Psych303 - 2

• early ejaculation
• inability to achieve or maintain an erection sufficient for successful intercourse
• because of anxiety, cognitive distractions
• 90% of men on antidepressant medications
• can be result of vascular disease
• Viagra

• Viagra makes nitric oxide more available
• only promotes erection if some excitation is present

• lack of interest in having sex can lead to an absence of feelings of sexual arousal and unresponsiveness to most forms of erotic stimulation
• can't produce characteristic swelling/lubrication of hte vulva
• people think this diagnostic is controversial because it is being pushed on the public by pharmaceutical companies
• often there are partner factors involved

• not well defined
• delay/absense of orgasm or reduced intensity of orgasmic sensation
• AND causes significant stress/impairment
• treatment by learning to masturabate
• as many as 80% of women have difficulty reaching orgasm during intercourse alone

• mostly for women
• thought to be psychological - now its more about a pain
• cause - Vulvar Vestibulitis

• causes genito-pelvic pain/penetration disorder in women
• the inflammation of skin surrounding the vaginal opening (treatable)

• involuntary spasm of hte muscles at hte entrace to the vagina that prevents penetration and sexual intercourse
• very rare
• treatment: training of the vaginal muscles

• painful coitus
• persistent genital pain with sexual intercourse
• far more common in women
• can be because of physical cause

• 1 - a strong and persistent cross - gender identification (desire/insistence that one is the opposite sex)
• 2 - gender dysphoria - persistent discomfort about one's biological sex/sense that the gender role of that sex is inappropriate

• recurrent, intense sexual urges, fantasies, or behaviors that involve unusual objects, activities, situations
• tend to occur only in men
• without the weird object orgasm is not possible
• tend to co-occur in the same individual
• tend to begin around puberty
• very strong sex desire

• fetishism
• transvestic fetishism
• voyeurism
• exhibitionism
• sexual sadism
• sexual masochism
• pedophilia
• frotteurism

• sexually deviant (sadists or necrophilic)
• psychopathic
• narcissistic (center of the world)
• prefer knives and ropes because its more hands on
• Ted Bundy, Dennis Rader, Gary Ridgeway

• sexual attraction to an immature body (prepubertal)
• can't be defined by age of the child but by body maturity
• mostly males - and most of the victims are girls
• some appear to be shy but want power over another
• some idealize aspects of childhood
• begin in adolescence usually
• perturbations of early neurodevelopment can create vulnerability to the disorder

• post-traumatic stress disorder
• sexual inappropriateness
• fears
• poor self-esteem
• no symptoms
• adult psychopathology
• sexual symptoms

• low SES
• young man
• sexual abused
• date rapists motives
• paraphilias
• impulsivity/loss of temper
• insensitivity to cues
• deficits in communicaiton skills

• modify patterns of sexual arousal
• cognitive restructuring
• social skills training
• change habits
• lower sexual drive
• aversion therapy - covert sensitization, assisted covert sensitization

castration or chemical castration - lowers testosterone - lowers sexual drive

• blend of unpleasant emotions and cognitions
• not really an emotion, but an emotional mood-state
• oriented to the future (anticipate negative events)
• cognitive, physiological, psychological components
• much more diffuse than fear
• prepares/primes someone for the fight or flight response should the activated danger occur!
• no immediate urge to flee as there is with fear!
• helps us plan
• usually are learned

• hear palpations, headaches, sweating, tension
• negative mood states, bad appraisals, worry, self-preoccupation, concern about lack of knowledge on the future
• avoid situations that may lead to negative consequences

• genetically predisposed (a gene) - stuff with the limbic system
• personality/temperament - neuroticism, negative affectivity
• psychosocial - intrusive/over controlling parents
• family styles
• psychological - classical conditioning, perceptions of uncontrollability, distorted patterns of cognition

• medications (anxiolitics) - faster responses, but big side effects, addicting, only treats the symptoms
• cognitive behavioral therapy - most effective, learning why we have anxiety about certain stuff
• exposure to feared cues
• cognitive-restructuring - change patterns of thinking about anxiety situations

• chronic, excessive, unreasonable, uncontrollable worrying
• anxious all the time, in almost all situations
• future-oriented mod state of anxious apprehension
• anxious apprehension - increased vigilance for perceived signs of threat!
• muscle tension, fatigue, irritability
• more for women, older adults, tends to occur with other Axis-I disorders

• attentional bias - biased toward negative things
• uncontrollability/unpredictability
• childhood trauma
• lack of safety signals
• believe that worry is effective and productive (avoidance of emotional topics (protective function), avoid catastrophes, coping, preparation)
• intrusive thoughts/inability to cope with them

• modest heritability
• common underlying genetic predisposition with depression
• neuroticism
• functional deficiency in GABA (GABA inhibits anxiety)
• also serotonin and norepinephrine roles
• effect of CRH hormone

• medications - benzodiazapines/anxiolytics, buspirones (less side effects)
• CBT - more effective, muscle relaxation, cognitive restructruing (make appraisals more realistic, know what you have control over/don't), coping skills

• cardio symptoms
• gastrointestinal symptoms
• neurological symptoms (dizzy, numbness)
• LIKE A HEART ATTACK
• depersonalization, derealization, fear of losing control or going crazy/dying

• catagelophobia - fear of ridicule in social situations
• agyrophobia - fear of streets/crossing streets

• more women than men (men maybe more prone to tough it out because of societal expectations)
• typically in teh 20s-30s
• like 5% of adults

• moderate heritable component
• neuroticism
• large overlap in genetic vulnerabilities for panic disorder/phobias
• norepinephrine and LOCUS COERULEUS
• increased activity in amygdala (sensitive fear network)
• hippocampus/limbic system involved
• noradrenergic/serotonergic neurotransmitter symptoms
• GABA

• panic attacks are conditioned to internal cues (interoceptive awareness)
• internal cues becomes associated with feeling of panic (noticing the physical cues triggers a panic attack!)

• individuals with panic disorder are hypersensitive to bodily sensations/prone to give them the best direct possible interpretation
• anxiety sensitivity - concerned with anxiety attacks!
• *catastrophize* about meaning of bodily sensations - automatic thoughts lead to triggers of panic!

• trait like belief that certain bodily symptoms have harmful consequences
• perceived control reduces anxiety/blocks panic!

people with panic disorders engage in safety behaviors - they attribute the lack of catastrophe to the fact that they did this safety behavior! - reinforced

• its a cycle
• biological vulnerability --> catastrophic cognitions (awareness for future) --> attacks --> hypervigilance --> back to biological vulnerability

• medications -
• anxiolytics - act quickly, but have side effects (benzodiazeprines)
• antidepressants - no dependence, slow acting (tricyclics, SSRI's)
• CBT - most effective
• interoceptive exposure
• cognitive restructuring techniques - help people identify cognitions
• relaxation exercises
• systematic desensitization

• 12%, way more women = specific
• 12%, slightly more women = social

more men than women b/c men may have more exposure therapy b/c of teasing, and women are more in tune with emotions

• behaviorally inhibition, fear
• some genetic contribution
• genetic temperatment that makes you learn/strengthen the fear/association

• evolutionary preparedness
• defense against anxiety that stems from repressed id impulses
• learned behavior - classical conditioning, neg. experience with stimulus, observing other people with phobias (monkeys with snakes)
• importance of prior familiarity with object/situation
• inflation effect

an experience after a conditioning experience that strenghtenss/maintains that conditioned fear

for example - person with mild fear of driving after a minor crash will develop full blown phobia is later is physically assulated

• childhood/adolescent experiences of bad social situations (vicarious/direct learning)
• evolutionary contributions (because of dominance hierarchies in primates social arrangements - stay submissive)
• perceptions of uncontrollability/unpredictability
• cognitive biases (think ambiguous situations are more dangerous - danger schemas, attribute a negative evaluation of themselves by others)

• 20% heritability
• behavioral inhibited temperament (emotionally negative - respond negatively to stimuli)
• tendency for high reactivity

they have exaggerated physiological responses to social stimulations - so all of hteir resources are devoted to modulating these responses - not much left to devote to social situations

• antidepressants (SSRIs, MAOIs, d-cycloserine with exposure therapy)
• CBT - longest lasting, best, cognitive restructuring (how to deal with social phobia, identify negative underlying thoughts, LOGICAL REANALYSIS)
• exposure to social situations
• challenge the negative thoughts

• everyday thoughts/actions are brought to an extreme
• unwanted/intrusive obsessive thoughts/distressing images accompanied by compulsive behaviors to neutralize these

• excess time
• reasons why you do the behavior - to relieve anxiety?
• How much distress does it cause?

about 1%, more divorced people, late adolescence, more adult women than men, more boys than girls

• avoidance learning - behavior makes them feel better about an obsession (an obsession that resulted from classical conditioning) - reinforcing
• preparedness - obsessions with dirt and contamination - related to safety!! and displacement ativities to reduce anxiety

• trying to suppress their thoughts (thought suppression leads to an increase in OCD symptoms)
• inflated sense of responsibility (having a thought about doing something is just as bad as doing it - thought-action fusion)
• perceived awfulness of any harmful consequences
• cognitive biases to focus on negative stuff

• more strongly associated in OCD than in any other anxiety disorders
• genetic basis varies with the OCD type
• brain abnormalities (cortico-basal-ganglionic-thalamic circuit - the circuit involved in social behavior - stuff of obsessions) (prevention of normal inhibition of thoughts)
• Neurotransmitters (excess serotonin), GABA

• tic related - severe chronic motor and vocal tics
• big genetic basis
• OCD type

• medications - SSRIs, d-cycloserine to reduce number of exposure therapy needed
• Exposure/ritual prevention = the best - exposed to obsession but can' act on it
• Psychosurgery in extreme cases (remove parts of social behavior circuit, target tissue damage areas)

• nature of stressor
• perception of stressor
• stress tolerance
• external resources/social supports

• task-oriented response - deal with requirements posed by stressor
• defense - oriented - protect self from hurt/disorganization

• personality (psychological) decompensation (lowering of adaptive psychosocial functioning)
• General Adaptation Syndrome - alarm reaction, resistance, exhaustion
• effects on the sympathetic nervous system
• effects on the immune system

• response to common stressor is maladaptive
• occurs within 3 months of a stressor

• an anxiety disorder
• response to a trauma (threatened/actual death/injury, unexpected death of others, threat to physical integrity)
• recurrent reexperiencing of it
• emotional numbing/detachment
• hypervigilance, increased arousal, insomnia

• feel responsible
• feel trapped, feel unsafe (military combat)
• if intense recurrent stress
• suddenness (mass catastrophes)
• intentional cruelty/inhumanity

• irritability
• anger anger control problems
• substance abuse with aggression
• sleep distrubances
• recurrent nightmares
• if not injured = bigger PTSD than if injured

• nature of traumatic event
• level of stress
• females get it more
• low social support
• neuroticism
• pre-existing problems
• negative appraisals
• if feel responsible/trapped, multiple stresors, very sudden

good cognitive ability (better able to make meaning out of trauma experiences and translate them to meaning)

• not baseline cortisol (except women do have higher baseline cortisol)
• gene involved
• smaller hippocampus

• if believe mission is valid = less PTSD
• if identify with combat unit - less PTSD
• returning to negative/unsupportive place = more PTSD

• CBT - desensitization, relaxation, challenge the distorted thinking
• MEds - SSRI's, Benzodiazapines

• about 1.5% of the population (lifetime)
• onset is around aolescence

• high heritability
• genes for suceptibility to anorexia
• involved with serotonin/serotonergic system
• we each have a biological set point and if we deviate our bodies will go through physiological opposition to get back to that start point

rigid, overprotective, controlling, marital discord, perfectionist parents, preoccupation with food

• gender - more in women than in men
• internalizing the thinness ideal
• Perfectionism - more likely to subscribe to thin ideal and pursue the perfect body
• negative body image - perceptual biases on themselves - body dissatisfaction
• dieting - usually starts with normal dieting (when efforts to diet fall short - we feel bad abotu ourselves)
• negative affect - risk factor for body dissatisfaction - self-critical - eating provides comfort
• childhood sexual abuse - abuse may increase risk for having the risk factors for eating disorders

• Meds - antidepressants/antipsychotics
• Family Therapy - considered the best treatment (refeed, negotiations of relationships, termination phase)
• CBT - change behavior/maladaptive thinking - but htere are limits for the efficacy

• Meds - antidepressants
• CBT - best choice, normalize eating patterns, change behaviors/thinking about the binge cycle

• antidepressants
• appetite suppressants
• anticonvulsant medications
• sibutramine - inhibits reuptake of serotonin/norepinephrine
• CBT/therapeutic programs

• genes - thinness runs in families/same with obesity, seems to be a genetic mutation associated with binge eating
• hormones - leptin, grehlin
• sociocultural
• family/relationships
• stress/comfort food
• pathways to obesity (binge eating, low support, pressures, negative affect)

• hormone produced by stomach - powerful appetite stimulator
• levels rise before a meal and fall after a meal
• causes hunger!
• Prader Willi syndrome = high levels of grehlin

• lifestyle modifications (diet, exercise, behavioral)
• medications - supress appetite, prevent absorption
• surgery - bariatric surgery (gastric bypass = most effective in the long run)

• pleasure center activation (MCL pathway - enjoyment of that thing)
• people are affected differently by the same substance
• physical dependence (changes in brain functioning/sensitivity to neural receptors)

• positive and negative reinforcement (take drugs = get high = positive) (get low = take drugs = no more negative feelings = negative)
• mediating effects of the substance - affects how other things are processed (nicotine makes all the things associated with smoking much more reinforcing)

• maladaptive use of a substance
• impairment in at least one domain (work, school, home)
• legal problems
• social/interpersonal problems
• no substance dependence!

• higher tolerance
• withdrawal causes irritability, problems concentrating, fidgeting
• amount and time is beyond the original intent
• desires to cut down/control their use
• activities to obtain, use or recover from use of substance
• sacrifice social, occupational, recreational activities
• continue despite negative physical or psychological effects

• suppressed thinking, slower physical response times, decreased perception of the long term, morality, thinking about reputation
• chronic fatigue
• mental health problems - alcohol withdrawal delirium
• Korsakoff's condition - memory defect
• inhibits glutamate - slowed activity in brain
• cirrhosis of liver

• memory defect
• falsification of events
• alcohol amnestic disorder

• activation of pleasure pathway (MCLP) - Dopamine
• runs in families
• inherited predisposition for alcohol abuse/impulsive
• GABA - usually controls the reward-pleasure system and opiates can inhibit the control
• alcohol increases brain activity for other regions
• inhibition of neurotransmitters for anxiety

• positive and negative reinforcement (self-medication, tension reduction, coping with negative affect)
• opponent-process theory - need to take more and more of the same drug --> higher and higher highs, lower and lower lows
• expectancy effects (positive reinforcements for social acceptance)
• tension reductions

• exposure to drugs - media/family/peers
• societal views abotu drug abuse
• cultural factors (interaction with bio factors like Asian flush)
• failures in parental guidance
• marital/other intimate relationships

• expsoure/access to a drug
• social/cultural expectations
• pleasurable effects
• more complex reasons too like stress, learning factors, genetics, etc.

• meds - to reduce cravings/ease detoxification process
• disulfiram (vomiting if drink)
• naltrexone - opiate antagonist - reduces craving for alcohol
• drugs to reduce the symptoms of detoxification/withdrawal
• can be agonists/antagonists/aversive treatments

• best once the drinking is under control
• group/individual therapy -
• environmental intervention - alleviate aversive life
• CBT - aversion therapy/sensitization (classical conditioning)
• AA - self help
• teach controlled use - for those with less severe use
• relapse prevention

• pleasure, curiosity, peer pressure
• changes in neurotransmitter systems that regulate motivation and ability to manage stress
• chronic underproduction of endorphins = cravings for narcotic drugs

drug - methadone

buprenorphine