• Pain in one or more than one site
• Pain causes significant distress or impairment
• Pain is not faked or intentionally produced
• Pyschological factors shave a role in the onset, severity or maintance of the pain
• Prevalence is unclear
• Maybe acute (<6 months) or chronic (>6 months)

• fears of having, or that one has a serious disease on misinterpertation of bodily symptoms
• fear exsists after many visits to doctors (doctor shopping: look for different doctors till one gives them the correct answer)
• Causes significant distress or impairment
• Duration of at least 6 months

• History of physical complaints beginning before age 30
• Medical treatment is sought or significant impairment in social or occupational functioning
• complaints not explained by medical condition

• one or more symptoms affecting voluntary or sensory function suggesting neurological or other medical conditions (ex. loss ability to walk, see, hear, etc)
• symptoms worsen under stressful conditions
• not faked or intentionally produced
• person maybe cured in emergency situation
• "If blindness is a symptom the person doesnt bump into things"
• Acute or Chronic

• preoccupation with imagined or exaggerated defect in physcial appearence.
• Engages in behaviors to remedy their apearence (but may actually increase severity of problem)
  • Behaviors are often time consuming
    • Safety/Avoidance behaviors aimed at improving or removing the defect. (exp. Plastic Surgery (89% of peple))

Does plastic surgery help?

• Weighs 85% or less than their healthy body weight, refusal to maintain healthy body weight
• stopping menstral cycle (Amenorrhea)
• extreme fear of being overweight, even though underweight
• marked disturbance as how they are percieved

• evaluate selves on body shape and weight
• Binge-eat/purge method
• frequency: Binge/purge behavior at least 2 times per week for 3 months or more.
• usually closer to normal weight

• Binge eating w/out purging behavior
• New needs further study

Associated features of Anorexia and Bulemia Nervosa

Anorexia Nervosa

-lower blood pressure and heart rate, sluggish movement, low energy, changes in brain chemistry and structure, may spend much time thinking about food, preparing food for other, not eating it though, high comorbidity with depression, anxiety disorders and substance abuse

Bulemia Nervosa

closer to normal weight, binge usually more food and followed by less consistent purging, high comobidity with anxiety disorder and low with mood disorders, substance abuse

Medical Consequences of Anorexia Nervosa

eating abnormally large amount of food in a short period of time (2 hours or less), have a sense of loss of control.

Purge/Compensatory

Do people seek treatment or are they forced?

Complaints or bodily symptoms that suggest some kind of physical defect or dysfunction for which no medical cause is found

or

Symptoms are in excess of what is expected from physical problems

Treatment of Bulemia Nervosa

Examines the family dynamics that may contribute to anorexia or interfere with recovery. Often includes some therapy sessions without the anorexic patient—a particularly important element when the person with anorexia denies having an eating disorder.

Major Depressive Disorder (symptoms)

(unipolar)

Symptoms:

(5 of 9) (always depressed mood and Anhedonia)

 lack of interest, depressed mood, low energy, weight loss or gain, thoughts of suicide (attempt), psychmotor agitation, worthliness and feelings of guilt, concentration of difficulties, change in sleep

Major Depressive Disorder

(frequency, duration)

Frequency:  most everyday, at least 2 weeks

Duration: at least 2 months

must cause distress or impairment

Recurrant is more common (85% will experience another) Episodic not chronic

Dysthymia

(symptoms)

Depressed mood for most of the day everyday for a period of 3 or more years. (CHRONIC) 

Symptoms (2 w/depressed mood): poor or large apetite, sleep disturbance, low energy levels, low self esteem, concentration difficulties

different than dysthymia: does not exceed 6 months, requires assitance of precipitating event (exp. someone loved dying or moving far away)

Chronic then disapears

Bipolar I Disorder

(symptoms)

alternating periods of mania and major depression

(3 or more symptoms): inflated self esteem,  decreased sleep, pressured speech, racing thoughts, distractabilty

RECURRENT AND EPISODIC

Cognitive Theory

Learned Helplessness (Seligman)

(depression)

(3) Depression 

^^^^^ 

(2) sense of helplessness 

^^^^^^ 

 (1) uncontrollable aversive thoughts

Attribution- Learned Helplessness (Abramson)

(depression)

Depression 

^^^ 

no response available to alter situations

 ^^^

attribution to global and state factors 

^^^ 

Aversive Events

 Depression

 ^^^

 nothing they can do to get out of situation

 ^^^

 global, state and cognitive factors

 ^^^

Aversive Events

Anhendonia

(depression)

overgeneralization and magnification

Negative Triad

(cognitive)

Bipolar II Disorder

(symptoms)

Alternating episodes of Major depressive Disorder and hypomania.

usually have a pattern of hypomania and depressed mood.

(always depressed>>>hypomania)

(always hypomanic>>>depressed)

Episodic

mild depression/hypomania

Chronic Mood disorder; long term changes in mood

lasting at lwast 2 years

Treating Unipolar Disorders

(Behavioral Activation)

Increase  acess tp reinforcements by trying new behaviors and activities.

Shows quick improvement

Treating Unipolar Disorders

(Medication)

Tricyclic Antidepressants, increases noneprinepine, serotonin, and dopamine

Treating Unipolar Disorders

(Last Resort)

Treating Unipolar Disorders

(drugs v.s therapy)

They both can be effective seperatly but the best results come from when you use the 2 together.

Drugs have a higher relapse rate

Therapy is shown more effective

Treating Bipolar Disorders

Medication

Lithium is an effective mood stabalizer

(too little is not effective and too much is lethal)

drugs from unipolar can intensify or trigger a manic episode.

DRUG THERAPY IS CRUICAL W/BIPOLAR

Suicide-attempters v.s completers

Attempters=usually females

Completers=usually men

Male=Guns, jumping

Women=Pills or cutting

Men=Depression, desire for death

Women=Depression, anger, change, help

Women-3-4 times more likely to attempt suicide

Men-4-5 times more likely to complete suicide

More common in white people than other races

Intent- carry out plan of suicide

Ideation- no plan, just thought (more common)

Stages of Sleep

(5)

(1)Body temp drops, breathing slows, Light sleep

(2) Increasing depth (3)&(4) Deep Sleep, hard to wake (5)REM

Insomnia

(Dyssomnia)

Problems maintaining or initiating sleep, usually have unrealistic expectation about sleep (need 8 hours or cant function)

Possible causes: Problems w/ biological clock and sleep/wake cycle or problems in enviroment: Too light or too much noise

Hypersomnia

(Dyssomnia)

Exccessive amounts of sleep, feeling sleepy through out the day and able to sleep through night.

Possible Causes: Family History in 39% of cases, exposure to viral infection (Mono, hepititas)

Narcolepsy

(Dyssomnia)

Hypnagogic Hallucinations

Breathing-Related Sleep Disorders

(Dyssomnia)

During respitory system, relaxes and makes it hard to breathe

(common in people who are overweight or people with sinuses or deviated ceptums)

Circadian Rhythm Sleep Disorders

(dyssomnia)

Disturbed sleep or excessive sleep, brains inability to sychronize sleep/wake cycle

(insomnia and hypersomnia)

Nightmare Disorder

(parasomnias)

Internal and external causes of

Circadian Rhythm Sleep Disorders

External: Jet lag, shift changing @ work

Internal: Delayed or Advanced sleep phase

Sleep Terrors

(parasomnia)

Sleep Waking Disorder

(Parasomnia)

Nocturnal Eating Syndrome

(parasomnias)

Person gets out of bed and eats while in deep sleep, often eat high calorie foods and bizarre combonations, recently been linked to ambien.

RARE

NREM and REM Parasomnias

NREM-Sleep terror, Sleep walking, nocturnal eating syndrome.

REM- Nightmare Disorder

Medical Treatments-Weight loss, Benzodiazepines and over the counter sleeping aids, antidepressants

Psychological- Relaxation and stress reduction and Stimulus control procedures

Substance Dependance

(tolerance)

Substance Dependance

(Withdrawl)

Depressants

(effects on brain on body)

Biological Factors

(substance use)

Neurobiological- Dopamine Theory: Drug use affects DA to enhance pleasant feelings, GABA Theory: Drug use enhances GABA to reduce fear/anxiety

Psychological factors

(tolerance and withdrawl Cycle)

Biological Treatments

(Agonist)

Biological Treatment

(antagonist)

Biological Treatment

(Aversive)

Psychosocial Treaments

(Inpatient Hospitilzation)

Psychosocial Treaments

(AA/NA)

Psychosocial Treatment

(aversion Therapy)

Psychosocial Treatment

(Contingency Management and Relapse Prevention)

Relapse Prevention - Teach better coping skills