a large corporation. Recently, he was overlooked for a promotion at
work. Initially, he was very depressed, staying in bed all day for several days. On about the 4th
day, he began feeling very exhilarated, and decided to throw a big party. He went shopping and
spent R10 000-00 on party supplies. He then gave the items away, and hired a caterer. At the
party he was very jovial and made sexual advances to many of the women. He left the party with
a woman he had never met before. At 3 a.m., he was picked up by the police under the pavilion of
the local soccer stadium, wearing only his underwear and carrying a bottle of vodka. He was
alone and talking very loudly and rapidly, in phrases that were difficult to follow. The police
brought him into the emergency department where he was admitted to the psychiatric unit with a
diagnosis of Manic Episode.
QUESTION 1
When apprehended by the police, William seemed to be having ‘flight of ideas.’ When this term is
used in connection with mood disorders it means:
a.
b.
c.
d.
anxiety about airplane travel
rapid speech expressing many exciting ideas at once
limited imagination reflected in a slow way of speaking
repression of all creative ideas
QUESTION 2
William has been suffering from untreated depressive episodes and untreated manic episodes. In
comparing the length of each of these, which of the following is an accurate statement?
a.
b.
c.
d.
Depressive episodes generally last longer.
Manic episodes generally last longer.
Both types of episodes typically last about the same amount of time.
This comparison cannot be made because depressive episodes are always treated.
QUESTION 3
If William was diagnosed with ‘Major Depressive Disorder, recurrent’ instead of ‘Major Depressive
Disorder, single episode,’ what significant finding would be noted?
a.
b.
c.
d.
family history of depression
severity of symptoms
more females having the single episode type
more males having the recurrent episode type
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QUESTION 4
An important difference between ‘Major Depressive Disorder, recurrent’ and ‘Major Depressive
Disorder, single episode’ is:
a.
b.
c.
d.
the single episode type is more common
the recurrent type is more common
single episode symptoms are more severe
recurrent symptoms are more severe
QUESTION 5
If William had experienced a single episode of Major Depressive Disorder, he would:
a.
b.
c.
d.
never have another episode
most likely have just one more episode
probably have several episodes throughout his life
later have a manic episode
QUESTION 6
Dysthymic Disorder differs from Major Depressive Disorder in that people diagnosed with
Dysthymia have symptoms of depression that are:
a.
b.
c.
d.
more severe
longer-lasting
episodic
temporary
QUESTION 7
William’s symptoms of severe depression would generally NOT be considered a psychological
disorder if they were associated with:
a.
b.
c.
d.
a grief reaction
a manic episode
anxiety
thoughts of suicide
QUESTION 8
With regard to the terms used to differentiate mood disorders, Cyclothymic is to Dysthymic as:
a.
b.
c.
d.
Bipolar is to Major Depressive
manic is to hypomanic
Major Depressive is to Bipolar
Bipolar I is to Bipolar II
QUESTION 9
In terms of the aetiology of mood disorders, William’s story confirms the research that has shown
that:
a. environmental stress plays a larger role in causing depression in men than in women
b. genetic factors are more important in the development of depression in men in comparison to
the development of depression in women
c. genetic and environmental factors are equally contributory to mood disorders
d. there are no sex differences in vulnerability to depression
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QUESTION 10
As the psychologist treating William, you are aware that current research into neurotransmitter
systems has produced the ‘permissive’ hypothesis which means that:
a. low levels of serotonin are sufficient to explain the aetiology of mood disorders
b. the norepinephrine system regulates serotonin levels; if norepinephrine is low, depression will
occur
c. when serotonin levels are low, other neurotransmitter systems become dysregulated
and contribute to mood irregularities
d. the absolute levels of neurotransmitters are more significant in mood regulation than the
overall balance of the various neurotransmitters
QUESTION 11
One symptom of depression is an increase in sleeping. What other symptoms related to sleep
would you, as the treating psychologist, expect William to experience during his depressed
episodes?
a.
b.
c.
d.
decreased delta (slow wave) sleep, the deepest stage of sleep
less intense REM activity
stages of deepest sleep occurring earlier in the sleep cycle
slower onset of REM sleep
QUESTION 12
As the treating psychologist, you know that with regard to the relationship between stress and
depression, all of the following statements are true, EXCEPT:
a. the context of the life event, as well as its meaning to the individual, are more important than
the nature of the event itself
b. an individual's current mood state might distort earlier memories of stressful life events that
precipitated the depression
c. stressful life events are strongly related to the onset of mood disorders
d. recurrent episodes of depression, but not initial episodes, are strongly predicted by
major life stress
QUESTION 13
You hypothesise that William is biologically vulnerable to depression. When people who are
biologically vulnerable to depression place themselves in high risk stressful environments, it is
called:
a.
b.
c.
d.
humoural theory
the cognitive-behavioural model
the reciprocal gene-environment model
a stress-depression linkage effect
QUESTION 14
Martin Seligman's theory would say that William becomes anxious and depressed because he
believes that he has no control over the stress in his life. This theory is called:
a.
b.
c.
d.
the learned helplessness model
cognitive-behavioural theory
humanistic/existential theory
the control theory of depression
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QUESTION 15
In 1989, Abramson and his colleagues revised Seligman's theory of learned helplessness.
According to Abramson and colleagues, the crucial factor in William’s depression would be:
a.
b.
c.
d.
lack of control
a sense of hopelessness
repressed anger
a feeling of failure
QUESTION 16
As you learn more about William in therapy, you realise that the development of his depression is
linked to his dysfunctional attitudes (a negative outlook) and hopelessness attributes (explaining
things negatively). This constitutes a _____________ vulnerability to depression.
a.
b.
c.
d.
biological
cognitive
behavioural
sociological
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CHAPTER 6
SCHIZOPHRENIA
1. Which of the following characterises the disorder known as Schizophrenia?
a. delusions and hallucinations
b. inappropriate emotions
c. disorganised speech and behaviour
d. all of these
2. In the 1850s, a French physician named Benedict Morel used the terms demence (loss of
mind) precoce (early, premature) to describe what we now know as Schizophrenia, because he
observed that the onset of symptoms often occurs:
a. in the early part of the year
b. during adolescence
c. in the morning
d. prior to symptoms of other mental illnesses
3. In the 1800s, physicians studying the disorder we now call Schizophrenia used the term
________________ because they observed that the onset of symptoms often occurred
before adulthood.
a.
b.
c.
d.
adolescent insanity
folie à deux
catatonia praevia
dementia praecox
4. Which of the following is characteristic of
a. silly and immature behaviour
b. early madness
c. immobility or agitated excitement
d. delusions of grandeur or persecution
definition of catatonia?
5. Which of the following is characteristic of paranoia?
a. silly and immature behaviour
b. early madness
c. alternating immobility and agitated excitement
d. delusions of grandeur or persecution
6. Which of the following is characteristic of hebephrenia?
a. silly and immature behaviour
b. early madness
c. alternating immobility and agitated excitement
d. delusions of grandeur or persecution
7. Which of the following is characteristic of dementia praecox?
a. silly and immature behaviour
b. early madness
c. alternating immobility and agitated excitement
d. delusions of grandeur or persecution
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8. The term ‘Schizophrenia’ was introduced
a. Emil Kraepelin
b. Sigmund Freud
c. Eugen Bleuler
d. Phillipe Pinel
about 1908 by a Swiss psychiatrist named:
9. Eugen Bleuler's concept of Schizophrenia as an ‘associative splitting’ of the basic functions of
personality led to the incorrect use of the term to mean:
a. a fugue state
b. multiple personality
c. cognitive slippage
d. folie à deux
10. If an individual is diagnosed as psychotic,
a. hallucinations
b. delusions
c. both of these
d. neither of these
it usually means that the person has:
11. In working with Schizophrenic patients, mental health professionals typically distinguish
between _________ symptoms (an excess or distortion of normal behaviour) and ___________
symptoms (deficits in normal behaviour).
a. positive; negative
b. negative; positive
c. manic; depressive
d. dysmorphic; dysfunctional
12. Which of the following is an example of a persecutory type
a. A familiar person is actually a double.
b. You are a famous or important person.
c. People are out to get you.
d. A body part has changed in some impossible way.
of psychotic delusion?
13. Which of the following is an example of a delusion of grandeur?
a. A familiar person is actually a double.
b. You are a famous or important person.
c. People are out to get you.
d. A body part has changed in some impossible way.
14. The most
a. visual
b. auditory
c. tactile
d. olfactory
common type of hallucination experienced by psychotic individuals is:
15. Research using brain imaging techniques has localised aud itory
hallucinations in the part
of the brain called:
a.
b.
c.
d.
Wernicke's area
Broca's area
the occipital lobe
the limbic system
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16. Results of research showing that auditory hallucinations are localised in the expressive
speech area of the brain suggest that:
a. these hallucinations are produced by the auditory nerve in the ear, as well as in the
speech area of the brain
b. people who are hallucinating think the voices of other people are actually their own
c. a person who is hallucinating is actually listening to his/her own thoughts
d. these hallucinations are related to the disorganised speech that occurs in Schizophrenia
17. The negative Schizophrenic symptom called avolition is
a. inability to initiate and persist in activities
b. inability to experience pleasure
c. lack of emotional response; blank facial expression
d. lack of speech content and/or slowed speech response
defined as:
18. The negative Schizophrenic symptom called alogia is defined
a. inability to initiate and persist in activities
b. inability to experience pleasure
c. lack of emotional response; blank facial expression
d. lack of speech content and/or slowed speech response
19. The negative Schizophrenic symptom called anhedonia
a. inability to initiate and persist in activities
b. inability to experience pleasure
c. lack of emotional response; blank facial expression
d. lack of speech content and/or slowed speech response
as:
is defined as:
20. Abdul was diagnosed with Schizophrenia many years ago. Most recently he has been
exhibiting some bizarre behaviours. For example, he has been standing for hours in unusual
postures. Abdul’s motor dysfunction is called:
a. cognitive slippage
b. inappropriate affect
c. catatonic immobility
d. hebephrenia
21. Marta, a hospitalised Schizophrenic patient, shows an unusual form of catatonia. If someone
moves one of her arms or legs into a different position, it just stays that way. Marta's bizarre
behaviour is called:
a. postural dysfunction
b. aerobic mobility
c. waxy flexibility
d. Schizophrenic Movement Disorder
22. Which of the following is most likely to occur in the Paranoid type of Schizophrenia?
a. disorganised speech
b. poor prognosis, when compared to the other subtypes of Schizophrenia
c. limited cognitive skills and flat affect
d. hallucinations and thematic or systematised delusions
23. Which of the following does NOT apply to the Disorganised subtype of Schizophrenia?
a. fragmented delusions and hallucinations
b. inappropriate or flat affect
c. frequent remissions and improvement of symptoms
d. self-absorption and mirror gazing
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24. The DSM-IV-TR criteria for the Disorganised type of Schizophrenia include all of the following,
EXCEPT:
a.
b.
c.
d.
disorganised speech
echolalia or echopraxia
disorganised behaviour
flat or inappropriate affect
25. Callie has been diagnosed with Schizoaffective Disorder. This means that in addition to
Schizophrenic symptoms, she also has symptoms of:
a. an anxiety disorder
b. a mood disorder
c. a split personality
d. Obsessive-Compulsive Disorder
26. In
which of the following disorders are hallucinations and delusions NOT part of the
symptom pattern?
a.
b.
c.
d.
Schizotypal Personality Disorder
Schizoaffective Disorder
Schizophreniform Disorder
Brief Psychotic Disorder
individuals have been arrested for stalking celebrities who they
believed were in love with them. This condition is called a(n) _________ delusion.
27. At various times,
a.
b.
c.
d.
jealous
erotomanic
somatic
persecutory
28. How do the delusions in Delusional Disorder differ from the delusions in Paranoid
Schizophrenia?
a. In Delusional Disorder, the imagined events could really be happening but there is
no evidence that they are happening.
b. In Paranoid Schizophrenia, the imagined events have actually happened or are now
happening.
c. In Delusional Disorder, the imagined events are so bizarre that they could never have
happened and never will happen.
d. There is no difference. Delusions are defined similarly for all conditions.
29. A woman diagnosed as Schizophrenic announces that she has a plan to end poverty and
homelessness in the world, and that the Pope has given her secret instructions on how this
can be accomplished. Her thinking is indicative of a delusion of _________.
a.
b.
c.
d.
persecution
thought insertion
grandeur
reference
30. Which of the following defines the jealous type of Delusional Disorder?
a. believing that one is loved by an important person or celebrity
b. falsely believing that one's sexual partner is unfaithful
c. believing in one's inflated worth, identity, or special relationship with someone
d. believing one is being malevolently treated in some way
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31. Which of the following defines the erotomanic type of Delusional Disorder?
a. believing that one is loved by an important person or celebrity
b. falsely believing that one's sexual partner is unfaithful
c. believing in one's inflated worth, identity, or special relationship with someone
d. believing one is being malevolently treated in some way
32. Which of the following defines the persecutory type of Delusional Disorder?
a. believing that one is loved by an important person or celebrity
b. falsely believing that one's sexual partner is unfaithful
c. believing in one's inflated worth, identity, or special relationship with someone
d. believing one is being malevolently treated in some way
33. Which of the following defines the grandiose type of Delusional Disorder?
a. believing that one is loved by an important person or celebrity
b. falsely believing that one's sexual partner is unfaithful
c. believing in one's inflated worth, identity, or special relationship with someone
d. believing one is being malevolently treated in some way
34. Type I Schizophrenia is associated with ‘positive symptoms’, including all of the following,
EXCEPT:
a.
b.
c.
d.
hallucinations and delusions
good response to medication
optimistic prognosis
flat affect
35. Type II Schizophrenia is associated with ‘negative symptoms’, including all of the following,
EXCEPT:
a.
b.
c.
d.
poor response to medication
intellectual impairment
poverty of speech (alogia)
hallucinations and delusions
36. Which of the following is true in regard to the genetic basis of S chizophrenia?
a. Researchers have discovered the gene responsible for causing Schizophrenia.
b. Genes are responsible for making some individuals vulnerable to Schizophrenia.
c. Both of these statements are true.
d. Neither of these statements is true.
37. Which of the following occurs when drugs are administered to S chizophrenic patients?
a. Drugs that increase dopamine (agonists) cause an increase in Schizophrenic behaviour.
b. Drugs that decrease dopamine (antagonists) decrease Schizophrenic symptoms.
c. Both of these statements are accurate.
d. Neither of these statements is accurate.
38. Which of the following statements contradicts the dopamine theory of S chizophrenia?
a. Many people with Schizophrenia are not helped by dopamine antagonists.
b. Clozapine, one of the weakest dopamine antagonists, reduces Schizophrenic symptoms in
those patients who were not helped by stronger dopamine antagonists.
c. Both of these statements contradict the dopamine theory of Schizophrenia.
d. Neither of these statements contradicts the dopamine theory of Schizophrenia.
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39. Recent and highly sophisticated research focusing on neurochemical abnormalities as the
cause of Schizophrenia involves all of the following, EXCEPT:
a. deficiency in the stimulation of prefrontal dopamine D1 receptors
b. excessive stimulation of striatal dopamine D2 receptors
c. alterations in prefrontal activity involving glutamate transmissions
d. changes in temporal lobe function associated with serotonin receptor activity
40. What is the evidence for structural damage in the brains of S chizophrenic patients?
a. All Schizophrenic patients have smaller ventricles in their brains.
b. In some Schizophrenic patients, there is an excess amount of ‘grey matter’ in the cerebral
cortex.
c. The majority of Schizophrenic patients have enlarged ventricles in their brains.
d. Many Schizophrenic patients have increased activity in the frontal lobes of the brain.
41. In historic records or ancient literature, there are descriptions of symptoms that today would
lead to a diagnosis of all of the following disorders, EXCEPT:
a. mood disorders (depression and mania)
b. Schizophrenia
c. Mental Retardation
d. Senile Dementia
42. In regard to the family interactions among Schizophrenic patients, the word
‘schizophrenogenic’ (no longer used), was first proposed in the 1940s to describe:
a. an abusive and alcoholic father whose child became Schizophrenic
b. an emotionally distant mother whose child became Schizophrenic
c. divorced parents who had several psychotic children
d. a family in which relatives on both sides were psychotic
43. In terms of a particular emotional communication style known as expressed emotion (EE),
researchers have shown that Schizophrenic patients were more likely to relapse if:
a. they had long periods of contact with their families
b. they had families who were disapproving and intrusive
c. Both of these are correct.
d. Neither of these is correct.
44. The familial communication style called expressed emotion (EE), sometimes used to predict
relapse rates in Schizophrenic patients, includes all of the following, EXCEPT:
a. over-involvement
b. criticism
c. emotional distance
d. hostility
45. In the late 1800s, the German psychiatrist Emil Kraepelin made all of the following
contributions to our knowledge of Schizophrenia, EXCEPT:
a. distinguish dementia praecox (Schizophrenia) from manic-depressive illness
b. note that hallucinations, delusions, and negativism were symptoms of dementia praecox
(Schizophrenia)
c. combine several symptoms of insanity (catatonia, paranoia, hebephrenia) that had usually
been viewed as reflecting separate and distinct disorders
d. conceptualise a treatment for Schizophrenic patients that is still being used today
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CASE STUDY QUESTIONS
Jack is a 27-year-old-man diagnosed with Schizophrenia. Jack graduated from high school and
got a job working in a video store. After working for about six months, Jack began to hear voices
that told him he was no good. He also began to believe that his boss was planting small video
cameras in the returned tapes to catch him making mistakes. Jack became increasingly agitated
at work, particularly during busy times, and began ‘talking strangely’ to customers. For example,
one customer asked for a tape to be reserved and Jack indicated that that tape may not be
available because it had ‘surveillance photos of him that were being reviewed by the SAPS’. After
about a year, Jack quit his job one night, yelling at his boss that he couldn't take the constant
abuse of being watched by all the TV screens in the store and even in his own home. Jack lived
with his parents at that time. He became increasingly confused and agitated. His parent took him
to the hospital where he was admitted. He was given Thorazine by his psychiatrist; this is a very
powerful psychotropic medication. However, he had painful twisting and contractions of his
muscles. He was switched to Haldol and had fewer side effects. From time to time, Jack stopped
taking his Haldol, and the voices and concerns over being watched became stronger. During the
past seven years, Jack has been hospitalised five times. He applied for, and now receives, a
social security grant and with the assistance of a case manager has moved into his own
apartment. He is now a member of a psychosocial ‘clubhouse’ for people with mental illness. He
attends the clubhouse three times a week. He answers the phone, and helps write the clubhouse
newsletter. He has a few friends at the clubhouse, but he has never had a girlfriend. Jack told his
case manager he would like to get a job so he can earn more money and maybe buy a car. Jack
is very worried about looking for a job. He doesn't know how to explain his disorder to a potential
employer, and he is afraid of becoming overwhelmed. He likes movies and would like to work with
them in some manner.
QUESTION 1
The fact that we are able to diagnose Jack with Schizophrenia can be attributed to the work of
Kraepelin, as in the late 1800s, he made all of the following contributions to our knowledge of
Schizophrenia, EXCEPT:
a. distinguish dementia praecox (Schizophrenia) from manic-depressive illness
b. note that hallucinations, delusions, and negativism were symptoms of dementia praecox
(Schizophrenia)
c. combine several symptoms of insanity (catatonia, paranoia, hebephrenia) that had usually
been viewed as reflecting separate and distinct disorders
d. conceptualise a treatment for Schizophrenic patients that is still being used today
QUESTION 2
If we were to use brain imaging techniques on Jack, we would probably find that his auditory
hallucinations are localised in the part of the brain called:
a.
b.
c.
d.
Wernicke's area
Broca's area
the occipital lobe
the limbic system
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QUESTION 3
Based on the above, the results would suggest that:
a. these hallucinations are produced by the auditory nerve in the ear, as well as the speech area
of the brain
b. people who are hallucinating think the voices of other people are actually their own
c. a person who is hallucinating is actually listening to his/her own thoughts
d. these hallucinations are related to the disorganised speech that occurs in Schizophrenia
QUESTION 4
From the case study, it does not seem as if Jack has been exhibiting any bizarre behaviours (for
example, standing for hours in unusual postures). Jack therefore does not seem to suffer from a
motor dysfunction called:
a.
b.
c.
d.
cognitive slippage
inappropriate affect
catatonic immobility
hebephrenia
QUESTION 5
Jack has a delusion that the SAPS are spying on him. How would this delusion differ from
delusions in Delusional Disorder?
a. In Delusional Disorder, the imagined events could really be happening but there is no
evidence that they are happening.
b. In Paranoid Schizophrenia, the imagined events have actually happened or are now
happening.
c. In Delusional Disorder, the imagined events are so bizarre that they could never have
happened and never will happen.
d. There is no difference. Delusions are defined similarly for all conditions.
QUESTIONS 6
From the case study, it is clear that Jack does not have a jealous type of Delusional Disorder, as
this type of disorder is best defined as:
a.
b.
c.
d.
believing that one is loved by an important person or celebrity
falsely believing that one's sexual partner is unfaithful
believing in one's inflated worth, identity, or special relationship with someone
believing one is being malevolently treated in some way
QUESTION 7
From the case study, it is clear that Jack does not have an erotomanic type of Delusional
Disorder, as this is best defined as:
a.
b.
c.
d.
believing that one is loved by an important person or celebrity
falsely believing that one’s sexual partner is unfaithful
believing in one’s inflated worth, identity, or special relationship with someone
believing one is being malevolently treated in some way
QUESTION 8
Jack does seem to have a persecutory type of Delusional Disorder, which is best described as:
a.
b.
c.
d.
believing that one is loved by an important person or celebrity
falsely believing that one’s sexual partner is unfaithful
believing in one’s inflated worth, identity, or special relationship with someone
believing one is being malevolently treated in some way
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QUESTION 9
Which of the following defines the grandiose type of Delusional Disorder?
a.
b.
c.
d.
believing that one is loved by an important person or celebrity
falsely believing that one's sexual partner is unfaithful
believing in one's inflated worth, identity, or special relationship with someone
believing one is being malevolently treated in some way
QUESTION 10
When considering the possible causes of Jack’s disorder, one has to keep genetics in mind.
Research studies on the genetic basis of Schizophrenia have focused on high-risk individuals
including all of the following, EXCEPT:
a.
b.
c.
d.
healthy twins of Schizophrenic patients
adopted children of Schizophrenic parents
family members or relatives of Schizophrenics
children adopted by Schizophrenic mothers
QUESTION 11
In which of the following situations would the risk of developing Schizophrenia be the lowest for a
child?
a.
b.
c.
d.
A child’s Schizophrenic parent has a non-Schizophrenic identical twin.
A child’s non-Schizophrenic parent has a Schizophrenic identical twin.
A child’s Schizophrenic parent has a non-Schizophrenic fraternal twin.
A child’s non-Schizophrenic parent has a Schizophrenic fraternal twin.
QUESTION 12
If you were looking for a genetic linkage, which of the following seems to be a possible ‘marker’
for Schizophrenia?
a.
b.
c.
d.
eye-tracking
dopamine sites
unusual facial features
blood type
QUESTION 13
When looking for abnormalities in the brain as clues to the influences of Schizophrenia, it is
important to keep certain questions in mind when doing correlational research. For example, if a
Schizophrenic person were found to have an excess of dopamine, a researcher would need to
ask all of the following questions, EXCEPT:
a.
b.
c.
d.
Does too much dopamine cause Schizophrenia?
Does having Schizophrenia cause an excess of dopamine?
Is there some factor that causes both Schizophrenia and an excess of dopamine?
Why is the dopamine system active in the Schizophrenic brain?
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QUESTION 14
Which of the following statements reflects ‘circumstantial evidence’ for the dopamine theory of
Schizophrenia?
a. Antipsychotic drugs (neuroleptics) act as dopamine agonists, increasing the amount of
dopamine in the brain.
b. Antipsychotic drugs (neuroleptics) can produce symptoms similar to those of
Parkinson’s disease (a disorder due to insufficient dopamine).
c. The drug L-dopa, a dopamine agonist, is used to treat Schizophrenic symptoms in patients
with Parkinson’s disease.
d. Amphetamines, which activate dopamine, can lessen psychotic symptoms in people with
Schizophrenia.
QUESTION 15
Which of the following statements contradicts the dopamine theory of Schizophrenia?
a. Many people with Schizophrenia are not helped by dopamine antagonists.
b. Clozapine, one of the weakest dopamine antagonists, reduces Schizophrenic symptoms in
those patients who were not helped by stronger dopamine antagonists.
c. Both of these statements contradict the dopamine theory of Schizophrenia.
d. Neither of these statements contradicts the dopamine theory of Schizophrenia.
QUESTION 16
Recent and highly sophisticated research focusing on neurochemical abnormalities as the cause
of Schizophrenia involves all of the following, EXCEPT:
a.
b.
c.
d.
deficiency in the stimulation of prefrontal dopamine D1 receptors
excessive stimulation of striatal dopamine D2 receptors
alterations in prefrontal activity involving glutamate transmissions
changes in temporal lobe function associated with serotonin receptor activity
QUESTION 17
What is the evidence for structural damage in the brains of Schizophrenic patients?
a. All Schizophrenic patients have smaller ventricles in their brains.
b. In some Schizophrenic patients there is an excess amount of ‘gray matter’ in the cerebral
cortex.
c. The majority of Schizophrenic patients have enlarged ventricles in their brains.
d. Many Schizophrenic patients have increased activity in the frontal lobes of the brain.
QUESTION 18
In contrast to retrospective research studies, i.e., those that rely on after-the-fact reports
(meaning after a person has already developed symptoms of Schizophrenia), prospective
research studies:
a. assess recovery rates in patients who have taken different medications
b. examine factors that predict the recurrence of Schizophrenic symptoms after a period
of improvement
c. compare genetic, biological, and social aetiological factors to try to determine inheritance
patterns in offspring of Schizophrenic parents
d. look at brain imaging diagnostic tests to determine if Schizophrenic patients have structural
neurological defects
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QUESTION 19
In terms of the particular emotional communication style known as expressed emotion (EE),
researchers have shown that Schizophrenic patients were more likely to relapse if:
a.
b.
c.
d.
they had long periods of contact with their families
they had families who were disapproving and intrusive
Both of the these are correct.
Neither of these is correct.
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CHAPTER 7
PERSONALITY DISORDERS
1. According to the definition of personality disorder, only individuals who show ____________
patterns of maladaptive behaviour should be diagnosed with a personality disorder.
a. suicidal
b. the most severe
c. relatively permanent
d. highly variable
2. All of the following are necessary conditions for the diagnosis of a personality disorder,
EXCEPT:
a.
b.
c.
d.
patient feelings of distress
pervasive pattern of behaviour
maladaptive functioning
chronic interpersonal problems
3. On which axis of DSM-IV-TR
a. I
b. II
c. III
d. IV
are personality disorders coded?
4. The reason that personality disorders are coded on Axis II of DSM-IV-TR is
a. they relate to extreme deficits in functioning
b. there is a relationship between personality disorder and Mental Retardation
c. they are biological in nature
d. they relate to more ingrained and permanent features than other disorders
that:
5. Unlike Schizophrenia or an eating disorder, personality disorders can be viewed as dis orders
of:
a.
b.
c.
d.
biology rather than learning
learning rather than disease
degree rather than kind
functioning rather than disease
6. Both John and Sam meet the diagnostic criteria for Paranoid Personality Disorder. John's
friends are aware of his paranoia although he continues to live a meaningful life. Sam 's paranoia
is so extreme that he finds it hard to function in society. The DSM-IV-TR Axis II
diagnosis for these individuals would be:
a.
b.
c.
d.
exactly the same
categorically different
in the same category but reflect the different levels of pathology
in the same category with different specifiers
7. The Five Factor Model of personality includes all of the following as personality dimensions,
EXCEPT:
a. extroversion
b. conscientiousness
c. expressiveness
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d. emotional stability
8. Cross-cultural research on the Five Factor Model of personality suggests
a. there is no such thing as a universal human personality structure
b. the five dimensions are fairly universal
c. only two dimensions are universal
d. Western type personality structure differs from the non-Western type
9. DSM-IV-TR divides
a. 1
b. 2
c. 3
d. 4
that:
personality disorders into ___ distinct clusters.
10. Which set of adjective pairs correctly describes the cl usters
into which DSM-IV-TR
personality disorders are grouped?
a.
b.
c.
d.
odd/eccentric, dangerous/inconsistent, and shy/withdrawn
shy/withdrawn, anxious/fearful, and dangerous/inconsistent
shy/withdrawn, dramatic/emotional, and bizarre/thought disordered
odd/eccentric, dramatic/emotional, and anxious/fearful
11. The characteristic features of personality disorders
a. rapid onset in late adolescence
b. gradual onset in adulthood
c. rapid onset in adulthood
d. onset in childhood that is difficult to pinpoint
tend to develop with:
12. The diagnosis of more than one personality disorder in an individual
a. common
b. impossible unless the person suffers from Dissociative Identity Disorder
c. rare
d. only possible for personality disorders in the same DSM-IV-TR cluster
patient is:
13. Sandile is always sure that others are trying to harm him. His perception that the world is a
threatening place impacts on most of his life. Most likely Sandile would be diagnosed with the
personality disorder called:
a. Histrionic
b. Avoidant
c. Paranoid
d. Antisocial
14. An individual presents for treatment and keeps talking about how gangsters are ‘out to get
him.’ Before diagnosing Paranoid Personality Disorder, we must determine whether:
a. his fears are justified
b. his family life is stable
c. he has ever been in trouble with the law
d. he avoids socialisation
15. The language barriers of refugees from other countries and people with hearing impairments
may make these individuals particularly susceptible to:
a. Histrionic Personality Disorder
b. Paranoid Personality Disorder
c. Schizotypal Personality Disorder
d. Schizoid Personality Disorder
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16. Theo is quite a loner. He walks to class by himself, does not talk to anyone and appears
indifferent to other people. It is clear that Theo neither desires nor enjoys closeness with
others. He does not act in any obviously unusual ways nor does he appear to possess
strange beliefs about the world. Of the following personality disorders, Theo appears to
be:
a.
b.
c.
d.
Avoidant
Antisocial
Schizoid
Schizotypal
17. An individual who goes through life as a loner with no motivation to interact with others but
with relatively normal behaviour and beliefs is likely to be diagnosed with ____________
Personality Disorder:
a. Histrionic
b. Narcissistic
c. Schizoid
d. Paranoid
18. Individuals who are socially isolated, behave in ways that seem unusual, tend to be
suspicious, and have odd beliefs are generally diagnosed with _____________ Personality
Disorder.
a. Schizotypal
b. Schizoid
c. Paranoid
d. Multiple
19. Individuals who have ‘ideas of reference’ but who sense that these beliefs are probably
unrealistic are generally diagnosed with ____________ Personality Disorder .
a. Schizotypal
b. Paranoid
c. Antisocial
d. Histrionic
20. The personality disorder that shares many similar symptoms with Schizophrenia
a. Schizoid
b. Paranoid
c. Borderline
d. Schizotypal
is:
21. Odwa steals money from his friends and family, lies to get what he wants, and often hurts
others with no sign of guilt or remorse. Odwa should probably be diagnosed with
______________ Personality Disorder.
a. Paranoid
b. Histrionic
c. Antisocial
d. Narcissistic
22. The most accurate statement regarding Antisocial Personality Disorder
that they:
a.
b.
c.
d.
are similar in almost every way except that psychopaths are criminals
completely different populations
overlap in some features but not all
just different names for the same features
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23. With which of the following
personality disorders is the term psychopath closely
associated?
a.
b.
c.
d.
Schizotypal
Schizoid
Paranoid
Antisocial
24. One difference between a psychopath and a person with Antisocial Personality Disorder is
that _____________ are used in diagnosing the psychopath but ________ are used to diagnose
Antisocial Personality Disorder.
a. personality traits; observable behaviours
b. observable behaviours; personality traits
c. clinical judgments; objective test scores
d. medical criteria; psychological assessments
25. An adult diagnosed with Antisocial Personality Disorder
is most likely to have met the
criteria for ___________ as a child.
a.
b.
c.
d.
Autistic Disorder
Conduct Disorder
a learning disability
Mental Retardation
26. Naren is a 15-year-old boy who has been repeatedly arrested for theft and assault. In addition
to shoplifting and other theft, he has been caught stealing money from his parents’ wallets and his
young sister's piggy bank. Naren shows no guilt or remorse for the many ways that he hurts
others. Naren's current diagnosis is most likely:
a. Antisocial Personality Disorder
b. Attention-Deficit/Hyperactivity Disorder
c. Conduct Disorder
d. Narcissistic Personality Disorder
27. The research examining the cause of Antisocial Personality Disorder
a. the primary cause is genetics
b. genetics and environment interact to cause the disorder
c. the primary cause is poor parenting
d. there is no evidence of either a genetic or environmental cause
suggests that:
28. The
presence of low frequency theta waves in the brains of psychopaths led to the
development of the:
a.
b.
c.
d.
underarousal hypothesis
fearlessness hypothesis
shamelessness hypothesis
cortical-immaturity hypothesis
29. According to the underarousal hypothesis, individuals with Antisocial Personality Disorder
may engage in their characteristic behaviours as a way to:
a. deal with their fears
b. provide a level of stimulation that most of us receive from more typical behaviours
c. provide a sense of relief from the feelings of depression that they experience when they
are not highly aroused
d. reduce the generally high level of arousal that they feel
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30. The concept of the fearlessness hypothesis of Antisocial Personality Disorder is that
individuals with this disorder:
a. learn to avoid punishment
b. have an under-active cortex
c. under-react to the threat of punishment
d. have brain damage that inhibits their ability to understand the implications of their actions
31. One prominent theory of Antisocial Personality Disorder suggests that the behaviou rs
are
caused by an imbalance between the brain's:
a.
b.
c.
d.
behavioural inhibition system and fight/flight system
fight/flight system and reward system
cortical stimulation system and behavioural inhibition system
behavioural inhibition system and reward system
32. If you had absolutely no concept or fear of the consequences of your actions (for yourself or
others) and were overly motivated by pleasing yourself, you might behave like a person with
__________ Personality Disorder.
a. Antisocial
b. Narcissistic
c. Histrionic
d. Schizotypal
33. Some research with psychopaths suggests that these individuals
a. more likely to quit trying as soon as failure appears imminent
b. less likely to attempt difficult goals
c. more likely to keep trying even though failure is certain
d. less likely to be motivated towards a goal
are:
34. One of the contributing factors in the developmental history of individuals with Antisocial
Personality Disorder appears to be that their parents were more likely to have utilis ed:
a. firm discipline
b. inconsistent discipline
c. an overly protective parenting style
d. physical discipline
35. The antisocial behaviour of those diagnosed with Antisocial Personality Disorder
a. continue to increase throughout the life span
b. increase dramatically at about age 30
c. decline significantly around age 40
d. remain stable throughout the lifespan
tends to:
36. The personality disorder characterised by extreme instability in behaviour and emotion,
impulsivity, depression, and self-injurious behaviours is ___________ Personality Disorder .
a. Narcissistic
b. Borderline
c. Dependent
d. Histrionic
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37. Nicole has difficulty maintaining relationships because she quite often goes back and forth
from being a best friend to hating people in her life. Her romantic relationships are always
characterised by incredible loving passion alternating with episodes of horrible fighting;
sometimes she becomes violent. At times, Nicole becomes so upset that she cuts herself and
reports that this makes her feel better emotionally. Nicole suffers from ___________ Personality
Disorder.
a. Dependent
b. Histrionic
c. Borderline
d. Narcissistic
38. All of the following are common disorders that tend to be comorbid, i.e., to coexist, with
Borderline Personality Disorder, EXCEPT:
a. depression
b. substance abuse
c. Bulimia Nervosa
d. Obssessive-Compulsive Disorder
39. One of the influences that has been associated with the development of Borderline
Personality Disorder is:
a. history of child abuse or neglect
b. developmental delay for major milestones (i.e., walking, talking)
c. parental alcoholism
d. deficits in neurotransmitter circuits involving dopamine
40. Childhood trauma as a cause of Borderline Personality Disorder
may be too simplistic an
explanation because:
a. there are too many neurological deficits that are noted in Borderline Personality Disorder
patients
b. individuals with Borderline Personality Disorder tend to respond to SSRI medications
c. most individuals diagnosed with Borderline Personality Disorder are female
d. a significant percentage of individuals diagnosed with Borderline Personality
Disorder do not have a history of childhood trauma
41. Which of the following is the most likely model to explain the cause of Borderline Personality
Disorder?
a. biological
b. early trauma resulting in Posttraumatic Stress Disorder symptoms that are not recognised
or dealt with during childhood
c. stressful life events
d. biological predisposition interacting with life events such as childhood trauma and
later life stressors
42. Individuals who over-react to everything, and are overly dramatic and vain are most likely to
be diagnosed with ___________ Personality Disorder.
a. Borderline
b. Histrionic
c. Narcissistic
d. Dependent
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43. Lindiwe quickly becomes the cente of attention when she enters a room. She is a tall and
attractive young woman who generally wears something striking. Lindiwe is known as a flirt and
acts in a seductive manner around men. When Lindiwe speaks, she uses very exaggerated
terms, even when describing relatively ordinary situations. Lindiwe’s diagnosis is most likely
_____________ Personality Disorder.
a. Histrionic
b. Narcissistic
c. Borderline
d. Dependent
44. There appears to be a relationship between ___________ Personality Disorder and
____________ Personality Disorder with some evidence that each may be gender-typed
alternative ways of expressing the same underlying condition.
a.
b.
c.
d.
Histrionic; Narcissistic
Dependent; Histrionic
Antisocial; Histrionic
Antisocial; Dependent
45. Narcissistic Personality Disorder is characterised by:
a. preoccupation with other people
b. obsession with keeping things neat and orderly
c. thinking of oneself as deserving of special treatment
d. pathological dishonesty
46. Johan is extremely impressed with himself. Although he has only achieved a moderate
amount of success, he thinks of himself as being uniquely special and deserving of the best of
everything. Johan fantasises frequently about great wealth and fame and does not really pay
much attention to other people except to note how they react to him. Johan should be diagnosed
with _____________ Personality Disorder.
a. Antisocial
b. Histrionic
c. Narcissistic
d. Dependent
47. One reason why individuals with Narcissistic Personality Disorder
tend to become
depressed at times is that they:
a.
b.
c.
d.
become upset when their intimate relationships fail
seldom live up to their unrealistic expectations of themselves
are overly sensitive to the pain of others
have faulty serotonin circuits
48. The reason that individuals with Avoidant Personality Disorder
avoid most relationships is
that they:
a. are extremely sensitive to the opinions of others and fear rejection
b. generally dislike other people and prefer to be alone
c. are so stimulated by the fantasy life in their own minds that they have little need for the
company of others
d. experience bizarre thoughts and beliefs that distance them from others
49. Without understanding the thought process motivating the patient's behaviour, it would
probably be impossible to determine whether a patient had ______________ Personality
Disorder or _____________ Personality Disorder.
a. Narcissistic; Antisocial
b. Dependent; Narcissistic
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c. Schizoid; Avoidant
d. Borderline; Histrionic
50. Individuals who keep to themselves because they are anxious and fearful of rejection are
likely to be diagnosed with ____________ Personality Disorder.
a. Avoidant
b. Schizoid
c. Schizotypal
d. Antisocial
51. When asked about their childhood, individuals diagnosed with Avoidant Personality Disorder
tend to remember their parents as:
a.
b.
c.
d.
warm and loving
substance abusing
rejecting
depressed
52. In Jill's psychotherapy sessions, the therapist has been using systematic desensitisation to
gradually make her more comfortable with social situations. Like the treatments used for
individuals with Social Phobia, the therapist has given Jill homework assignments that require her
to practice talking to strangers, join informal groups, and speak in front of small groups. Most
likely she is being treated for _______________ Personality Disorder .
a. Antisocial
b. Dependent
c. Avoidant
d. Histrionic
53. The personality disorder characterised by unreasonable fear of abandonment, fear of being
rejected, avoidance of disagreement, inability to make decisions for oneself, and clinging
behaviour is ______________ Personality Disorder.
a. Dependent
b. Avoidant
c. Schizoid
d. Histrionic
54. In terms of feelings of inadequacy, sensitivity to criticism, and need for reassurance,
individuals with _____________ Personality Disorder and _______________ Personality
Disorder are quite similar.
a. Dependent; Avoidant
b. Dependent; Schizoid
c. Schizoid; Avoidant
d. Histrionic; Antisocial
55. Individuals who have excessive feelings of social inadequacy, sensitivity to criticism, and a
need for reassurance are likely to develop either ______________ Personality Disorder or
_____________ Personality Disorder.
a. Narcissistic; Antisocial
b. Dependent; Narcissistic
c. Avoidant; Dependent
d. Antisocial; Histrionic
56. The personality disorder that is characterised by an insistence that things have to be done
‘the right way’ is ______________ Personality Disorder .
a. Antisocial
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b. Avoidant
c. Paranoid
d. Obsessive-Compulsive
57. Tshepo is viewed by many as a workaholic and not very social. He is at his desk every
morning at 7:30 and takes few breaks (although these breaks are always at the same time every
day). Tshepo is known to be a perfectionist. The problem is that he does not seem to get much
accomplished since he spends so much time making sure that everything is perfect before
moving on to the next task. Tshepo appears to suffer from _______________ Personality
Disorder.
a. Avoidant
b. Obsessive-Compulsive
c. Schizoid
d. Antisocial
58. One of the major differences between individuals with Obsessive-Compulsive Personality
Disorder and Obsessive-Compulsive Disorder (OCD) is that patients with the personality
disorder generally:
a.
b.
c.
d.
have more obsessive thoughts
show more compulsive and ritualistic behaviours
do not have obsessive thoughts and compulsive behaviours
have multiple diagnoses
59. One of the major differences between individuals with Obsessive-Compulsive Personality
Disorder and Obsessive-Compulsive Disorder (OCD) is that OCD is a disorder of:
a. anxiety
b. dopamine imbalances
c. modeled behaviour
d. achievement related fears
60. Of the following, the most accurate statement regarding the cause of Obsessive-Compulsive
Personality Disorder is that Obsessive-Compulsive Personality Disorder appears to be:
a. caused by neurotransmitter imbalances
b. influenced by an interaction between serotonin deficiencies and early learning
c. influenced by genetics and early learning
d. caused by classically conditioned social anxiety
CASE STUDY QUESTIONS
Andre was referred by the court for an assessment by a psychologist. You will have to testify in
court as to whether Andre should serve prison time, do community work, or be sent for
rehabilitation, for a criminal charge of fraud. The scam perpetrated by him involved hundreds of
retired men and women in various provinces over a period of three years. All his victims lost their
life savings and suffered grievous and life-threatening stress symptoms. He seems rather put out
at having to attend the sessions but tries to hide his displeasure by claiming to be eager to ‘heal,
reform himself, and get reintegrated into normative society’. When you ask him how he feels
about the fact that three of his victims died of heart attacks as a direct result of his misdeeds, he
barely suppresses an urge to laugh out loud and then denies any responsibility: his ‘clients’ were
adults who knew what they were doing and, had the deal he was working on gone well, they
would all have become ‘filthy rich.’ He then goes on the attack: aren't psychologists supposed to
be impartial? He complains that you sound exactly like the ‘vicious and self-promoting low-brow’
prosecutor at his trial.
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Andre looks completely puzzled and disdainful when you ask him why he did what he did. ‘For the
money, of course’ - he blurts out impatiently and then recomposes himself: ‘Had this panned out,
these guys would have had a great retirement, far better than their meagre and laughable
pensions could provide.’
Can he describe his typical ‘customer’? Of course he can - he is nothing if not thorough. He
provides you with a litany of detailed demographics. You tell him that you are actually interested
in knowing about their wishes, hopes, needs, fears, backgrounds, families, emotions. He is
stumped for a moment: “Why would I want to know these things? It's not like I was their bloody
grandson, or something!” Andre is contemptuous towards the ‘meek and weak’. Life is hostile;
one long cruel battle, no holds barred. Only the fittest survive. Is he one of the fittest? He shows
signs of unease and contrition but soon you find out that he merely regrets having been caught. It
depresses him to face incontrovertible proof that he is not as intellectually superior to others as
he had always believed himself to be.
Is he a man of his word? Yes, but sometimes circumstances conspire to prevent him from fulfilling
his obligations. Is he referring to moral or to contractual obligations? He says that he believes in
contracts because they represent a confluence of the self-interests of the contracting parties.
Morality is another thing altogether: it was invented by the strong to emasculate and enslave the
masses. So, is he immoral by choice? Not immoral, he grins, just amoral. How does he choose
his business partners? They have to be alert, super-intelligent, willing to take risks, inventive, and
well-connected. “Under different circumstance, you and I would have been a great team”, he
promises you because you are definitely ‘one of the most astute and erudite persons he has ever
met.’ You thank him and he immediately asks for a favour: could you recommend to the prison
authorities to allow him to have free access to the public pay phone? He can't run his businesses
with a single daily time-limited call and this is ‘adversely affecting the lives and investments of
many poor people.’ When you decline to do his bidding, he sulks, clearly consumed by barely
suppressed rage. How is he adapting to being incarcerated? He is not because there is no need
to. He is going to win his case as the case against him is flimsy, tainted, and dubious. What if he
fails? He doesn't believe in ‘premature planning’. “One day at a time is my motto.”, he says
smugly. “The world is so unpredictable that it is far better to improvise.”
He seems disappointed with your first session. When you ask him what his expectations were, he
shrugs: “Frankly, doctor, talking about scams, I don't believe in this psycho-babble of yours. But I
was hoping to be able to finally communicate my needs and wishes to someone who would
appreciate them and lend me a hand here.” You suggest that it would be helpful if admitted that
he erred and if he felt remorse; this strikes him as very funny and the encounter ends as it had
begun, with him deriding his victims.
QUESTION 1
Based on your first interview, you consider the following Axis II working diagnosis:
a.
b.
c.
d.
Narcissistic Personality Disorder
Histrionic Personality Disorder
Antisocial Personality Disorder
Difficult to determine, and you decide on a ‘Cluster B’ diagnosis
QUESTION 2
You decide to approach this diagnosis in a more dimensional way and want to describe Andre’s
personality in terms of the Five Factor Model. You are cautious or not cautious about this because
you know that cross-cultural research on the Five Factor Model of personality suggests that:
a.
b.
c.
d.
there is no such thing as a universal human personality structure
the five dimensions are fairly universal
only two dimensions are universal
Western type personality structure differs from the non-Western type
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QUESTION 3
You have a lot of experience with testifying in court and you expect to be asked what the
difference is between a psychopath and a person with an Antisocial Personality Disorder. You are
not concerned about this because you will point out that the one difference between a psychopath
and a person with Antisocial Personality Disorder is that _____________ are used in diagnosing
the psychopath but ________ are used to diagnose Antisocial Personality Disorder.
a.
b.
c.
d.
personality traits; observable behaviours
observable behaviours; personality traits
clinical judgments; objective test scores
medical criteria; psychological assessments
QUESTION 4
You sent Andre off for a neurological assessment and you get the EEG report back. The
neurologist reports low frequency theta waves. You expected this because the presence of low
frequency theta waves in the brains of psychopaths led to the development of the:
a.
b.
c.
d.
underarousal hypothesis
fearlessness hypothesis
shamelessness hypothesis
cortical-immaturity hypothesis
QUESTION 5
In your preparation for your court experience, you ponder the possible cause of Andre’s disorder.
You do a literature search and come across one prominent theory of Antisocial Personality
Disorder, which suggests that the behaviours are caused by an imbalance between the brain's:
a.
b.
c.
d.
behavioural inhibition system and fight/flight system
fight/flight system and reward system
cortical stimulation system and behavioural inhibition system
behavioural inhibition system and reward system
QUESTION 6
During your assessment, you are committed to making an accurate diagnosis, and you are aware
that your own gender bias may influence this process. You know that a woman demonstrating
very stereotypical female traits would probably be diagnosed with Histrionic Personality Disorder.
Which of the following would probably occur if a man demonstrated very stereotypical masculine
traits?
a.
b.
c.
d.
He would be given a diagnosis of Antisocial Personality Disorder.
He would be given a diagnosis of Avoidant Personality Disorder.
He would be given a diagnosis of Narcissistic Personality Disorder.
He would not be diagnosed with a personality disorder.
QUESTION 7
In order for Andre to have pulled off his scam, he must have extremely good social skills. This
knowledge helps you in arriving at a final diagnosis as you know that individuals who, unlike
Andre, have excessive feelings of social inadequacy, sensitivity to criticism, and a need for
reassurance are likely to develop either ______________ Personality Disorder or
_____________ Personality Disorder.
a.
b.
c.
d.
Narcissistic; Antisocial
Dependent; Narcissistic
Avoidant; Dependent
Antisocial; Histrionic
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QUESTION 8
As an experienced diagnostician, you make a diagnosis by means of a process of elimination.
You therefore have to eliminate the possibility of an Obsessive-Compulsive Personality Disorder.
You know that one of the major differences between individuals with Obsessive-Compulsive
Personality Disorder and Obsessive-Compulsive disorder (OCD) is that OCD is a disorder of:
a.
b.
c.
d.
anxiety
dopamine imbalances
modelled behaviour
achievement related fears
During the trial, some of the victims testify against Andre. You are requested to sit in during their
testimony as you need to assist the court in evaluating the damage that was done to them by
Andre.
QUESTION 9
The first victim to testify is Quentin, who recently immigrated to South Africa from Portugal. He
has a poor command of the English language and the court had to appoint a translator to help
him. You are immediately aware that the language barrier of immigrants from other countries may
make these individuals particularly susceptible to:
a.
b.
c.
d.
Histrionic Personality Disorder
Paranoid Personality Disorder
Schizotypal Personality Disorder
Schizoid Personality Disorder
QUESTION 10
As Quentin testifies, he mentions that he bought into Andre’s scam because, while he was
considering whether or not to invest, a white dove sat on his window sill. He interpreted this as a
sign that he should invest in the scheme. This confirms or changes your initial diagnosis because
individuals who have ‘ideas of reference’ but who sense that these beliefs are probably unrealistic
are generally diagnosed with ____________ Personality Disorder.
a.
b.
c.
d.
Schizotypal
Paranoid
Antisocial
Histrionic
QUESTION 11
The next victim to testify is Theo, who is seemingly quite a loner. He does not talk to anyone and
appears indifferent to other people. It is clear that Theo neither desires nor enjoys closeness with
others. He does not act in any obviously unusual ways nor does he appear to possess strange
beliefs about the world. Of the following personality disorders, Theo appears to be:
a.
b.
c.
d.
Avoidant
Antisocial
Schizoid
Schizotypal
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QUESTION 12
Finally the court asks your opinion about therapy for Andre. You point out that one of the likely
problems a therapist may encounter while trying to help a patient with an Antisocial Personality
Disorder is the patient's:
a.
b.
c.
d.
unwillingness to admit there is a problem
use of threatenting language
lack of intellectual ability necessary to succeed in therapy
manipulative use of crying, charm, or seductive behaviour
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CHAPTER 8
EATING DISORDERS
1. The most important motivating factor in both Anorexia and Bulimia
a. a desire to starve oneself
b. a desire to purge
c. an overwhelming urge to be thin
d. an overwhelming drive to eat
is:
2. Eating disorders are most common in:
a.
b.
c.
d.
non-Western cultures where food is plentiful
Western cultures where food is plentiful
Western cultures where food is scarce
non-Western cultures where food is scarce
3. Over the past 30 years, most Western countries have experienced a dramatic:
a.
b.
c.
d.
increase in the incidence of Anorexia but a decrease in the incidence of Bulimia
increase in the incidence of Anorexia and Bulimia
increase in the incidence of Bulimia and no change in the rate of Anorexia
decrease in the incidence of Anorexia and Bulimia
4. The characteristic profile of a patient with either Bulimia or Anorexia is:
a. young, white, female, upper socio-economic status, socially competitive
environment
b. young, female, any race, any socio-economic status, highly competitive
c. any age, female, white, upper socio-economic status, few friends
d. young, white, female, any socio-economic status, history of depression
5. Heather sometimes eats more than any other girl that you know. You wonder if her
eating could at times be considered bingeing. In order to establish this, you would have to
know:
a.
b.
c.
d.
whether she is eating junk foods
the situations under which she eats a great deal
whether her eating gets to be out of her control
the caloric intake of the foods
6. The most significant characteristic of Bulimia is:
a. overeating followed by an urge to vomit
b. purging
c. overeating
d. binge eating followed by compensatory behaviour
7. Bella, a woman of relatively normal weight, sometimes eats huge amounts of junk food without
being able to stop herself. She follows this with lengthy periods of complete fasting. Based on this
information, Bella would:
a. be diagnosed with Bulimia
b. not be diagnosed with any disorder because she is of normal weight
c. not be diagnosed with Bulimia because she is not purging
d. be diagnosed with Anorexia
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8. Neli is a young lady who is very competitive and comes from a wealthy, high achieving family.
She is very social and likes the fact that she is quite popular. She believes that her continued
popularity depends on the weight and shape of her body. Neli has a boyfriend but worries that
she may care more about their relationship than he does. The feature that puts Neli most at risk
for an eating disorder such as Bulimia is her:
a. belief that her weight and body shape influence her popularity
b. successful family
c. competitive nature
d. belief that her boyfriend cares less about the relationship than she does
9. The most serious medical consequence of Bulimia
a. electrolyte imbalance
b. starvation
c. tooth erosion
d. salivary gland damage
is potential:
10. Most people with Bulimia are:
a. of fairly normal body weight
b. overweight during the development of the disorder but become underweight as the
disorder progresses
c. significantly underweight
d. significantly overweight
11. Bulimic patients often present with additional psychological di sorders,
especially ________
and _________.
a.
b.
c.
d.
mood disorders; sexual disorders
Obsessive-Compulsive Disorder; sexual disorders
anxiety disorders; mood disorders
Body Dysmorphic Disorder; substance disorders
12. The central diagnostic factor in Anorexia is:
a. rapid, intentional weight loss and the belief that more weight needs to be lost
b. food refusal
c. intentional weight loss reaching 15% or more of expected body weight
d. a binge-purge cycle
13. The most common reason that anorexics
usually do not seek treatment on their own is
that they:
a.
b.
c.
d.
fear that they will be hospitalised
have little desire for food
do not see themselves as too thin
are ashamed of their disorder
14. The most common medical complication of Anorexia
a. electrolyte imbalance
b. brittle hair
c. downy hair on limbs
d. cessation of menstrual cycle
is:
15. Current research suggests that the restricting and binging/purging subtypes of Anorexia
a. are useless distinctions of the same disorder
b. are really different disorders
c. show few differences in severity of symptoms
d. have completely different causes
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16. People who experience loss of control over their eating and consume large amounts of food
but do not engage in any attempts to compensate f or their binge would be diagnosed with:
a. Obsessive-Compulsive Disorder
b. Binge-Eating Disorder
c. Buffet Disorder
d. Bulimia, non-purging type
17. Men who are most likely to develop an eating disorder such as Bulimia
a. only children
b. overweight
c. homosexual
d. depressed
18. The age range for the onset for Anorexia and Bulimia
a. 13 to 19
b. early childhood
c. 8 to 12
d. 20 to 26
are those who are:
is characteristically:
19. Which of the following may help to explain the vast difference s
in the incidence of eating
disorders among men and women?
a. the differences in the way boys and girls tend to gain weight from overeating
b. the influence of behavioural genetics
c. the fact that puberty brings boys' bodies closer to the societal ideal and girls'
bodies further from the societal ideal
d. the fact that boys are encouraged to play sports and girls to be active in social functions
20. When considering all the factors that influence the development of eating disorders, it is
evident that the ___________ is unique when compared to factors that affect the
development of other psychopathologies.
a.
b.
c.
d.
power of neurobiological influences
role that family instability plays
strong influence of genetics
influence of society and culture
21. Some of the most compelling evidence that helps to explain the observed increase in the
incidence of Bulimia and Anorexia over the past 30 years is:
a. the generally improved health of society and an increased emphasis on diet and exercise
b. improved diagnostic and reporting practices
c. concurrent increases in the rate of depression
d. the decrease in the weight of both Miss America contestants and Playboy centrefold
models
21. Examination of past and cross-cultural weight ideals shows that th e
weight considered ideal
by society:
a.
b.
c.
d.
fluctuates over time
is consistent with a thinner appearance
is always unhealthy
is usually unattainable for the average person
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22. The increase in the incidence of eating disorders such as Bulimia and Anorexia has been
referred to as a ‘collision between our culture and our physiology.’ The most accurate
interpretation of this statement is that:
a.
b.
c.
d.
dieting has become a fad that has been taken to an extreme
media standards of beauty are increasingly unattainable for the average woman
society has no business telling us how to define beauty
people have become too dependent on media determinations of beauty
23. Which of the teenage girls described below has the highest risk for developing an
eating
disorder?
a. Tammy is currently on a diet; her friends also diet aggressively.
b. Cindi's friends are concerned about the weight she has lost since she began working out
with the swimming team.
c. Susan has always been fairly thin despite the fact that she eats quite normally.
d. Melanie is of average to slightly above average weight but wants to lose a few pounds.
24. The families of patients with Anorexia are characteristically:
a. no different from the average family
b. successful and perfectionist
c. very different from the average family
d. reserved and quiet
25. The families of Anorexia patients are characteristically distinguished by all of the following,
EXCEPT:
a.
b.
c.
d.
open communication
concern with external appearances
high achievement
perfectionism
26. Which of the following young women appears to be at the highest risk for developing
an eating disorder?
a.
b.
c.
d.
Anneline, whose family members always seem to be fighting with each other
Nicole, whose family emphasises achievement, support, and communication
Fatima, whose mom and dad recently divorced
Jacqueline, whose family is perfectionist, successful, and eager to maintain
harmony
27. Regarding the biological influences of Anorexia and Bulimia, the most accurate statement
a. the biological influences of Anorexia and Bulimia have not been studied
b. although the studies are limited, there does appear to be a large biological influence for
Anorexia and a very small biological influence for Bulimia
c. although the studies are still limited, there appears to be some biological influence
in the development of Anorexia and Bulimia
d. anorexia and bulimia are culturally determined and not biologically influenced
28. Genetic influences on eating disorders most likely involve:
a. recessive genes
b. an inherited personality tendency that may make development of an eating disorder
more likely
c. a specific gene for each actual eating disorder
d. multiple genes, interacting in ways not yet determined, that directly produce eating
disordered behaviour
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29. Regarding the likelihood of developing an eating disorder in the future, it should be a
cause for concern when a 9-year-old girl is:
a.
b.
c.
d.
not very popular with the other girls in her class
high achieving
very concerned about her weight
competitive
30. Two forms of maladaptive eating pattern associated with obesity are _________ and
________.
a.
b.
c.
d.
Binge-Eating Disorder; Night-Eating Syndrome
Night-Eating Syndrome; Caloric Deregulative Disorder
Binge-Eating Disorder; Pica
Pica; Night-Eating Syndrome
CASE STUDY QUESTIONS
As the Clinical Psychologist in the eating disorder ward of a psychiatric hospital, you have
received the following two referrals:
Lisa is a 10-year-old female. Her Grade 4 teacher consulted with the clinical nurse specialist
assigned to work with the school system via a local community mental health centre. With an
office in the school building, the nurse had easy access to students and to teachers who had
concerns or questions about particular students. Mrs. G, Lisa's teacher, sought help from the
clinical nurse specialist after noticing a dramatic change in Lisa's weight over the first 10 weeks of
the school year. Lisa had begun the year as a somewhat overweight, cheerful youngster with dark
hair and bright green eyes who excelled at school and had a reputation as a perfectionist in her
work. While Lisa's schoolwork remained exemplary, her mood and appearance had changed
dramatically. She preferred to stay in the classroom at break and read, her social contacts with
female peers lessened, and Mrs. G noticed that Lisa no longer ate lunch. She was observed
giving most of her lunch away and nibbling at a small piece of fruit or vegetable. Mrs. G estimated
that Lisa lost between 10 and 15 kgs in 10 weeks and was looking very thin and gaunt. Her
clothes no longer fit, and her hair appeared dry and straw-like. When questioned, Lisa denied
there were any problems at home or in the classroom. Mrs. G called Lisa's mother, who worked
as an evening nurse in a local hospital. An only child, Lisa was cared for by a neighbour during
the evenings when her mother was at work. Lisa's father had left the home when she was quite
young, and she never spoke of him. Lisa's mother had agreed to meet with Mrs. G but noted she
was quite pleased that Lisa had lost some weight since “she was getting a little fat”. She
scheduled a meeting for the following week, the first available time the mother was willing to
speak to the teacher. Meanwhile, Mrs. G noticed Lisa was beginning to fall asleep in the
classroom, and her marks had slipped slightly. Mrs. G could not pinpoint why she was so worried
about Lisa but believed something was dreadfully wrong.
Cindy’s (18) behaviour began three-and-a-half years ago after many unsuccessful attempts to
lose weight via caloric restriction and exercise. Cindy is of average height and above average
weight for her age. Her personal sense of body dissatisfaction was intensified several years ago
by external pressure from her school coach, peers, and family to lose weight. Cindy was
frustrated by her dieting attempts since her caloric restriction resulted in food cravings and binges
due to intense hunger. Her girlfriends at school told her that she could be successful at weight
loss and not have to restrict food intake by using laxatives and vomiting after food consumption.
Cindy and her friends began to plan purging activities and food binges together to prevent weight
gain and satisfy their hunger. In addition to this behaviour, Cindy continued to exercise regularly.
Her behaviour caused her to lose 7.5 kg in four weeks. Unaware of her food addiction, her family
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and coach expressed great pride in her weight loss. The attention and encouragement further
reinforced her behaviour and intensified her desire for thinness. Cindy’s disorder progressed
rapidly. Within a year of onset she was bingeing and purging as much as five times a day with an
average of 3,000 calories at each binge. Eventually, it became increasingly difficult for Cindy to
focus on her school work and she withdrew from many social activities. Her boyfriend recognised
these changes in her personality and insisted she talk to the school nurse (point of entry) for an
evaluation. Cindy refused to see the school nurse and tried to assure him that her bulimic
behaviour was under control. At the same time, some of Cindy’s girlfriends became increasingly
concerned about her condition. They expressed their concern about Cindy with the school nurse
and pleaded with Cindy to talk with the nurse. Cindy reluctantly conceded. The school nurse
noted physical findings including enlargement of the parotid glands, bloodshot eyes, and callused
knuckles on Cindy's hands. A review of the medical history completed by the school nurse
revealed recent fluctuations in Cindy's weight. The school nurse recognised the need for
immediate intervention.
QUESTION 1
You make a diagnosis based on Cindy’s symptoms and behaviour. The most significant feature of
Cindy’s disorder is:
a.
b.
c.
d.
purging
overeating
overeating followed by an urge to vomit
binge eating followed by compensatory behaviour
QUESTION 2
Based on the information that Cindy sometimes eats huge quantities of food with no ability to stop
herself, followed by vomiting and laxative use, she would:
a.
b.
c.
d.
be diagnosed with Bulimia
be diagnosed with Anorexia
not be diagnosed with any disorder because she is of normal weight
not be diagnosed with Bulimia because she is not purging
QUESTION 3
During therapy, you learn that Cindy is very competitive and comes from a high achieving,
wealthy family. She is quite popular. She believes that her popularity is dependent on the weight
and shape of her body. Cindy has a boyfriend but worries that she may care more about their
relationship than he does. The feature that puts Cindy most at risk for an eating disorder such as
Bulimia is her:
a.
b.
c.
d.
belief that her weight and body shape influence her popularity
belief that her boyfriend cares less about the relationship than she does
successful family
competitive nature
QUESTION 4
The most serious medical consequence of Cindy’s disorder is potential:
a.
b.
c.
d.
electrolyte imbalance
salivary gland damage
starvation
tooth erosion
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QUESTION 5
You are aware that it is likely that Cindy will present with additional psychological disorders,
particularly ________ and _________.
a.
b.
c.
d.
Body Dysmorphic Disorder; substance disorders
mood disorders; sexual disorders
anxiety disorders; mood disorders
Obsessive-Compulsive Disorder; sexual disorders
QUESTION 6
The core diagnostic factor in Anorexia is:
a.
b.
c.
d.
food refusal
a binge-purge cycle
intentional weight loss reaching 15% or more of expected body weight
rapid, intentional weight loss and the belief that more weight needs to be lost
QUESTION 7
The best evidence that Binge-Eating Disorder (BED) may not just be a special case of Bulimia is
that:
a.
b.
c.
d.
more males than females suffer from Binge-Eating Disorder
no genetic component has been identified for Binge-Eating Disorder
Bulimic women outnumber Bulimic men by 9:1, but this ratio is about 3:1 for BED
the average age of onset is much younger for BED than it is for Bulimia or Anorexia
QUESTION 8
Which of the following might help to explain the vast differences in the incidence of eating
disorders among men and women?
a. the influence of behavioural genetics
b. the fact that boys are encouraged to play sports and girls to be active in social functions
c. the fact that puberty brings boys' bodies closer to the societal ideal and girls' bodies
further from the societal ideal
d. the differences in the way boys and girls tend to gain weight from overeating
QUESTION 9
Some of the most convincing evidence that helps to explain the observed increase in the
incidence of Anorexia and Bulimia over the past thirty years is:
a.
b.
c.
d.
improved diagnostic and reporting practices
concurrent increases in the rate of depression
the generally improved health of society and an increased emphasis on diet and exercise
the decrease in the weight of both Miss America contestants and Playboy centerfold
models
QUESTION 10
Examination of past and cross-cultural weight ideals (as demonstrated by old paintings and other
art forms, for example) indicates that the weight considered ideal by society:
a.
b.
c.
d.
fluctuates over time
is usually unattainable for the average person
is consistent with a thinner appearance
is always unhealthy
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QUESTION 11
The increase in the incidence of eating disorders such as Anorexia and Bulimia has been referred
to as a ‘collision between our culture and our physiology.’ The most accurate interpretation of this
statement is that:
a.
b.
c.
d.
people have become too dependent on media determinations of beauty
media standards of beauty are increasingly unattainable for the average woman
dieting has become a fad that has been taken to an extreme
society has no business telling us how to define beauty
QUESTION 12
With regard to the biological influences of Anorexia and Bulimia, the most accurate statement is:
a. Anorexia and Bulimia are culturally determined and not biologically influenced
b. the biological influences of Anorexia and Bulimia have not been studied
c. although the studies are still limited, there appears to be some biological influence in
the development of Anorexia and Bulimia
d. although the studies are limited, there does appear to be a large biological influence for
Anorexia and a very small biological influence for Bulimia
QUESTION 13
Genetic influences on eating disorders most likely involve:
a. a specific gene for each actual eating disorder
b. an inherited personality tendency that may make development of an eating disorder
more likely
c. multiple genes interacting in ways not yet determined that directly produce eating disordered
behaviour
d. recessive genes
QUESTION 14
Regarding the possibility of developing an eating disorder in the future, it should be a cause for
concern that Lisa, as a 10-year-old girl, is:
a.
b.
c.
d.
high achieving
competitive
very concerned about her weight
not very popular with the other girls in her class
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CHAPTER 9
SEXUAL AND GENDER IDENTITY DISORDERS
1. The major difference in sexual behaviour between men and
a. women are more likely to masturbate
b. women are more likely to engage in premarital sex
c. men are more likely to masturbate
d. men are more likely to engage in premarital sex
women is that:
2. The
differences in male and female attitudes toward sexuality have generally
___________ over the past 40 years.
a.
b.
c.
d.
decreased
increased
disappeared completely
remained the same
3. Research concerning sexual orientation suggests that homosexuality
a. based on learning and choice only
b. purely genetic
c. completely caused by biological factors
d. influenced by biological/genetic, psychological, and social factors
is:
4. Bruno
is homosexual and has an identical (monozgyotic) twin named James. The
following statement is true:
a.
b.
c.
d.
James is more likely than the general population to be homosexual.
James is homosexual also.
James is only likely to become homosexual if Bruno is a positive role model.
James is no more likely than the general population to be homosexual.
5. The
percentage of monozygotic (identical) twins in which both twins are homosexual
is 50%. This means that:
a.
b.
c.
d.
the environment determines sexual orientation
genes are only one influence for sexual orientation
genes are not an influence for sexual orientation
homosexuality is determined by genetics
6. Gender Identity Disorder is diagnosed when:
a. a person's physical gender is inconsistent with the person's gender identity
b. an individual is born with ambiguous genitalia
c. an individual receives sexual pleasure from cross-dressing
d. All of these are correct.
7. Which of the following individuals should be diagnosed with Gender Identity D isorder?
a. Suren, who can only become sexually aroused while dressed like a woman
b. Anton, who gets sexually aroused by wearing women's bras
c. Wayne, who feels like a woman trapped in a man's body
d. Helen, who is gay and has many traditionally masculine traits
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8. Sexual dysfunctions are:
a. generally not reported, so little is known about their incidence
b. more common in heterosexuals than homosexuals
c. equally common in heterosexuals and homosexuals
d. more common in homosexuals than heterosexuals
9. Of the following, the person most likely to receive a correct diagnosis of Hypoactive Sexual
Desire Disorder is:
a. Ned, who thinks about sex, but does not have sexual relations because he thinks it is
morally wrong to do so unless the goal is procreation
b. Sindi, whose husband wishes she thought about sex more often because she seems
satisfied having sex a few times a month
c. Margaret, who fantasises about sex often but is so exhausted when she gets home that
she only has sex about twice a month
d. Tholeni, who has sex at least once a week to satisfy his wife, but would prefer to be
left alone since he is rarely interested in sex
10. The person with the greatest probability of having Hypoactive Sexual Desire Disord er
a. 45-year-old female
b. 30-year-old male
c. 30-year-old female
d. 18-year-old male
is a(n):
11. Just thinking
about sex makes Michael anxious. When exposed to sexual images, he
reports feeling disgust. Michael would most likely be diagnosed with:
a.
b.
c.
d.
Gender Identity Disorder
Hypoactive Sexual Desire Disorder
Sexual Aversion Disorder
Hyperactive Sexual Desire Disorder
12. About 25% of patients with Sexual Aversion Disorder
a. Panic Attacks
b. Gender Identity Disorder
c. Paraphilias
d. Hypoactive Sexual Desire Disorder
also suffer from associated:
13. The key feature of sexual arousal disorders is:
a. the experience of pain during sex
b. lack of desire for sex despite normal physical sexual response
c. sexual arousal to inappropriate stimuli
d. lack of physical sexual response despite desire for sex
14. Sexual arousal disorders are diagnosed when there is an:
a. inability to achieve orgasm for either gender despite erection in males and lubrication in
females
b. inability to achieve or maintain an erection in males and a lack of desire for sex in females
c. inability to achieve or maintain an erection in males and a lack of orgasm in females
d. inability to achieve or maintain an erection in males and a lack of lubrication in
females
15. The prevalence of sexual arousal disorders
a. much higher than it is for women
b. slightly lower than it is for women
c. much lower than it is for women
for men is:
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d. about the same in both sexes
16. Hester and Hannes have been happily married for several years. Hester reports that she
reaches orgasm from intercourse only about half of the time and she wonders if something is
‘wrong’ with her. Hester should:
a. realise that her inhibited orgasm problem means that she doesn't really love Hannes
b. have a medical exam before assuming that she has a diagnosable psychological disorder
c. not worry because this is not unusual for women
d. seek treatment for Inhibited Orgasm Disorder
17. Donna and Miles have been happily married for several years. Miles reports that despite
being sexually aroused and having an erection, he only reaches orgasm from intercourse about
half of the time. He often wonders if something is ‘wrong’ with him. Miles should:
a. seek treatment for Inhibited Orgasm Disorder
b. not worry because that this is normal
c. seek treatment for Sexual Aversion Disorder
d. realise that this problem means that he does not really love his wife
18. The most common of all
a. inhibited orgasm
b. sexual aversion
c. premature ejaculation
d. erectile dysfunction
19. Which
the male sexual dysfunctions is:
of the following pairings is correct based on the ages most affected by the
disorders:
a.
b.
c.
d.
young men—erectile dysfunction; older men—sexual aversion
young men—premature ejaculation; older men—erectile dysfunction
young men—premature ejaculation; older men—sexual aversion
young men—inhibited orgasm; older men—erectile dysfunction
20. One reason that it is difficult to provide an accurate diagnosis of Premature Ejaculati on
is
that:
a.
b.
c.
d.
the concept of ‘too soon’ is dependent on the individual and the couple
men are often unaware of what is considered ‘normal’
most men are too ashamed to admit the problem
women generally are reluctant to tell their partners of the problem
21. It is essential to rule out ____________ before diagnosing a sexual pain disorder.
a. Vaginismus
b. relationship issues that could be the cause of the dysfunction
c. a medical cause of the pain
d. other sexual dysfunction such as Sexual Aversion Disorder that has almost identical
symptoms
22. The condition called Dyspareunia is diagnosed:
a. only when pain is present in the genital area
b. when medical conditions are ruled out as a cause of painful intercourse
c. when intercourse is uncomfortable or painful
d. only when Vaginismus is also present
23. One of the most important skills that a therapist must possess when conducting an interview
regarding sexual behaviour is:
a. being able to diagnose medical causes of sexual dysfunction
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b. communicating their own sexual values
c. demonstrating that they are comfortable talking about sexual issues
d. using only the proper clinical terms for sexual behaviour
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24. Psycho-physiological assessment of sexual dysfunction is usually conduct ed by:
a. using a device that measures physical arousal during exposure to an erotic video or
audio tape
b. using a device that measures brain waves during exposure to an erotic video or audio
tape
c. asking patients to keep a diary of their sexual activities
d. a physician during a medical exam
25. A patient
complaining of erectile dysfunction is observed to have a complete lack of
nocturnal penile erections while sleeping. We can conclude that:
a.
b.
c.
d.
more information is needed to diagnose his problem
his erectile dysfunction is caused by a medical problem
his erectile dysfunction is caused by a medication side effect
his erectile dysfunction is due to psychological difficulties
26. A situation in which a patient suffers from more than one sexual disorder at the same time (for
example, Male Erectile Disorder and Premature Ejaculation) is:
a. almost always due to a medical condition
b. very uncommon
c. common
d. impossible in many cases (i.e., both erectile dysfunction and Premature Ejaculation)
27. Two exceedingly common medical
a. arthritis and diabetes
b. vascular disease and diabetes
c. asthma and diabetes
d. vascular disease and asthma
causes of erectile dysfunction are:
28. Lucille and Morgan have been having some sexual difficu lties lately. They have both
experienced some symptoms of sexual arousal disorders. They decide to have a few
glasses of wine before engaging in sex tonight. Is this a good idea or a bad idea?
a.
b.
c.
d.
It's a bad idea since wine tends to decrease desire.
It's a good idea since wine could increase desire.
It's a bad idea since wine could further impair arousal.
It's a good idea since wine could help performance.
29. The effects of alcohol on sexual behaviour were well noted by William Shakespeare and can
be summarised as:
a. alcohol increases desire and performance
b. alcohol may increase performance but it decreases desire
c. alcohol may increase desire but it decreases performance
d. alcohol decreases desire and performance
30. Our current knowledge of the psychological causes of sexual dysfunction suggests that the
chief psychological factor in sexual dysfunction is/are :
a. relationship issues
b. distraction
c. unreasonable expectations
d. anxiety
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31. As a typical male with erectile dysfunction, we can expect Paul to show:
a. decreased arousal during performance demand and an inaccurate sense of how
aroused he is
b. increased arousal during performance demand and an accurate sense of how aroused he
is
c. decreased arousal during performance demand and an accurate sense of how aroused he
is
d. increased arousal during performance demand and an inaccurate sense of how aroused
he is
32. The original notion of performance anxiety as a cause of sexual dysfunction has been
replaced with a more modern view that performance anxiety is comprised of:
a. arousal, anxiety, and distraction
b. cognition, arousal, and distraction
c. distraction, cognition, and depression
d. arousal, cognitive processes, and negative affect
33. Craig often has problems
with premature ejaculation. As he becomes more anxious
about his problem, the amount of time between initiating intercourse and ejaculation will
most likely:
a.
b.
c.
d.
remain the same
decrease
increase
depend upon what is making him anxious
34. The most accurate description of the condition called Erotophobia
a. negative feelings toward sexuality
b. fear of being raped
c. negative feelings about other people
d. fear of relationships
is:
35. Belief in common sexual myths such as ‘women normally reach orgasm every time they have
intercourse’ are more frequently held by men:
a. with conservative sexual attitudes
b. who are homosexual
c. who have sexual disorders
d. who do not have sexual disorders
36. Paraphilia is defined as:
a. difficulty with achieving orgasm
b. an attraction to inappropriate individuals or objects
c. a dysfunction
d. an attraction to machines
37. The definition of a fetish is sexual:
a. dysfunction
b. attraction to inappropriate individuals
c. attraction to nonliving objects
d. urges to hurt someone
38. Al gets very sexually excited by women's shoes. While he used to fantasis e about
women
wearing particular shoes, he now focuses almost exclusively on the shoes themselves. Al
has a(n):
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a.
b.
c.
d.
frotteuristic obsession
sexual dysfunction
fetish
unusual interest but does not have a diagnosable disorder
39. Gareth and Dina often begin their sexual activity with Gareth putting on a striptease show for
Dina. They both report great satisfaction and excitement with this activity. In fact, Gareth says
that he gets aroused by exposing himself and Dina reports getting aroused when she
watches him undress. Which of the following statements is true?
a. Both Diana and Greg have non-specific fetishes because they admit to getting sexually
excited by their atypical behaviours.
b. Greg is a voyeur and Diana is an exhibitionist.
c. Greg is an exhibitionist and Diana is a voyeur.
d. Neither Greg nor Diana should be diagnosed with a fetish because these
behaviours involve consenting individuals.
40. One psychological aspect of voyeurism and exhibitionism that seems to maintain the
disordered behaviour is:
a. some anxiety about getting caught
b. some sense that their victims really enjoy being subjected to their fetish
c. the fact that these individuals are rarely caught
d. the desire to hurt their victims
41. All of the following statements regarding transvestic fetishism are true, EXCEPT:
a. transvestic fetishists are either homosexual or transsexual
b. some transvestic fetishists compensate by joining macho or paramilitary organisations
c. a significant percentage of individuals with this disorder are married
d. there are cross-dressing clubs and newsletters for individuals with this fetish
people who receive a sexual thrill from inflicting pain on others and
_____________ are people who receive a sexual thrill from receiving physical pain.
42. ____________ are
a.
b.
c.
d.
Sadists; masochists
Paraphiliacs; transvestites
Masochists; sadists
Transvestites; paraphiliacs
43. ‘Opportunistic’
rape differs from sadistic rape in that the rape in the latter is committed
by someone
a.
b.
c.
d.
during an unplanned assault
with a particular pattern of sexual arousal
who meets the criteria for Antisocial Personality Disorder
who rarely masturbates
44. When the term paraphilia is used to describe the rapist’s behaviou r,
it means that the rapist
is aroused by:
a.
b.
c.
d.
images of forced sex
non-violent sexual imagery
any sexual image
consensual sex
45. Which of the following statements is true about most rapists?
a. Rapists are either hyposexual or asexual.
b. Rapists are aggressive and have little regard for others.
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46. Victims of incest tend to be ____________ and victims of paedophilia
(who are not also
incest victims) tend to be ___________.
a.
b.
c.
d.
young children; girls who are beginning to mature physically
female; male
girls who are beginning to mature physically; young children
male; female
47. The typical adult who molests a child:
a. threatens the child physically but is not violent
b. is fully aware of the psychological damage that he/she is causing the child
c. does not use physical force
d. is violent and aggressive
48. Inappropriate sexual arousal, e.g., fetishism, seems to be learned
a. social ‘scripts’ that are transferred from one generation to the next
b. masturbatory fantasies about the object
c. poor social skills
d. exposure to pornography
through:
49. According
to the classical conditioning model of learning, which of the following
boys might grow up to be a voyeur?
a.
b.
c.
d.
Sanjay who thinks it's funny to spy on people
Dwayne whose father is a voyeur
Kevin who masturbates while peeping at his neighbour
Max who watches a lot of pornography
CASE STUDY QUESTIONS
As a clinical psychologist you have decided to specialise in sexual disorders and sex therapy. You
have been invited to appear on a television talk show to educate people on sexual health and to
provide some counseling to people who phone in to the programme. During the first part of the
programme, you inform the talk show host and the public of the following facts:
QUESTION 1
According to recent surveys (Diokno et al., 1990), the following statement is true regarding sexual
activity of the elderly:
a.
b.
c.
d.
Very few individuals remain sexually active beyond age 70.
More than half of the individuals over age 70 remain sexually active.
80% of males and 50% of females aged 75 - 79 remained sexually active.
50% of males and 36% of females aged 75 - 79 remained sexually active.
QUESTION 2
Data from research studies on gender differences in human sexuality (Peplau, 2003) reflect all of
the following themes, EXCEPT:
a.
b.
c.
d.
men show more sexual desire and arousal than women
men emphasise committed relationships more than women
men's self-concept is characterised in part by power, aggression, and independence
women's sexual beliefs are more influenced by cultural, social, and situational factors
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QUESTION 3
The individual with the greatest likelihood of Hypoactive Sexual Desire Disorder is a(n):
a.
b.
c.
d.
18-year-old male
30-year-old male
30-year-old female
45-year-old female
QUESTION 4
Approximately 25% of the patients with Sexual Aversion Disorder also suffer from associated:
a.
b.
c.
d.
Panic Attacks
Paraphilias
Hypoactive Sexual Desire Disorder
Gender Identity Disorder
QUESTION 5
The most common of all the male sexual dysfunctions is:
a.
b.
c.
d.
erectile dysfunction
inhibited orgasm
premature ejaculation
sexual aversion
QUESTION 6
The condition called Dyspareunia is diagnosed:
a.
b.
c.
d.
when intercourse is uncomfortable or painful
when medical conditions are ruled out as a cause of painful intercourse
only when Vaginismus is also present
only when pain is present in the genital area
QUESTION 7
A situation in which a patient experiences more than one sexual disorder at the same time (for
example, Male Erectile Disorder and Premature Ejaculation) is:
a.
b.
c.
d.
very uncommon
impossible in many cases (i.e., both erectile dysfunction and Premature Ejaculation)
common
almost always due to a medical condition
QUESTION 8
Our current understanding of the psychological causes of sexual dysfunction suggests that the
primary psychological factor in sexual dysfunction is/are:
a.
b.
c.
d.
anxiety
distraction
relationship issues
unreasonable expectations
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The talk show host says that you will now take calls. Caller number 1 is a 38-year-old man
who phones in because over the last six months, he has been experiencing the occasional
inability to achieve an erection. His relationship is satisfying, and he usually enjoys the sexual
aspect of his life. The man is concerned that the situation will worsen.
QUESTION 9
You tell the caller that this is a:
a.
b.
c.
d.
variation of normal function
dysfunction
reason for concern
somatoform disorder
QUESTION 10
The caller wants to know what the possible causes could be. Your answer is:
a.
b.
c.
d.
e.
stress
inadequate sleep
alcohol consumption
medication
all of the above
Caller number 2 is a 28-year-old woman in a sexually exclusive relationship of one year who
wants to know if she is normal because she does not always have orgasms although she enjoys
sex with her partner and feels satisfied. Her friend told her that something is wrong if she does
not have orgasms.
QUESTION 11
You tell the caller that this is a:
a.
b.
c.
d.
variation of normal function
dysfunction
reason for concern
Somatoform Disorder
QUESTION 12
You explain to her that a belief in common sexual myths such as ‘women normally reach orgasm
every time they have intercourse’ are more commonly held by men:
a.
b.
c.
d.
who do not have sexual disorders
with conservative sexual attitudes
who have sexual disorders
who are homosexual
QUESTION 13
Despite, or because of, your answer to her previous question, she remains concerned. You point
out to her that:
a. this is not a dysfunction, because she experiences sexual satisfaction and experiences
orgasm at a rate that is acceptable to her
b. orgasm does not have to be the goal of each sexual encounter for sexual satisfaction
c. sexual fulfillment can be achieved without orgasm
d. if more consistent orgasm is desired, exploration of different positions and extended or more
elaborate foreplay can be recommended
e. all of the above
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Caller number 3 is a 55-year-old woman who wants to know why her partner, 10 years her
senior, has lost his desire for sex. She says that he is not always as aroused as he used to be in
situations where previously he would be ‘ready to go.’ Her partner enjoys sex but states that it just
takes him longer to ‘get going.’
QUESTION 14
You tell the caller that this is a:
a.
b.
c.
d.
variation of normal function
dysfunction
reason for concern
Somatoform Disorder
QUESTION 15
She is obviously concerned that one of the reasons may be that he no longer finds her attractive,
or even that he may be having an affair. You put her mind at ease by pointing out that the cause
of this could also be:
a.
b.
c.
d.
e.
changes due to the aging process
possible decreasing testosterone levels in the absence of disease
use of medication
some underlying medical condition
all of the above
Caller number 4 is a 49-year-old woman who is concerned that her partner of the same age no
longer initiates sexual intimacy. Her partner has been experiencing irregular menses and low
energy for the past year. Nothing seems to stimulate her partner as it used to before. When the
woman extends foreplay to give her partner more time to respond, she does not respond as
before, and this pattern is beginning to affect their relationship.
QUESTION 16
You tell the caller that this is a:
a.
b.
c.
d.
variation of normal function
dysfunction
reason for concern
Somatoform Ddisorder
QUESTION 17
While talking to her, you are contemplating a diagnosis and your thoughts are that this most
probably a:
a.
a.
b.
c.
d.
Sexual Aversion Disorder
Female Sexual Arousal Disorder
Female Orgasmic Disorder
Dyspareunia
Hypoactive Sexual Desire Disorder
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QUESTION 18
Having listened to the case, which one of the following would you consider to the most likely
cause of the problem?
a.
a.
b.
c.
d.
hormonal changes of perimenopause
depression
stress
alcohol or drug abuse
relationship problems.
Caller number 5 is an 18-year-old man who has been to a clinic twice, complaining of penile
discharge. Both times the findings were negative for infection, and he seems evasive about the
nature of the discharge. By talking to him, you are able to find out that he has recently had sex for
the first time, and that during that encounter, he ejaculated almost immediately after penilevaginal insertion. His girlfriend asked him “Is that it?” He believes there is something wrong with
him and says he hoped the doctors would find the problem if he said he had a discharge.
QUESTION 19
You tell the caller that this is a:
a.
b.
c.
d.
variation of normal function
dysfunction
reason for concern
Somatoform Disorder
QUESTION 20
While talking to him you are contemplating a diagnosis, and your thoughts are that this is most
probably:
a.
b.
c.
d.
Sexual Aversion Disorder
Premature Ejaculation
Male Orgasmic Disorder
Male Erectile Disorder
QUESTION 21
You point out to the caller that as he becomes more anxious about his problem, the amount of
time between initiating intercourse and ejaculation will most likely:
a.
b.
c.
d.
increase
decrease
remain the same
depend upon what is making him anxious
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QUESTION 22
The caller wants to know what may cause this, and you reply by saying that it could be due to all
of the following reasons, EXCEPT:
a. sexual inexperience
b. guilt
c. low testosterone levels
d. fear of discovery
e. anxiety
Caller number 6 is a frustrated and concerned man who tells you that every time he and his new
wife attempt lovemaking, she becomes hysterical and writhes in pain when he attempts vaginal
penetration. He does not want to force her, and they have successfully satisfied each other
through mutual masturbation, but he thinks that something is wrong or that he is doing something
wrong.
QUESTION 23
While talking to this caller you are contemplating a diagnosis, and your thoughts are that his wife
probably has:
a.
b.
c.
d.
e.
Sexual Aversion Disorder
Female Sexual Arousal Disorder
Female Orgasmic Disorder
Dyspareunia
Vaginismus
QUESTION 24
The caller asks what the probable cause(s) of his wife’s problem may be, and you answer:
a.
history of sexual trauma (rape)
b.
painful or traumatic first intercourse
c.
history of physical abuse
d.
religious orthodoxy
e.
all of the above
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CHAPTER 10
SUBSTANCE ABUSE AND ADDICTIONS
1. Which of the following
a. smoking a cigarette
b. drinking a cup of coffee
c. taking a sleeping pill
d. getting drunk
would NOT be an example of substance use?
2. The American Psychiatric Association defines Substance Ab use in terms of:
a. how drunk or intoxicated a person gets after ingesting a psychoactive substance
b. whether or not the substance interferes with the person's life
c. the type and intensity of the substance abuser's biological reaction
d. which drug is used and whether it is legal or illegal
3. Substance Intoxication includes all of the following,
a. the specific drug that is used
b. how much of a drug is used or ingested
c. the drug user's individual biological reaction
d. physiological dependence on the drug
EXCEPT:
4. In
terms of substance-related disorders, the word addiction is most closely associated
with:
a.
b.
c.
d.
substance use
intoxication
substance dependence
polysubstance abuse
5. A person who is physiologically dependent on a drug
a. tolerance to the effects of the drug
b. withdrawal symptoms if the drug is withdrawn
c. both tolerance and withdrawal
d. neither tolerance nor withdrawal
will experience:
6. Chantal has been addicted to narcotics for many years. Recently, she has been trying to quit
and has not used any drugs for the last week; however, it is likely that she will experience the
following symptoms:
a.
b.
c.
d.
fever and chills
nausea, vomiting and diarrhoea
aches and pains
all of these
7. The condition called delirium tremens, also known as the ‘DTs,’
involves hallucinations and
body tremors during withdrawal from:
a.
b.
c.
d.
heroin
cocaine
alcohol
marijuana
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8. Substance Dependence that involves ‘drug-seeking behaviours’ includes all of the following,
EXCEPT:
a.
b.
c.
d.
repeated use of the drug
a desperate need to ingest more of the drug
resuming drug use after a period of abstinence
physical symptoms when the drug is no longer used
9. The DSM-IV-TR definition of Substance Dependence includes both
physiological and
psychological aspects, specifically:
a.
b.
c.
d.
tolerance and withdrawal only
drug seeking behaviours only
both of these
neither of these
10. Experts in the field of substance abuse were asked about the relative addictiveness of
various drugs. At the top of the list, as most addictive, was:
a. crack cocaine
b. heroin
c. nicotine
d. methamphetamine
11. Alcoholism, previously considered a/an ________________, is now conceptualis ed
by many
as a disease.
a.
b.
c.
d.
Antisocial Personality Disorder
Schizophrenic-like behavioural pattern
type of Dependent Personality Disorder
Hysterical Conversion Syndrome
12. Which of the following is an
a. faster reaction time
b. improved judgment
c. impaired motor coordination
d. clear speech
example of alcohol's effects on brain functioning?
13. What explains the apparent stimulation, feeling of well-being, and outgoing behaviou r
that
occur as the initial effects of alcohol ingestion?
a.
b.
c.
d.
depression of the inhibitory centers in the brain
activation of the inhibitory centers in the brain
depression of the autonomic nervous system
stimulation of the autonomic nervous system
14. Although most psychoactive substances interact with specific substances in the brain cells,
the effects of ___________ are much more complex because several different
neurotransmitter systems are affected.
a.
b.
c.
d.
the opiates
tranquilisers
alcohol
marijuana
15. All of the following are symptoms of withdrawal from alcohol,
a. nausea and/or vomiting
b. hypersomnia
c. hallucinations
EXCEPT:
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d. delirium tremens
16. In some individuals, chronic alcohol use causes physical damage to the body. Whether this
occurs depends on all of the following factors, EXCEPT:
a. blood alcohol levels during drinking periods
b. type of alcohol consumed (e.g., beer, wine, liquor)
c. genetic vulnerability
d. how frequently drinking binges occur, how long they last, and how much time elapses
between binges
17. Consequences of long-term excessive
a. liver disease and/or pancreatitis
b. cardiovascular disorders
c. brain damage
d. all of these
drinking include:
18. In people who are alcohol dependent for even short periods of time, all of the following occur,
EXCEPT:
a.
b.
c.
d.
blackouts and/or seizures
hallucinations
memory loss
dementia
19. The correct
pairing of the names, causes, and symptoms of two types of organic brain
syndromes that may result from chronic, long-term alcohol abuse are:
a. dementia—loss of intellectual abilities caused by a deficiency of the vitamin called
thiamine
b. Wernicke's disease—confusion, loss of muscle coordination, and unintelligible
speech caused by a deficiency of the vitamin called thiamine
c. dementia—confusion, loss of muscle coordination, and unintelligible speech caused by the
toxic effects of alcohol on the brain
d. Wernicke's disease—loss of intellectual abilities caused by the toxic effects of alcohol on
the brain
20. The possibility that a heavy drinker's cognitive ability might improve if the person stops
drinking is based on research findings showing that:
a. alcohol damages neurons in the brain but not the neurotransmitters
b. alcohol damages the connections between the neurons but not the neurons
themselves
c. alcohol damages the neurons in the brain but not the connections between them
d. alcohol damages the neurotransmitters but not the neuronal connections
21. Foetal Alcohol Syndrome (FAS) is a combination of problems that can occur in a child whose
mother drank alcohol while pregnant. Symptoms of FAS include all of the following, EXCEPT:
a. cognitive deficits and behaviour problems
b. distorted facial features
c. learning difficulties
d. excessive foetal growth
22. Which of the following is an accurate statement about alcoholism?
a. A progressive pattern leading to alcoholism is inevitable for those who drink alcohol.
b. The factors that determine a drinker's susceptibility to alcoholism are not yet
known.
c. Alcohol use and aggressive behaviour are negatively correlated.
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23. Although alcohol use and aggression are positively correlated, the factors that actually
determine aggressive behaviour involve all of the following, EXCEPT:
a. quantity and timing of alcohol consumed
b. the person's previous history of violence
c. the circumstances and events related to the person's drinking
d. the person's level of intelligence
24. You have just heard about a situation in which someone who was drunk vandalised a building
and assaulted a security guard. From your knowledge of abnormal psychology, you are aware
that although alcohol does not cause aggressive behaviou r, it may:
a. stimulate the inhibitory center of the brain, causing aggressive behaviour
b. activate the aggressive genes in the person's DNA
c. impair the person’s ability to consider the consequences of acting impulsively
d. increase the anxiety associated with being punished for one's actions
25. Stimulation of the __________ neurons in the ‘pleasure pathway’ (the site in the brain that
seems to be involved in the experience of pleasure) probably causes the ‘high’ associated with
cocaine use.
a.
b.
c.
d.
dopamine
serotonin
adrenaline
endorphin
26. From a physiological perspective, the reason that a nicotine addict smokes cigarettes
frequently throughout the day is to prevent withdrawal symptoms, which include all of the
following, EXCEPT:
a. irritability
b. weight loss
c. depression
d. difficulty concentrating
27. Which of the following is an accurate statement about opiate (narcotic) addiction?
a. Discontinuing narcotic use brings on withdrawal symptoms in 1-2 hours.
b. Since opiates (narcotics) are usually injected, users are at increased risk for
HIV/AIDS.
c. The withdrawal process for narcotic addiction takes about 1 to 3 weeks.
d. Most addicts die before the age of 50 from a drug overdose.
28. Enkephalins and endorphins
a. the brain
b. the humoural system
c. DNA
d. poppy seeds
are natural opioids found in:
29. Which of the following hallucinogenic
a. marijuana
b. LSD
c. psilocybin
d. mescaline
substances is processed synthetically?
30. All of the following are informative and accurate statements about inhalants, EXCEPT:
a. inhalant use is most commonly observed among teenagers
b. symptoms of inhalant use include slurred speech, dizziness, and euphoria
c. long-term inhalant use can damage bone marrow, the kidneys, the liver, and the brain
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d. use of inhalants can cause users to be antisocial and aggressive
31. A recent research study on alcoholism suggests that use of illegal drugs is influenced by
environmental factors but abuse and dependence are more influenced by:
a. genetic factors
b. psychological factors
c. non-biological factors
d. cultural factors
32. The common factor among psychoactive drugs may be:
a. their ability to activate the ‘pleasure pathways’ of the brain
b. the ease of obtaining them and the relatively inexpensive cost
c. the similar way in which they are metabolised in the body
d. their identical effect on neurotransmitters at the synapse
33. In trying to understand why some individuals become addicted to drugs and others do not, it
is important to consider the negative reinforcement that is associated with the anxiolytic effect,
i.e., a drug's ability to:
a. produce a ’high’
b. reduce anxiety
c. metabolise quickly
d. relieve pain
34. In trying to understand why some people continue to use drugs until they become dependent
on them and others are able to stop before this happens, it is important t o consider:
a. how sensitive a person is to both the negative effects of alcohol when it is first ingested
and to the negative effects of alcohol after a few hours
b. how sensitive a person is to the positive effects of alcohol when it is first ingested
and to the negative effects after a few hours
c. how sensitive a person is to the negative effects of alcohol when it is first ingested and to
the positive effects a few hours later
d. how sensitive a person is to the positive effects of alcohol when it is first ingested and to
the positive effects a few hours later
35. Many individuals use drugs as negative reinforcement, i.e., to escape from the
unpleasantness (pain, stress, anxiety) in their lives. This phenomenon is related to all of the
following, EXCEPT:
a. self-medication
b. tension reduction
c. controlled dosing
d. negative affect
36. The integrative
approach to substance abuse reflects the concept of equifinality, which
means that:
a. a genetic factor alone is the cause of substance abuse
b. neurobiological factors determine whether substance abuse will develop
c. psychological factors are the primary determinants of whether or not a person becomes a
drug addict
d. for any particular individual, substance abuse may arise from multiple and different
causes
37. Which
of the following are examples of agonist types of treatment for substance
abuse?
a. the use of methadone to treat heroin addiction
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Complete the following table (Table 10.1 in your textbook) by answering the questions related to
it:
COMMON SUBSTANCES OF ABUSE
Category and Name
barbiturates
Commercial and Street Names
Effects and Potential Health Consequences
Common Effects: euphoria, reduced thinking and reaction time, confusion, impaired balance
and coordination, coughing, frequent respiratory infections; impaired memory and learning;
increased heart rate, anxiety; panic attacks; tolerance, addiction
Gangster, hash, hash oil, hemp
As in Common Effects above
Dagga, dope, ganja, grass, herb,
Question 49
joints, Mary Jane, pot, reefer,
skunk, weed
Common Effects:
Question 38
Question 39
Question 42
Question 56
Question 40
Common Effects Question 44
benzodiazepines
Question 41
Cannabinoids
hashish
marijuana
Question 51
flunitrazepam
GHB
methaqualone
Dissociative
Anaesthetics
ketamine
PCP and analogs
Question 50
LSD
Question 45
psilocybin
Opioids and
Morphine Derivatives
codeine
heroin
morphine
opium
Stimulants
Question 45
Common Effects + sedation,
drowsiness/dizziness
Question 43
Common Effects + visual and gastrointestinal
disturbances, urinary retention, memory loss
while under the influence of the drug'.
gamma-hydroxybutyrate:
Common Effects + drowsiness, nausea and/ or
G, Georgia home boy, grievous
vomiting, headache, loss of consciousness, loss
bodily harm, liquid ecstasy
of reflexes, seizures, coma, death
Quaalude: ludes, mandrex, quad,
Common Effects + euphoria, depression, poor
quay
reflexes, slurred speech, coma
Common Effects: increased heart rate and blood pressure, impaired motor function, memory
loss; numbness; nausea and vomiting
Question 48
Common Effects + at high doses, delirium,
depression, respiratory depression and arrest
phencyclidine; angel dust, boat,
Common Effects + possible decrease in blood
hog, love boat, peace pill
pressure and heart rate, panic, aggression,
violence, loss of appetite, depression
Common Effects: altered states of perception and feeling; nausea; persisting perception
disorder (flashbacks).
lysergic acid diethylamide: acid,
Common Effects + increased body temperature,
blotter, boomers, cubes, microdot,
heart rate, blood pressure; loss of appetite,
yellow sunshines
sleeplessness, numbness, weakness, tremors,
persistent mental disorders
buttons, cactus, mesc, peyote
Common Effects + increased body temperature,
heart rate, blood pressure; loss of appetite,
sleeplessness, numbness, weakness, tremors
magic mushroom, shrooms
Common Effects + nervousness, paranoia
Common Effects: Questions 52 - 55
Common Effects + less analgesia, sedation, and
Robitussin A-C, Tylenol with
respiratory depression than morphine
Codeine: Captain Cody,
schoolboy
Common Effects + staggering gait
morphine: brown sugar, dope, H,
horse, junk, skag, skunk, smack,
white horse
Roxanol, Duramorph: M, Miss
As in Common Effects above
Emma, monkey, white stuff
laudanum, paregoric: big O,
As in Common Effects above
block, gum, hop
Common Effects: increased heart rate, blood pressure, metabolism; feelings of exhilaration,
energy, increased mental alertness, rapid or irregular heart beat; reduced appetite, weight
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amphetamine
cocaine
MDMA
(methylenedioxymethamphetamine)
loss, heart failure, nervousness, insomnia
Dexedrine: bennies, black
beauties, crosses, hearts, LA
turnaround, speed, uppers
Cocaine hydrochloride: blow,
bump, C, candy, Charlie, coke,
crack, flake, rock, snow, toot
ecstasy, Eve, lover's speed,
peace, STP, X, XTC
methamphetamine
chalk, crank, crystal, fire, glass,
go fast, ice, meth, speed, tik
methylphenidate
(for
treatment of ADHD)
nicotine
Ritalin: JIF, MPH, R-ball, Skippy,
the smart drug, vitamin R
cigarettes, cigars, smokeless
tobacco, snuff
Other Compounds
anabolic steroids
inhalants
Anadrol, Oxandrin, Durabolin,
Depo-Testosterone, Equipoise:
roids, juice
Solvents (paint thinners, gasoline,
glues), gases (butane, propane,
aerosol propellants, nitrous
oxide), nitrites (isoamyl, isobutyl,
cyclohexyl): laughing gas,
poppers, snappers
Common Effects +
Question 46
Common Effects +
Question 47
Common Effects + mild hallucinogenic effects,
increased tactile sensitivity, empathic feelings,
impaired memory and learning, hyperthermia,
cardiac toxicity, renal failure, liver toxicity
Common Effects + aggression, violence,
psychotic behaviour, memory loss, cardiac and
neurological damage; impaired memory and
learning, tolerance, addiction
As in Common Effects above
Common Effects + additional effects attributable
to tobacco exposure; adverse pregnancy
outcomes; chronic lung disease, cardiovascular
disease, stroke, cancer, tolerance, addiction
no intoxication effects/hypertension, blood clotting
and cholesterol changes, liver cysts and cancer,
kidney cancer, hostility and aggression, acne; in
adolescents, premature stoppage of growth; in
males, prostate cancer, reduced sperm
production, shrunken testicles, breast
enlargement; in females, menstrual irregularities,
development of beard and other masculine
characteristics
stimulation, loss of inhibition; headache; nausea
or vomiting; slurred speech, loss of motor
coordination; wheezing unconsciousness,
cramps, weight loss, muscle weakness,
depression, memory impairment, damage to
cardiovascular and nervous systems, sudden
death
38. Which of the following terms is the definition of anxiolytic?
a. sleep-inducing
b. anxiety-reducing
c. anti-seizure
d. calming
39. Which of the following terms is the definition of sedative?
a. sleep-inducing
b. anxiety reducing
c. anti-seizure
d. calming
40. Which of the following
a. Amytal
b. Seconal
c. Rohypnol
d. Nembutal
drugs is NOT classified as a barbiturate?
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41. Which of
a. Halcion
b. Valium
c. Xanax
d. Seconal
the following drugs is NOT classified as a benzodiazepine?
42. The benzodiazepine
a. pain
b. depression
c. anxiety
d. addiction
medications are prescribed primarily to treat:
43. Misuse of the benzodiazepine derivative _________ has resulted in it being referred to as the
‘date rape drug.’
a. Amytal
b. Halcion
c. Rohypnol
d. Ritalin
44. Which
of the following types of drugs typically is used in large amounts to commit
suicide?
a.
b.
c.
d.
benzodiazepines
barbiturates
stimulants
hallucinogens
45. The most commonly consumed of all the psychoactive drugs are the stimulants, which include
all of the following, EXCEPT:
a. caffeine
b. cocaine
c. nicotine
d. mescaline
46. Which
of the following is an accurate statement about amphetamines and/or
amphetamine use disorders?
a. Amphetamines cause a period of depression and fatigue (called ‘crashing’), which is
followed by feelings of elation and euphoria.
b. Amphetamines cause an increase in appetite and a decrease in fatigue.
c. Amphetamines decrease the availability of dopamine and norepinephrine in the nervous
system.
d. Amphetamine overdose can cause hallucinations, panic, agitation, and paranoid
delusions.
47. Which of the following effects is associated
a. decreased alertness
b. increased appetite
c. decreased pulse and blood pressure
d. rapid and irregular heartbeat
with cocaine use?
48. Among the so-called recreational or illicit ‘designer drugs’ is a dissociative ana esthetic
that
produces a sense of detachment along with a reduced awareness of pain. It is called:
a. Ecstasy (MDMA)
b. ‘K’ or ‘Special K’
c. Eve
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d. Nexus
49. Which of the following is an accurate statement concerning
a. Paranoia and hallucinations can occur.
b. Tolerance develops rapidly.
c. Psychological dependence can occur with even occasional use.
d. Marijuana is free of carcinogens.
50. Substances that distort sensory experiences, feelings,
a. opiates
b. hallucinogens
c. ‘roofies’
d. ’benzos’
marijuana use and abuse?
and perceptions are known as:
51. Alcohol and the drugs Seconal, Halcion, and Valium are al l classified
a. stimulants
b. opiates
c. depressants
d. narcotics
52. All of the following analgesic substances are classified as opiates,
a. cocaine
b. codeine
c. heroin
d. morphine
53. Both morphine and codeine are analgesics, which
a. activate the central nervous system
b. relieve pain and produce euphoria
c. increase alertness
d. cause delusions and dissociative experiences
as:
EXCEPT:
means that they:
54. Among the opioids are both natural substances (opiates) and the synthetic narcotic
a. morphine
b. heroin
c. methadone
d. codeine
called:
55. Legally
available narcotic medications, including morphine and codeine, are used
primarily as:
a.
b.
c.
d.
antagonists
analgesics
antibiotics
antidotes
56. Which of the following drugs is known
a. methamphetamine
b. alcohol
c. caffeine
d. LSD
to have an anxiolytic (anxiety-relieving) effect?
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CHAPTER 11
DISSOCIATIVE DISORDERS, SOMATOFORM DISORDERS,
AND ILLNESS-ENDORSING BEHAVIOURS
1. All of the following fit the classification of somatoform disorders,
a. Dissociative Identity Disorder
b. Body Dysmorphic Disorder
c. Hypochondriasis
d. Conversion Disorder
EXCEPT:
2. The factor in all somatoform disorders is a pathological:
a. belief that one's appearance is ugly
b. concern with the meaning of a physical pain
c. concern with appearance or functioning of the body
d. belief that a serious medical condition will cause death
3.Hypochondriasis is diagnosed when:
a. normal bodily sensations are interpreted by the patient as a sign of a serious illness
b. the patient is truly ill but does not trust the medical establishment enough to seek
treatment
c. real physical illness is exaggerated to the point where the patient can only focus on the
pain
d. the patient has an unrealistic fear of being in contact with germs
4. The central element of Hypochondriasis
a. depression
b. anxiety
c. dissociation
d. psychosis
is:
5. The core characteristic of Hypochondriasis is:
a. disease conviction
b. preoccupation with an imagined body defect
c. compulsive behaviour such as hand washing
d. fear of contamination
6. Candice is a medical student and is always worried that she will get sick. Although she feels
well now and believes that she is healthy, she still worries continually about de veloping a
serious illness. Most likely Candice would be diagnosed with:
a.
b.
c.
d.
illness phobia
Body Dysmorphic Disorder
Hypochondriasis
Somatisation Disorder
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7. Although both Hypochondriacs and Panic Disorder patients tend to misinterpret bodily
sensations, patients with Panic Disorder:
a. are having imagined physical sensations while Hypochondriacs are experiencing real
physical sensations
b. tend to fear immediate catastrophe while Hypochondriacs tend to fear long-term
illness
c. tend to ignore the symptoms of their first attacks while Hypochondriacs tend to seek
immediate medical treatment following the first indication of pain
d. are having real physical sensations while Hypochondriacs' sensations are ‘all in their
heads’
8. Regarding the diagnosis of Hypochondriasis, women are:
a. equally likely as men to be diagnosed
b. more likely than men to be diagnosed during middle to late adulthood but no more likely
than men to be diagnosed during the teen years and early adulthood
c. less likely than men to be diagnosed
d. more likely than men to be diagnosed
9. Hypochondriasis is basically an emotional disturbance
a. social concerns
b. misinterpretation of normal physical sensations
c. severe or unusual physical sensations
d. physical pathology
triggered by:
10. Which of the following has NOT been implicated in the development and maintenance of
Hypochondriasis:
a. the high incidence of disease in the family during the Hypochondriac's childhood
b. a specific Hypochondriac gene
c. learning to worry from family members overly concerned with health
d. the additional attention one receives when sick
11. When
no concrete physical cause can be found for pain or other symptoms, the
diagnosis is usually:
a.
b.
c.
d.
Body Dysmorphic Disorder
Hypochondriasis
Pain Disorder
Somatisation Disorder
12. Portia and Mo both experience physical symptoms of pain and discomfort. Both have been
examined by doctors and declared healthy. Portia fears that her pain is a sign of a serious illness
while Mo is not worried that he is sick. However, he is so focused on his pain that he finds it hard
to participate in normal life activities. Which of the following statements is true?
a. Portia has Hypochondriasis; Mo has Somatisation Disorder.
b. Both Mo and Portia are Hypochondriacs.
c. Portia has Somatisation Disorder; Mo has Hypochondriasis.
d. Both Portia and Mo have Somatisation Disorder.
13. There seems to be a common genetic component involved in Somatisation D isorder
a. Body Dysmorphic Disorder
b. Antisocial Personality Disorder
c. Panic Disorder
d. Hypochondriasis
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14. The hypothesised relationship between Antisocial Personality Disorder and Somatisation
Disorder can be explained by:
a. genetic defects and poor nutrition
b. poor modelling by parents and other authority figures
c. pleasure seeking and impulsivity
d. sibling rivalry and attention deficits
15. Which of the following are the typical traits of individuals with Somatisation Disorder ?
a. female and impulsive
b. male and impulsive
c. male and aggressive
d. female and sexually conservative
16. The disorder
that involves a physical malfunction without any physical cause is
called:
a.
b.
c.
d.
Conversion Disorder
Somatisation Disorder
Body Dysmorphic Disorder
Hypochondriasis
17. Tap-Tap
plays soccer for a big soccer club. He has completely lost his vision during
the past year but medical experts can find no physical reason for his blindness. This could
be an example of:
a.
b.
c.
d.
Dissociative Disorder
Somatisation Disorder
Conversion Disorder
Hypochondriasis
18. Patients with Conversion Disorder were conceptualis ed by Freud
a. converting unconscious conflicts into physical symptoms
b. experiencing physical symptoms as a result of the superego
c. experiencing internal conflicts as a result of physical illness
d. converting unconscious conflicts into defence mechanisms
as:
19. Symptoms of Conversion Disorder usually appear:
a. in children
b. randomly
c. shortly after a stressful event
d. following a physical injury to the affected area
20. Which of the following would be characteristic of a patient suffering from a Conversion
Disorder?
a. the ability to avoid walking into things even though they report being unable to see
anything
b. the ability to identify everything in the visual field even though the patient reports that they
are blind
c. the ability to see some bright objects when calm, but suffering complete loss of sight
during a stressful period or emergency
d. great concern with the loss of function, and a belief that it is a symptom of a potentially
fatal disease
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21. The disorder called ‘Munchausen Syndrome by Proxy’ (or Factitious Disorder by Proxy) is
characterised by:
a. deliberate actions directed toward making a child sick
b. convincing a child to lie to a doctor about factitious symptoms
c. a parent lying to a doctor, e.g., saying that the child has had symptoms that never really
existed
d. a parent developing the same symptoms that the child has
22. In Factitious Disorder, the patient:
a. voluntarily makes up symptoms with no apparent motivation
b. makes up symptoms in an effort to avoid work or to receive some other benefit
c. is unaware that he/she is making up symptoms
d. truly experiences symptoms with no apparent physical cause
23. The contemporary view on the causes of Conversion Disorder is:
a. based on social learning theory
b. somewhat similar to the causes that Freud described for this disorder
c. completely different from Freud's ideas of the aetiology of this disorder
d. a combination of genetic predisposition and neurobiological deficits
24. Psychological Pain Disorder is diagnosed when a patient:
a. has physical reasons for pain but psychological factors play a major role as well
b. has physical reasons for pain, but knowingly exaggerates the pain to gain sympathy,
attention, or some other benefit
c. is malingering (faking the experience of significant pain)
d. has significant pain with no apparent physical cause
25. One significant feature of Pain Disorder is
a. real and it hurts
b. partly real and partly faked
c. entirely imagined
d. entirely faked
that the pain is:
26. Devin injured his back at work several years ago. Although he was treated and considered
recovered by his physicians, he still complains of severe and debilitating back pain. Other
than some minor scar tissue, his doctors can't find anything that could be causing more
than some minor stiffness. It appears that Devin might be diagnosed with:
a.
b.
c.
d.
Hypochondriasis
Conversion Disorder
Pain Disorder
Somatisation Disorder
27. One reason that it is quite difficult to diagnose Pain Disorder is that:
a. the experience of pain usually involves some level of both physical and
psychological factors
b. most patients lie about the degree of pain that is experienced
c. pain is often accompanied by secondary gains such as attention or disability payments
from an employer
d. Pain Disorder is almost the same as Conversion Disorder
28. People who perceive themselves as having some defect in appearance
such defect exists are diagnosed with:
a. Somatoform Disorder
b. Conversion Disorder
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c. Hypochondriasis
d. Body Dysmorphic Disorder
29. Regarding body image, people with Body Dysmorphic Disorder:
a. never recognise that their beliefs are irrational
b. sometimes do not recognise that their beliefs are irrational
c. only realise that their beliefs are irrational if told by a professional
d. always recognise that their beliefs are irrational
30. In terms of seriousness, Body Dysmorphic Disorder is:
a. very serious with a significant suicide rate
b. very serious because patients usually become Schizophrenic
c. not very serious because it only involves patient perceptions
d. very serious because it generally leads to Bipolar Disorder
31. Patients with Body Dysmorphic Disorder
are often diagnosed with another
psychopathology called:
a.
b.
c.
d.
Somatisation Disorder
Conversion Disorder
Panic Disorder
Obsessive-Compulsive Disorder
32. The experience of dissociation occurs i n:
a. only those individuals who have experienced great personal trauma
b. psychotic disorders only
c. individuals with dissociative disorders only
d. certain psychological disorders as well as in non-disordered people at times
33. In healthy, well-adjusted people, dissociation generally
a. reading or any activity that requires great concentration
b. calm, reflective periods
c. participation in a group activity
d. stress or exhaustion
occurs following:
34. Depersonalisation is defined as:
a. altered perception including loss of the sense of one's own reality
b. the feeling that one is no longer a person
c. altered perception involving loss of the sense of reality of the external world
d. vivid hallucinations
35. Derealisation is defined as:
a. the feeling that one is no longer a person
b. vivid hallucinations
c. altered perception involving loss of the sense of reality of the external world
d. altered perception involving loss of the sense of one's own reality
36. Hotstix is a taxi driver who has recently experienced strange sensations. He suddenly notices
that the world looks strange to him. Some objects look bigger than normal and others look
smaller. Cars passing by seem oddly shaped and people appear dead or mechanical. He is most
likely experiencing:
a. derealisation
b. mania
c. depersonalisation
d. classic early psychosis symptoms
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37. While driving in her car, Shirley suddenly looks around and, for a moment, she can't
remember where she is, how she arrived at this place in the road, or even why she is driving
her car. Shirley is experiencing:
a.
b.
c.
d.
the early stages of what will eventually become a severe psychotic disorder
depersonalisation
symptoms of a mood disorder
derealisation
38. The diagnosis of Depersonalisation Disorder is:
a. quite rare and only applied when the experience of depersonalisation interferes with
normal functioning
b. fairly common since many people experience depersonalisation
c. fairly common and applied to anyone who is frightened by an experience of
depersonalisation
d. quite rare but applied to anyone who experiences depersonalisation
39. In Dissociative Amnesia, the person typically has no recollection of:
a. events following a trauma, particularly those involving interpersonal issues
b. any events
c. selective events, particularly those involving trauma
d. events prior to a trauma
40. In Dissociative Amnesia, memory loss
a. always complete
b. associated with traumatic events only
c. either partial or complete
d. always partial
41. In Dissociative Fugue, the word ’fugue’
a. hallucination
b. flight or travel
c. confusion
d. loss of consciousness
is:
means:
42. During a fugue state, patients diagnosed with Dissociative F ugue:
a. travel and typically experience memory loss during their trip
b. seldom recover any sense of their own identity
c. travel but do not experience memory loss
d. experience memory loss but do not travel
43. During a Dissociative Fugue state, it is not unusual for
a. contact friends and family
b. commit suicide
c. take on a new identity
d. see the world as a strange and foreign place
individuals to:
44. A dissociative disorder that is not found in Western cultures and seems to have some features
in common with Dissociative Fugue is:
a. amok
b. voodoo
c. exorcism
d. trance
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45. Dissociative Trance Disorder is diagnosed:
a. only when the trance causes harm to the individual or others
b. only when the trance is undesirable and considered pathological in the individual's
culture
c. whenever an individual repeatedly enters a trance state
d. only when the trance is unpredictable in terms of when it appears (i.e., individual goes into
a trance without prior religious ritual)
46. In non-Western cultures, possession and trance are:
a. never considered a disorder
b. the rarest forms of dissociative disorders
c. the most common forms of dissociative disorders
d. extremely rare
47. The disorder in which more than one distinct personality exists within one person is now
called ___________ in the DSM-IV-TR.
a. Dissociative Identity Disorder
b. Multiple Personality Disorder
c. Dissociative Trance Disorder
d. Schizophrenia
48. People with Dissociative Identity Disorder typically:
a. suffer a loss of their own identity that lasts several years
b. maintain complete awareness of all of their personalities
c. have only one other distinct personality
d. have several distinct personalities
49. The defining characteristic of Dissociative Identity Disorder is that aspects of the individual's
personality are:
a. completely suppressed
b. characterised by fugue states
c. dissociated
d. fixated
50. With regard to Dissociative Identity Disorder, the term ’alter’
refers to ______________
within the person.
a.
b.
c.
d.
a dangerous personality
the most recent personality to emerge
the ’host’ personality
a different personality
51. In Dissociative Identity Disorder, the ’host’ personality
a. is sexually provocative
b. asks for treatment and becomes the patient
c. is the most aggressive of the personalities
d. earns income for the individual
is generally the one that:
52. Vicky, who is 40, apparently believes that she is a 23-year-old woman. Suddenly, however,
she starts to speak and act very differently, and says she no longer thinks of herself as ’Vicky.’
Instead she claims to be Miriam, a 10 year-old child. It is likely that Vicky has just experienced
a. switch
b. Schizophrenic moment
c. Dissociative Trance Disorder
d. conversion reaction
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53. In Dissociative Identity Disorder, the transition
a. substitution
b. alteration
c. switch
d. transformation
from one personality to another is called a:
54. The process of changing from one personality to another typically occurs ________ in most
patients with Dissociative Identity Disorder.
a. slowly
b. quickly
c. only after many warning signs that a change is about to occur
d. rarely
55. With regard to evidence for the scientific validity of Dissociative Identity Disorder
(DID), the
most accurate statement is:
a. objective tests can always determine which patients are faking Dissociative Identity
Disorder
b. research suggests that faking dissociative experiences is possible
c. most DID patients are faking
d. it is virtually impossible to fake the types of changes that occur in Dissociative Identity
Disorder
56. One distinction that may help distinguish those with Dissociative Identity Disorder
from
people who are malingering (faking their symptoms) is that malingerers are:
a.
b.
c.
d.
usually eager to demonstrate their symptoms
less likely to seek treatment
usually hiding the existence of a major life crisis
more likely to have many ‘alters’
57. The mean number of alter personalities observed in individuals with Dissociative Identity
Disorder is:
a. one
b. two
c. fifteen
d. one hundred
58. Dissociative Identity Disorder
a. females
b. children
c. elderly
d. males
is most common in:
59. Cara has Dissociative Identity Disorder. It is
a. at least one other psychological disorder
b. no desire to get better
c. a problem with her weight
d. a history of problems with the law
very likely that she also has:
60. The major reason Dissociative Identity Disorder
patients tend to have many additional
psychopathologies is that:
a. they seek attention
b. the severe trauma of childhood leads to many problems in later life
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c. they are substance abusers
d. the number of personalities increases the number of disorders
61. One reason that Dissociative Identity Disorder
is sometimes misdiagnosed as psychosis is
that:
a.
b.
c.
d.
auditory hallucinations are common in both disorders
substance abuse makes it difficult to differentiate these disorders
both disorders are in the same DSM-IV-TR category
mental health professionals generally do not believe that dissociation is possible
62. A common feature in almost all cases of Dissociative Identity Disorder
a. a history of Body Dysmorphic Disorder
b. hallucinations and delusions
c. unrelenting substance abuse
d. a history of severe child abuse
63. In some ways, Dissociative Identity Disorder
is:
can be seen as developing from an adaptive
response because:
a.
b.
c.
d.
overall physical health is improved
the patient receives a great deal of attention
psychologically, at least, the child can escape an intolerable situation
family problems are identified
64. Which of the following abused children would be most likely to develop Dissociative Identity
Disorder later in life?
a. Sheila—has Attention-Deficit/Hyperactivity Disorder
b. Kim—lives in a chaotic, non-supportive family
c. Maria—has a few good friends
d. Tanya—has a learning disability
65. The experience
of dissociation (feelings of unreality, blunting of emotional experience
and physical pain) during or immediately after a life-threatening situation is:
a.
b.
c.
d.
extremely rare in non-disordered individuals
not well documented
a sign of psychopathology
a normal reaction
CASE STUDIES
You are appointed as a Clinical Psychologist at the Helen Joseph Hospital. As part of your
duties you have to supervise Intern Psychologists. They have brought the following cases
to supervision for your input:
Susara is a 15-year-old girl with a 2-year history of body aches, fatigue, fevers, headaches,
diarrhea, nausea, joint pain, dysuria, and irregular menses. Her mother stated that she had
chronic fatigue syndrome (CFS). During multiple medical clinic visits, Susara repeatedly had
normal physical and extensive laboratory examinations. The patient repeatedly denied stressors,
psychological trauma, and/or victimisation despite assessments by an adolescent medical
specialist and a psychiatrist. While being evaluated by neurology department personnel for her
headaches, Susara became completely mute. Following a negative medical workup, she was
admitted to a psychiatry inpatient unit where she began talking upon arrival. During this
admission, she disclosed that her stepbrother had been sexually abusing her and her mother's
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boyfriend had physically abused her for several years. Gambling and domestic violence in the
home were also identified. Susara was placed in foster care with some decrease in her somatic
complaints. Susara subsequently recanted her previous allegations of physical and sexual abuse
to child protective services. Despite family court involvement, she was allowed to return home
and was lost to follow-up.
Julia is a 15-year-old pregnant girl who presented in the emergency room with her right elbow
held in a flexion position and her left toe pointed downward in plantar extension. When asked
about her symptoms, she stated with little affect that, "I'll get used to it." Her presentation could
not be explained by any known medical condition and was subsequently diagnosed as a
Conversion Disorder. She subsequently reported that her boyfriend, who was the father of the
baby, had recently started seeing another girl. Julia noted that she was so angry with her exboyfriend that she wanted to hit and kick him, yet, with her current symptoms, she could not do
so.
Bomkazi is an attractive college student who complained of her face being slightly asymmetrical.
She felt this was the first thing people noticed about her; yet, it was an almost imperceptible
feature. She went to a craniofacial surgeon to try and have this corrected. In his opinion, she was
not disfigured, so he sent her to a mental health specialist for evaluation.
Jennifer is a mildly anxious and depressed 13-year-old adolescent girl who feared the possibility
of having cancer. She became convinced she had cancer when her breast development was
asymmetrical. She felt her hair was falling out, and, in her mind, this further confirmed her
diagnosis. She was seen by her paediatrician who reassured her that her symptoms were normal
and provided her with information about her normal physical examination findings.
Antidepressants improved her symptoms of depression and anxiety, and somatic complaints
decreased with a combination of reassurance and psychopharmacologic intervention.
QUESTION 1
The common aspect of all the above cases is a pathological:
a.
b.
c.
d.
belief that a serious medical condition will cause death
belief that one's appearance is ugly
concern with appearance or functioning of the body
concern with the meaning of a physical pain
QUESTION 2
In terms of Jennifer’s diagnosis, you explain to your students that they can expect her to see her
physician:
a.
b.
c.
d.
often and feel completely reassured that there is nothing wrong with her health
rarely but continue to believe that she is quite ill
almost never because she does not trust physicians
often but continue to be anxious about her health anyway
QUESTION 3
Jennifer has a tendency misinterpret bodily sensations. She would not be diagnosed with Panic
Disorder though, because patients with Panic Disorder:
a. are having real physical sensations while Jennifer's sensations are ’all in her head’
b. tend to fear immediate catastrophe while Jennifer tends to fear long-term illness
c. are having imagined physical sensations while Jennifer is experiencing real physical
sensations
d. tend to ignore the symptoms of their first attacks while Jennifer tends to seek immediate
medical treatment following the first indication of pain
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QUESTION 4
Jennifer’s disorder is essentially an emotional disturbance triggered by:
a.
b.
c.
d.
physical pathology
misinterpretation of normal physical sensations
social concerns
severe or unusual physical sensations
QUESTION 5
Since no physical cause can be found for Susara’s pain or other symptoms, the diagnosis would
be:
a.
b.
c.
d.
Hypochondriasis
Pain Disorder
Body Dysmorphic Disorder
Somatisation Disorder
QUESTION 6
The hypothesised connections between Susara’s disorder and Antisocial Personality Disorder
are:
a.
b.
c.
d.
poor modelling by parents and other authority figures
sibling rivalry and attention deficits
pleasure seeking and impulsivity
genetic defects and poor nutrition
QUESTION 7
Which of the following statements is true with regard to the treatment of Susara’s disorder?
a. Cognitive-behavioural treatment has been demonstrated in several studies to be the best
available treatment.
b. It is relatively easy to treat as long as the patient is willing to participate in therapy.
c. Assignment of a ’gatekeeper’ physician has been found to cure most patients.
d. It is difficult to treat and there are no treatments with proven effectiveness.
QUESTION 8
In terms of Julia’s disorder you explain to your students that symptoms generally appear:
a.
b.
c.
d.
randomly
following a physical injury to the affected area
shortly after a stressful event
in children
QUESTION 9
You inform your students that when making a diagnosis for someone with Julia’s symptoms, it is:
a. quite apparent when a patient is malingering (faking) but it is difficult to determine whether
symptoms are due to real physical disorders or a Conversion Disorder
b. quite apparent when a symptom is due to a real physical disorder, but it is impossible to
determine the difference between a Conversion Disorder and patient malingering (faking)
c. rather easy to determine the difference between symptoms that the patient fakes, those
caused by real physical disorder, and symptoms caused by Conversion Disorder
d. very difficult to determine whether the symptoms are due to malingering (faking), real
physical disorders, or Conversion Disorder
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QUESTION 10
The modern view of the causes of Julia’s disorder is:
a.
b.
c.
d.
completely different from Freud's ideas of the aetiology of this disorder
somewhat similar to the causes that Freud described for this disorder
a combination of genetic predisposition and neurobiological deficits
based on social learning theory
QUESTION 11
Evidence for the influence of social and cultural factors in Julia’s disorder includes the fact that
this disorder:
a.
b.
c.
d.
is almost exclusively experienced by women
is being diagnosed more frequently in our society
tends to occur in lower socio-economic groups where there is less medical knowledge
tends to occur in wealthy areas where there is easy access to sophisticated medical tests
QUESTION 12
Due to Bomkazi’s disorder, in terms of her body image, she would:
a.
b.
c.
d.
always recognise that her beliefs are irrational
sometimes not recognise that her beliefs are irrational
never recognise that her beliefs are irrational
only realise that her beliefs are irrational if told by a professional
QUESTION 13
You inform your students that one of the problems with trying to determine the prevalence of Body
Dysmorphic Disorder (BDD) is that:
a.
b.
c.
d.
patients with this disorder generally do not seek psychotherapy
it is almost impossible to differentiate from Conversion Disorder
therapists are reluctant to report statistics for this disorder
many BDD patients are misdiagnosed with an anxiety disorder
QUESTION 14
You also tell your students that they need to be very aware that in terms of seriousness, Body
Dysmorphic Disorder is:
a.
b.
c.
d.
very serious with a significant suicide rate
very serious because it generally leads to Bipolar Disorder
very serious because patients usually become Schizophrenic
not very serious because it only involves patient perceptions
QUESTION 15
Bomkazi’s seemingly odd motivations with regard to her disorder may be more easily understood
by:
a. examining the great lengths people go to in various cultures to alter their bodies in a
manner consistent with the cultural ideals
b. using hypnosis to explore the patient's unconscious desires to be attractive
c. exploring the neurobiological differences between patients diagnosed with Body Dysmorphic
Disorder and those without the diagnosis
d. examining the family histories of patients diagnosed with Body Dysmorphic Disorder
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CHAPTER 12
DEVELOPMENTAL PSYCHOPATHOLOGY
1. Psychopathologies are considered developmental
a. general decline in functioning over time
b. change in symptoms over the lifespan
c. significant dysfunction during childhood
d. genetic component to the disorder
disorders when there is a:
2. Although
not classified as developmental disorders, many, if not most,
psychopathologies can be considered developmental because they:
a.
b.
c.
d.
appear early in life and change over the lifespan
are unique to children
have a genetic component
lack biological causes and are influenced by learning
3. The main reason that developmental disorders are considered to be so serious in terms
of their ability to disrupt later functioning is:
a. the impact that they have on family functioning
b. that the purely biological nature of developmental disorders leads to subsequent
developmental failures
c. the fact that medications used in children can have long-term effects
d. that failure to develop at one level is thought to inhibit later stages of development
4. Jared is a 2-year-old boy who has no motivation to interact with other people. His lack of
interest in people may also lead to severe deficits in his abi lity to:
a. walk
b. amuse himself
c. communicate
d. think
5. A person diagnosed with Attention-Deficit/Hyperactivity Disorder will always
a. periods of distraction that lead to hyperactive/impulsive behaviour
b. patterns of inattention or hyperactivity/impulsivity
c. hyperactive behaviour that alternates with periods of distraction
d. both patterns of inattention and hyperactivity/impulsivity
present with:
6. The two DSM-IV-TR symptom clusters for Attention-Deficit/Hyperactivity Disorder are:
a. impulsivity and distraction
b. hyperactivity and impulsivity
c. inattention and hyperactivity/impulsivity
d. inattention and distraction
7. The inattention cluster of Attention-Deficit/Hyperactivity Disorder symptoms is characterised by:
a. careless mistakes
b. not waiting one's turn to answer questions
c. fidgeting
d. all of these
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8. In order to diagnose a person with Attention-Deficit/Hyperactivity Disorder, it is essential for
symptoms to be present in:
a. the hyperactivity cluster
b. the area of impulsivity
c. both symptom clusters
d. either of the symptom clusters
9. Two different reasons that have been proposed to explain why children with AttentionDeficit/Hyperactivity Disorder (ADHD) have problems with academic work are:
a. ADHD symptoms directly inhibit school performance and a brain deficit associated
with ADHD inhibits academic ability.
b. Social difficulties make school a negative experience for children with ADHD and a brain
deficit associated with ADHD inhibits academic ability.
c. Dietary factors responsible for ADHD limit school performance and ADHD symptoms
directly inhibit school performance.
d. ADHD symptoms directly inhibit school performance and social difficulties make school a
negative experience for children with ADHD.
10.
a.
b.
c.
d.
Children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD)
uninterested in socialisation
popular with other children because of their ‘acting out’
unpopular with other children
no more or less popular than other children
11. Children with Attention-Deficit/Hyperactivity Disorder
tend to be:
(ADHD) tend to be disliked by other
children because:
a.
b.
c.
d.
of their ADHD behaviours
teachers tend to stigmatise and isolate children with ADHD
brain deficits that lead to ADHD negatively influence the desire to socialise
children with ADHD are uninterested in socialisation
12. Which best describes the way Attention-Deficit/Hyperactivity Disorder (ADHD)
progresses as children grow into adulthood?
a. Symptoms remain relatively stable throughout the life-span for most individuals.
b. Children tend to outgrow ADHD.
c. ADHD tends to evolve into more severe forms of pathology.
d. Manifestations of ADHD tend to change over time but many problems often persist.
13. Which of the following neurotransmitters are NOT implicated in the cause of AttentionDeficit/Hyperactivity Disorder (ADHD)?
a. norepinephrine
b. endorphins
c. GABA
d. dopamine
14. Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with smaller brain volume in all
of the following areas, EXCEPT the:
a. cerebellar vermis
b. basal ganglia
c. frontal cortex
d. brain stem
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15. All of the following are defined as pervasive developmental disorders, EXCEPT:
a. Rett's Disorder
b. Asperger's Disorder
c. Autistic Disorder
d. learning disorder
16. The word ‘pervasive’ in the phrase ‘pervasive developmental disorders’
relates to the fact
that these disorders:
a.
b.
c.
d.
are generally terminal
occur with great frequency
significantly affect individuals throughout their lives
are found in virtually all cultures
17. One of the most typical
a. uninterested in people
b. hyperactive
c. very intelligent
d. extremely talkative
characteristics of autistic children is that they are usually:
18. Sindisiwe is a 3-year-old girl who appears uninterested in people. She usually interacts with
her mother only when she needs something, in other words, she uses her mother only as a tool
to help her get what she wants. This is an indication of:
a.
b.
c.
d.
Autistic Disorder
a learning disorder
Asperger's Disorder
Rett's Disorder
19. The restricted behavioural pattern typically observed
a. lack of recognition of significant others
b. an intense preference for keeping things the same
c. repetitive movements such as spinning in circles
d. inappropriate communication patterns
in autism involves:
20. Aisha is a 15-year-old autistic girl who seems compelled to run around touching each
cupboard every time she comes home. If she is prevented from touching each cupboard, Aisha
has a tantrum. This is an example of:
a.
b.
c.
d.
maintenance of sameness
restricted behaviour pattern
ritualistic behaviour
social impairment
21. Which of the following are NOT typical behaviours for autistic children?
a. becoming wildly upset when one toy is removed from the shelf
b. spinning a wheel on a toy truck and staring at it for hours
c. throwing a loud tantrum when prevented from carrying out a ritual
d. performing complex math calculations that appear well beyond their abilities
22. Most autistic people develop symptoms of the disorder:
a. by teen years
b. at birth
c. by age three
d. by age one
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23. Research regarding the behaviour of the parents of autistic children suggests that
autism is:
a. the result of an overindulgent parenting style
b. the result of cold and aloof parenting
c. the result of a complex interaction of genetics and parenting style
d. not the result of parenting behaviours
24. One major difference between Asperger's Disorder and Autistic Disorder is that:
a. Autistic Disorder develops in early childhood and Asperger's Disorder develops during
adolescence
b. Asperger's Disorder is associated with longer language delays and lower IQ
c. Autistic Disorder is associated with social impairment while Asperger's Disorder is not
d. Asperger's disorder is not associated with severe language delays
25. Gavin is a teenager who has no friends. Although he is quite verbal, he speaks in a strange
and formal style. Gavin is obsessed with boats and behaves in a very strange way. All of his
activities centre around boats and he possesses an almost encyclopaedic knowledge of them.
Gavins's constant verbal display of this knowledge interferes with socialisation. Most people
consider him ‘weird’ and avoid him. The most likely diagnosis for Gavin is:
a. Pervasive Developmental Disorder Not Otherwise Specified
b. Asperger's Disorder
c. Autism
d. Rett's Disorder
26. Which is the most common characteristics in children with pervasive development disor ders?
a. body rocking
b. perseveration with objects
c. difficulty communicating with others
d. resisting change in routines
27. Autism typically appears during what stage of a child’s life?
a.
b.
c.
d.
during the first three years of life
about the time they enter kindergarten
by the age of eight
at the onset of puberty
29. Rett’s Disorder only affects:
a. preschool children
b. females
c. males
d. students with cognitive disabilities
30. Individuals with Autistic Disorder typically exhibit all of the following behaviours, EXCEPT:
a. impairment in social interactions
b. significant clinical delay in language
c. normal functioning cognitive abilities
d. lack of social reciprocity
31. When asked a question, Johan often repeats what he hears verbatim rather than providing an
answer. This condition is referred to as:
a. mimicking
b. perseveration
c. echolalia
d. receptive questioning
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32. Which of the following is an area of psychology that is concerned with mapping how early
childhood experiences may act as risk factors for later diagnosable psychological disorders, and
attempts to describe the pathways by which early experiences may generate adult
psychological problems?
a.
b.
c.
d.
clinical psychopathology
developmental psychopathology
applied psychopathology
cognitive psychopathology
33.
a.
b.
c.
d.
parental psychopathology
repeated early separation from parents
harsh or inadequate parents
all of the above
Which of the following are risk factors for childhood psychiatric disorders?
34. Children with Attention-Deficit/Hyperactivity Disorder are known to have deficits in which of
the following brain areas?
a. perception
b. motor functioning
c. executive functioning
d. memory
35. Children with Attention-Deficit/Hyperactivity Disorder are known to have deficits in executive
functioning, and specifically have difficulty inhibiting responses. Which of the following brain
areas normally controls these types of functions?
a.
b.
c.
d.
thalamus
amygdala
parietal lobes
frontal lobes
36. Which of the following characteristics are present in Conduct D isorder?
a. violent or aggressive behaviour
b. deliberate cruelty towards people or animals
c. vandalism or damage to property
d. all of the above
37. Apart from Conduct Disorder, another disruptive behaviour disorder outlined in DSM-IV-TR is
Oppositional Defiant Disorder (ODD). ODD is a diagnosis usually reserved for those children who
do not meet the full criteria for Conduct Disorder, but who display which of the following?
a. regular temper tantrums
b. refusal to comply with requests or instructions
c. appear to deliberately indulge in behaviours that annoy others
d. all of the above
38. When children are exposed to uncertainty and stress early in their lives, they may experience
a range of emotions, including rejection, fear, confusion, anger, hatred, and misery. Consequently
the individual may become withdrawn and inward-looking. This is known as a/an :
a. externalising disorder
b. dissocialising disorder
c. internalising disorder
d. attachment disorder
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CHAPTER 13
LEGAL AND ETHICAL ISSUES IN ABNORMAL PSYCHOLOGY
1. The HPCSA is a statutory body that is committed to:
a. promoting the health of South Africa’s population
b. determining standards of professional education and training
c. setting and maintaining fair standards of professional practice
d. all of the above
2. The HPCSA allows a registered practitioner to violate the commitment to confidentiality in the
following instances:
a. in terms of a statutory provision
b. at the instruction of a court of law
c. where justified in the public interest
d. all of the above
3. Which one of the following would be considered to be a serious transgression of the ethical
code for Psychologists?
a. sexual relations with a client
b. a practitioner refusing to make a derogatory statement about a colleague
c. not charging a client for a session
d. the practitioner refused to visit a client at home
e. all of the above
4. Do you think that the following statement is true or false? The therapist is in a position of power
and should therefore be very careful not to abuse this position or to harm the client in a
therapeutic environment.
a. True
b. false
5. What makes civil commitment so problematic?
a. Liberty is traditionally deprived only after a crime is committed.
b. It is very difficult to predict dangerousness.
c. Judges usually overturn requests for civil commitment.
d. Both a. and b. are true.
6. Which of the following is NOT one of the three elements that are included in all statutes about
civil commitment?
a. the presence of a mental disorder
b. dangerousness to self or others
c. child abuse
d. grave disability
7. What is true regarding mental illness and dangerousness?
a. People with serious mental illness are two to three times more likely to show aggression
than non-patients.
b. Most individuals with mental illnesses never show aggressive behaviour.
c. The view that the mentally ill are dangerous is a misperception.
d. All of the above are true.
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8. Some,
like Thomas Szasz, argue that involuntary commitment and involuntary
treatment should be abolished because:
a.
b.
c.
d.
the criteria for mental disorders are not precise or specific enough
certain antipsychotic drugs have adverse side effects
the guidelines for involuntary treatment are too restrictive
both a. and b.
9. What are the consequences of malpractice for mental health practitioners?
a. The practitioner loses his or her professional licence.
b. The practitioner is barred from membership in professional organisations.
c. There may be legal proceedings against the practitioner.
d. All of the above are possible consequences.
10. What was the driving force behind the de-institutionalisation of mental patients in the midtwentieth century?
a. the introduction of psychotropic medications
b. the community health movement
c. governmental attempts to make systematic changes in the health care system
d. both a. and b.
11. On what grounds are the most involuntary hospitalisations justified?
a. the presence of a mental disorder
b. dangerousness to self or others
c. child abuse
d. grave disability
12. Which of the following is the most problematic today in involuntarily committing someone who
is mentally ill to a hospital?
a. people who are committed when they should not be
b. people who are not committed when they probably should be
c. countries without rules regarding involuntary commitment
d. countries without procedures regarding involuntary commitment
ESSAY QUESTIONS
1. Define ethical behaviour in your own words.
2. Examine the role of the Health Professions Council of South Africa in ensuring ethical conduct
in the health and behavioural disciplines.
3. Critically explain the different circumstances where a therapist can divulge client information to
a third party. Highlight your answer with a case study.
4. Debate the possible consequences unethical conduct can have for a practitioner.
5. Explain what legal implications unethical conduct can have for a practitioner.
6. Elucidate in your own words certain unique factors to consider in the South African context in
order to ensure ethical conduct at all times
7. Discuss critically the prerequisites for ethical conduct in a therapeutic context.
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