Unit 4

Question 1

what percentage of PTSD is accounted for by genetics?

Answer 1

35%

Question 2

trauma

Answer 2

exposure to actual or threatened severe harm, death, or serious injury
- rare, severe event or series of events
- traumatic for anyone
- EX: physical or sexual abuse, exposure to violence, severe neglect, accidents, natural disasters, war, traumatic loss

Question 3

child maltreatment

Answer 3

generic term that refers to a range of types of maltreatment (may be traumatic)
EX: psychological maltreatment, neglect, sexual abuse, physical abuse

Question 4

“stressful events”

Answer 4

more common and less extreme than truamatic events
- stressful but no threat of death/major injury
- for many kids, will not lead to enduring harm/symptoms
- may increase risk for disorders in some children
- EX: parental divorce, moving to a new school, being bullied, chronic illness

Question 5

childhood neglect

Answer 5

neglect: failure to provide for basic physical, educational, or emotional needs

Question 6

physical neglect

Answer 6

• don’t seek medical care
• don’t provide a safe and clean enviornment
• don’t provide food, safe shelter

Question 7

emotional neglect

Answer 7

• inattention to emotional needs / lack of affection
• refusal to seek psychological care
• permit to use alcohol or other substances
• spousal abuse in child’s presence

Question 8

educational neglect

Answer 8

• allow truancy (skipping class)
• fail to enroll children in school
• do not attend to special education needs

Question 9

what is the prevalence of physical and psychological abuse in children?

Answer 9

1 in 10 (10%)

Question 10

psychological abuse

Answer 10

acts that cause psychological harm to the child (abusive threats, extreme punishments, verbal abuse)

no physical harm, but just as impactful

Question 11

who is usually the perpetrator of physical and psychological childhood abuse?

Answer 11

often caregiver, but can also be peers, siblings
- caregiver often provides affection and attention along with maltreatment; child may feel loyalty to the family

Question 12

what are some negative outcomes children who are abused show?

Answer 12

• more disruptive than other children
• higher rates of stress/anxiety/depression
• increased rates of abusive behavior later (cycle of violence)
• delinquent and criminal behaviors

*some don’t experience any negative impact at all, though

Question 13

sexual abuse in children

Answer 13

sexual contact with a child (can range from fondling to rape)

Question 14

what is the prevalence of sexual abuse?

Answer 14

1 in 4 girls
1 in 20 boys

Question 15

what are some immediate negative outcomes of sexual abuse?

Answer 15

physical symptoms due to sexual contact
stress/anxiety/depression, especially right after the event

Question 16

what are some long-term negative outcomes of sexual abuse?

Answer 16

• an important subgroup are resilient and show few symptoms (but more work is needed)
• increased rates of sexually abusive behavior (most dont’ show! but sexually abusive behavior is hard to treat)
• for some: low sexual interest/sexual aversion (this is fairly treatable)
• for others: initial overly sexualized behavior, later high risk/provocative sexual behavior (RED FLAG in children: a child showing sexual behavior)

Question 17

characteristics of physical and psychological abusers (4 of them):

Answer 17

• high level of personal stress (financial, interpersonal (low social support))
• emotional/cognitive factors (executive function weaknesses: impulsivity and difficulty regulating and controlling behavior, depression)
• own personal history (poor child rearing preparation/ childhood experience, fewer close social relationships, previous history of abuse)
• substance abuse

Question 18

characteristics of sexual abusers (4 of them)

Answer 18

-interpersonal features (significant social deficits, socially isolated and awkward with same-age peers, difficulty forming close relationships)
- often report pedophilic urges from early in life (before 17) (many know these urges are terrible)
- often more planful than physical abuse (opportunisti or predatotory behavior, strategies to get children alone and gain their trust, may seek out positions of leadership inc hildren’s activities, target kids who are vulnerable)
- often have personal history of sexual abuse

Question 19

what is the intervention for child sexual abusers?

Answer 19

prevent access to children

Question 20

DSM-5 PTSD criteria (A - E, with C-1 and C-2)

Answer 20

A) exposure to actual or threatened death, serious injury, or sexual violence
- direct experience (highest risk), witness truama happening to others, in kids: learn about traumatic event happening to a caregiver
B) “intrusive” symptoms associated with event
- memories, dreams, flashbacks, distress when exposed to cues about the event
C-1) persistent avoidance of stimuli associated with event
C-2) negative alterations in cognitions
- increased negative emotional state intensity, diminished interest in activities, reduction in positive emotion expression
D) alterations in arousal / reactivity
- hypervigilient to danger, irritable or angery outbursts, exagerrated startle response, poor concentration, sleep diffiulties
F) clinically significant distress and/or impirment
**E) duration of at least 1 month

Question 21

PTSD with dissociative symptoms

Answer 21

• depersenalization: feeling detached from one’s own body, almost like an outside observer
• derealization: experience as unreal, dreamlike, distorted

Question 22

what is the prevalence of PTSD?

Answer 22

• 50% of people experience potentially traumatic event by age 16
• PTSD = 5% of children: female > male
• highest risk: sexual abuse / assualt and chronic physical abuse

Question 23

what is the typical onset for PTSD?

Answer 23

• usually within 3 months of trauma
• symptoms may even emerge months or years later

Question 24

what is the course of PTSD like?

Answer 24

• often chronic without treatment
• treatment during first three months of symptoms is most effectivewh

Question 25

commorbidities of PTSD

Answer 25

- anxiety disorders - depression - later substance use disorders - later eating disorders

Question 26

what are some important specific characteristics of traumatic events?

Answer 26

- proximity/invasiveness: close and more invasive = greater risk - severity (including whether or not trauma re-occurs) - perceived threat of death

Question 27

How does PTSD develop?

Answer 27

**genetic predisposition** - 30 - 35% herritable - pre-trauma: strong and reactive negative emotions / anxiety - elevated physiological reactivity (stratle response, etc.) **enviornment: pre-trauma risk factors)** - female - childhood poverty, abuse, or other severe stress - low social support - impulsivity / substance use

Question 28

what's happening in the brain during INITIAL traumatic events?

Answer 28

**initial trauma** - exreme fear response for all (or nearly all) - danger = activation of *sympathetic nervous system* "fight or flight" (amygdala and connected structures) - once danger is gone: *parasympathetic nervous system* should return system back to normal - PTSD: the stress response system stays *overactivated*

Question 29

what's happening in the brain LONG TERM after traumatic events?

Answer 29

**long term: overactive stress response circuit** - chronic amygdala and general physiological overarusal - cortisol levels elevated - draumatically oversensitive and intense fear response

Question 30

what are some possible interventions for maltreatment?

Answer 30

**ideal** prevent maltreatment in the first place - support for high risk groups (potential perpetrators) - usually perpetrators are unlikely to seek help on their own **if abuse happens: first, end maltreatment** - psycholigsts are mandated reports if suspect child maltreatment or abuse - structured support (and monitoring) for the family - sometimes the child is removed from the home - sexual offenders --- remove access to children **later treatment** - parent support to develop skills and address needs of child - supportive therapy of the child - family approaches targeting parent-child interactions

Question 31

which system in the brain tries to reregulate when trauma/PTSD is experienced?

Answer 31

the executive functioning circuit - it will avoid anything associated with the trauma - be hypervigilant to enviornmental cues - in severe PTSD this system is relatively unsuccessful, and activation in the stress response system remains high

Question 32

sex/gender demongeraphic risk factors for suicide

Answer 32

suicide attempts: twice as often among females than males completed suicide: three times more frquent among males than females

Question 32

what are some cognitive and behavioral interventions for PTSD?

Answer 32

very similar to many of the treatments for anxiety disorders and OCD! (stop the avoidance process the traumatic event in a safe enviornment - in therapy, actively imagine the traumatic event, or engage with the memories in other ways like play - pair with relaxation / cognitive coping strategies - eventually can "sit with" the memories without severe distress Goal: decrease distress and impairment - this doesn't mean thoughts about trauma (or exposure to similar situations) won't continue to be hard - the goal is for the impact of the truama to be manageable so it doesn't lead to ongoing impairment of functioning

Question 33

ethnicity demographic factors for suicide

Answer 33

white males = 65% of completed suicides - native american elevated

Question 34

region

Answer 34

highest in western states WHY?

Question 35

psychological risk factors for suicide

Answer 35

**genetic risk** - shared genes with depressed mood - strong emotional reactivity - possible: greater impulsivity **extremly low serotonin** - measured after attempts, or analysis of brain after death - increased number of attempts, more lethal method - severe depression, high aggression and impulsivity **emotion-reward circuit** - extreme underactivity - correlated with extremely low serotonin

Question 36

enviornmental risk factors for suicide

Answer 36

**social isolation** - actively rejected or little social contact (especially in the end) - 50% no close friends, few close with parents **occupational/situational stress** - first responders - psychologists and psychiatrists - farmers and dentists **abusive enviornment** - especially important if feel no escape is possible **social "contagion"** - cluster suivides - family members, friends/colleagues - celeberties / highly publicized cases

Question 37

other risk factors for a completed suicide

Answer 37

**previous attempts** = strongest risk factor access to lethal methods **cognitive factors** - hopelessness -- no other way out - psychological pain/distress - impulsivity **psychopathology** - most disorders = elevated risk compared to the general population, _but the majority will not attempt suicide_ - depression: 10 - 20% completed suicide - bipolar: 15 - 20% completed suicide - schizophrenia: 10% completed suicide - substance use disorders: 10% completed suicide

Question 38

what to do if someone is suicidal

Answer 38

remember; you won't cause suicidal thoughts if they weren't there before! - ask: what are their sucidal thoughts? do they have a plan? do they have a means to enact the plan **remove access to the means (if possible)** - get guns out of the house or lock them up - take away care keys - store potentially lethal medications safely **remove/lessen the opportunity** - don't leave the person alone - if you must leave them alone, set up a safety contract **help them seek treatment** - if needed call 988 or 911

Question 39

more general suicide prevention

Answer 39

- increase awareness and treatment of underlying psychopathology - increase awareness of warning signs - make it hard to complete a suicide attempt (barriers on bridges, gun safes) - hotlines/prevention centers: increase awareness and accessibility, get through the initial crisis, facilitate access to service - intensive treatment after an attempt

Question 40

DSM-5 anorexia nervosa

Answer 40

- intentionally take on too little nourishment _body weight significantly below that of other people_ of similar age and gender (2/3 of body weight of that age and gender) - intense and unrealistic fear of weight gain - distorted body perception (extreme different from what the body actually looks like) - denial or lack of awareness of serious health implications (nutritional defencies, reduced bone density, dry skin/hair loss, loss of menstral cycles

Question 41

DSM-5 Bulmia nervosa

Answer 41

- **recurrent binge eating episodes** (large quantities, 2-3x more than a normal meal, frequent: multiple times a week, uncontrollable, fast, little attention to taste - **repeated compensatory behavior** in attempt to prevent weight gain (and avoid calories): vomiting, laxatives/diuretics, fasting, excessive exercise - _weight is in the normal range_ but fluctuates - **physical consequences (due to compensatory behavior)**: eroded dental enamel, electrolyte imbalence, cramps, digestive system problems

Question 42

what are some key similarities between anxiety and bulimia?

Answer 42

- body image is distorted - health problems - about a 1 - <1% prevalence - average age of onset: 15 (anorexia) 18 (bulimia) - comorbid anxiety

Question 43

what are some key differences between anxiety and bulimia?

Answer 43

**restricted calories** - anorexia: almost always - bulimia: no **repeated binges** - anorexia; very rare - bulimia: yes **compensatory behavior** - anorexia: often, not required - bulimia: yes **weight** - anorexia: well below normal - bulimia: normal range **course** - anorexia: >5% die, 20% recover bulimia: 75% recover **comorbid OCD** - anorexia: high (getting stuck on thoughts about food) - bulimia: moderate **comorbid MDD** - anorexia: moderate - bulimia: high **seek treatment** - anorexia: 20% (treatment is often mandated) - bulimia: 80%

Question 44

what are some genetic risk factors for anxiety and bulimia?

Answer 44

genetic predisposition is about 50% of the risk - anorexia and bulimia: strong neg. emotion / high reactivity to stress - anorexia and bulimia: emotional instability and low self control anorexia: genetic links with OCD

Question 45

what are some enviornmental risk factors for anorexia and bulimia?

Answer 45

**cultural pressures** - media: skewed view of healthy weight, "fat is bad" **family factors** - "emeshed" family relationships: really close mother daughter relationship that isn't helpful - parentla perfectionism/crticism (especially in anorexia) - parental dieting **childhood sexual abuse** **dieting: up to 95% begin here** - more children are dieting - dieting tends to begin younger - higher rates of childhood obesity may lead to earlier dieting

Question 46

treatment of anorexia

Answer 46

critical first step: increase and stablize weight - hospitalization might be required - in conjunction with other therapy - frequent small meals (often observed) - positive reinforcement for eating - confront/prevent purging - avoid reenacting family patterns later steps: - family therapy - individual therapy (CBT) - challenge body image - medication (but very limited effectiveness)

Question 47

treatment of bulimia

Answer 47

behavior therapy - change eating behaviors - monitor and prevent purging, reinforce positive eating - good initial results - moderate relapse if treatment is discontinued cognitive therapy - change attitudes toward food - change eating behaviors - good inital results that are sustained medications: SSRIs some effectiveness (especially helpful when combined with behavior or CBT) - makes sense, considering link with MDD

Question 48

DSM-5 Schizophrenia

Answer 48

**"positive" symptoms**: pathological excessive or additions to a person's thoughts, emotions, or behavior - hallucinations: perceptions with no external stimulus - delusions: false beiefs despite lack of conflicting evidence - striking odd/unusal, obvious to anyone - often responds well to medications (Easy to dampen symptoms) **negative symptoms**: deficits or loss of thoughts, emotion, or behavior - loss of speech, emotional response, energy, socialability - may not always be as immedately obvious (but is potentially more impactful) - often very difficult to treat with medication (or otherwise) **psychomotor symptoms**: unusual movements or gestures (can be excessive movements or loss of movement) - EX: freezing in place - may be less common in kids

Question 49

what is the lifetime prevlanece of schizophrenia?

Answer 49

about 1%

Question 50

what is the prevalence of childhood onset schizophrenia?

Answer 50

1 in 50,000 (.002%)

Question 51

what is the typial age of onset for schizophrenia?

Answer 51

late teens to early 20s 0 earlier onset is assocated with greater severity

Question 52

what are early symptoms that show the beginning of deteroration for those with schizophrenia?

Answer 52

- social dysfunction - quirky behaviors - odd/loose thinking -- hard to follow an important area of research: how can we catch schizophrenia sooner?

Question 53

what is th genetic and enviornmental risks of schizophrenia?

Answer 53

- about 80% of the risk is genetic - enviornment: prenatal malnutrition or influenza - enviornment: significant stress

Question 54

tourette's syndrome

Answer 54

- significant tics with onset in childhood - highly comorbid with OCD and ADHD - behavioral treatments are effective (collaborate with the client) - antipsychotics that block dopamine receptors are effective

Question 55

social media and eating disorders

Answer 55

- nearly all 13-17 year olds and almost half of 8-12 year olds use social media - children and adolescents are especially sensitive to social media - greater exposure to apperance-focused social media is associated with higher rates of eating-related symptoms - some sites/hashtags foster communities that actively encourage eating disorders - social media changes so quickly that it is incredibly hard to design an optimal approach to combat these effects

Question 56

upstream risk factors for suicide

Answer 56

- as usual, very complicated - many community and personal factors contribute - progams to combat substance abuse at the level of individual and community may be especially helpful

Question 57

traumatic brain injury and psychopathology

Answer 57

- repeated concussions increase risk for a range of symptoms in psychopathology, especially attention and emotion regulation

Question 58

schizophrenia across cultures

Answer 58

- psychopathology is more similar than different across cultures for virtually all other disorders we have discussed - cultural factors also have an important impact, so its important to consider these factors in assessment and treatment