 

Jan Patrick Gutierrez, RP, RPm

 Facebook Email: janpatrickgutierrez@[Link]
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 Contact number: 0923-5270-824
1. "I've got to get out of here right now, or I may not make it!"
This statement is most likely to be said by someone
experiencing a(n)
A. panic attack.
B. future oriented mood state.
C. fear reaction.
D. parasympathetic "surge."
E. panic disorder
2. Mrs. Galvez has an anxiety disorder in which she has
occasional panic attacks when visiting a cemetery. This type of
panic attack is referred to as _______________.
A. uncued
B. a normal response to fear
C. cued
D. situationally premeditated
 Anxiety is defined as apprehension over an anticipated
problem.
 Fear is defined as a reaction to immediate danger.

 Anxiety Disorder – A group of disorder that share high or

frequent anxiety. Except for generalized anxiety disorder, the
anxiety disorders involve tendencies to experience
unusually intense fear.
o Symptoms must interfere with important areas of functioning or
cause marked distress.
o Symptoms are not caused by a drug or a medical condition.
o The fears and anxieties are distinct from the symptoms of another
anxiety disorder.
 Panic - after the Greek god Pan who terrified travelers with
bloodcurdling screams.
 panic attack is defined as an abrupt experience of intense
fear or acute discomfort, accompanied by physical
symptoms that usually include heart palpitations, chest
pain, shortness of breath, and, possibly, dizziness.
A discrete period of intense fear or discomfort, in which four (or more) of the
following symptoms developed abruptly and reached a peak within 10
minutes:
 (1) palpitations, pounding  (8) feeling dizzy, unsteady,
heart. or accelerated heart lightheaded, or faint
rate  (9) dereali zation (feelings of
 (2) sweating unreality) or depersonalization
 (3) trembling or shaking (being detached from oneself)
 (4) sensations of shortness of  (10) fear of losing control or
breath or smothering going crazy
 (5) feeling of choking  (11) fear of dying
 (6) chest pain or discomfort  (12) paresthesias (numbness
 (7) nausea or abdominal or tingling sensations)
distress  (13) chills or hot flushes
 Situationally bound (cued) panic attack – The panic is
bound to a specific stimulus. Ex. If you know you are afraid
of high places or of driving over long bridges, you might
have a panic attack in these situations but not anywhere
else.
 Unexpected (uncued) panic attacks – No stimulus can
determine the panic attack. Ex. if you don’t have a clue
when or where the next attack will occur.
 Situationally predisposed panic attack – Between cued and
uncued types. You are more likely to, but will not inevitably,
have an attack where you have had one before
 For example, a person whose panic attacks begin with
hyperventilation is asked to breathe rapidly for 3 minutes,
or someone whose panic attacks are associated with
dizziness might be requested to spin in a chair for several
minutes.
 When sensations such as dizziness, dry mouth,
lightheadedness, increased heart rate, and other signs of
panic begin, the person experiences them under safe
conditions; in addition, the person practices coping tactics
for dealing with somatic symptoms (e.g., breathing from the
diaphragm to avoid hyperventilation
 The person’s ability to create these physical sensations
and then cope with them makes them seem more
predictable and less frightening
 Agoraphobia (from the Greek agora, meaning
“marketplace”) is defined by anxiety about situations in
which it would be embarrassing or difficult to escape if
anxiety symptoms occurred.
 Commonly feared situations include crowds and crowded
places such as grocery stores, malls, and churches.
Sometimes the situations are those that are difficult to
escape from, such as trains, bridges, or long road trips.
 Susto - a fright disorder in Latin America that is
characterized by sweating, increased heart rate, and
insomnia but not by reports of anxiety or fear, even though
a severe fright is the cause.
 Ataque de nervios – An anxiety-related, culturally defined
syndrome prominent among Hispanic Americans,
particularly those from the Caribbean
 Kyol goeu – ‘wind overload’ – among Khmer (Cambodian)
panic attacks are associated with orthostatic dizziness
(dizziness from standing up quickly) and “sore neck.”
3. Maxima joins a parade on a bright sunny day when,
unexpectedly, she had an sudden attack of intense fear that
totally surprised her. This is what type of panic attack?
A. Situationally predisposed
B. Situationally bound
C. Cued
D. Uncued
4. Suppose you are a psychologist, which of the part of the
brain you would not expect to be associated with anxiety?
A. Hippocampus
B. Amygdala
C. Prefrontal cortex
D. Hypothalamus
 Biological
o Behavioral Inhibition System
o Fight or Flight System
o Fear Circuit of the Brain
o Imbalance of Neurotransmitters
 Psychological
o Behavioral
o Cognitive
o Personality Type
 Social – stressful life events
 One part of the fear circuit that seems particularly activated
among people with anxiety disorders is the amygdala.
 The medial prefrontal cortex appears to be important in
helping to regulate amygdala activity—it is involved in
extinguishing fears as well as using emotion regulation
strategies to control emotions.
 Researchers have found that people who meet diagnostic
criteria for anxiety disorders display less activity in the
medial prefrontal cortex.
 Persons with anxiety disorders has low levels of GABA and
Serotonin, while Norepinephrine is in higher than normal
levels.
 Mowrer’s two-factor model
 1. Through classical
conditioning, a person learns
to fear a neutral stimulus (the
CS) that is paired with an
intrinsically aversive stimulus
(the UCS).
 2. Through operant
conditioning, a person gains
relief by avoiding the CS. This
avoidant response is
maintained because it is
reinforcing (it reduces fear).
 Behavioral inhibition system (BIS) - activated by signals
from the brain stem of unexpected events, such as major
changes in body functioning that might signal danger.
 The BIS is responsible for our ability to stop or slow down
when we are faced with impending punishment, nonreward,
or novel situations; activation of this system leads to anxiety
and frustration.
 fight/flight system (FFS) - When stimulated in animals, this
circuit produces an immediate alarm-and-escape response
that looks very much like panic in humans.
 FFS is activated partly by deficiencies in serotonin.
1. Sustained Negative Beliefs about the Future
 People with anxiety disorders often report believing that
bad things are likely to happen.
 To protect themselves against feared consequences, they
engage in safety behaviors.
 They come to believe that only their safety behaviors have
kept them alive. Hence, safety behaviors allow a person to
maintain overly negative cognitions.
2. Perceived Control
 A lack of control over the environment can promote anxiety.

3. Attention to Threat
 People with anxiety disorders have been found to pay more
attention to negative cues in their environment than do
people without anxiety disorders
5. Research suggests that people with GAD worry
A. with images but try to avoid the associated negative affect.
B. without images but try to avoid the associated negative
affect.
C. with images to magnify the associated negative affect.
D. without images to magnify the associated negative affect.
 People with GAD are
persistently worried, often
about minor things.
 Worry - refers to the cognitive
tendency to chew on a
problem and to be unable to
let go of it.
 The worries of people with
GAD are similar in focus to
those of most people: they
worry about relationships,
health, finances, and daily
hassles but they worry more
about these issues, and
these persistent worries
interfere with daily life.
 Elders (45 and above)
 Women (2/3)
 Men in South Africa
 worry is actually reinforcing
because it distracts people
from more powerful negative
emotions and images.
 worry does not involve
powerful visual images and
does not produce the
physiological changes that
usually accompany emotion
 many people with GAD report
past traumas involving death,
injury, or illnes, which they
might have been avoiding.
 Statistics
o 3.1% (year)
o 5.7% (lifetime)
o Similar rates worldwide
o Insidious onset
• Early adulthood
o Chronic course
 Inherited tendency to become anxious
 “Neuroticism”
 “Autonomic restrictors” - less responsiveness on most
physiological measures, such as heart rate, blood pressure,
skin conductance, and respiration rate than do individuals
with other anxiety disorders.
 Threat sensitivity
 Left Frontal lobe activation
6. A teenage girl had recently been having panic attacks while
shopping at the mall. 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.
7. People with a psychological vulnerability to panic attacks
tend to ________ normal physical sensations.
A. catastrophize
B. minimize
C. fake
D. ignore
 Neurobiological Factors
 Hyperactive Locus Ceruleus
o The locus ceruleus is the major source of the neurotransmitter
norepinephrine in the brain, and norepinephrine plays a major role
in triggering sympathetic nervous system activity.
o In humans, drugs that increase activity in the locus ceruleus can
trigger panic attacks, and drugs that decrease activity in the locus
ceruleus, and some antidepressants, decrease the risk of panic
attacks.
 Behavioral Factors: Classical Conditioning
 Classical conditioning of panic attacks in response to bodily
sensations has been called interoceptive conditioning: a
person experiences somatic signs of anxiety, which are
followed by the person’s first panic attack; panic attacks
then become a conditioned response to the somatic
changes
Cognitive Factors in Panic Disorder
 Catastrophic misinterpretations of somatic changes
o According to this model, panic attacks develop when a person
interprets bodily sensations as signs of impending doom
o The person may interpret the sensation of an increase in heart rate
as a sign of an impending heart attack. Obviously, such thoughts
will increase the person’s anxiety, which produces more physical
sensations, creating a vicious circle.
8. Which is most accurate rationale behind panic control
treatment therapy?
A. PCT allows the patient to develop alternative attitudes about
the feared situation.
B. PCT convinces the patient that panic attacks are not real.
C. PCT forces the panic attacks into the unconscious.
D. PCT helps patients identify what makes them panic.
 A psychodynamic treatment for panic disorder has been
developed. The treatment involves 24 sessions focused on
identifying the emotions and meanings surrounding panic
attacks.
 Therapists help clients gain insight into areas believed to
relate to the panic attacks, such as issues involving
separation, anger, and autonomy.
 Panic control therapy (PCT) is based on the tendency of
people with panic disorder to overreact to the bodily
sensations discussed.
 In PCT, the therapist uses exposure techniques—that is, he
or she persuades the client to deliberately elicit the
sensations associated with panic.
 For example, a person whose panic attacks begin with
hyperventilation is asked to breathe rapidly for 3 minutes,
or someone whose panic attacks are associated with
dizziness might be requested to spin in a chair for several
minutes.
 When sensations such as dizziness, dry mouth,
lightheadedness, increased heart rate, and other signs of
panic begin, the person experiences them under safe
conditions; in addition, the person practices coping tactics
for dealing with somatic symptoms (e.g., breathing from the
diaphragm to avoid hyperventilation
 The person’s ability to create these physical sensations
and then cope with them makes them seem more
predictable and less frightening
9. A friend stated that when she went to a clinic, she had to
spend several 30- to 60-second sessions shaking her head
from side to side, spinning in a chair, tensing all her muscles,
hyperventilating, or breathing through a narrow straw. She is
surprised that you correctly guessed that she is receiving
treatment for
A. specific phobia.
B. social phobia.
C. panic disorder.
D. posttraumatic stress disorder.
 Clinical description
o Extreme and irrational fear of a specific object or situation
o Significant impairment
o Recognizes fears as unreasonable
o Avoidance
 Blood-injection-injury phobia
o Decreased heart rate and blood pressure
o Fainting
o Inherited vasovagal response
o Onset = ~ 9
 Situational phobia
o Fear of specific situations
• Transportation, small places
o No uncued panic attacks
o Onset = early to mid 20s
 Natural environment phobia
o Heights, storms, water
o May cluster together
o Associated with real dangers
o Onset = ~7
 Animal phobia
o Dogs, snakes, mice, insects
o May be associated with real dangers
o Onset = ~7
Object of Fear Phobia
Anything new Neophobia
Asymmetrical things Asymmetriphobia
Books Bibliophobia
Children Pedophobia
Dancing Chorophobia
Englishness Anglophobia
Garlic Alliumphobia
Peanut butter sticking to the roof Arachibutyrophobia
of the mouth
Technology Technophobia
Mice Musophobia
Pseudoscientific Terms Hellenophobia
Object of Fear Phobia
Dark Nyctophobia
High places Acrophobia
Open places Algophobia
Spiders Aracnophobia
Thunder, lightning, storms Astraphobia
Cold Cheimophobia
Closed spaces Claustrophobia
Drinking Dipsophobia
Home Ecophobia/Oikophobia
Electricity Electrophobia
Blushing Erythrophobia
Marriage Gamophobia
Blood Hematophobia
Thoughts Ideaphobia
Crowd Ochlophobia
Object of Fear Phobia
Disease Pathophobia
Phobia Phobophobia
Eating Sitophobia
Buried Alive Taphophobia
Heat Thermophobia
Strangers Xenophobia
Dirt Rypophobia
Clowns Coulrophobia
Erotic Love Erotophobia
Good News Euphobia
13 Triskaidekaphobia
Rejection Kakorrhaphiophobia
 Statistics
o 12.5% (life); 8.7% (year)
o Female : Male = 4:1
o Chronic course
o Onset = ~ 7
1. Behavioral Factors: Conditioning of Specific Phobias
 Behavioral theory suggests that phobias could be
conditioned by direct trauma, modeling, or verbal
instruction.
 Phobias are seen as a conditioned response that develops
after a threatening experience and is sustained by avoidant
behavior.
 Watson and his graduate
student Rosalie Rayner
published a case report in
1920 in which they
demonstrated creating an
intense fear of a rat (a
phobia) in an infant, Little
Albert, using classical
conditioning. Little Albert
was initially unafraid of the
rat, but after repeatedly
seeing the rat while a very
loud noise was made, he
began to cry when he saw
the rat.
2. Prepared Learning
 Our fear circuit may have been “prepared” by evolution to
learn fear of certain stimuli.
 As researchers have tested this model, some have
discovered that people can be initially conditioned to fear
many different types of stimuli.
3. Development of anxiety about the possibility that the event
will happen again.
4. Social and cultural factors
 Social and cultural factors are strong determinants of who
develops and reports a specific phobia. In most societies, it
is almost unacceptable for males to express fears and
phobias. Thus, the overwhelming majority of reported
specific phobias occur in women (Arrindell et al., 2003b;
LeBeau et al., 2010).
 SAD is a persistent, unrealistically intense fear of social
situations that might involve being scrutinized by, or even
just exposed to, unfamiliar people.
 Although this disorder is labeled social phobia in the DSM-
IV-TR, the term social anxiety disorder in the DSM-5
because the problems caused by it tend to be much more
pervasive and to interfere much more with normal activities
than the problems caused by other phobias.
 People with social anxiety disorder usually try to avoid
situations in which they might be evaluated, show signs of
anxiety, or behave in embarrassing ways.
 The most common fears include public speaking, speaking
up in meetings or classes, meeting new people, and talking
to people in authority (Ruscio et al., 2008). Although this
may sound like shyness, people with social anxiety disorder
avoid more social situations, feel more discomfort socially,
and experience these symptoms for longer periods of their
life than people who are shy (Turner, Beidel, & Townsley,
1990).
 Statistics
o 12.1% (life); 6.8% (year)
o Female : Male = 1:1
o Onset = adolescence
• Peak age of 13
o Young (18–29 years), undereducated, single, and of low
socioeconomic class, 13.6%
o Over 60, 6.6%
 Japan—taijin kyofusho
o Fear of offending others
o Symptoms
o Female : Male = 2:3
Behavioral Factors: Conditioning of Social Anxiety Disorder
 Behavioral perspectives on the causes of social anxiety
disorder are similar to those on specific phobias, insofar as
they are based on a two-factor conditioning model.
 A person could have a negative social experience (directly,
through modeling, or through verbal instruction) and
become classically conditioned to fear similar situations,
which the person then avoids. Through operant
conditioning, this avoidance behavior is maintained
because it reduces the fear the person experiences.
Cognitive Factors:
 Too Much Focus on Negative Self-Evaluations
o People with social anxiety disorders appear to have unrealistically
negative beliefs about the consequences of their social behaviors.
o They attend more to how they are doing in social situations and their
own internal sensations than other people do.

 Too much attention to internal cues rather

than external (social) cues.
o people with social anxiety disorder appear to spend more time than
other people do monitoring for signs of their own anxiety.
10. Researches identified a part of the brain damaged among
sufferers of PTSD. It appears that ___________ is related to
PTSD.
A. the hippocampus, which disrupts sleep.
B. the amygdala, which disrupts learning and memory.
C. the hippocampus, which disrupts learning and memory.
D. the amygdala, which disrupts sleep.
Natural Disasters
 Traumatic Events
Abuse
 Traumatic Events
Combat -/ War-
related traumas
 Traumatic Events
Common
Traumatic Events
 Clinical description
o Trauma exposure
o Extreme fear, helplessness, or horror
o Continued re-experiencing
• (e.g., memories, nightmares, flashbacks)
o Avoidance
o Emotional numbing
o Reckless or self-destructive behavior
o Interpersonal problems
o Dysfunction
o One month
1. Intrusively reexperiencing the traumatic event. The person
may have repetitive memories or nightmares of the event.
 Ex. helicopter sounds that remind a veteran of the
battlefield; darkness that reminds a woman of a rape
2. Avoidance of stimuli associated with the event. Some may
try to avoid all reminders of the event.
 For example, a Turkish earthquake survivor stopped
sleeping indoors after he was buried alive at night.
 3. Other signs of mood and cognitive change after the
trauma. These can include inability to remember important
aspects of the event, persistently negative cognition,
blaming self or others for the event, pervasive negative
emotions, lack of interest or involvement in significant
activities, feeling detached from others, or inability to
experience positive emotions.
 4. Symptoms of increased arousal and reactivity. These
symptoms include irritable or aggressive behavior, reckless
or self-destructive behavior, difficulty falling asleep or
staying asleep, difficulty concentrating, hypervigilance, and
an exaggerated startle response.
 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 posttraumatic stress disorder, and in
addition, in response to the stressor, the individual
experiences persistent or recurrent symptoms of
depersonalization or derealization.
 Statistics
o 6.8% (life); 3.5% (year)
o Prevalence varies
• Type of trauma
• Proximity

 Most common traumas

o Sexual assault 2.4 to 3.5 increase
o Accidents
o Combat
 Social Factors
 Psychological Factors
 Biological Factors
The nature of a traumatic event plays an important role in
determining people's likelihood of developing PTSD in
response to the event. The response of family members
and friends to a trauma survivor is a critical influence on
the survivor's vulnerability to PTSD.

 Severity, duration, and proximity of trauma

 Social Support
 People who experience more severe and long-lasting
traumas and are directly affected by traumatic event are
more prone to develop PTSD if they were on the front lines
of the war for an extended period of time or if they were
taken prisoner of war than if they were not.

War veterans who were on the front lines for months at a time more prone
to PTSD.
 People who have others who will support them emotionally
through recovery from their traumas, allowing them to
discuss their feelings and memories of the trauma, recover
more quickly than those who do not.

Women whose husbands commit suicide are less prone to PTSD if they can
discuss it with friends.
People facing the same circumstance around a
trauma vary greatly in their risk for PTSD. At least
three psychological factors have been identified to
explain differences between people in response to
trauma.
 Shattered Assumptions

 Pre-existing Distress

 Coping styles
 Personal Invulnerability
 The world is meaningful and just and that things happen for
a good reason
 People who are good, who “play by the rules,” do not
experience bad things.
 Most people believe that bad things happen to other people
and that they are relatively invulnerable to trauma. When
trauma happens, people lose their illusion of invulnerability.
It makes them chronically feeling vulnerable, hypervigilant,
and shows signs of chronic anxiety.
 This assumption can be shattered by events that seem
senseless, unjust, or perhaps evil, such as terrorist bombing
of a day care center.
 Trauma victims often say that they have lived a good life,
have been good people, and thus can't understand how
trauma happened to them.
 People who are already experiencing increased symptoms
of anxiety or depression are more likely to develop PTSD
than those who were not anxious or depressed.
 The style of coping with stressful events and with their own
symptoms of distress may also influence their vulnerability
to PTSD.

 Self Destructive/ Avoidant coping strategies

 Dissociation

 Making Sense
 People who engage in drinking or self isolation as coping
styles are more likely to experience PTSD.
 People who dissociate following a trauma may feel they are
in another place or in someone else's body, watching the
trauma and its aftermath unfold. People who dissociate
shortly after a trauma are at increased risk to develop
PTSD.
 Psychodynamic and Existential Theorist argued that
searching for meaning in trauma is a healthy process, which
can lead people to gain a sense of mastery over their
traumas and to integrate their traumas into their
understanding of themselves. People make sense through
their religious or philosophical beliefs.
Physiological hyperreactivity
Genetics
 The difference occurs in activity levels in the parts of the
brain involved in the regulation of emotion and the fight or
flight response.
 Amygdala
 Hippocampus
 Cortisol
 Exaggerated Physiological Response to Stress
 The amygdala appears to be hyperreactive to trauma
related stimuli in PTSD sufferers. Increased blood flow in
this area can be seen while imagining traumatic experience.
 Shrinkage in the hippocampus
among PTSD patients was shown in
some studies. The hippocampus is
involved in the memory. Damage to
it may result in some of the
memory problems that PTSD
patients report.
 Hippocampus plays a role in the
extinction of responses, so damage
could interfere with an individual's
ability to overcome fearful
response reminiscent of the
trauma.
 Hyperactivity of HPA Axis
 Resting levels of cortisol among PTSD sufferers tend to be
lower than among people without PTSD. Cortisol shuts
down sympathetic nervous system activity after stress, so
the lower the levels of cortisol may prolong the activity of
the sympathetic nervous system following stress. As a
result, they may easily develop a conditioned fear of stimuli
associated with trauma and subsequently develop PTSD.
 One study of about 4000 twins who had served in the
Vietnam War found that, if one twin developed PTSD, the
other twin was more likely to develop PTSD if he was an
identical twin than if he was a fraternal twin.
11. Which type of compulsion has the highest prevalence
rate?
A. Symmetry
B. Cleaning and contamination
C. Hoarding
D. Forbidden thoughts or actions
12. Tony 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 really happened
to his brother, it would be his fault. For no explainable reason, Tony
starts mentally counting by odd numbers each time he walks past
his brother's room and discovers that this activity makes him less
anxious. Tony's behavior can be described as
A. a phobia of going into his brother's room because he is afraid his
hatred will actually hurt him.
B. a mental compulsion developed to neutralize his bad thoughts.
C. an attempt to be better in math than his brother to gain parental
acceptance.
D. a compulsive ritual designed to make him like his brother more.
 Obsessions are  Compulsions are
intrusive and recurring repetitive, clearly
thoughts, images, or excessive behaviors or
impulses that are mental acts that the
persistent and person feels driven to
uncontrollable and that perform to reduce the
usually appear anxiety caused by
irrational to the person obsessive thoughts or
experiencing them. to prevent some
o 60% have multiple calamity from
obsessions occurring.
• Need for symmetry o Four major categories
• Forbidden thoughts or • Checking
actions
• Ordering
• Cleaning and
contamination • Arranging
• Hording • Washing/cleaning
 With good or fair insight: the individual recognizes that
obsessive-compulsive disorder beliefs are definitely or
probably not true or that they may or may not be true.
 With poor insight: The individual thinks
obsessivecompulsive disorder beliefs are probably true.
 With absent insight/delusional: the person is completely
convinced that obsessive-compulsive disorder beliefs are
true.
 Tic-related: The individual has a current or past history of a
tic disorder.
 Statistics
o 1.6% to 2.3%(life); 1% (year)
o Female = Male
o Chronic
o Onset = childhood to 30s medial 19
13. Which of the following is an example of the treatment technique for
OCD called exposure and response prevention (ERP)?
A. Carla has an obsessive fear of contamination that has led to compulsive
hand-washing rituals. Her therapist is treating her by making her touch
dirty laundry but not allowing her to wash for increasingly longer periods of
time afterward.
B. Cora has an obsessive fear of contamination that has led to compulsive
hand-washing rituals. Her therapist is treating her by forcing her to wash
her hands repeatedly, even when she doesn't feel anxious.
C. Kara has religious obsessions. She feels that if she doesn't read biblical
passages every hour of the day, she will do something evil. Her therapist is
treating her by having her attend religious services more frequently so that
good thoughts will replace the bad ones.
D. Carlota has a hoarding compulsion. She becomes anxious whenever she
has to throw something away; she even keeps stuff that she doesn't need
and will never use. Her therapist has arranged for all Callie's junk to be
dumped when she is away from home.
 1. Medications - Use of SSRI
 2. Psychological Treatment
Exposure and response prevention (ERP)
 Meyer developed ERP by tailoring the exposure treatment to
address the compulsive rituals that people with OCD use to
reduce anxiety.
• Exposure – exposure to feared objects
• Response prevention – consciously preventing doing the response to
the feared object.
For OCD
o Exposure – the person touches a dirty dish
o Response Prevention - refrains from washing his or her hands.
For BDD
o Exposure - clients might be asked to interact with people who could be
critical of their looks.
o Response Prevention - clients are asked to avoid the activities they use
to reassure themselves about their appearance, such as looking in
mirrors and other reflective surfaces.
For HD
o Exposure - getting rid of their objects.
o Response Prevention - focuses on preventing the rituals that they
engage in to reduce their anxiety, such as counting or sorting their
possessions.
14. Marika regularly shows up at school with bandages on her
arm. When her friends ask her why she has a new one, she
dodges the question and just says, "oh I got a small cut." She
is regularly seen playing with the bandages, and on day one of
her friends was sure she saw Marika actually picking at her
own skin in te same area of her arm. Which problem may
Marika be challenged by?
A. Excoriation
B. Major depressive disorder
C. Schizophrenia closely related to Hebephrenia
D. Borderline personality disorder
 The urge to pull out one’s own hair from anywhere on the
body, including the scalp, eyebrows, and arms, is referred to
as trichotillomania

 Excoriation (skin picking disorder) is characterized by

repetitive and compulsive picking of the skin, leading to
tissue damage
o Habit reversal training, show best results
15. According to psychological theory, neuroses stem from
A. underlying unconscious conflicts.
B. the clash of conscious and unconscious therapy.
C. dream process.
D. identity concepts.
16. Illness anxiety disorder exists when
A. a person is excessively concerned about being sick, even
when only experiencing minor symptoms.
B. real physical illness is exaggerated to the point where the
patient can only focus on the pain.
C. the patient has an unrealistic fear of contacting germs.
D. the patient is truly ill but does not trust the medical
establishment enough to seek treatment.
17. Panic disorder shares several common characteristics with
both somatic symptom disorder and illness anxiety disorder.
Which of the following is not one of those shared features?
A. Age of onset
B. Running in families
C. Personality characteristics
D. Manner in which anxiety is expressed
18. Although Jill feels fine now and believes that she is
healthy, she still worries endlessly about developing a serious
illness. Most likely Jill would be diagnosed with
A. illness anxiety disorder.
B. delusional disorder, somatic type.
C. somatization disorder.
D. body dysmorphic disorder.
 A preoccupation with fears of
having a serious disease
despite having no significant
somatic symptoms.
 Illness anxiety disorder was formerly known as
“hypochondriasis”
o Less concerned with any specific physical symptom and more
worried about the idea that she was either ill developing an illness
• Reassurances from numerous doctors has little affect
 The diagnostic criteria also stipulate that the belief cannot
have the intensity of a delusion (more appropriately
diagnosed as delusional disorder) and cannot be restricted
to distress about appearance (more appropriately
diagnosed as body dysmorphic disorder).
 Brief hypochondriacal states can occur after major
stresses, most commonly the death or serious illness of
someone important to the patient, or a serious (perhaps
life-threatening) illness that has been resolved but that
leaves the patient temporarily hypochondriacal in its wake.
 Statistics
o 1% to 5%
o 6.7% median rate of medical patients
o Female : Male = 1:1
o Onset at any age
• Peaks: adolescence, middle age, elderly
o Chronic course
 Causes
o Disorder of cognition or perception
• Physical signs and sensations
o Cause is unlikely to be found in isolated biological or psychological
factors
o Familial history of illness and learning
o Three factors that may contribute to etiology
• Stressful life events
• High family disease incidence
• “Benefits” of illness
19. Although both panic disorder patients and persons with somatic
symptom disorder tend to misinterpret bodily sensations, patients
with panic disorder
A. are having real physical sensations, while the sensations of those
with somatic symptom disorder are "all in their heads."
B. tend to fear immediate catastrophe, while those with somatic
symptom disorder tend to fear long-term illness.
C. are having imagined physical sensations, while those with
somatic symptom disorder are experiencing real physical
sensations.
D. tend to ignore the symptoms of their first attacks, while those
with somatic symptom disorder tend to seek immediate medical
treatment following the first indication of pain.
20. A possible link between antisocial personality disorder and
somatic symptom disorder is the lack of_____________.
A. control over their impulses
B. control over aggression
C. support from the society
D. control over the environment
21. Mark injured his back while playing basketball several
years ago. Even though he was already treated and considered
healed by his doctors, he still claims of severe 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 Mark might be diagnosed with
_________________.
A. a conversion disorder
B. a certian type of delusion
C. somatic symptom disorder with predominant pain
D. a neurocogntive disorder
Three core criteria for complex somatic symptom disorder:
(1) one or more somatic symptoms that are distressing or
result in significant disruption in daily life
(2) excessive anxiety, concern, or time and energy devoted to
the somatic concern, and
(3) duration of at least 6 months.
 4 Pain
 2 Gastrointestinal symptom
 1 sexual Symptom
 1 pseudoneurological symptom
Hyperactive
 Anterior insula and the
anterior cingulate - Pain
and uncomfortable
physical sensations,
such as heat, increase
activity in these regions
of the brain.
 Somatosensory cortex –
Heightened activity in
these regions is related
to greater propensity for
somatic symptoms
22. Which of the following would be typical for a patient
suffering from a conversion disorder?
A. Feeling a lump in the throat that interferes with swallowing,
eating, or talking.
B. Ability to see some bright objects when calm but suffering
complete loss of sight during a stressful period or emergency
C. Great concern with the loss of function and belief that it is a
symptom of a potentially fatal disease
D. Ability to identify everything in the visual field even though
the patient reports that she is blind
 Conversion disorders generally have to do with physical
malfunctioning, such as paralysis, blindness, or difficulty
speaking (aphonia), without any physical or organic
pathology
 Functional Neurological Symptom Disorder
 Motor Symptoms o Astasia-abasia
o Involuntary movements o Paralysis
o Tics o Weakness
o Blepharospasm - any abnormal o Aphonia (inability to produce
contraction or twitch of the voice)
eyelid.  Sensory Deficits
o Torticollis - a symptom defined o Anesthesia, especially of
by an abnormal, asymmetrical extremities
head or neck position Midline anesthesia
o Opisthotonos - a condition in o Blindness
which the body is held in an
o Tunnel vision
abnormal position.
o Deafness
o Seizures
o Abnormal gait
o Falling
 Visceral Symptoms
o Psychogenic vomiting
o Pseudocyesis - false pregnancy
o Globus hystericus - the sensation of a lump in the throat causing
difficulty with swallowing when there is no physical cause.
o Swooning or syncope - medical term for fainting or passing out, is
precisely defined as a transient loss of consciousness and postural
tone.
o Urinary retention
o Diarrhea
 Statistics
o Rare
o Prevalence depends on setting
o Female > male
o Onset = adolescence
o Chronic, intermittent course
Primary Gain
 Patients achieve primary gain by keeping internal conflicts
outside their awareness. Symptoms have symbolic value;
they represent an unconscious psychological conflict.
Secondary Gain
 Patients accrue tangible advantages and benefits as a
result of being sick; for example, being excused from
obligations and difficult life situations, receiving support
and assistance that might not otherwise be forthcoming,
and controlling other persons' behavior.
La Belle Indifference
 La belle indifference is a patient's inappropriately careless
attitude toward serious symptoms; that is, the patient
seems to be unconcerned about what appears to be a
major impairment.
Identification
 Patients with conversion disorder may unconsciously model
their symptoms on those of someone important to them.
For example, a parent or a person who has recently died
may serve as a model for conversion disorder.
23. A person who fakes symptoms of pain for a goal is called a
_________, while a person who fakes symptoms of pain to
claim sick role has a ________disorder.
A. malingerer, factitious
B. anti social personality disorder, manchausen syndrome by
proxy
C. sexual sadist, sexual masochism
D. both are symptoms of pseudologia phantastica
24. Barry suddenly finds himself in a forest in which he cannot
identify with no memory of how he got there may have
___________.
A. dissociative amnesia with dissociative fugue
B. neurocognitive disorder, prion disease
C. an episode of brief psychotic disorder
D. dissociative identity disorder
 The essential feature of the dissociative disorders is a
disruption in the usually integrated functions of
consciousness, memory, identity, or perception of the
environment.
 Types of disorders
o Depersonalization Disorder
o Dissociative Amnesia
o Dissociative Fugue
o Dissociative Trance Disorder
o Dissociative Identity Disorder
 Severe alterations or detachments
o Normal perceptual experiences

 Significant impairments
o Identity
o Memory
o Consciousness
 Depersonalization—Distortion in perception of reality
 Derealization —Losing a sense of the external world
 Statistics
o 0.8% to 2.8%
o Female : Male = ~1:1
o High comorbidities
• Anxiety and mood disorders
o Onset = age 16
o Lifelong, chronic course
 Cognitive deficits
o Attention
o Short-term memory
o Spatial reasoning
o Easily distracted

 Decreased emotional response

 Dissociative amnesia
o Generalized type—
Inability to recall
anything, including their
identity
o Localized or selective
type—Failure to recall
specific (usually
traumatic) events
 Dissociative fugue:
o Flight or travel
o Assumption of new identity
o Amok as in “running amok”
 Statistics
o Tends to occur in adulthood
o Rapid onset
o Rapid dissipation
o Females > males
 Causes
o Little is known
o Trauma and life stress

 Treatment
o Resolution without treatment
o Memory returns
 Clinical description
o Amnesia
o Dissociation of personality
o Adopt several new identities or “alters”
• 2 to 100
• Average = 15
• Unique characteristics

 Characteristics
o Alters—The different identities
o Host—The identity that keeps other identities together
o Switch—Quick transition from one personality to another
 Statistics
o 1.5% (year)
o Female : Male = 9:1
o Onset = childhood
o Lifelong, chronic course
25. Which is the least that can explain why dissociative
identity disorder develops?
A. role playing of alters in specified situations
B. childhood experience of trauma
C. unintentional hypnotic suggestions of the therapist
D. substance use that disorients the brain
26. Which of the following statements is FALSE about
dissociative identity disorder?
A. Once established, the disorder lasts a lifetime without
treatment.
B. For prevalence rates, the ratio of females to males is
approximately 9 to 1.
C. The frequency of switching from one personality to another
increases with age.
D. The form that the disorder takes does not differ
substantially over the lifespan.
27. Dissociative identity disorder is most commonly found in
______________.
A. females in general
B. female westerners
C. children
D. the elderly
 Statistics
o 1.5% (year)
o Female : Male = 9:1
o Onset = childhood
o Lifelong, chronic course
 Posttraumatic Model
 The posttraumatic model proposes that some people are
particularly likely to use dissociation to cope with trauma,
and this is seen as a key factor in causing people to develop
alters after trauma

 Sociocognitive Model
 the sociocognitive model, considers DID to be the result of
learning to enact social roles. According to this model, alters
appear in response to suggestions by therapists, exposure
to media reports of DID, or other cultural influences
 Role playing
 A leading advocate of the idea that DID is basically a role-
play suggests that people with histories of trauma may be
particularly likely to have a rich fantasy life, to have had
considerable practice at imagining they are other people,
and to have a deep desire to please others.
 DID Symptoms Can Be Role-Played
 it has been established that people are capable of role
playing the symptoms of DID. One relevant study was
conducted in the 1980s after the trial of a serial murderer
in California known as the Hillside strangler. The accused
murderer, Ken Bianchi, unsuccessfully pled not guilty by
reason of insanity, claiming that the murders had been
committed by an alter, Steve.
28. Jack has experienced recurrent episodes of major
depressive episodes. In the intervals between the episodes,
he does not seem to return to "normal." In fact, during those
periods, he has been diagnosed as suffering from persistent
depressive disorder. Jack's condition is referred to as
_______________.
A. double depression
B. bipolar disorder
C. atypical depression
D. dysfunctional dysthymia
29. Melanie has been mildly depressed for many years. Just
recently, however, her depression deepened, and she was
severely depressed for about three months. Her deep
depression then lifted and she was once again mildly
depressed. Melanie
A. will be easier to treat now that the severe depression is
resolved.
B. will quickly respond to treatment and will recover completely
from her depression.
C. will require a longer and more intense course of treatment
to maintain a normal mood state.
D. will require treatment for the rest of her life.
30. Hanna gave birth to a healthy child four days ago. Now she
is tearful and having mood swings. Fortunately, these
symptoms disappeared relatively quickly. Hanna was probably
suffering from _______________.
A. major depressive disorder with peripartum onset
B. baby blues. Her condition does not meet a diagnostic
criteria
C. adjustment disorder, depressed mood type
D. major depressive episode with seasonal onset
 occur in 50% to 80% of women between 1 and 5 days after
delivery.
 mothers may be tearful and have some temporary mood
swings, but these are normal responses to the stresses of
childbirth and disappear quickly
 Adjustment Disorder is an abnormal and excessive reaction
to an identifiable life stressor. The reaction is more severe
than would normally be expected, and can result in
significant impairment in social, occupational or academic
functioning.

Note: The disorder is time-limited, usually beginning within 3 months of the

stressful event, and symptoms lessen within 6 months upon removal of the
stressor or when new adaptation occurs.
A. Depressed Mood – tearfulness, or feelings of hopelessness
B. Anxiety – nervousness, worry or jitteriness
C. Mixed anxiety and depressed mood – combination of A and
B
D. Disturbance of conduct – violates rights of others or of
major age appropriate societal norms and rules
E. Mixed disturbance of emotion and conduct – combination
of A, B, and D.
F. Unspecified – maladaptive reactions
31. If a friend of yours stops sleeping and suddenly claims that
he is going to go to law school and medical school
simultaneously so he can change the world, you might suspect
he is __________.
A. delusional, grandiose type individual
B. depressed individual
C. manic individual
D. goal oriented individual
 Mood disorders
o “Depressive disorders”
o “Affective disorders”
o “Depressive neuroses”
o Gross deviations in mood
• Depression
• Mania
 Disorders, such as depressive disorders or mania, in which
there are disabling disturbances in emotion.

 Mood – Long and sustained feeling tone.

 Emotion – A psychological and physiological reaction to a
stimulus
 Affect – An outward manifestation of emotion.
 Major Depressive Episode
 Manic Episode
 Mixed Episode
 Hypomanic Episode
 Majordepressive
episode
o Extreme depression
o 2 weeks
o Cognitive symptoms
o Physical dysfunction
o Anhedonia
o Duration—4 to 9
months, untreated
 Manic episode
o Exaggerated elation, joy,
euphoria
o 1 week, or less
o Cognitive symptoms
o Duration—3 to 4
months, untreated

 Hypomanic episode
Mixed Episode
 Presence of Manic Episode and Major Depressive Episode
nearly every day during at least a 1–week period.

Hypomanic Episode
 4 days symptoms similar to manic episode but not does not
require hospitalization
 Unipolar disorders
o Depression or mania alone
o Typically depression

 Bipolar disorders
o Depression and mania
o Dysphoric manic episode
o Mixed manic episode
 Major depressive
disorder, single episode
o No mania/hypomania
o Single episode
• Rare

 Major depressive
disorder, recurrent
o 4 – 7 episodes (lifetime)
o Duration—4 to 5 months
o Milder symptoms
o 2+ years
o Chronic
o Persistent
 Double Depression
o Major depressive
episodes and dysthymic
disorder
o Dysthymia first
o Severe psychopathology
o Poor course
o Psychotic features o Atypical features
• Hallucinations • Oversleeping and overeating

• Delusions o Catatonic features

• Catalepsy
o Anxious distress
o Peripartum onset
• Comorbid disorders
• 13 -19% meet criteria for
or anxiety symptoms depression
o Mixed features o Seasonal pattern
• At least 3 symptoms • Seasonal affective disorder
of mania (SAD)
• 2.7% of population
o Melancholic
• Melatonin Phototherapy
• Severe somatic
• CBT
symptoms
 Onset and duration
o Onset average 30 years old for depression
• 5-12 years 5%
• 13-17 years 19%
• 18-23 years 24%
• 24-30 years 16%
o Duration 2 weeks to several years for depression
o Early onset has poor prognosis in dysthymic disorder
o Dysthymic disorder may last 20 to 30 years
32. Gelo, 26 years old accountant, is seen as an extremely active,
high spirited, competitive yet moody individual. He works with two
companies all at the same time, both at regaular shift, one at night
another in the morning. He has kept this routine for 3 years and the
fact that he performs well in both company by never missing his
responsibilities, both companies kept him as an employee, though
this practice is not allowed. If you are the psychologist, what might
be the diagnosis to the individual?
A. No diagnosis can be made
B. Obsessive Compulsive Personality Disorder
C. Cyclothimia
D. Bipolar II Disorder
 Bipolar I  Bipolar II
o Alternating major o Alternating major
depressive and manic depressive and
episodes hypomanic episodes

o Single manic episode

o Recurrent
• Symptom-free for 2
months
 Alternating manic and
depressive episodes
o Less severe
o Persists longer

 Chronic symptoms
o Adults = symptoms more than 2
years
o Children and adolescents =
symptoms more than 1 year

 Statistics
o Chronic
o Risks for Bipolar I/II
33. Depressive individuals tend to exhibit
A. greater right anterior brain activity.
B. greater left anterior brain activity.
C. more alpha wave activity.
D. less overall brain activity.
34. In 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, is 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.
 Neurobiological Factors
 Social Factors
 Psychological Factors
Genetics
 37 percent for MDD based on the comparison of MZ and DZ.
 93 percent for bipolar disorders.
 Higher heritability for females

Neurotransmitters
 Depression – Low norepinephrine, dopamine, serotonin levels
 Mania – Low serotonin, high norepinephrine and dopamine
levels
o Dopamine plays a major role in the sensitivity of the reward system in
the brain, which is believed to guide pleasure, motivation, and energy
in the context of opportunities to obtain rewards. Some research
suggests that diminished function of the dopamine system could help
explain the deficits in pleasure, motivation, and energy in major
depressive disorder.
o Mania is also linked to hypersensitive dopamine receptors.
o Amygdala - The amygdala
helps a person to assess how
emotionally important a
stimulus is. Functional brain
activation studies show
elevated activity of the
amygdala among people with
MDD.
o Subgenual Anterior cingulate
– greater activation for MDD
o Hippocampus – MDD has
diminished activity of the
hippocampus.
o Dorsolateral prefrontal cortex
– diminished activity
 Striatum – responsible
for reactions to reward,
is overly active for
Mania
 there is evidence that the amygdala is overly reactive
among people with MDD, and the amygdala sends signals
that activate the HPA axis. The HPA axis triggers the release
of cortisol, the main stress hormone. Cortisol is secreted at
times of stress and increases activity of the immune system
to help the body prepare for threats.
 Cushing’s syndrome - which causes oversecretion of
cortisol, frequently experience depressive symptoms.
 Neuroticism - a personality trait that involves the tendency
to react to events with greater-than-average negative affect,
predicts the onset of depression.
 As you would expect, neuroticism is associated with anxiety
as well as dysthymia.
 Beck’s Theory
o Cognitive Bias - tendencies to process information in certain
negative ways.
o Negative/Cognitive Triad – negative views about:
• Self
• World
• Future
 Hopelessness Theory - an expectation that
o (1) desirable outcomes will not occur and that
o (2) the person has no responses available to change this situation.
 Rumination Theory - Rumination is defined as a tendency to
repetitively dwell on sad experiences and thoughts, or to
chew on material again and again. The most detrimental
form of rumination may be a tendency to brood or to
regretfully ponder why an episode happened.
 Reward Sensitivity - Researchers have demonstrated that
people with bipolar disorder describe themselves as highly
responsive to rewards on a self-report measure.

 Sleep Disruption - Experimental studies indicate that sleep

deprivation can precede the onset of manic episodes.
 Marriage and Interpersonal Relationships

o Relationship disruption precedes depression

• Strongest effects for males
o Martial conflict vs. marital support
o Gender differences in causal direction
 Mood Disorders in Women
o Prevalence: Females > males
o True for all mood disorders
• Except bipolar
 Mood Disorders in Women
o Gender roles
• Perceptions of uncontrollability
• Socialization
o Access to resources
 Social Support
o Related to depression
o Lack of support
• predicts late onset depression
o Substantial support
• predicts recovery for depression (not mania)
35. A student who has been doing very well in her psychology
class receives a minor critical comment on an essay that she
wrote as part of an exam. The student thinks, "This is terrible.
I'm probably going to fail the course." This type of cognitive
error in thinking is called _________.
A. arbitrary inference
B. overgeneralization
C. splitting
D. dissociating
 Arbitrary inferences - Making conclusions without
evidences. This includes “catastrophizing,” or thinking of
the absolute worst scenario and outcomes for
most situations. For example, you believe that someone
doesn’t like you without actual information to support that
belief
 Selective Abstraction - Making conclusions out of selective
or minority information. This includes ignoring the context or
other relevant details. For example, you fail a quiz and you
think that this will ruin your entire grade, when really the
quiz was only worth 3% and you still have an entire course
to ace
 Overgeneralization - single event is applied to all other
events. For example, after you failed the quiz, you think that
you will now fail quizzes in all other classes. Another
example is when you embarrassed yourself in public
speaking and you now think that you will always embarrass
yourself when speaking to anyone.
 Magnification and Minimization consist of perceiving a case
or situation in a greater or lesser light than it truly deserves.
An example of magnification is when you make a small
mistake and you think that you’ve made a really big one. An
example of minimization is when you failed a test worth
25% and you think that this will not impact your grade.
 Personalization is a tendency for individuals to relate
external events to themselves, even when there is no basis
for making this connection. For example, this is like when
you blame yourself for something you didn’t do.
 Labeling and mislabeling involve portraying one’s identity
on the basis of imperfections and mistakes made in the
past and allowing them to define one’s true identity. For
example, you screwed up in the past, and now you think you
are an evil person.
 Dichotomous thinking involves categorizing experiences in
either-or extremes. It’s a type of polarized thinking where
events are labeled as either black or white. For example,
you think that people are either good or bad
36. Possible reasons for the higher rates of depression found
in women include all of the following EXCEPT
A. culturally induced dependence and passivity.
B. sense of uncontrollability and helplessness.
C. low value placed on intimate relationships.
D. self-blame for being depressed.
37. Research has found that low serotonin levels may be
implicated in suicidal behavior because they affect all of the
following EXCEPT _______.
A. impulsivity
B. instability
C. agnosia
D. overreactivity
38. Impulsive suicidal behavior is often a symptom of
_____________ .
A. intermittent explosive disorder
B. borderline personality disorder
C. obsessive-compulsive disorder
D. paranoid schizophrenia
 DSM-5
o Intermittent explosive disorder
o Kleptomania
o Pyromania

 Commonalities
o Increased tension/anxiety before
o Relief after
o Social and occupational impairment
 Intermittent explosive disorder
o Frequent aggressive outbursts
o Injury and/or destruction of property
o Biological
• Serotonin, norepinephrine, testosterone
o Psychosocial
• Stress, disrupted family life, parenting
o CBT is most promising treatment
 Kleptomania
o Failure to resist urge to steal unnecessary items
o High comorbidities
• Mood disorders
• Substance abuse & dependence
o Treatments
• Behavioral interventions?
• Antidepressants?
 Pyromania
o Irresistible urge to set fires
o 3% of arsonists
o Little etiological and treatment research
• CBT
39. Jill has a 12 hour work shift. Her job requires both physical
and mental demands. At the end of each shift, she
uncontrollably eats heavy dinner until she feels that her
stomach already aches. Jill might be suffering what disorder?
A. No disorder can be diagnosed based on the given data
B. She is suffering form Bulimia Nervosa
C. Binge Eating Disorder can be diagnosed to Jill
D. Night eating syndrome is the disorder of Jill
40. Outcome research regarding the long-term success of
treatment for eating disorders indicates that
A. anorexia nervosa patients tend to have a better prognosis
than bulimia nervosa patients.
B. bulimia nervosa patients tend to have a better prognosis
than anorexia nervosa patients.
C. both anorexia nervosa and bulimia nervosa patients almost
always make a full and long-term recovery after treatment.
D. neither anorexia nervosa nor bulimia nervosa patients tend
to make long-term recoveries, with most patients going
through repeated bouts of these disorders throughout their
lives.
 Binge eating
o Excess amounts of food
o Perceived as ‘out of control’

 Compensatory behaviors
o Purging
o Excessive exercise
o Fasting

 Belief that popularity and

self-esteem are
determined by weight and
body shape
Subtypes
o Purging (most common)
• Vomiting, laxatives, or diuretics
o Nonpurging
• Exercise and/or fasting
• 6-8% of Bulmics

 Most are within 10% of normal weight

 Medical consequences
o Salivary gland enlargement causes by repeated vomiting. The result
is a chubby facial appearance.
o Erosion of dental enamel on the inner surface of the front teeth.
o May produce an electrolyte imbalance (i.e., disruption of sodium and
potassium levels) which, in turn, can lead to potentially fatal cardiac
arrhythmia and renal failure.
o Intestinal problems resulting from laxative abuse are also potentially
serious.
 Some individuals with bulimia also develop marked
calluses on the fingers and backs of hands resulting from
efforts to vomit by stimulating the gag reflex.
Associated psychological
disorders

o Anxiety (80.6%)
o Mood disorders (50-70%)
o Substance abuse (36.8%)
Bulimia
o 90-95% female
• Caucasian, middle to upper class
o Onset = age 10 to 21
o Chronic, if untreated
Bulimia in men
o 5-10% male
• Caucasian, middle to upper class
• Gay or bisexual
• Athletes with weight regulations
o Onset = older
 “Overly-successful”
weight loss
o 15% below expected
weight
o Intense fears
• Gaining weight
• Losing control of
eating
o Relentless pursuit of
thinness
o Often begins with
dieting
 Subtypes
o Restricting—Limit caloric intake via diet and
fasting
o Binge-eating-purging—About 50% of anorexics

 Associated features
o Body image disturbance
o Pride in diet and control
o Rarely seek treatment
Associated psychological disorders

o Anxiety
• OCD
o Mood disorders (71%)
o Substance abuse
• Suicide
Anorexia
o More female than males
• Caucasian, middle to upper class
o Onset = age 13 to 18
o Chronic
o Resistant to treatment
 Marked distress because
of binge eating but do not
engage in extreme
compensatory behaviors
and therefore cannot be
diagnosed with bulimia
o Often found in weight-control
programs 20%
o 50% among candidates for
bariatric surgery
o Better response to treatment
Associated Features
o Many are obese
o Older
o More psychopathology
• vs. non-binging obese
o Concerned about shape and weight
Social dimensions
o Cultural imperatives in a highly
competitive environment
• Thinness = success, happiness
o Media
• few fat female characters gives a strong
message to women
o Social and gender
standards
• Internal and
perceived
o Dieting – 8x more likely to develop eating
disorder
• Girls who attempted dieting faced more
than 300% greater risk of obesity than
those who did not diet. Repeated cycles of
“dieting” seems to produce stress-related
withdrawal symptoms in the brain, much
like other addictive substances, resulting
in more eating than would have occurred
without dieting.
Family influences
o “Typical” family of an individual with
anorexia
• Successful
• Driven
• Concerned about appearance
• Eagers to maintain harmony
o History of dieting, eating disorders
o Self (patient) reported family conflicts
 Biological dimensions
o Heritability studies (.56)
• Relatives = 4-5x higher
• Fraternal twins = 9%
• Identical twins = 23%
o Inherited tendency to be emotionally responsive
to stress, eat impulsively
o Hypothalamus
• Low serotonin levels ”serotonin promotes satiety.”
• Low levels of endorphins
 Psychological Dimensions
 Perfectionism (needing to have things exactly right) has long
been regarded as an important risk factor for eating
disorders. This is because people who are perfectionistic
may be much more likely to subscribe to the thin ideal and
relentlessly pursue the “perfect body.”
 Negative affect (feeling bad) is a causal risk factor for body
dissatisfaction. When we feel bad, we tend to become very
self-critical.
 Childhood sexual abuse has been implicated in the
development of eating disorders
41. Individuals who feel tired and cranky all day despite falling
asleep at a normal hour and awakening at their usual time are
most likely suffering from a(n) _____________.
A. parasomnia
B. dyssomnia
C. type of REM sleep deprivation
D. physical fatigue
Dyssomnias
 involve difficulties in getting enough sleep, problems with
sleeping when you want to

Parasomnias
 characterized by abnormal behavioral or physiological
events that occur during sleep, such as nightmares and
sleepwalking.
42. Sam sleeps for 8 or more hours every night but never feels
rested. He can't understand why he is always tired despite the
fact that he reports no difficulties with the quality or quantity
of his sleep. Of the following, Sam's most likely diagnosis is
____________.
A. hypersomnolence disorder
B. boderline personality disorder
C. major depressive disorder
D. non-specific parasomnia
 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 normal amounts
of sleep.
 Statistics
o Prevalence = 35% (year) older adults
o Female : Male = 2:1
• More likely to report?
o Frequently associated with:
• Anxiety
• Depression
• Substance use disorder
• Dementia of the Alzheimer’s type
o Pain, physical discomfort
 Delayed temperature rhythm - people with insomnia
seem to have higher body temperatures
 than good sleepers, and their body temperatures seem to
vary less;
o Light, noise, temperature
o Other sleep disorders
• Apnea - a disorder that involves obstructed
nighttime breathing)
• Periodic limb movement disorder - excessive
jerky leg movements
o Stress and Anxiety
o Alcohol – used to initiate sleep but interrupts
ongoing sleep, which causes anxiety, with leads
to repeated alcohol use.
 Hypersomnolence
Disorders - Excessive
sleepiness that is
displayed as either
sleeping longer than is
typical or frequent
falling asleep during
the day.
Hypersomnolence disorders
o Sleeping too much
o Excessive sleepiness
o Subjective experience as a problem
o Unrelated to other condition
o Rare
 Narcolepsy - Episodes of irresistible attacks of
refreshing sleep occurring daily, accompanied by
episodes of brief loss of muscle tone (cataplexy).
 Narcolepsy  Statistics
o Daytime sleepiness o Prevalence = .03%
o Cataplexy to .16%
o Cataplexic attacks o Female : Male = 1:1
• REM sleep o Typically improves
• Triggered by over time
strong emotion o Daytime sleepiness
o Sleep paralysis persists without
treatment
o Hypnagogic
hallucinations
 Obstructive sleep apnea (OSA)—Airflow stops, but
respiratory system works
 Central sleep apnea (CSA)—Respiratory system stops for
brief periods , patients frequently during the night but they
tend not to report excessive daytime sleepiness and often
are not aware of having a serious breathing problem.
 Mixed sleep apnea—Combination of OSA and CSA
Statistics
o Obstructive sleep apnea = 10-20%
o Female < Male
o Associated with
• Obesity
• Increasing age
 Insomnia or
hypersomnia
 Inability to synchronize
day and night
 Suprachiasmatic
nucleus (part of
hypothalamus, right
above the Optic
Chiasm)
o Brain’s biological clock
o Stimulates melatonin
 Jetlag type—Problems related to crossing time
zones
o People with jet lag usually report difficulty going to sleep
at the proper time and feeling fatigued during the day.
o Westward traveling > Eastward and/or less than three
time zones
 Shift work type—Problems related to work schedule
o Many people, such as hospital employees, police, or
emergency personnel, work at night or must work
irregular hours; as a result, they may have problems
sleeping or experience excessive sleepiness during
waking hours.
 Delayed Sleep Phase Type – ‘sleeps late, wakes up
late’
 Advanced Sleep Phase Type – ‘sleeps early, wakes
up early’
 Irregular Sleep Wake Type – ‘variable sleep
patters’
 Non-24-hour Sleep-Wake Type – sleeping on a 25-
or 26-hour cycle with later and later bedtimes
ultimately going throughout the day
43. Samantha started having difficulty falling asleep during
final exam week. Although exams are over, she now starts to
worry about sleep right after dinner. Even the sight of her bed
makes her very anxious. The fact that Samantha's insomnia
continues long after the stress of exams is over points to the
role of ___________in the maintenance of sleep disorders.
A. biology
B. other medical conditions
C. learning
D. unknown factors
44. In which of the following situations is Bill, who has
narcolepsy, most likely to experience cataplexy?
A. Immediately upon waking up after a long, restful sleep
B. At any random moment
C. Under hypnosis
D. While jumping up and cheering for his favorite team
Nightmare Disorder
 REM sleep
 Involves dreams:
o Distressing & disturbing
o Disrupt sleep, cause awakening
o Interfere with functioning
 More common in children
 More common in children
 Piercing scream
 Signs of elevated arousal
(e.g., sweating)
 Person looks extremely
upset
 Difficult to awaken
 Little memory of the event
 Prevalence
o Children 6%
o Adults 2%
 More boys than girls
 Somnambulism
o Non-REM sleep
o Usually during first few hours of deep sleep
o Person must leave the bed
 Related Conditions
o Nocturnal eating syndrome
• Person eats while asleep
 Somnambulism
o Non-REM sleep
• First few hours of deep sleep
o Person must leave the bed
o More common in children 15-30%
o Difficult (not dangerous) to wake
o Genetic component
o Usually resolves on its own
o Related to nocturnal eating syndrome
• Person eats while asleep
o Sexsomnia
45. The main feature of sexual arousal disorders is
A. lack of desire for sex despite normal physical sexual
response.
B. sexual arousal to inappropriate stimuli.
C. the experience of pain during sex.
D. lack of physical sexual response despite desire for sex.
46. Sandra and Jim have been happily married for several
years. Sandra reports that she reaches orgasm from
intercourse only about half of the time and wonders if
something is "wrong" with her. Sandra should
A. seek treatment for inhibited orgasm disorder.
B. realize that her inhibited orgasm problem means that she
doesn't really love Jim.
C. relax and realize that this is not unusual for women.
D. have a medical exam before assuming that she has a
diagnosable psychological disorder.
 Prevalence of sexual practices
o 15 or more partners (lifetime)
• M = 29%
• F = 9%
o 2 or more partners (year)
• M = 17%
• F = 10%

 Homosexual sex attraction or behavior

o Men = 10%
o Women = 9%
 Sexuality in the elderly
o Activity can and does last past age 80
o Age 75-85
• M = 38.5% active
• F = 16.7% active
o Decreases = physical health changes

 Masturbation
o M = 81%
o F = 45%
o Frequency 2.5x higher in men
 Casual premarital sex
o Men are more permissive, gap is shrinking

 Elements of satisfaction
o Women = demonstrations of love, intimacy
o Men = focus on arousal

 No gender differences in several domains

o Acceptability of homosexuality
o Acceptability of masturbation
o Experience of satisfaction
 (1) men show more sexual desire and arousal than women
 (2) women emphasize committed relationships as a context
for sex more than men;
 (3) men’s sexual self-concept, unlike women’s, is
characterized partly by power, independence, and
aggression; and
 (4) women’s sexual beliefs are more “plastic” in that they
are more easily shaped by cultural, social, and situational
factors.
 (5) Women are less frequent in reaching orgasm
 Summary of sexuality differences
o Men
• Show more sexual desire and arousal
• Self-concept includes power, independence and aggression
o Women
• Emphasize context of committed relationship
• Sexual beliefs are shaped by cultural, situational, and social factors
 Genetic/familial component
o Homosexuality in twins
• Identical = 50%
• Fraternal = 16-22%
o No specific genes

 Biology interacts with environment

 Men with “attractive” (to women) faces have higher sperm
quality.
 Women with “attractive” (to men) bodies are more fertile.
 Both men and women with “attractive” voices lose their
virginity sooner.
Desire
 Distinct from any identified solely through physiology and
reflects the patient's motivations, drives, and personality;
characterized by sexual fantasies and the desire to have sex
Excitement
 Subjective sense of sexual pleasure and accompanying
physiological changes; all physiological responses noted in
Masters and Johnson's excitement and plateau phases are
combined in this phase
Orgasm
 Peaking of sexual pleasure, with release of sexual tension
and rhythmic contraction of the perineal muscles and pelvic
reproductive organs
Resolution
 A sense of general relaxation, well-being, and muscle
relaxation; men are refractory to orgasm for a period of time
that increases with age, whereas women can have multiple
orgasms without a refractory period
47. The most common of all the male sexual dysfunctions is
____________________.
A. erectile dysfunction
B. inhibited orgasm
C. premature ejaculation
D. sexual aversion
48. One of the most important skills that therapists must
possess when conducting an interview regarding sexual
behavior is
A. communicating their own sexual values.
B. using only the proper clinical terms for sexual behavior.
C. demonstrating that they are comfortable talking about
sexual issues.
D. being able to diagnose medical causes of sexual
dysfunction.
 Classification
o Lifelong (the disorder has been present since the individual became
sexually active)
o Acquired (the disorder has been present after a period of relatively
normal sexual function)
o Generalized (Not limited to certain types of stimulation, situations,
or partners)
o Situational (Only occurs with certain types of stimulation, situations,
or partners).

o Psychological factors
o Psychological and medical conditions
 Dysfunction in the sexual response cycle
o Desire
o Arousal
o Orgasm

 Pain associated with sex

 Male hypoactive sexual desire disorder
o Little or no interest in sexual activity
o Decreased frequency:
• Masturbation
• Sexual fantasies
• Intercourse
o Prevalence = 25%
• M = 5%
• Female Sexual Interest/Arousal Disorder
• F = 22%
 Sexual aversion disorder
o Little interest in sex
o Extreme fear, panic, disgust
o Females > males

*Proposed but did not push through in the DSM 5

 Male erectile disorder
o Difficulty achieving and maintaining an erection

 Female sexual arousal disorder

o Difficulty achieving and maintaining adequate lubrication
 Associated features
o Problem is arousal, not desire
o Prevalence may increase with age
o ED is the main reason men seek treatment
 In men delayed ejaculation

 In women the condition is referred to as female orgasmic

disorder
o Adequate desire and arousal
o Unable to achieve orgasm
o Rare in adult males
• 8% delayed or absent
o Common complaint of adult females
• 25% report difficulty reaching orgasm
 Premature ejaculation
o Before the man or partner wishes, 1 minute
o Most prevalent male sexual dysfunction
• M = 21%
• Declines with age
o Common in younger, inexperienced males
 Genito-pelvic pain/penetration disorder
o Marked pain during intercourse
o Extreme pain during intercourse
o Adequate sexual desire, arousal, orgasm
o Must rule out medical reasons
 Vaginismus
o Females only
o Involuntary pelvic spasms
• Outer third of vagina
o Feelings of ripping, burning, or tearing
o Prevalence = 6%
o Related to conservative views of sexuality

 Female pain during intercourse

o 15%
 Interviews
o Clinician must demonstrate comfort
o Assess multiple dimensions
• Sexual attitudes
• Behaviors
• Sexual response cycle
• Relationship issues
• Physical health
• Psychological disorders
• Questionnaires are advised
49. Sherri and Leo have been having some sexual difficulties
lately. Both have 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. It's a good idea since wine could increase desire.
B. It's a good idea since wine could help performance.
C. It's a bad idea since wine could further impair arousal.
D. It's a bad idea since wine tends to decrease desire.
 Biological
o Physical disease
• diabetes and kidney disease to Erectile Dys.
o Medical illness
• Coronary artery disease and sexual dysfunction commonly coexist
o Prescription medications
• antihypertensive medications may contribute
to sexual dysfunction
• Selective-serotonin reuptake inhibitor (SSRI)
antidepressant medications and other
antidepressant and antianxiety drugs may
also interfere with sexual desire and arousal
in both men and women
o Alcohol and drugs
• alcohol suppresses sexual arousal
• 60% of a large number of cocaine users had a sexual
dysfunction

o Chronic alcohol abuse may cause permanent

neurological damage and may virtually eliminate the
sexual response cycle. Such abuse may lead to liver and
testicular damage, resulting in decreased testosterone
levels and related decreases in sexual desire and
arousal.
 Psychological contributions
o “Anxiety” vs. “distraction”
o Performance anxiety
• Arousal
• Cognitive processes
• individuals who are dysfunctional tend to expect the worst
and find the situation to be relatively negative and
unpleasant
• Distract themselves with negative thoughts
• Negative affect
 Social and cultural contributions
o Erotophobia - belief that sexuality can be
negative and somewhat threatening
o Negative or traumatic experiences
• substantial impact of early traumatic sexual events
on later sexual functioning, particularly in women.
o Poor interpersonal relationships
• It is difficult to have a satisfactory sexual
relationship in the context of growing dislike
for a partner.
o Scripts - we all operate by following
“scripts” that reflect social and cultural
expectations and guide our behavior
50. Children or young adults who experience sexual
victimization are
A. no more likely to experience sexual dysfunction as adults
than anyone else.
B. more likely to experience sexual dysfunction as adults if
they are females.
C. more likely to experience sexual dysfunction as adults if
they are males.
D. more likely to experience sexual dysfunction as adults.
51. Development of sexual dysfunction can be viewed as a negative cycle
that involves a variety of factors, since the typical case progresses in the
following manner:
A. initial dysfunction may be triggered by an event such as substance use;
concern about the dysfunction then leads to more dysfunction, and sex
itself becomes associated with negative feelings.
B. initial dysfunction may be triggered by an event such as substance use;
this causes a strain on the relationship and reduces the intimacy in the
relationship, which then leads to anxiety about one's desirability.
C. initial dysfunction occurs through slow and gradual deterioration,
possibly due to a medical condition; as the medical condition develops, the
individual's concern with failing sexuality increases, resulting in
relationship problems.
D. a general medical condition triggers the first dysfunction, which is
followed by increased anxiety; as the anxiety increases, the sexual
dysfunction becomes more severe over time and causes loss of interest in
sex.
52. Victims of incest tend to be ____________, and victims of
pedophilia (who are not also incest victims) tend to be
___________.
A. male; female
B. young children; girls who are beginning to mature physically
C. girls who are beginning to mature physically; young children
D. female; male
 Paraphilias or perversions are sexual stimuli or acts that
are deviations from normal sexual behaviors, but are
necessary for some persons to experience arousal and
orgasm.
 These individuals can experience sexual pleasure, but are
inhibited from responding to stimuli that are normally
considered erotic
 Types of paraphilias
o Frotteuristic disorder, unwanted touching in public
o Fetishistic disorder, sexual attraction to nonliving objects
o Voyeuristic disorder is the practice of observing, to become aroused,
an unsuspecting individual undressing or naked
o Exhibitionistic disorder, is achieving sexual arousal and gratification
by exposing genitals to unsuspecting strangers
 Types of paraphilias
o Transvestic disorder, sexual arousal is strongly associated with the
act of (or fantasies of) dressing in clothes of the opposite sex,
o Sexual sadism and sexual masochism are associated with either
inflicting pain or humiliation (sadism) or suffering pain or
humiliation (masochism)
o Pedophilic disorder, sexual attraction to children
o Incest, sexual attraction to family member
 Fetishism
o Sexual attraction to nonliving objects
• Inanimate
• Tactile
• Partialism?
o Examples: rubber, hair, shoes

o the sexual focus is on objects (e.g., shoes, gloves, pantyhose, and

stockings) that are intimately associated with the human body. The
particular fetish is linked to someone closely involved with a patient
during childhood and has a quality associated with this loved,
needed, or even traumatizing person.
 Voyeurism
o Observing an unsuspecting individual undressing or naked
o Risk is necessary for arousal

 also known as scopophilia, is the recurrent preoccupation

with fantasies and acts that involve observing persons who
are naked or engaged in grooming or sexual activity.
Masturbation to orgasm usually accompanies or follows the
event.
 Exhibitionism
o Exposure of genitals to unsuspecting strangers
o Compulsive, out of control
o Thrill and risk are necessary for sexual arousal

 The recurrent urge to expose the genitals to a stranger or to

an unsuspecting person. Sexual excitement occurs in
anticipation of the exposure, and orgasm is brought about
by masturbation during or after the event.
 Transvestic fetishism
o Sexual arousal via cross-dressing
o Males may show highly masculine compensatory behaviors
• Most do not
o Many are married
• Behavior is known to spouse
 Sexual sadism
o Inflicting pain or humiliation

 Sexual masochism
o Suffering pain or humiliation
o Different from hypoxiphilia (involves self-strangulation to reduce the
flow of oxygen to the brain and enhance the sensation of orgasm.)
 Sadistic rape
o Some rapists are sadists
o Few show paraphilic patterns of arousal rather antisocial PD
o Arousal to violent material
• Sexual and non-sexual
 Pedophiles—sexual attraction to young children
o 90% of perpetrators are male
o 10% women

 Incest—sexual attraction to one’s own children or relatives

 Victims are children or young adolescent
 Typically female
 12% of men and 17% of women reported
being touched inappropriately by adults
when they were children
 Tend to develop sexual dysfunction as
adults
 Paraphilic disorders in women
 Approximately 5% to 10% of all sexual
offenders are women
 Causes of paraphilic disorders
o Low levels of arousal to appropriate stimuli
o Sexual problems
o Social deficits
o Early experiences
• Inappropriate arousal / fantasy
o High sex drive
o Low suppression of urges / drive
o Reinforcement via orgasm
 Failure to resolve the oedipal crisis by identifying with the
father-aggressor (for boys) or mother-aggressor (for girls)
results either in improper identification with the opposite-
sex parent or in an improper choice of object for libido
cathexis.
 Molestation as a child can predispose a person to accept
continued abuse as an adult or, conversely, to become an
abuser of others.
 Learning theory indicates that because the fantasizing of
paraphiliac interests begins at an early age and because
personal fantasies and thoughts are not shared with others
(who could block or discourage them), the use and misuse
of paraphiliac fantasies and urges continue uninhibited
until late in life.
 Biological Cause
 Because the overwhelming majority of people with
paraphilias are men, there has been speculation that
androgens (hormones like testosterone) play a role.
Androgens regulate sexual desire, and sexual desire
appears to be atypically high among people with paraphilias
53. Learning theory can also explain the development of
paraphilic disorder. Which case below fits the learning model
for paraphilia?
A. Tim, whose sees his father peeping to his mother while she
takes bath.
B. Joe, who watches a lot of pornography but do not
masturbate.
C. Sid, who masturbates while peeping at his neighbor
undressing
D. Jim, who caught one of their neighbor peeping at him.
54. Patients undergoing the procedure called orgasmic
reconditioning are instructed to
A. masturbate to their usual fantasies but to substitute more
desirable ones just before ejaculation.
B. masturbate to their usual fantasies but substitute images of the
consequences associated with their behavior (such as getting
caught, hurting someone else, etc.) just before ejaculation.
C. substitute images of the consequences associated with their
behavior (such as getting caught, hurting someone else, etc.) every
time they feel aroused by thoughts of their inappropriate desires.
D. watch video tapes of normal adult sexuality repeatedly until such
images result in arousal.
55. All of the following would be considered as substance use
except _________.
A. Smoking a cigarette
B. Drinking a cup of coffee
C. Taking a sleeping pill
D. Getting drunk
 Substance-related disorders
o Use and abuse of psychoactive substances
o Significant impairment
o Costs
o Polysubstance use
 Impulse-control disorders
o Inability to resist acting on drives or impulses
 Levels of involvement
 Substance use is the ingestion of psychoactive substances
in moderate amounts that does not significantly interfere
with social, educational, or occupational functioning.
 Substance intoxication A cluster of temporary undesirable
behavioral or psychological changes that develop during or
shortly after the ingestion of a substance.

 Psychoactive substances alter mood, behavior, or both

 Substance abuse - Pattern of psychoactive substance use
leading to significant distress or impairment in social and
occupational roles and in hazardous situations.

 Substance dependence - Maladaptive pattern of substance

use characterized by the need for increased amounts to
achieve the desired effect, negative physical effects when
the substance is withdrawn, unsuccessful efforts to control
its use, and substantial effort expended to seek it or
recover from its effects. Also known as addiction.
 Tolerance - The brain and body’s need for ever larger doses
of a drug to produce earlier effects.

 Withdrawal Unpleasant, sometimes dangerous reactions

that may occur when people who use a drug regularly stop
taking or reduce their dosage of the drug.
o Withdrawal from many substances can bring on chills, fever,
diarrhea, nausea and vomiting, and aches and pains.
 include 11 symptoms that range from relatively mild (e.g.,
substance use results in a failure to fulfill major role
obligations) to more severe (e.g., occupational or recreational
activities are given up or reduced because of substance use)

Main categories
 Depressants - These substances result in behavioral
sedation and can induce relaxation.
 Stimulants - These substances cause us to be more active
and alert and can elevate mood.
 Opiates - The major effect of these substances is to produce
analgesia temporarily (reduce pain) and euphoria.
 Hallucinogens - These substances alter sensory perception
and can produce delusions, paranoia, and hallucinations.
 Other drugs of abuse
• Inhalants
• Anabolic steroids
• Medications
56. Substance intoxication includes all of the following EXCEPT
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.
57. Eventhough alcohol makes an individual active in social
situations, it is still considered as depressant because
________.
A. it decreases the ability of the inhibitory centers of the
nervous system.
B. depression like symptoms follows after the effect of alcohol
is experienced.
C. alcohol interacts with serotonin, the main neurotransmitter
involved in depression.
D. alcohol eventually kills neurons leading to memory loss.
58. Molly is a chronic alcoholic. She has symptoms of
confusion, loss of muscle coordination, and unintelligible
speech. Such behavior is probably the result of _______.
A. dementia
B. substance abuse psychotic disorder
C. fetal alcohol syndrome
D. Wernicke-Korsakoff syndrome
59. The most common of the psychoactive substances is
__________.
A. nicotine
B. caffeine
C. crystal meth
D. cocaine
60. Individuals continues to use drugs and eventually
becomes dependent to it to avoid unwanted withdrawal
symptoms and, at the same time, experience feelings of
increased pleasure reflects ____________.
A. the opponent process theory.
B. amotivational syndrome.
C. substance induced myopia.
D. an expectancy effect.
61. Which describes best the relationship between genetics
and drug dependence?
A. drug dependence is not heritable; environment is the main
determinant of drug dependence
B. heritability of drug dependence is associated with
environmental factors
C. children of drug dependents only inherit the dependence on
the drugs. If it is not triggered by the environment, it will not
manifest.
D. the inheritance of dependence is limited to the type of drug
to which the parent has tolerance, which is genetically
encoded as it is continually used
62. Antabuse for alcoholics is an example of __________ drug.
A. agonist
B. antagonist
C. aversive
D. 12 step
63. Although most impulse control disorders are considered
rare, one that affects an increasing number of people is
______________.
A. kleptomania
B. pyromania
C. gambling disorder
D. intermittent explosive disorder
 Personality disorder is a common and chronic disorder.
 Personality disorder is also a predisposing factor for other
psychiatric disorders (e.g., substance use, suicide, affective
disorders, impulse-control disorders, eating disorders, and
anxiety disorders).
 Persons with personality disorders are far more likely to
refuse psychiatric help
 Personality disorder symptoms are alloplastic (i.e., able to
adapt to, and alter, the external environment) and ego-
syntonic (i.e., acceptable to the ego).
 Persons with personality disorders do not feel anxiety about
their maladaptive behavior. Because they do not routinely
acknowledge pain from what others perceive as their
symptoms, they often seem disinterested in treatment and
impervious to recovery.
 Personality disorders
o A persistent pattern of emotions, cognitions and behavior that
results in enduring emotional distress for the person affected
and/or for others and may cause difficulties with work and
relationships
 High comorbidity
o Poorer prognosis

 Therapist reactions
o Countertransference

 10 specific personality disorders

 3 clusters
 Cluster A includes three disorders with odd, aloof features,
such as paranoid, schizoid, and schizotypal.
 Cluster B includes four disorders with dramatic, impulsive,
and erratic features, such as borderline, antisocial,
narcissistic, and histrionic.
 Cluster C includes three disorders sharing anxious and
fearful features, such as avoidant, dependent, and
obsessive-compulsive.
 Categorical vs. dimensional models
o “Kind” vs. “Degree”
• Dimensions instead of categories
• By a dimensional model individuals would not only be given categorical
diagnoses but also would be rated on a series of personality
dimensions
o “Emerging measures and models”
 Five factor model of personality (“Big Five”)
o Openness to experience
o Conscientiousness
o Extraversion
o Agreeableness
o Emotional stability

 Cross-cultural research establishes the universal nature of

the five dimensions
 Prevalence
o Barlow (2015) = 6%, may be closer to 10%
o Kring (2012) = 10 – 20%
 Origins and course
o Begin in childhood
o Chronic course
• Can remit but is replaced by other personality disorder
o High comorbidity
 Men diagnosed with a personality disorder tend to display
traits characterized as more
o Aggressive, structured, self-assertive and detached

 Women tend to present with characteristics that are

o More submissive, emotional and insecure
64. Which of the following does not belong to the group?
A. Dependent personality disorder
B. Histrionic personality disorder
C. Narcissistic personality disorder
D. Anti social personality disorder
65. Which of the following is not true regarding personality
disorders?
A. Patients often are able to accept their symptoms to
themselves.
B. Individuals with personality disorder can easily fit in to their
environment.
C. Personality disorders are rare type of disorder.
D. Individuals with personality disorder are rarely diagnosed.
66. Research shows that patients with anti social personality
disorder developed from _________ as a child.
A. conduct disorder
B. ADHD
C. eating disorder
D. somatic symptom disorder
67. Ricky feels inferior with his employees because of their
high levels of competency. As a result, he tend to become lax
in his work, which would he would, later on, pass all the
responsibility to his employees. His employees, eventually, fails
to accomplish the task due to lack of time and experience
handling the task. Upon failing with the tasks, Ricky would
scold his employees and have it as a ground for termination.
Ricky might have ___________.
A. Anti social personality disorder
B. Passive aggressive personality disorder
C. Obsessive complusive personality disorder
D. Narcissistic personality disorder
 Clinical description
o Mistrust and suspicion
• Pervasive
• Unjustified
o Few meaningful relationships
o Volatile
o Tense
o Sensitive to criticism
 Causes
o Possible relationship to schizophrenia
o Possible role of early experience
• Trauma
• Learning
• People are malevolent and deceptive
o Cultural factors
• Prisoners
• refugees
• people with hearing impairments
• older adults
 The hallmarks of paranoid personality disorder are
excessive suspiciousness and distrust of others expressed
as a pervasive tendency to interpret actions of others as
deliberately demeaning, malevolent, threatening, exploiting,
or deceiving.
 Persons with this disorder externalize their own emotions
and use the defense of projection; they attribute to others
the impulses and thoughts that they cannot accept in
themselves.
 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 four (or more) of the following:
o suspects, without sufficient basis, that others are exploiting,
harming, or deceiving him or her
o is preoccupied with unjustified doubts about the loyalty or
trustworthiness of friends or associates
o is reluctant to confide in others because of unwarranted fear that
the information will be used maliciously against him or her
o reads hidden demeaning or threatening meanings into benign
remarks or events
o persistently bears grudges, i.e., is unforgiving of insults, injuries, or
slights
o perceives attacks on his or her character or reputation that are not
apparent to others and is quick to react angrily or to counterattack
o has recurrent suspicions, without justification, regarding fidelity of
spouse or sexual partner
 Treatment
o Unlikely to seek on own
• Crisis
o Focus on developing trust
o Cognitive therapy
• Assumptions
o No empirically-supported treatments
• Poor improvement rate
 Clinical description
o Appear to neither enjoy nor desire relationships
• Loner
o Limited range of emotions
• Appear cold, detached
o Appear unaffected by praise, criticism
• Unable or unwilling to express emotion
o No thought disorder
 Schizoid personality disorder is diagnosed in patients who
display a lifelong pattern of social withdrawal. Their
discomfort with human interaction, their introversion, and
their bland, constricted affect are noteworthy. Persons with
schizoid personality disorder are often seen by others as
eccentric, isolated, or lonely.
 Persons with the disorder tend to gravitate toward solitary
jobs that involve little or no contact with others. Many prefer
night work to day work, so that they need not deal with
many persons.
o Their affect may be constricted, aloof, or inappropriately serious, but
underneath the aloofness, sensitive clinicians can recognize fear.
o Their speech is goal-directed, but they are likely to give short
answers to questions and to avoid spontaneous conversation. They
may occasionally use unusual figures of speech, such as an odd
metaphor, and may be fascinated with inanimate objects or
metaphysical constructs.
o Their mental content may reveal an unnecessary sense of intimacy
with persons they do not know well or whom they have not seen for
a long time.
 Causes
o Limited research
o Precursor: childhood shyness
o Possibly related to:
• Abuse/neglect
• Autism
 Treatment
o Unlikely to seek on own
• Crisis
o Focus on relationships
o Social skills therapy
• Empathy training
• Role playing
• Social network building
o Empirically-supported treatments limited
 Clinical description
o Psychotic-like symptoms
• Magical thinking
• Ideas of reference
• Illusions
o Odd and/or unusual
• Behavior
• Appearance
o Socially isolated
o Suspicious
 Persons with schizotypal personality disorder are strikingly
odd or strange, even to laypersons. Magical thinking,
peculiar notions, ideas of reference, illusions, and
derealization are part of a schizotypal person's everyday
world.
 These patients may be superstitious or claim powers of
clairvoyance and may believe that they have other special
powers of thought and insight.
 Causes
o Schizophrenia phenotype?
• Lack full biological or environmental contributions
o Cognitive impairments
• Left hemisphere
• More generalized
 Treatment
o Treatment of comorbid depression 30 – 50%
o Multidimensional approach
• Social skill training
• Antipsychotic medications
• Community treatment
68. Which among the disorders would less likely to engage in
casual sex?
A. Borderline personality disorder
B. Histrionic personality disorder
C. Dependent personality disorder
D. Delusional disorder, erotomanic type
69. Which disorder can be most likely measured as extremely
high in conscientiousness as compared to other traits of the
big 5 model?
A. Obsessive compulsive disorder
B. Obsessive compulsive personality disorder
C. Bipolar disorder, manic episode
D. Insomnia disorder
70. Max is always sure that others are trying to harm him. His
perception that the world is a threatening place impacts most
of his life and has become one of his core trait. Most likely,
Max would be diagnosed with a psychological disorder called
_______________.
A. paranoid schizophrenia
B. delusional disorder, persecution type
C. paranoid personality disorder
D. generalized anxiety disorder
71. Which among the disorder below are more likely to develop
____________ if he has a relative with schizophrenia?
A. Major depressive disorder
B. Bipolar disorder
C. Schizoid personality disorder
D. Schizotypal personality disorder
72. Which is false regarding individuals with antisocial
personality disorder?
A. more often that they will not show their hostility against
their victims
B. most of them are highly intellectual individuals
C. its development is genetically determined
D. people with ASPD have weak interpersonal skills
 Clinical description
o Noncompliance with social norms
o “Social Predators”
• Violate rights of others
• Irresponsible
• Impulsive
• Deceitful
o Lack a conscience, empathy, and remorse
 Nature of psychopathy
o Glibness/superficial charm
o Grandiose sense of self-worth
o Pathological lying
o Conning/manipulative
o Lack of remorse
o Callous/lack of empathy
 DSM-5
o More trait based approach

 Overlap with ASPD, criminality

o Intelligence
 Developmental considerations
o Early histories of behavioral problems
 Conduct disorder
o childhood-onset type
o adolescent-onset type
 Families history of:
o Inconsistent parental discipline
o Variable support
o Criminality
o Violence
 Gene-environment interaction
o Genetic predisposition
o Environmental triggers

 Arousal hypotheses
o Underarousal
o Fearlessness
 Antisocial personality disorder is an inability to conform to
the social norms that ordinarily govern many aspects of a
person's adolescent and adult behavior.
 Patients with antisocial personality disorder can fool even
the most experienced clinicians. In an interview, patients
can appear composed and credible, but beneath the veneer
(or, to use Hervey Cleckley's term, the mask of sanity) lurks
tension, hostility, irritability, and rage.
 Patients with antisocial personality disorder can often seem
to be normal and even charming.
 Their histories, however, reveal many areas of disordered
life functioning. Lying, truancy, running away from home,
thefts, fights, substance abuse, and illegal activities are
typical experiences that patients report as beginning in
childhood. These patients often impress opposite-sex
clinicians with the colorful, seductive aspects of their
personalities, but same-sex clinicians may regard them as
manipulative and demanding.
 They are extremely manipulative and can frequently talk
others into participating in schemes for easy ways to make
money or to achieve fame or notoriety. These schemes may
eventually lead the unwary to financial ruin or social
embarrassment or both.
 A notable finding is a lack of remorse for these actions; that
is, they appear to lack a conscience.
 Treatment
o Unlikely to seek on own
o High recidivism
o Incarceration
o Early intervention
o Prevention
• Parent training
• Rewards for pro-social behaviors
• Skills training
• Improve social competence
 Patients with borderline personality disorder stand on the
border between neurosis and psychosis and they are
characterized by extraordinarily unstable affect, mood,
behavior, object relations, and self-image.
 Persons with borderline personality disorder almost always
appear to be in a state of crisis.
 Patients can be argumentative at one moment, depressed
the next, and later complain of having no feelings. Patients
can have short-lived psychotic episodes (so-called
micropsychotic episodes) rather than full-blown psychotic
breaks, and the psychotic symptoms of these patients are
almost always circumscribed, fleeting, or doubtful.
 The behavior of patients with borderline personality
disorder is highly unpredictable, and their achievements are
rarely at the level of their abilities.
 The painful nature of their lives is reflected in repetitive self-
destructive acts. Such patients may slash their wrists and
perform other self-mutilations to elicit help from others, to
express anger, or to numb themselves to overwhelming
affect.
 Patients with borderline personality disorder cannot tolerate
being alone, and they prefer a frantic search for
companionship, no matter how unsatisfactory, to their own
company.
 They often complain about chronic feelings of emptiness
and boredom and the lack of a consistent sense of identity
(identity diffusion)
 Clinical description
o 1 – 2% of population
o Patterns of instability
• Intense moods
• Turbulent relationships
o Impulsivity
o Very poor self-image
o Self-mutilation
o Suicidal gestures
 Comorbid disorders
o Depression – 20%
• Suicide – 6%
o Bipolar – 40%
o Substance abuse – 67%
o Eating disorders
• 25% of bulimics have BPD
 Causes
o Genetic/biological components
• Serotonin
• Limbic network
o Cognitive biases
o Early childhood experience
• Neglect
• Trauma
• Abuse
 Treatment
o Highly likely to seek treatment
o Antidepressant medications
o Dialectical behavior therapy
• Reduce “interfering” behaviors
• Self-harm
• Treatment
• Quality of life
o Outcomes
 Persons with histrionic personality disorder are excitable
and emotional and behave in a colorful, dramatic,
extroverted fashion.
 Persons with histrionic personality disorder show a high
degree of attention-seeking behavior. They tend to
exaggerate their thoughts and feelings and make everything
sound more important than it really is.
 They display temper tantrums, tears, and accusations when
they are not the center of attention or are not receiving
praise or approval.
 Seductive behavior is common in both sexes. Sexual
fantasies about persons with whom patients are involved
are common, but patients are inconsistent about
verbalizing these fantasies and may be shy or flirtatious
rather than sexually aggressive.
 Clinical description
o Center of attention
o Sexually provocative
o Shallow shifting emotions
o Physical appearance-focused
o Impressionistic
o Overly dramatic
o Suggestible
o Misinterprets relationships
 Causes
o Little research
o Links with antisocial personality
• Sex-typed alternative expression
 Treatment
o Problematic interpersonal relationships
• Attention seeking
• Long-term consequences of behavior
o Little empirical support
 Persons with narcissistic personality disorder are
characterized by a heightened sense of self-importance and
grandiose feelings of uniqueness.
 Persons with narcissistic personality disorder have a
grandiose sense of self-importance; they consider
themselves special and expect special treatment.
 Persons with this disorder want their own way and are
frequently ambitious to achieve fame and fortune.
 Their relationships are fragile, and they can make others
furious by their refusal to obey conventional rules of
behavior. Interpersonal exploitiveness is common place.
 They cannot show empathy, and they feign sympathy only to
achieve their own selfish ends.
 Clinical description
o Exaggerated and unreasonable sense of self-importance
• Grandiosity
o Require attention
o Lack sensitivity and compassion
o Sensitive to criticism
o Envious
o Arrogant
 Causes
o Deficits in early childhood learning
• Altruism
• Empathy
o Sociological view
• Increased individual focus
• “Me generation”
 Treatment focuses on:
o Grandiosity
o Lack of empathy
o Hypersensitivity to evaluation
o Co-occurring depression
o Little empirical support
73. When presented with words projected on a computer
screen, individuals with borderline personality disorder are
more likely than individuals without the disorder to remember
the word ____________.
A. celebrate
B. abandon
C. full
D. charming
74. When Axel arrives late for class, he walks in and apologizes to
the professor and the students in class. He proceeds to tell them he
had every intention of being at class on time, but the traffic was
terrible and many accidents occurred, which delayed him. Axel
describes this in much detail before he takes his seat. This
commonly happens every time he is late, and Axel appears to enjoy
being the “center of attention” in those moments. Axel could be
diagnosed with which disorder?
A. Histrionic Personality Disorder
B. Narcissistic Personality Disorder
C. Bipolar Disorder, during a hypomanic episode
D. Axel's behavior only manifest his high levels of extraversion and
agreeableness
75. Thomas was an elementary school principal who would meet
with a team of professionals to discuss various children's problems
within the school. He would tell them his philosophy of education,
discipline, interacting with staff and children, etc. and why this was
the best way to run the school. After his lengthy dissertation, the
school psychologist wanted to discuss a child who appeared to have
a learning disability. Thomas immediately excused himself to take
inventory. Which type of personality disorder best typifies Thomas'
behavior?
A. Bipolar Disorder, during a hypomanic episode
B. Histrionic personality disorder
C. Narcissistic personality disorder
D. None
76. The most common type of hallucination is associated with
hyperactivity of which part of the brain?
A. Wernicke's Area
B. Broca's Area
C. Frontal lobe
D. Occipital lobe
77. Which physiological etiology of schizophrenia is not true
below?
A. There is decrease in volume of the cortical area in general
B. The ventricles of the brain have already been enlarged
C. Brain imaging techniques shows a weak activity of the
prefrontal cortex
D. There is increased activity on the language comprehension
area that explains auditory hallucination
 Four causes of schizophrenia

 (1) the possible genes involved in schizophrenia,

 (2) the chemical action of the drugs that help many people with
this disorder

 (3) abnormalities in the working of the brains of people with

schizophrenia

 (4) environmental risk factors that may precipitate the onset of

the symptoms
Genetic
 Family Studies - Other studies have found that people with
schizophrenia in their family histories have more negative
symptoms than those whose families are free of
schizophrenia
 Twin Studies - The risk for MZ twins (44.3 percent) is greater
than that for DZ twins (12.08 percent).
2. Neurotransmitter
 Dopamine Hypothesis - The simplest formulation of the
dopamine hypothesis of schizophrenia posits that
schizophrenia results from too much dopaminergic activity.
 Excessive dopamine release in patients with schizophrenia
has been linked to the severity of positive psychotic
symptoms.
 Serotonin - Current hypotheses posit serotonin excess as a
cause of both positive and negative symptoms in
schizophrenia.
 Gamma Aminobutyric Acid - GABA has a regulatory effect on
dopamine activity, and the loss of inhibitory GABAergic
neurons could lead to the hyperactivity of dopaminergic
neurons.
 Glutamate - The hypotheses proposed about glutamate
include those of hyperactivity, hypoactivity, and glutamate-
induced neurotoxicity.
 Cerebral Ventricles - Computed tomography (CT) scans of
patients with schizophrenia have consistently shown lateral
and third ventricular enlargement and some reduction in
cortical volume.
 Hypofrontality
• Dorsolateral prefrontal cortex
 Limbic System - Studies of postmortem brain samples from
schizophrenic patients have shown a decrease in the size of
the region including the amygdala, the hippocampus, and
the parahippocampal gyrus.
 Prenatal and perinatal influences
o Viral infections
• Influenza
o Pregnancy complications
• Bleeding
 Prenatal and Perinatal Influences
o Delivery complications
• Asphyxia - lack of oxygen
o Chronic and early use of marijuana
o Likely interact with genetics and environment
 Stress
o Activates vulnerability
o Increases relapse risk

 Family and relapse

o Schizophrenogenic mother
o Double-bind communication – double meaning communication
o Expressed emotion (EE) - high expressed emotion communication in
a family are a good predictor of relapse among people with chronic
schizophreni
o Criticism, hostility, emotional over involvement
 Prefrontal Cortex - There is considerable evidence from
postmortem brain studies that supports anatomical
abnormalities in the prefrontal cortex in schizophrenia.
Functional deficits in the prefrontal brain imaging region
have also been demonstrated.
 Thalamus - Some studies of the thalamus show evidence of
volume shrinkage or neuronal loss. The total number of
neurons, oligodendrocytes, and astrocytes is reduced by 30
to 45 percent in schizophrenic patients.
 Psychoanalytic Theories
 Sigmund Freud postulated that schizophrenia resulted from
developmental fixations that occurred earlier than those
culminating in the development of neuroses. These
fixations produce defects in ego development and Freud
postulated that such defects contributed to the symptoms
of schizophrenia. Ego disintegration in schizophrenia
represents a return to the time when the ego was not yet, or
had just begun, to be established.
 Learning Theories
 According to learning theorists, children who later have
schizophrenia learn irrational reactions and ways of
thinking by imitating parents who have their own significant
emotional problems.
78. DSM-5 no longer specifies different subtypes of
schizophrenia, but in DSM-IV-TR the subtype called paranoid
schizophrenia was characterized by
A. silly and immature behavior.
B. a complete mental breakdown.
C. alternating immobility and agitated excitement.
D. delusions of grandeur or persecution.
 Paranoid Schizophrenia - Type of schizophrenia in which
symptoms primarily involve delusions and hallucinations;
speech and motor and emotional behavior are relatively
intact.

 Disorganized Schizophrenia - Type of schizophrenia

featuring disrupted speech and behavior, disjointed
delusions and hallucinations, and silly or flat affect.
o Previously called hebephrenic.
 Catatonic Schizophrenia - Type of schizophrenia in which
motor disturbances (rigidity, agitation, and odd
mannerisms) predominate.
o They sometimes repeat or mimic the words of others (echolalia) or
the movements of others (echopraxia). There may be subtypes of
catatonic schizophrenia, with some individuals showing primarily
symptoms of labeled “negative withdrawal” (immobility, posturing,
mutism), “automatic” (routine obedience, waxy flexibility),
“repetitive/echo” (grimacing, perseveration, echolalia), and
“agitated/resistive” (excitement, impulsivity, combativeness)
 Undifferentiated Schizophrenia – Category for individuals
who meet the criteria for schizophrenia but not for one of
the defined subtypes.

 Residual Schizophrenia – Diagnostic category for people

who have experienced at least one episode of
schizophrenia and who no longer display its major
symptoms but still show some bizarre thoughts or social
withdrawal.
79. Marshall has suffered from several symptoms that
indicate a schizophrenia-related condition, but his symptoms
have only been present for 4 months. Which of the following
would be the appropriate diagnosis?
A. Brief psychotic disorder
B. Delusional disorder
C. Schizoaffective disorder
D. Schizophreniform disorder
 Positive Symptoms
 Negative Symptoms
 Disorganized behavior
 Active manifestations
o Delusions
o Hallucinations
 Obvious signs
 Distortions of normal behavior
 Exaggerations or excesses
 50-70% experience
 Delusions
o Gross misrepresentations of reality
o Disorder of thought content
o Grandeur
o Persecution
o Capgras and Cotard’s syndromes
o Motivational view
o Deficit view
 More overt symptoms, such as delusions and
hallucinations, displayed by some people with
schizophrenia.
 Delusion - A belief that would be seen by most members of
a society as a misrepresentation of reality.
o Example - you believe that squirrels are aliens sent to Earth on a
reconnaissance mission, you would be considered delusional.
 Hallucination -The experience of sensory events without any
input from the surrounding environment.
o “He told me to turn off the TV. He said, ‘It’s too damn loud, turn it
down, turn it down.’”
 Broca’s Area are more
active in people with
schizophrenia than
the Wernicke’s area.
 Hallucinations
o Sensory experience in absence of environmental stimuli or input
o Can involve all senses
o Most common: auditory
• Own vs. others voice
• Broca’s area
• Prosody
 Absence or insufficiency of normal behavior
 25% experience
 Symptom Cluster
o Avolition (or apathy)
o Alogia
o Anhedonia
o Affective flattening
 usually indicate the absence or insufficiency of normal
behavior.
 Avolition
 Alogia
 Anhedonia
 Affective Flattening
 Avolition – the inability to initiate and persist in activities.
People with this symptom (also referred to as apathy) show
little interest in performing even the most basic day-to-day
functions, including those associated with personal
hygiene.
o Interviewer: Do you have any children?
o Client: Yes.
o I: How many children do you have?
o C: Two.
o I: How old are they?
o C: Six and twelve.
 Alogia - refers to the relative absence of speech. A person
with alogia may respond to questions with brief replies that
have little content and may appear uninterested in the
conversation.
 Anhedonia - which derives from the combination of a
(“without”) and the word hedonic (“pertaining to pleasure”).
Anhedonia is the presumed lack of pleasure experienced by
some people with schizophrenia.
 Flat affect - Apparently emotionless demeanor (including
toneless speech and vacant gaze) when a reaction would
be expected.
 They are similar to people wearing masks because they do
not show emotions when you would normally expect them
to.
 These include a variety of erratic behaviors that affect
speech, motor behavior, and emotional reactions.
o Disorganized Speech
o Inappropriate affect and Disorganized Behavior
 Disorganized Speech - Style of talking often seen in people
with schizophrenia, involving incoherence and a lack of
typical logic patterns.
o Example
Therapist: Why are you here in the hospital, David?
David: I really don’t want to be here. I’ve got other things to do. The
time is right, and you know, when opportunity knocks . . .
o Therapist: I was sorry to hear that your Uncle Bill died a few years
ago. How are you feeling about him these days?
o David: Yes, he died. He was sick, and now he’s gone. He likes to fish
with me, down at the river. He’s going to take me hunting. I have
guns. I can shoot you and you’d be dead in a minute.
 Inappropriate Affect - Emotional displays that are improper
for the situation.

 Catatonia - Disorder of movement involving immobility or

excited agitation.
80. James is a security guard at the mall who seems lost in his
own world. Often, he feels the presence of his dead mother
nearby. He knows it is an illusion and that she is not real. Her
presence does give him comfort. James probably would be
diagnosed with
A. schizoaffective disorder.
B. schizotypal disorder.
C. schizoid disorder.
D. brief psychotic disorder.
 Schizophreniform Disorder
 Schizoaffective Disorder
 Delusional Disorder
 Brief Psychotic Disorder
 Shared Psychotic Disorder (Folie à Deux)
 Schizophreniform Disorder - Psychotic disorder involving the
symptoms of schizophrenia but lasting less than 6 months.
o Schizophrenic symptoms
o Few months only
o Associated with good premorbid functioning
o Most resume normal lives
o Prevalence = 0.2% (life)
 Schizoaffective Disorder - Psychotic disorder featuring
symptoms of both schizophrenia and major mood disorder.
o Symptoms of schizophrenia plus a mood disorder
o Disorders are independent
• Delusions for 2 weeks in absence of mood
o Prognosis = similar to schizophrenia
• Persistent
• No improvement without treatment
 Delusional Disorder - Psychotic disorder featuring a
persistent belief contrary to reality (delusion) but no other
symptoms of schizophrenia.
• Erotomanic
• Grandiose
• Jealous
• Persecutory
• Somatic
 Brief Psychotic Disorder - Psychotic disturbance involving
delusions, hallucinations, or disorganized speech or behavior but
lasting less than 1 month; often occurs in reaction to a stressor.

 Rare 26-60 per 100,000

o Later age of onset
• Between 35 - 55
o Female>Male
• 55% to 45%
 Prognosis
o Better than schizophrenia
o Worse than other psychotic disorders

 Conflicting evidence about the biological or the psychosocial

influences
 Shared Psychotic Disorder - Psychotic disturbance in which
individuals develop a delusion similar to that of a person
with whom they share a close relationship.
81. Extrapyramidal symptoms, serious side effects of first
generation anti-psychotic drugs, are similar to the symptoms
of ______________.
A. Alzheimer's disease
B. Parkinson's disease
C. multiple sclerosis
D. leukemia
82. Which is an example of negative symptom in
schizophrenia?
A. Lucy hears the voice of her dead grandmother.
B. Baron believes that he is the new Messiah.
C. Gary responds using monosyllabic words after being asked.
D. Oliver sits in a posture too difficult for others to maintain.
83. Though there are identifiable biological explanation
regarding Alzheimer's disease, _________________.
A. there is still no medication that would treat the disorder.
B. cause and effect relationship between biomarkers and the
disorder cannot be established.
C. these brain plaques and tangles cannot be removed if the
patient is still alive.
D. psychological etiologies cannot be explained.
84. Why are the symptoms of vascular neurocognitive disorder
so different in each patient?
A. It is not known why patients with vascular neurocognitive
disorder have different symptoms.
B. The symptoms relate to the area of the brain damaged.
C. The symptoms depend upon the person's other medical
conditions.
D. Patients tend to be elderly and easily confused.
85. If Jane's neurocognitive disorder is caused by a process
that has damaged her brain's dopamine pathways, it can be
assumed that this condition is caused by
__________________.
A. head trauma
B. Parkinson's disease
C. substance use disorder
D. medication
86. Compared to most disorders, Huntington's disease is very
unusual because it is
A. the result of one gene.
B. influenced by many genes.
C. always a cause of neurocognitive disorder.
D. associated with subcortical impairment.
87. An individual with borderline personality disorder claims
that a psychologist has unsatisfactory services after the
psychological intervention. In relation to the ethical codes,
what should the psychological clinic do?
A. Schedule less patients to the psychologist
B. Charge the appropriate fee to the patient
C. Charge the service for free
D. Refer the patient to other clinics right away
88. Andrew has been accused of committing a crime and is
currently in a mental health facility. He will stay there until it is
determined that he is fit to participate in legal proceedings
against him. The commitment process by which Andrew is
being held is called ____________.
A. civil
B. criminal
C. parens patriae
D. mens rea
89. Margaret has been schizophrenic for many years and has
been hospitalized several times. She has paranoid delusions
and hallucinations. Her speech is rambling and incoherent.
Most recently, Margaret got a hold of a gun and shot several
people, believing that they were her enemies. Following her
arrest, what is the most likely scenario for Margaret?
A. If convicted, she will go to prison.
B. Following a trial, she will be hospitalized again.
C. Her case will never go to trial.
D. She will be found competent to stand trial.
90. The ethical codes adopted a policy to base principles of
psychological practice on
A. clinical assumptions.
B. evidence-based practice.
C. historical assumptions.
D. superiority of practitioners.
91. The legal concept of mens rea is generally used to mean
________________.
A. guilty mind
B. criminal intent
C. both of guilty mind and criminal intent
D. neither of guilty mind and criminal intent
92. The outcome of Miguel's trial resulted in a finding of "not
guilty by reason of insanity." According to criminal law, Miguel
now will be sent to ____________.
A. prison
B. a mental health facility
C. a community mental health center
D. a surgical center
93. When parens patriae is used to take a mentally ill
individual into custody, it means that the state is acting as a
A. mental health counselor.
B. surrogate parent.
C. legal advisor.
D. social worker.
94. Which of the following conditions that affects women has
been included in DSM-5 as a mood disorder, after previously
being called "late luteal phase dysphoric disorder?"
A. Premenstrual Dysphoric Disorder
B. Climacteric Dissatisfaction Disorder
C. Genito-Pelvic Penetration/Pain disorder
D. Menopause Dyspareunic Disorder
95. In the Caspi and colleagues (2003) gene–environment
interaction study of depression, those who were at highest risk
for developing depression were:
A. those who were maltreated as children and had a biological
parent with depression
B. those who were maltreated as children and had at least
one long allele of the 5-HTT gene
C. those who were maltreated as children and had at least one
short allele of the 5-HTT gene
D. those who were not maltreated as children but had at least
one short allele of the 5-HTT gene
96. Thomas Stephen Szasz’s views of mental illness
A. is chemically and biologically based
B. mental illnesses are real in the sense that cancers are real
C. has an objective measure or methods of detecting
D. as created by the society.
97. Which of the following statements would best describe
IMPAIRMENT as a characteristic of abnormal behavior?
A. Judy doesn’t want to participate in classroom activities and
would just remain seated even when she is called
B. Anne only stays inside the house and would prefer watching
TV rather than seeing her friends
C. Mariah is so shy and she finds it impossible to date or even
interact with people and makes every attempt to avoid
interactions
D. Jen seemed to be lazy and is not willing to perform
household chores and would just stay inside the room
sleeping all day
98. Brett persistently injects himself with pain killers. This has
greatly increased his chance of overdosing and dying. His
behavior harms no one else. According to the DSM, is Brett's
behavior consistent with the definition of a mental disorder?
A. Yes, because very few people in society engage in this
behavior.
B. Yes, because he is persistently acting in a way that harms
him.
C. No, because his behavior must also harm the well-being of
others in the community.
D. No, because there is no evidence that his actions are out of
his own control.
99. When one examines the current state of knowledge
regarding genetics and life experience effects on brain
structure and function, the best overall conclusion is that most
psychological disorders are
A. the result of a complex interaction of genetics and faulty
neurotransmitter circuits.
B. the result of stressful early life experiences and the
negative effects such experiences have on brain structure or
function.
C. the result of both biological and psychosocial factors.
D. beyond our current ability to understand in any meaningful
way.
 Dysfunction - to a breakdown in cognitive, emotional, or
behavioral functioning.
 It interferes with daily functioning. It so upsets, distracts, or
confuses people that they cannot care for themselves
properly, participate in ordinary social interactions, or work
productively.
 Distress - According to many clinical theorists, behavior,
ideas, or emotions usually have to cause distress before
they can be labeled abnormal.
 Danger - Individuals whose behavior is consistently
careless, hostile, or confused may be placing themselves or
those around them at risk.
 Deviance - something is considered abnormal because it
occurs infrequently; it deviates from the average. The
greater the deviation, the more abnormal it is.
 Abnormal behavior, thoughts, and emotions are those that
differ markedly from a society’s ideas about proper
functioning.
o norms—stated and unstated rules for proper conduct.
o culture—A people’s common history, values, institutions, habits,
skills, technology, and arts.
 Behavioral, psychological, or biological dysfunctions that
are unexpected in their cultural context and associated with
present distress and impairment in functioning, or
increased risk of suffering, death, pain, or impairment.
 Thomas Szasz (1920–2012)
o Emphasized on society’s role that he found the whole concept of
mental illness to be invalid, a myth of sorts.
o According to Szasz,the deviations that society calls abnormal are
simply “problems in living,” not signs of something wrong within the
person.
o Definition is only used to control deviating, distressing, dangerous,
and dysfunctional behavior.
 Represents the unique combination of behaviors, thoughts,
and feelings that make up a specific disorder; specify what
makes the disorder different from normal behavior or from
other disorders.
Statistical Description
o Prevalence – Number of people suffering from the disorder as a
whole
o Incidence – Number of new cases in a given period of time
o Sex Ratio – percentage of male and females suffering a disorder
Pattern of the Disorder
 Chronic course - meaning that they tend to last a long time,
sometimes a lifetime
 Episodic course - in that the individual is likely to recover
within a few months only to suffer a recurrence of the
disorder at a later time.
 Time-limited course - meaning the disorder will improve
without treatment in a relatively short period.

Difference of Onset of the Disorder

 Acute onset – the disorder begin suddenly.
 Insidious onset – the disorder develop gradually over an
extended period.
 Etiology - or the study of origins; has to do with why a
disorder begins (what causes it) and includes biological,
psychological, and social dimensions.
 Treatment - A systematic procedure designed to change
abnormal behavior into more normal behavior. Also called
therapy.
 Predisposing Factors – Factors that can make a person
susceptible of developing a disorder.
o 2 students failed in a subject, one student manifested a symptom,
the other did not.
 Precipitating Factors – Factors that can trigger the
development of a disorder.
o 2 individuals has a relative with schizophrenia, the other was
abused by a parent while the other was not, the abused developed
schizophrenia.
 100. According to the diathesis-stress model, monozygotic
twins raised in the same household will
 A. not necessarily have the same disorders because of
potential differences in their diathesis.
 B. have the same disorders because their diathesis and
stress are exactly the same.
 C. not necessarily have the same disorders because of
potential differences in their stress.
 D. have no more likelihood of sharing a disorder than any
other two randomly selected individuals from the
population.
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