Somatic Symptom and Related Disorder
- An excessive concern about physical symptoms
or health that had no known physical cause
Somatic Symptom Disorder
- Having a significant focus on physical
symptoms (pain, shortness, or weakness of
breath) resulting to major distress and
problem in functioning
- Excessive thoughts, feelings or behaviors
relating to physical symptoms
- At least 1 symptom
- More than 6 months
- Usually begins by age of 30
Somatic delusion
- Delusion whose content pertains to
bodily functioning, bodily sensations, or
physical appearance. Usually the false
belief is that the body is somehow
diseased, abnormal or changed.
Illness Anxiety Disorder
- “hypochondriasis” is preoccupied
worrying excessively that you are or may
seriously ill/ having serious medical
condition
- At least 6 months
- Begins early adulthood
- Common in men than women
Conversion Disorder (Functional
Neurological
Disorder)
- A psychological condition that causes
symptoms that appear to be neurological
(paralysis, speech impairment, tremors)
- At least 2 sensory or motor impairment
symptoms
- Caused by psychological reaction to a
highly stressful event
- Women have higher risk
- Incompatibility of evidence between
symptoms and recognized medical
condition
Factitious Disorder
- Falsification of psychological/physical
symptoms or signs for secondary gain as
emotional attention and affection
Psychological Factor Affecting Other
Medical
Conditions
- When a medical condition is adversely
affected by psychological/behavioral
factors either by making it worst or
stopping recovery
- Factors include psychological distress
interpersonal problems, coping styles and
maladaptive health behavior
Malingering
- There is personal gain in the deception/
pretending to have psychological/physical
condition
- Not considered mental illness
 Dissociative Disorder
Dissociation- involves the failure of consciousness to perform its usual role of integrating our cognitions,
emotions, motivations, and other aspects of experiences in our awareness

Dissociative Identity Disorder

- Have at least 2 separate identities/
personalities or alters-different modes of
being, thinking, feeling, and acting that
exist independently of one another,
emerged at different time
- 2 of the alters recurrently take control
- Inability of at least 1 to recall important
information
Dissociative Amnesia
- Unable to recall important personal
information usually about some
traumatic experience
- Fugue is a severe subtype
- Localize/selective amnesia for specific
events
- Explicit memory conscious recall of
experiences
Depersonalization/Derealization
Disorder
Depersonalization
- Persistent or recurrent experiences of
detachment from one’s mental processes
or body
- Loss of sense of self Derealization
- Persistent or recurrent experiences of
unreality of surroundings
- Sensation that the word becomes real
Dissociative Fugue (DSM IV-TR)
- Memory loss revolves around an
unexpected
trip
- They just take off and find themselves in
a new place but unable to remember how
they got there

-
 Mood Disorders
DEPRESSIVE DISORDERS - cardinal
symptoms of depression include profound sadness
BIPOLAR DISORDER - people experiencing
and/or an inability to experience pleasure
mania and depression during their lifetime
1. Disruptive Mood Dysregulation Disorder
Mania- state of intense elation/irritability
- Severe recurrent temper outburst and persistent
Hypomania
negative mood
- “under” mania; less extreme (4 days)
- At least 1 year
- Before age 10
1. Bipolar I Disorder
2. Major Depressive Disorder
- Formerly” Manic-depressive disorder”
- Sad mood or loss of pleasure in usual activities
- At least 1 lifetime manic episode
- At least 5 symptoms
2. Bipolar II Disorder
- Nearly every day for at least 2 weeks (episodic)
- At least 1 lifetime major depressive
recurring
episode and one hypomanic episode
- With suicidal thoughts
3. Cyclothymic Disorder
3. Persistent depression Disorder (Dysthymia) -
- Frequent mild symptoms of depression
Depressed mood for most of the day
alternating with mild symptoms of mania
- At least 2 years in adult & 1 year for children and
(hypomania) “Ups and Downs”
adolescents)
- At least 2 years (1 year for children and
- At least 2 symptoms
Adolescents)
4. Premenstrual Dysphoric Disorder
- *chronic
- Depressive or physical symptoms in the week
Rapid Cycling - experiencing 4 or more
before menstruation
episodes of mania/depression in 1 year
- Marked affective lability
5. Seasonal Affective Disorder
- Seasonal subtype of Mood
- Winter blues
- Depression during 2 consecutive winters then
clears during summers
NEUROBIOLOGICAL FACTORS
- Genetic heritability among twins
- Neurotransmitters
↓norepinephrine
↓dopamine
=DEPRESSION
↑norepinephrine
↑dopamine

=MANIA
↑serotonin = ANTIDEPRESSANT

SOCIAL FACTORS
- Stressful life events
- Interpersonal problems within the families
- Constant reassurance-seeking of care

PSYCHOLOGICAL FACTORS
- Neuroticism
- Negative thoughts and beliefs (pessimistic & self-critical thoughts)
- Hopelessness
• Desirable outcomes will not occur
• Ni response to change the situation
Rumination
• Repeatedly dwell on sad experiences or thoughts
• To chew on material again and again
• Tendency to brood/regretfully ponder why an episode happened

BIOLOGICAL TREATMENT
- Electro cumulative therapy (ECT)
- Repetitive Transcranial Magnetic Stimulation (rTMS)
- Vagus Nerve Stimulation
 Suicide
THREE OTHER IMPORTANT INDICES OF SUICIDAL BEHAVIOR ARE:
1. suicidal ideation (thinking seriously about suicide)
2. suicidal plans (the formulation of a specific method for killing oneself)
3. suicidal attempts (the person survives)

TYPES OF SUICIDE (Durkheim)

1. Altruistic Suicide - for the benefit of the community
e.g as the ancient custom of hara-kiri in Japan, in which an individual who brought dishonor
to himself or his family was expected to impale himself on a sword.

2. Egoistic Suicide - low social integration.

e.g older adults who kill themselves after losing touch with their friends or family fit
into this category.

3. Anomic suicides - are the result of marked disruptions or disappointments, such as the
sudden loss of a high-prestige job. (Anomie is feeling lost and confused.)

4. Fatalistic Suicides - result from a loss of control over one’s own destiny. The mass suicide of 39 Heaven’s
Gate cult members in 1997 is an example of this type because the lives of those people were largely in the hands
of Marshall Applewhite, a supreme and charismatic leader.
 Feeding and Eating Disorders
BULIMIA NERVOSA - Out of control eating or
binges followed by self-induced vomiting,
excessive use of laxatives, or other attempts to
purge (get rid of) the food.
ANOREXIA NERVOSA - The person eats only
minimal amounts of food or exercises vigorously
to offset food intake, so body weight sometimes
drops dangerously.
EATING DISORDER - Individuals may binge
repeatedly and find it distressing, but they do not
attempt to purge the food.
OBESITY - is not considered an official disorder
in DSM, but we consider it here because it thought
to be one of the most dangerous epidemics
confronting public health authorities around the
world today.
PICA - eating of one or more nonnutritive food,
nonfood substances on a persistent basis
RUMINATION DISORDER - repeated
regurgitation of food occurring after feeding or
eating (re-chewed, re-swallowed and re-spit out)
AVOIDANT/ RESTRICTIVE FOOD INTAKE
DISORDER - avoidance of restriction of food
intake manifested by persistent failure to meet
appropriate nutritional and/or energy needs
associated w/ one or more: 9weight loss,
nutritional deficiency, dependence on enteral
feeding/ oral nutritional supplements and marked
interfere w/ psychosocial functioning
Ego dystonic - with stress and anxiety
Ego syntonic - without stress and anxiety
BULIMIA NERVOSA
-eating a larger amount of food typically
more junk food than fruits and vegetables than
most people would eat
under similar circumstances.
-ashamed of both their eating issues and
their lack of control
Purging techniques- individual’s attempts to
compensate for the binge eating and potential
weight gain, almost always.
Include self-induced vomiting immediately after
eating.
Subtypes:
1. Purging type
2. Non purging type
Medical Consequences
CHRONIC BULIMIA with PURGING
1. Salivary gland enlargement caused by
repeated vomiting, which gives the face
chubby appearance.
2. Repeated vomiting also may erode the
dental enamel on the inner surface of the
front teeth as well as tear the esophagus.
3. Continued vomiting may upset the
chemical balance of bodily fluids,
including sodium and potassium levels.
Electrolyte imbalance- results in serious medical
complications if unattended. (e.g., cardiac
arrthymia or disrupted heartbeat, seizures, and
renal/kidney failure
ANOREXIA NERVOSA
- *nervous loss of appetite*
- Intense fear of obesity and relentlessly
pursue thinness.
*Individuals with bulimia have a history of
anorexia; that is, they once used fasting to reduce
their body weight below desirable levels.
Medical Consequences
- Cessation of menstruation
- Medical signs and symptoms:
1. Dry skin
2. Brittle hair and nail
3. Sensitivity to or intolerance of cold temperature.
CAUSES OF EATING DISORDERS
A. Social Dimensions
For young women:
- Looking good than being healthy
- Self-worth, happiness, and success are largely
determining by BODY measurements and fats.
1. Dietary restraint - if cultural pressures to be thin
are is important as they seem to be in trigger eating
disorders, then such disorders would be expected to
occur where these pressures are particularly severe
(e.g ballet dancers; under extraordinary pressures to
be thin)
2. Family influences - typical family of someone
with anorexia is successful, hard driving, concerned
about external appearances and eager to maintain
harmony.
B. Biological dimensions
- Genetic component
- Eating disorders runs in families
-Hypothalamus and Major neurotransmitter;
norepinephrine, dopamine, and serotonin. - That
passes through it to determine whether something is
malfunctioning when eating disorders occur.
- Low levels of serotonergic activity - the system
most often associated with eating disorders.
- Proud of both their diets and their
extraordinary control.
- Lanugo
1. Downy hair on the limbs and cheeks
- Cardiovascular problems
- Electrolyte imbalance
BINGE EATING DISORDER
- Experience marked distress because of binge
eating but do not engage in extreme compensatory
behaviors and therefore cannot be diagnosed with
bulimia.
- Found in weigh control programs
- associated with impulsivity generally and binge
eating disorders
- Association between ovarian hormones and
dysregulated or impulsive eating in women prone to
binge episodes.
C. Psychological Dimensions
- Young women with eating disorder diminished a
sense of personal control and confidence in their own
abilities and talents.
- More perfectionist attitude which may reflect
attempts to exert control over important events in
their lives.
- Preoccupied with how they appear to others
- Perceived themselves as frauds, considering false
any impressions they make of being adequate, self-
sufficient or worthwhile.
- Feel like impostors in their social group and
experienced heightened levels of social anxiety.
- Women with bulimia judged that their bodies were
larger after they ate a candy bar and soft drinks
- Difficulty tolerating any negative emotion (mood
intolerance)
TREATMENT OF EATING DISORDER
A. Drug treatments
❖ Not been found effective in the treatment of OBESITY
anorexia nervosa - not formally considered as eating disorder in DSM
❖ May be useful for people with bulimia, - increases risk of cardiovascular disease, diabetes,
particularly during the bingeing and purging hypertension, stroke, and other physical problems.
cycle. (Same antidepressant medications for Night eating syndrome
anxiety and mood disorders) - Consume a third or more of their daily intake after
❖ Prozac their evening meal and get out of bed at least once
B. Psychological treatments during the night to have a high calories snack.
BN: - In the morning, they are not hungry and do not
- Short term cognitive behavioral therapy (CBT) to usually eat breakfast.
address behavior and attitudes on eating and body
shape CAUSE
- Interpersonal psychotherapy (IPT) to improve Psychological Influences
interpersonal functioning - Affects impulse control, attitudes and
- Tends to be chronic if left untreated motivation towards eating and responsiveness to the
AN: consequences of eating
- Outpatient treatment to restore weight and correct Social Influences
dysfunctional attitudes on eating and body shape. - Advancing technology promotes sedentary
- Family therapy lifestyle and consumption of high fat foods.
- Tends to be chronic if left untreated more resistant Biological Influences
to treatment than bulimia - Genes influence an individual’s number of
BE: fat cells tendency toward fat storage and activity
- Short term CBT to address behavior and attitudes levels.
on eating and body shape.
- IPT to improve interpersonal functioning TREATMENT
- Self-help approaches 1. Self- directed weight loss programs
- Prevent Eating Disorders: Healthy Weight 2. Commercial self-help programs, such as
weight watchers
3. Professionally directed behavior modification
programs which are the most effective
treatment.
4. Surgery as a last resort.
 Sleep-Wake Disorders: Major Dyssomnias
DYSSOMNIAS - problems in the amount, thing, or
quality of sleep; involve in difficulties in getting
enough sleep, problems with sleeping when you want
to and complaints about the quality of sleep.
Insomnia Disorder - difficulty falling asleep at
bedtime, problems staying asleep throughout the
night, or sleep that does not result in the person
feeling rested even after amounts of sleep
Hypersomnolence Disorders - excessive sleepiness
that is displayed as either sleeping longer than is
typical or frequent falling asleep during the day.
Narcolepsy - episodes of irresistible attacks of
refreshing sleep occurring daily, accompanied by
episodes of brief muscle tone (cataplexy)
BREATHING RELATED SLEEPING
DISORDERS
- a variety of breathing disorders occur during sleep
and that lead to excessive sleepiness or insomnia
Obstructive Sleep Apnea Hypopnea Syndrome -
occurs when Airflow stops despite continued activity
by the respiratory system.
Central Sleep Apnea - complete cessation of
respiratory activity for brief periods and is often
associated with certain central nervous system
disorders (cerebral vascular diseases, head trauma
and degenerative disorders)
Sleep related Hypoventilation - a decrease in
airflow without a complete pause in breathing
CIRCADIAN RHYTHM SLEEP DISORDER
- disturbed sleep (either insomnia or excessive
sleepiness during the day) brought on by the brain’s
inability to synchronize it’s sleep pattern with the
current pattern of day and night.
Jet Lag Type - caused by rapidly crossing multiple
time zones
Shift Work Type - associated with work problems
Delayed sleep phase type - sleep is delayed or there
is a later than normal bedtime
Irregular sleep wake type - people who experience
highly varied sleep cycles
Non- 24-hour sleep - wake type - sleeping on a 25–
26-hour cycle with later and later bedtime ultimately
going throughout the day.
PARASOMNIAS - abnormal behavior or
physiological events that occur during sleep.
Disorder of Arousal - motor movements and
behaviors that occur during NREM sleep including
incomplete awakening (confusional arousals) sleep
waking, or sleep terrors (abrupt awakening from
sleep that begins with a panicky scream)
Nightmare Disorder - frequently being awakened by
extended and extremely frightening dreams that
causes significant distress and impaired functioning.
Rapid Eye Movement Sleep Behavior Disorder -
episodes of arousal during REM sleep that result in
behaviors that can cause harm to the individual and
others.
Restless Legs Syndrome - irresistible urges to move
the legs as a result of unpleasant sensations
(sometimes labeled “creeping”, “tugging” or
“pulling” in the limbs) (otherwise referred to as
Willis-Ekbom-Disease)
Polysomnigraphic evaluation - patient spend one or
more nights sleeping in a sleep laboratory and being
monitored on a number of measures including:
• respiration and oxygen desaturation (a
measure of airflow)
• leg movements
• brain wave activity (by EEG)
• eye movements (by electrooculagram)
• muscle movements (by electromyogram)
• heart activity (by electrocardiogram)
Actigraph - records the number of arm movements
and the data can be downloaded into a computer to
determine the length and quality of sleep.
Sleep efficiency - the percentage of time actually
spent asleep.
100%: you fall asleep as soon as your head
hits the pillow and do not wake up during the night.
50%: half of your time in bed is spent trying to sleep-
you are half the time awake.
INSOMIA DISORDER:
- most common sleep wake disorder
- micro sleeps
- Fatal Insomnia: total lack of sleep
eventually leads to death
- “not sleeping” trouble falling asleep at night
(difficulty initiating sleep), if they wake up
frequently or too early and can’t go back to sleep
(difficulty maintaining sleep), or even and can’t sleep
reasonable number of hours but still not rested the
next day (NONRESTORATIVE SLEEP)
Primary Insomnia- sleep problems were not related
to other medical or psychiatric problems.
CAUSE
• Problems with the biological clock and its
control of temperature.
• Delayed temperature rhythm:
1. Body doesn’t drop
2. Drowsy until later at night
• People with Insomnia seems to have higher
body temperature than good sleepers
• Drug use
• Environmental influences: light, noise, and
temperature
Sleep apnea - a disorder that involves obstructed
nighttime breathing
Periodic limb movement disorder- excessive
leg movements
• Family history of insomnia, narcolepsy, or
obstructed breathing. (Predispotioning
Conditions)
Light sleeper- easily aroused at night
Sleep Stress - includes a number of events that can
negatively affect sleep
Rebound Insomnia - sleep problems reappear
sometimes worst- may occur when the medication is
withdrawn.
HYPERSOMNOLENCE DISORDER
”hyper” in great amount
- people who sleep all night find themselves
falling asleep several times the next day.
- excessive sleepiness
NARCOLEPSY
- experience cataplexy, a sudden loss of
muscle tone.
Cataplexy
- person is awake and can range from slight
weakness in the facial muscles to complete physical
collage
- preceded by strong emotion such as anger
or happiness.
Two characteristics:
1. Sleep Paralysis - brief period after
awakening when they cant move or speak
that is often frightening to those who go
through.
2. Hyponagogic hallucinations - vivid and
often terrifying experiences that begin at the
start of sleep and are said to be unbelievably
realistic because they include not only visual
aspects but also sensation of body
movements.
Isolated sleep paralysis - sleep paralysis
commonly occurs with anxiety disorders.
Hypoventilation - breathing is constricted a
great deal and may be labored
- Signs:
• loud snoring
• heavy sweating during the night
• morning headaches
• sleep attacks
Three types of Apnea
1. OBSTRUCTURE SLEEP APNEA HYPOPNEA
SYNDROME
✓ airflows stop continued activity by the
respiratory system
✓ snoring at night
✓ obesity
✓ used of MDMA (ecstasy)
✓ young and healthy adults (mostly male)
CIRCADIAN RHYTHM SLEEP DISORDERS
“circa” means about “dian” means day
- Disturbed sleep (either insomnia or
excessive sleepiness during the day) brought by
brain’s inability to synchronize its sleep patterns with
the current patterns of day and night.
Suprachiasmatic nucleus
- Our biological clock (hypothalamus)
- connected to it is a pathway that comes
from our eyes

BREATH-RELATED SLEEP DISORDERS

- People whose breathing is interrupted during their
sleep often experience numerous brief arousals
throughout the nights and do not feel rested even
after 8 or 9 hours.

Types of Circadian Rhythm
1. Jet lag type - caused by rapidly crossing
multiple time-zones
2. Shift work type sleep - associated with work
schedules
3. Delayed sleep phase type - sleep is delayed
or there is a later than normal bedtime
4. Advanced sleep phase type - early to bed
early to rise
5. Irregular sleep wake type - people who
experience highly varied sleep cycles
6. Non- 24-hour sleep- wake type - sleeping
on a 25–26-hour cycle with later and later
bedtime ultimately going throughout the day.
TREATMENT OF SLEEP DISORDER
1. Medical Treatment
Insomnia:
➢ Benzodiazepine - can cause excessive sleep
➢ Medications:
o triazolam (halcion)
o zaleplon (sonata)
o zolpidem (ambien)
➢ Long-acting drug: flurazepam (dalmane)
➢ Short acting drug:
Cause only brief drowsiness Drawbacks:
- Benzodiazepines can cause excessive sleepiness
- People can easily become dependent on them
and rather easily misuse them
- Meant for short-term treatment and are not
recommended for use longer than 4 weeks.
- Longer use may cause dependence and rebound
insomnia.
- Increase the likelihood of sleepwalking related
problems
- Not intended for long term chronic problems.
Hypersomnolence or Narcolepsy
- Methylphenidate
- Modafinil
Cataplexy
- Antidepressant medication, suppress REM
(dream) sleep
Breathing- related sleeping disorder
- Recommending weight loss
Obstructive Sleep apnea
- Mechanical device called CPAP or
Continuous Positive Air Pressure Machine
2. Environmental Treatments
- General principles in treating Circadian rhythm
disorder
Phase Delays (moving bedtime later)
Phase advances (moving bedtime earlier)
- Light Therapy (using bright light to trick
the brain into readjusting the biological clock)
3. Psychological Treatment
4. Relaxation treatment: reduce physical
tension that seems to prevent some people
from falling asleep at night.
5. Cognitive Treatment: Focus on worries about
sleep.
a) Guided Imagery Relaxation
Uses medication or imagery to help with
relaxation at bedtime or after a night waking
b) Graduated Extinction
6. Instruct the parents of the child who has
tantrums to check the progressively longer
period until the child falls asleep on his or her
own.
- Paradoxial Intention
7. Instructing individuals in the opposite
behavior from the desired outcome.
- Progressive Relaxation
 8. Relaxing muscles of the body in an effort to
introduce drowsiness
Sleep Hygiene - changes in lifestyle can be relatively
simple to follow and can help avoid problems such as
insomnia for some people.

PARASOMNIAS
- Not problems with sleep itself but abnormal events
that occur during sleep or during that twilight time
between sleeping and waking.

Nightmare
- occur during REM or dream sleep
- disturbing dreams that awaken the sleeper
Disorder of Arousal
- Includes a number of motor movements and
behavior during NREM sleep such as sleepwalking,
sleep terrors and incomplete awakening.

Sleep terrors
- The child is extremely upset often sweating
and frequently has a rapid heartbeat.

Sleep walking (Somnambulism)

- Occurs during NREM sleep
- People walk in their sleep, they probably
not acting out a dream.
- Occurs during the first few hours while a
person is in deep stages of sleep.

RELATED DISORDER:
1. Nocturnal Eating Syndrome - Individuals rise
from their beds and eats while they are still
sleeping.
2. Night Eating Syndrome
3. Sexsomnia - Acting out a sexual behavior
such as masturbation and sexual intercourse
with no memory of the event.
 Physical Disorders and Health Psychology
PSYCHOLOGICAL AND SOCIAL FACTORS
THAT INFLUENCE HEALTH
Psychological, Behavioral, and Social
Factors - Are major contributors to medical illness
and disease
Examples: Genital herpes, AIDS, cancer,
cardiovascular diseases
1. (PHYSICAL DISORDERS) known physical
causes and mostly observable physical pathology.
2. (PHSYCHOSOMATIC MEDICINE) study of
how a psychological and social factor affects physical
disorders used to be distinct and somewhat separate
from the remainder of psychopathology.
3. (PSYCHOPH YSIOLOGICAL DISORDER)
used to communicate a similar idea.
Psychosocial factors directly affect physical health
Psychological and Social Factors that Influence
Health
(continued)
DSM-IV-TR and Physical Disorders
- Coded on Axis III
- Recognize that psychological factors affect
medical conditions
Psychological Approaches to Health and Disease
- Behavioral medicine - Study of factors
affecting medical illness
- Health psychology - Promotion of health
HOW DO PSYCHOLOGICAL AND SOCIAL
FACTORS INFLUENCE MEDICAL ILLNESS?
Two Primary Paths
1. Psychological factors can influence basic
biological processes that lead to illness and disease.
2. Long-standing behavior patterns may put people at
risk to develop certain physical disorders.
- AIDS is an Example of Both Forms of
Influence
- Leading Causes of Death in the U.S.
o 50% are linked to lifestyle and behavior
patterns
OVERVIEW OF STRESS AND THE STRESS
RESPONSE
Nature of Stress
o Stress - Physiological response of an
individual
o Stressor - Event that evokes stress response
o Stress responses vary from person to person
o Stress Physiology
The Stress Response and the General Adaptation
Syndrome (Sustained Stress)
1. Phase 1 - Alarm response to immediate
danger or threat (sympathetic arousal)
2. Phase 2 - Resistance (mobilized coping and
action mechanisms to stress)
3. Phase 3 - Exhaustion (chronic stress,
permanent damage)
PHYSIOLOGY OF STRESS
The Biology of Stress
- Activates the sympathetic branch of the
ANS
- Neuromodulators and neuropeptides act like
neurotransmitters
- Activates the HPA axis, producing cortisol
- The relation between the hippocampus and
HPA activation
The Function of the Hippocampus in HPA-Stress
Response Cycle
- Part of the limbic system
- Highly responsive to cortisol
- Hippocampus helps to turn off the HPA
cycle
- Chronic stress may damage cells in the
hippocampus
- Damage to hippocampal cells interferes
with stopping the HPA loop
PSYCHOLOGICAL AND SOCIAL FACTORS:
THEIR RELATION TO STRESS PHYSIOLOGY
Primate Research: High and Low Social Status
- High cortisol is associated with low social
status
- Low social status Fewer lymphocytes and
immune suppression
- Dominant males benefit from predictability
and controllability
Vulnerabilities in Mental Illness Contribute to
Physical Illness
- Stress
- Perceived uncontrollability, low social
support, negative affect
Interpretation of Physiological Response and
Situation
- Seems critical in the stress response
- The role of self-efficacy
STRESS AND THE IMMUNE SYSTEM
Immune system- protects the body from
foreign materials that may enter it, including cold
viruses.
✓ Depression - lowers immune system
functioning (older adults)
✓ Optimism & positive affect - Stronger
immune system
How Immune System work?
1. Eliminates foreign materials called
ANTIGENS (bacteria, viruses or
parasites)
2. Divisions of the Immune System
a) Humoral branch
i. Blood and other bodily fluids
b) Cellular branch
i. Protects against viral and
parasitic infections
Function of the Immune System
✓ Identify and eliminate antigens from the body
✓ Leukocytes (White Blood Cells) are the
primary agents
LEUKOCYTES: Subtypes and Functions
a) Macrophages
i. First line of defense, destroy antigens,
signal lymphocytes
LYMPHOCYTES
a) B cells (humoral branch) releasing
molecules that seek antigens in blood and
other bodily fluids with purpose of
neutralizing them
b) B cells produce highly specific molecule
called IMMUGNOGLOBIN act as
antibodies, combine with the antigens to
neutralize.
c) Memory B cells are created so that the next
time that the antigen is encountered, the
immune system response will be even faster.
d) Functional role of B and T cells and
associated memory cells
e) T cells (cellular branch
antibodies.
f) Killer T cells directly destroy viruses and
cancer cells.
g) Memory T cells are created to speed future
responses to the same antigen.
h) T4 cells (Helper T cells) enhance the immune
system response by signaling B cells to
produce antibodies and telling other T cells to
destroy the antigen.
i) Autoimmune disease such as Rheumatoid
arthritis, over reactive and may attack the
body’s normal cells rather than antigens.
j) Psychoneuroimmunology or PNI object of
study is psychological influences on the
neurological responding implicated in our
immune response.
Psychosocial Effects on Physical Disorders
ACQUIRED IMMUNODEFICIENCY
VIRUS (AIDS)
Nature of AIDS
o Course from HIV to full blown AIDS is
variable
o Median time from initial infection to full-
blown AIDS?
▪ 7.3 to 10 years or more
o Stress of getting an AIDS diagnosis can be
devastating
o AIDS-related complex (ARC) after several
months to several years with no symptoms,
patients may develop minor health problems
such as weight loss, fever, and night sweats.
Role of Stress Reduction Programs
✓ Higher stress and low social support speed
disease progression
✓ Reduce stress, improve immune system
functioning
The Development and Course of AIDS
✓ Influenced by psychological, behavioral, and
social factors
CANCER: PSYCHOLOGICAL AND SOCIAL
INFLUENCES Contributing Factors and Associated Features
Oncology- Study of cancer ✓ Affects 20% of all adults (between ages of 25
Psychoncology - Study of psychological factors and and 74)
their relation to cancer ✓ African Americans are most at risk
Psychological and Behavioral Contributions to ✓ Affected by salt, fluid volume, sympathetic
Cancer arousal, and stress
✓ Perceived lack of control ✓ Psychological contributors include anger and
✓ Inadequate or inappropriate coping responses hostility
(e.g., denial)
✓ Overwhelming stressful life events Influenced by Psychological, Behavioral, and
✓ Life-style risk behaviors Social Factors
✓ Psychological factors also are involved in CARDIOVASCULAR DISEASES: CORONARY
chemotherapy HEART DISEASE (CHD)
Coronary Heart Disease (CHD) - Blockage
Cancer is influenced by Psychological, Behavioral, of the arteries supplying blood to the heart muscle
and Social Factors ( MYOCARDIUM)

CARDIOVASCULAR PROBLEMS: Angina pectoris: Chest pain from partial obstruction

HYPERTENSION of the arteries
Cardiovascular System
✓ Heart, blood vessels and complex control Atherosclerosis: Accumulation of artery plaque (i.e.,
mechanisms for regulating function fatty substances)

Hypertension - High Blood Pressure Ischemia: Deficiency of blood supply because of too
much plaque
✓ Major risk factor for stroke, heart disease,
and kidney disease
✓ Blood pressure increases when the blood Myocardial infarction: Heart attack involving death
vessels leading to organs and peripheral areas of heart tissue
constrict (become narrower) forcing
increasing amounts of blood to muscles in Psychological and Behavioral Risk Factors for
central parts of the body. CHD
✓ Causes wear and tear of the blood vessels ✓ Stress, anxiety, anger,
✓ Essential hypertension is the most common ✓ Poor coping skills
form ✓ Low social support
✓ Systolic Blood Pressure- pressure when the ✓ Lifestyle factors (e.g., smoking, diet,
heart is pumping blood. exercise)
✓ Diastolic Blood Pressure- pressure between
beats when the heart is at rest.
✓ “Silent killer”
Classic Type A Behavior Pattern
✓ Anger and negative affect
✓ Impatience, accelerated speech and motor
activity
Classic Type B Behavior Pattern
✓ Relaxed, less concerned about deadlines and
seldom feels the pressure or excitement of
challenges or overriding ambition.
CHD Is Influenced by Psychological, Behavioral, and
Social Factors
CHRONIC PAIN
Two Kinds of Clinical Pain
✓ Acute pain - follows an injury and
disappears once the injury heals or
effectively treated, often within a month.
✓ chronic pain- may begin with an acute
episode but does not decrease over time, even
when the injury has healed, or effective
treatments have been administered
✓ Severity of pain does not predict one’s
reaction to it
Pain: Some Clinical Distinctions
Subjective vs. overt behavioral
manifestations of pain
Psychological and Social Factors in Chronic Pain
• Perceived control over pain and its
consequences
• Negative emotion, poor coping skills
• Low social support, compensation
• Social reinforcement for pain behaviors
MECHANISMS OF PAIN EXPERIENCE AND
PAIN CONTROL
Gate Control Theory: nerve impulses from
painful stimuli make their way to the spinal column
and from the brain.
Dorsal Horns of the Spinal Column: acts as a gate
and may open and transmit sensations of pain if the
stimulation is sufficiently intense.
- Small Fibers: A-Delta and C fibers
- Large Fibers: A-Beta fibers
THE ROLE OF ENDOGENOUS (Natural)
OPIODS
- the neurochemical means by which the
brain inhibits pain is an important discovery
- drugs such as heroin and morphine are
manufactured from opioid substances.
- Exist within the body
- Endorphins (shut down pain even in the
presence of marked tissue damage or injury.) and
encephalin.
CHRONIC FATIGUE SYNDROME:
PSYCHOLOGICAL, BEHAVIORAL, AND
SOCIAL INFLUENCES
Nature of Chronic Fatigue (CF)
✓ Lack of nerve strength, marked fatigue, pain,
low-grade fever
✓ Most common in females
✓ Incidence increasing in Western countries
✓ Unrelated to viral infection, immune
problems, depression
Speculation About Causes
✓ High-achievement oriented lifestyle
✓ Fast paced lifestyle combines with stress and
illness
✓ Psychological misinterpretation of
consequences of illness
Treatment
✓ Medications are ineffective
✓ Cognitive-behavioral interventions appear
promising
PSYCHOSOCIAL TREATMENT OF • Smoking in China: Children intervene in
PHYSICAL DISORDERS smoking. They wrote letters to their father
asking them to quit smoking and they
Biofeedback: An Overview submitted monthly reports on their fathers’
• Patient learns to control bodily responses smoking habits to the school.
• Used with chronic headache and • Stanford three community study: Diet,
hypertension exercise, promotion of health and wellness

Relaxation and Meditation

• Progressive muscle relaxation
SUMMARY OF PHYSICAL DISORDERS AND
• Transcendental meditation (TM)
HEALTH PSYCHOLOGY

Comprehensive Stress Reduction and Pain

Psychological Factors Play a Major Role in
Management Programs
Physical Disorders
• Own stress- management program
o Behavioral medicine and health psychology
• More effective and durable than individual
interventions alone
Psychological and Social Factors: Their Role in
Illness and Disease
Modifying Behaviors to Promote Health
o Stress, immune function, and disease
o Such influences interact with other
Life-Style Practices - Core of Many Health psychosocial factors
Problems
• Behavioral risk factors are also influenced by
Risk for Physical Illness
psychosocial factors
o Related to long-standing patterns of behavior
• Prevention and intervention programs target & life-style factors
behavioral risks

Psychosocial Treatments
Types of Life-Style Behaviors
o Aim to prevent and/or treat physical
• Injury and injury prevention: Repeated disorders
warnings are not enough
o Comprehensive individual or community
• AIDS: Highly preventable by changing programs are best
behaviors
 Sexual Dysfunction
- difficulty to function adequately while having sex
Two disorders (sex specific)
Heterosexual Behavior: Sex with opposite sex
Homosexual Behavior: Sex with same sex
Gender Difference
- Men and women tend toward a
monogamous
(One Partner) pattern of relationship, gender
differences in sexual behavior do exist and some of
them are quite dramatic.
- Reflected in the incidence of casual sex,
attitudes toward casual premarital sex and
pornography use, with men expressing more
permissive attitudes and behaviors than women.
- Four themes of gender differences in human
sexuality:
1. Men show more sexual desire and arousal than
women.
2. Women emphasize committed relationships as a
context for sex more than me
3. Men’s sexual self-concept, unlike women’s is
characterized partly by power, independence, and
aggression
4. Women’s sexual beliefs are more: plastic” in that
they are more easily shaped by cultural, social and
situational factors.
1. Premature (early) ejaculation- males
2. Genito-pelvic pain/penetration disorder-
females
SD can be:
✓ Lifelong - present during entire sexual history
✓ Acquired - interrupts normal sexual pattern
✓ Generalized - present in every encounter
Situational - present only with a certain
partner or at certain times
Four Phases of sexual response cycle
1. Desire Phase - refers to sexual interest/desire
associated with arousing fantasies or thoughts
2. Excitement Phase - experience of pleasure
and increase blood flow to the genitalia
3. Orgasm phase - sexual pleasure peaks in
ways occurring a general muscle tension
4. Resolution phase - relaxation and sense of
wellbeing followed an orgasm
Types of Sexual Dysfunction
Male Hypoactive Sexual Desire Disorder
A. Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual
activity. The judgment of deficiency is made by the clinician, taking into account factors that affect sexual
functioning, such as age and general and sociocultural contexts of the individual’s life.

Female Sexual Interest/Arousal Disorder

A. Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least three of the following:
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 generalized, 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 no genital sensations during sexual activity in almost all or all
(approximately 75%-100%) sexual encounters (in identified situational contexts or, if generalized, in
all contexts).

Erectile Disorder
A. At least one of the three following symptoms must be experienced on almost all or all (approximately 75%-
100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts):
1. Marked difficulty in obtaining an erection during sexual activity.
2. Marked difficulty in maintaining an erection until the completion of sexual activity.
3. Marked decrease in erectile rigidity.
• Female sexual interest/arousal disorder recurring inability to maintain adequate lubrication
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 generalized, in all contexts):
1. Marked delay in, marked infrequency of, or absence of orgasm.
2. Markedly reduced intensity of orgasmic sensations.
Premature (Early) Ejaculation
A. A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within
approximately 1 minute following vaginal penetration and before the individual wishes it. (Approximately
75%-100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts).
Delayed Ejaculation
A. Either of the following symptoms must be experienced on almost all or all occasions (Approximately 75%-
100%) of partnered sexual activity (in identified situational contexts or, if generalized, in all contexts), and
without the individual desiring delay:
1. Marked delay in ejaculation.
2. Marked infrequency or absence of ejaculation.

Sexual Pain Disorder

Genito-Pelvic pain/Penetration Disorder - marked pain, anxiety, and tension associated with intercourse for
which there is no medical cause
Vaginismus - muscle spasm in the front of the vagina that prevent the intercourse
- pelvic muscles in the outer third of the vagina undergo involuntary spasms when intercourse is attempted
Assessing Sexual Behavior
1. Interview- supported by numerous
questionnaires because patients may provide
more information on paper than in verbal
interview
2. Thorough medical evaluation- to rule out
variety of medical conditions that can
contribute to sexual problems
3. Psychophysiological assessment- to directly
measure the physiological aspects of sexual
arousal.
Vaginal photoplethysmograph- smaller
than a tampon, inserted by the woman into her
vagina.
Causes:
Biological predisposition and psychological factors
a. Neurological and other NS problems
b. Vascular Disease
c. Chronic illness
d. Prescription medication
e. Drug abuse, and alcohol
f. Distraction
g. Underestimates arousal
h. Negative thought processes
i. Erotophobia - sexuality can be negative and
somewhat threatening and the responses they
develop reflect this belief
j. Negative experiences, such as rape
k. Deterioration of relationship
Treatment:
1. Education- ignorance of the most basic
aspects of the sexual response cycle and
intercourse often leads to long lasting
dysfunction
2. Psychosocial treatments: SEX THERAPY
providing a brief, and reasonably
successful therapeutic program for sexual
dysfunction.
- Conducted over a 2-weeks period
- Primary goal is to eliminate psychologically
based performance
3. Sensate and nondemand pleasuring -
couples are instructed to refrain from
intercourse or genital caressing and simply
explore and enjoy each other’s body through
touching, kissing, hugging, massaging or
similar kinds of behavior.
4. Squeeze technique- penis is stimulating
usually by the partner, to nearly full erection.
Partners firmly squeeze the penis near the
top where the head of penis joins the shaft,
which quickly reduces arousal. Steps are
repeated until eventually penis is briefly
inserted in the vagina without thrusting.
5. Explicit training in masturbatory
procedure- Lifelong female orgasmic
disorder
6. To treat vaginismus and pain related to
penetration in genital pelvic pain/
penetration disorder, the woman and
eventually the partner gradually insert
increasingly larger dilators at the woman’s
pace. Then after that the woman gradually
insert man’s penis. These exercises are
carried out in the context of genital and
nongenital pleasuring so as to retain arousal.
7. MEDICAL:
a. Viagra, Levitra, and Cialis
b. Four most popular procedures:
A. Oral medication,
B. Injection of vasoactive substances
directly into the penis,
C. surgery and
D. Vacuum device therapy
8. Testosterone- treat erect dysfunction
9. Papaverine or prostaglandin- vasodilating
drugs that inject directly into the penis when
they want to have sexual intercourse.
10. Medical Urethral System for Erection
(MUSE) - a soft capsule that contains
papaverine inserted directly into the urethra,
somewhat painful, is less effective than
injections and remain awkward and artificial
enough to preclude wide acceptance
11. Penile Protheses- implants, good enough to
approximate normal sexual functioning.
12. Vacuum Device Therapy- creating a vacuum
in a cylinder and placed over the penis it
draws blood into the penos, which is then
trapped by a specially designed ring placed
around the base of the penis.
 Paraphilic Disorder
- Sexual arousal occurs almost exclusively
in the context of inappropriate objects or
individuals
Types of Paraphilic Disorder
1. Fetishistic Disorder
- sexual attraction to nonliving objects (1) an
inanimate object or (2) a source of specific tactile
stimulation such as rubber, particularly clothing
made out of rubber.
- Over a period of at least 6 months, recurrent and
intense sexual arousal from either the use of
nonliving objects or a highly specific focus on
nongenital body part(s), as manifested by
fantasies, urges, or behaviors.
2) Voyeuristic Disorder
- sexual arousal achieved by viewing unsuspecting
person undressing or naked
- 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 behaviors.
- The individual has acted on these sexual urges
with a nonconsenting person, or the sexual urges
or fantasies cause clinically significant distress or
impairment in social, occupational, or other
important areas of functioning.
3) Exhibitionistic Disorder
- sexual gratification from exposing one’s genitals
to unsuspecting strangers
- 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 behaviors.
4) Transvestic Disorder
- sexual arousal from Cross dressing
- A. Over a period of at least 6 months, recurrent
and intense sexual arousal from crossdressing, as
manifested by fantasies, urges, or behaviors.
Autogynephilia - arousal by thought/ images of
self as a FEMALE
5) Frotteuristic Disorder
- grope in public places
- at least 6 months, recurrent and intense sexual
arousal from touching or rubbing against a
nonconsenting person, as manifested by fantasies,
urges, or behaviors.
6) Sexual Sadism Disorder
- sexual arousal associated with inflicting pain or
humiliation
- at least 6 months, recurrent and intense sexual
arousal from the physical or psychological
suffering of another person, as manifested by
fantasies, urges, or behaviors.
7) Sexual Masochism Disorder
- sexual arousal associated with experiencing pain
or humiliation
- 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 behaviors.
8) Pedophilic Disorder
- strong sexual attraction to children
- at least 6 months, recurrent, intense sexually
arousing fantasies, sexual urges, or behaviors
involving sexual activity with a prepubescent child
or children (generally age 13 years or younger).
- The individual has acted on these sexual urges, or
the sexual urges or fantasies cause marked distress
or interpersonal difficulty.
- The individual is at least age 16 years and at
least 5 years older than the child or children in
Criterion A.
9) Incest - sexual attraction to family members
Causes:
a. Preexisting deficiencies
b. Treatment received from adults during
childhood
c. Early sexual fantasies reinforced by
masturbation
d. Extremely strong sex drive combined with
uncontrollable thought processes
Treatment:
1. Covert sensitization - repeated mental
reviewing of aversive consequences to
establish negative associations with
behaviors
2. Relapse intervention - therapeutic
preparation for coping with future situation
3. Orgasmic reconditioning - pairing
appropriate stimuli with masturbation to
create positive arousal patterns
4. Medical - drug that reduce testosterone to
suppress sexual desire; fantasies and
arousal return when drugs are stopped