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18 September 2006 @ 07:10 pm
STUDY SHEET – EXAM #1
DEVELOPMENTAL PSYCHOLOGY

Chapter 1: History, Theory, & Research Strategies

Human development: a field of study devoted to understanding constancy and change throughout the lifespan

Theory: an orderly, integrated set of statements that describes, explains, and predicts behavior (D.E.P.)

Two Basic Issues in HD:
Continuous Development: a process of gradually augmenting the same types of skills that were there to begin with.
- the difference between immature and mature being is simply one of amount or capacity
- change is gradual and ongoing

Discontinuous Development: a process in which new and different ways of interpreting and responding to the world emerge at particular time periods
- infants and children have unique ways of thinking, feeling, and behaving—quite
different than adults
- development is in stages: qualitative changes in thinking, feeling and behaving that
characterize specific periods of a development (ex: climbing a staircase)
- change is sudden

Lifespan perspective: a complex vision of change and the factors that underlie it
Four assumptions of development:
1) Lifelong- no age period is supreme in its impact on the life course
2) Multidimensional: affected by an intricate blend of biological, psychological, and social forces
-multidirectional: growth and decline
3) Plastic- a metamorphosis with continued potential
4) Embedded in multiple contexts-
-Age-graded influence: events that are strongly related to age and therefore fairly predictable in when they occur and how long they last
-History-graded influences: explain why people born around the same time—called a cohort—tend to be alike in ways that set them apart from people born at other times
-Nonnormative influences: events that are irregular, in that they happen to just one or a few people and do not follow a predictable timetable; nonnormative influences have become more powerful & age-graded influences less so in contemporary adult development



3 DOMAINS OF DEVELOPMENT:
Physical Development: changes in body size, proportions, appearance, functioning of body systems, perceptual and motor capacities, and physical health.

Cognitive Development: changes in intellectual abilities, including attention, memory, academic and everyday knowledge, problem solving, imagination, creativity, and language.

Emotional & Social Development: changes in emotional communication, self-understanding, knowledge about other people, interpersonal skills, friendships, intimate relationships, and moral reasoning and behavior.

Major Periods of Human Development

Period Age Range Description
Prenatal Conception-birth The one-celled organism transforms into a human baby with remarkable capacities to adjust to life outside the womb.
Infancy & Toddlerhood Birth-2 years Dramatic changes in the body and brain support emergence of a wide array of motor, perceptual, and intellectual capacities and first intimate ties to others.
Early Childhood 2-6 years The play years, in which motor skills are refined, thought and language expand at an astounding pace, a sense of morality is evident, and children begin to establish ties to peers.
Middle Childhood 6-11 years The school years, marked by advances in athletic abilities; logical thought processes; basic literacy skills; understanding of self, morality, and friendship; and peer-group membership.
Adolescence 11-20 years Puberty leads to an adult-size body and sexual maturity. Thought become abstract and idealistic and school achievement more serious. Adolescents focus on defining personal values and goals and establishing autonomy from the family.
Early Adulthood 20-40 years Most young people leave home, complete their education, and begin full-time work. Major concerns are developing a career; forming an intimate partnership; and marrying, rearing children, or establishing other lifestyles.
Middle Adulthood 40-60 years Many people are at the height of their careers and attain leadership positions. They must also help their children begin independent lives and their parents adapt to aging. They become more aware of their own mortality.
Late Adulthood 60 years-death People adjust to retirement, to decreased physical strength and health, and often to the death of a spouse. They reflect on the meaning of their lives.

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Historical Foundations

Preformationism: in medieval Europe, once children emerged from infancy, they were regarded as miniature, already-formed adults—no philosophies of the uniqueness of childhood or separate developmental periods
-Puritan beliefs tried to promote reason in their sons and daughters so they could tell right from wrong and resist temptation

John Locke: British philosopher, forerunner of behaviorism
-tabula rasa: “blank slate”—children are, to begin with, nothing at all, and all kinds of experiences can shape their characters
-parents can mold the child in any way they wish through careful instruction, effective example, and rewards for good behavior
-led change from harshness toward children to kindness and compassion
-believed in continuous development, nurture (the power of the environment to shape the child), children are passive in the development

Jean Jacques Rousseau: French philosopher, child-centered philosophy
-noble savages: children were naturally endowed with a sense of right and wrong and with an innate plan for orderly, healthy growth
-maturation: refers to a genetically determined, naturally unfolding course of growth
-believed in discontinuous development, a stagewise process that follows a single, unified course mapped out by nature

Charles Darwin: the forefather of scientific child study
-began by studying plant and animal species
-theory of evolution; natural selection & survival of the fittest

G. Stanley Hall: founder of the child study movement Arnold Gesell
-normative approach: measures of behavior are taken on large numbers of individuals, and age-related averages are computed to represent typical development

Alfred Binet: first practical intelligence tests; used normative data
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The Psychoanalytic Perspective:
-people move through a series of stages in which they confront conflicts between biological drives and social expectations. The way these conflicts are resolved determines the individual’s ability to learn, to get along with others, and to cope with anxiety.

Sigmund Freud:
-psychosexual theory: emphasized that how parents managed their child’s sexual and aggressive drives in the first few years is crucial for healthy personality development.
-id (largest part-source of basic biological needs and desires), ego (conscious rational part), superego (conscience-moral reasoning)



Freud’s Psychosexual Stages (Discontinuous)

Stage Period Description
Oral Birth-1 year The new ego directs the baby’s sucking toward breast or bottle. If oral needs are not met, may develop such habits as thumb sucking, fingernail biting, and pencil chewing in childhood and overeating and smoking in later life.
Anal 1-3 years Enjoy holding and releasing urine and feces. Toilet training becomes a major issue between parent and child. If parents insist that children be trained before they are ready or make too few demands, conflicts about anal control may appear in the form of extreme orderliness and cleanliness or messiness and disorder.
Phallic 3-6 years Id impulses transfer to the genitals, and the child finds pleasure in genital stimulation. Oedipus conflict for boys and Electra conflict for girls—the young child feels a sexual desire for the other-sex parent. To avoid punishment, they give up the desire and, instead, adopt the same-sex parent’s characteristics and values. As a result, the superego is formed, and children feel guilty each time they violate its standards. The relations among id, ego, and superego established at this time determine the individual’s basic personality.
Latency 6-11 years Sexual instincts die down, and the superego further develops. The child acquires new social values from adults outside the family and from play with same-sex peers.
Genital Adolescence Puberty causes the sexual impulses of the phallic stage to reappear. If development has been successful during earlier stages, it leads to marriage, mature sexuality, and the birth and rearing of children.


Erik Erikson:
-psychosocial theory: the ego does not just mediate between id impulses and superego demands. At each stage, it acquires attitudes and skills that make the individual an active, contributing member of society.
-child rearing can be understood only by making reference to the competencies valued and needed by the individual’s society.

Erikson’s Psychosocial Stages (Discontinuous)

Stage Period Description
Basic trust vs mistrust (Oral) Birth-1 year From warm responsive care, infants gain a sense of trust or confidence that the world is good. Mistrust occurs when infants have to wait too long for comfort and or handled harshly.
Autonomy vs shame and doubt (Anal) 1-3 years Using new mental and motor skills children want to choose and decide for themselves. Autonomy is fostered when parents permit reasonable free choice and do not force or shame the child.
Initiative vs guilt (Phallic) 3-6 years Through make-believe play children experiment with the kind of person they can become. Initiative- a sense of ambition or responsibility- develops when parents support their child’s new sense of purpose. The danger is that parents will demand too much self-control, which leads to over-control, meaning too much guilt.
Industry vs diffusion (Latency) 6-11 years At school, children develop the capacity to work and cooperate with others. Inferiority develops when negative experiences at home, at school, or with peers leads to feelings of incompetence.
Identity vs identity confusion (Genital) Adolscence The adolescent tries to answer the question “Who am I? and What is my place in society?” Self-chosen values and vocational goals lead to lasting personal identity. The negative outcome is confusion about future adult roles.
Intimacy vs isolation Young adulthood Young people work on establishing intimate ties to others. Because of earlier disappointments, some individuals cannot form close relationship and remain isolated.
Generativity vs stagnation Middle adulthood Generativity means giving to the next generation through child rearing, caring for other people, or productive work. The person who fails in these ways feels an absence of meaningful accomplishment.
Ego integrity vs despair Old age In this final stage, individuals reflect on the kind of person they have been. Integrity results from feeling that life was worth living as it happened. Older people who are dissatisfied with their life fear death.


Behaviorism and Social Learning Theory:
-Behaviorism: directly observable events—stimuli and responses
-John Watson & little Albert
-classical conditioning (Pavlov) & operant conditioning (BF Skinner)
-Social learning theory: (Bandura) emphasized modeling, (imitation or observational learning), as a powerful source of development (dev. is continuous)
-children acquire many favorable and unfavorable responses simply by watching and listening to others around them
-Behavior modification: procedures that combine conditioning and modeling to eliminate undesirable behaviors and increase desirable responses

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Piaget’s Cognitive-Developmental Theory:
-Cognitive-developmental theory: children actively construct knowledge as they manipulate and explore their world
-adaptation--structures of the mind are adapted to fit with, or represent, the external world

Piaget’s Stages of Cognitive Development (Discontinuous)

Stage Period Description
Sensorimotor Birth-2 years Infants “think” by acting on the world with their eyes, ears, hands, and mouth. As a result, they invent ways of solving sensorimotor problems, such as pulling a lever to hear the sound of a music box, finding hidden toys and putting objects in and taking them out of containers.
Preoperational 2-7 years Preschool children use symbols to represent their earlier sensorimotor discoveries. The development of language and make-believe play takes place. However, thinking lacks the logical qualities of the two remaining stages.
Concrete operational 7-11 years Children’s reasoning becomes logical. School-age children understand that a certain amount of lemonade or play-dough remains the same even after its appearance changes. They also organize objects into hierarchies of classes and subclasses. However, thinking falls short of adult intelligence. It is not yet abstract.
Formal operational 11 years on The capacity for abstraction permits adolescents to reason with symbols that do not refer to objects in the real world, as in advance mathematics. They can also think of all possible outcomes in a significant problem, not just the most obvious ones.

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Information Processing:
-the human mind is viewed as a symbol-manipulating system through which information flows
-information is actively coded, transformed, and organized
-regards people as active, sense-making beings BUT no stages of development
-thought process include: perception, attention, memory, planning strategies, categorization of information, and comprehension of written and spoken prose—similar at all ages but present to a lesser or greater extent (continuous)



Ethology and Evolutionary Developmental Psychology:
-Ethology: concerned with the adaptive, or survival, value of behavior and its evolutionary history
-imprinting (the early following behavior of some animals), critical period (limited time span during which the individual is biologically prepared to acquire certain adaptive behaviors)
-sensitive period: time that is optimal for certain capacities to emerge and in which the individual is especially responsive to environmental influences—boundaries are less defined than critical period
Evolutionary developmental psychology: seeks to understand the adaptive value of species-wide cognitive, emotional, and social competencies as those competencies change with age; sees development as discontinuous and continuous.

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Vygotsky’s Sociocultural Theory:
-examines the relationship of culturally specific practices to development—it focuses on how culture (the values, beliefs, customs, and skills of a social group) is transmitted to the next generation.
-Social interaction (cooperative dialogues with more knowledgeable members of society) is necessary for children to acquire the ways of thinking and behaving that make up a community’s culture
-cognitive development is a socially mediated process
- sees development as discontinuous and continuous

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Ecological systems theory:(Bronfenbrenner)
(this approach is not specified whether continuous or discontinuous)
-views the person as developing within a complex system of relationships affected by multiple levels of the surrounding environment
--a child’s biological dispositions join the environmental forces to mold development
--The environment has various layers:
**Microsystem: the innermost level of the environment
--consists of activities and interaction patterns in the person’s immediate surroundings
--all relationships are bidirectional
--ex: immediate family, day care or school, neighborhood, church
**Mesosystem: second level
--encompasses connections between Microsystems
--ex: parent support influences school performance and behavior
**Exosystem: social settings that do not contain the developing person but nevertheless affect experiences in immediate settings
--ex: extended family members, friends and neighbors, workplace, health services
**Macrosystem: outermost level
--not a specific context
--consists of cultural values, laws, customs, and resources



CHAPTER 2: Biological and Environmental Foundations

- phenotypes: direct observable characteristics of a person (height, weight, etc.)
- genotype: complex blend of genetic info that determines our species and influences all of our unique characteristics
- we are all made up of several cells; each cell has a control center called a nucleus
- inside each nucleus are rodlike structures called chromosomes which store and transmit genetic information; chromosomes are made up of a chemical substance called deoxyribonucleic acid (DNA)
- a gene is a segment of DNA along the length of the chromosome
- gametes: sex cells (sperm & ovum) they contain only 23 chromosomes
- gametes are formed through a process called meiosis, which ensures a constant quantity of genetic material is transmitted from one generation to the next
- zygote: when sperm ad ovum unite making the chromosomes
- 22 of the 23 pairs of chromosomes are matching called autosomes; the 23rd pair consists of sex chromosomes (Females are XX; Males are XY)
- fraternal twins are diyzygotic; the fertilization of two ova; identical twins are monozygotic; they have the same genetic make-up because the cluster of cells splits
- homozygous: if the genes from both parents are alike
- heterozygous: relationship between the genes determine the trait that will appear
- incomplete dominance: when the dominant doesn’t take over when it is supposed to
- dominant-recessive inheritance: (in heterozygous pairs) only one gene affects the child’s characteristics
- carriers: parents can pass the recessive gene to their children (under stress they can experience sxs)
- codominance: a pattern of inheritance in which both genes influence the person’s characteristics (when both experience themselves like AB Blood type)
- X-linked inheritance: when a harmful recessive gene is carried on the X chromosome, males are more likely affected because their sex chromosomes don’t match
- Genetic imprinting: genes are imprinted or chemically marked, in such a way that one member of the pair (either the mother’s or the father’s) is activated, regardless of its makeup
- mutation: a sudden but permanent change in a segment of DNA
- polygenic inheritance: traits like height, weight, intelligence and personality, many genes determine these
- most chromosome abnormalities result from mistakes during meiosis (most diseases from recessive genes)
- down syndrome: most common 1 out of 800 births; result of the 21st pair of chromosomes not separating at meiosis; sxs include: mental retardation, memory, speech problems, limited vocabulary & slow motor development
- adding or subtracting the usual number of X chromosomes results in particular intellectual deficits
- genetic counseling: a communication process designed to help couples assess their chances of giving birth to a baby with a hereditary disorder and chose the best course of action in views of risks and family goals, they prepare a pedigree, which gives a picture of the family tree and which relatives are affected
- prenatal diagnostic methods: medical procedures that permit detection of problems before birth (e.g. amniocentesis, chorionic villus sampling)
- over 90% of pregnancies in the U.S. result in the birth of healthy infants w/ a good change of life free of genetic disease
- genetic testing: concerns of letting people know they can become ill and have no methods of fixing it can be cruel

Environmental Contexts:
- direct influences: the behavior of one family member helps sustain a form of interaction in the other that either promotes or undermines psychology well-being
- indirect influences: the effects of 3rd parties
- adapting to change: a lot of changes in families like new job, birth of a child, grandparent moving in, etc.
- socioeconomic status: researchers use this to asses a family’s status (1) years of education; (2) prestige and skill required by one’s job, both which measure social status, and (3) income, which measures economic status
- impact of poverty: 1) development is threatened; 2) U.S. has higher % of extremely poor children

Beyond the Family:
- neighborhoods: have more of an impact on economically disadvantaged than well-to-do young people (less dependency)
- towns & cities: more active role in the community if the town is smaller
- cultural context: cultures shape family interaction and community settings beyond the home
- subcultures: groups of people w/ beliefs and customs that differ from those of the larger culture
- extended family households: 3 or more generations live together; collectivism vs. individualism
- more public policies exist for elders than for children

- heritability estimates: measure the extent to which individual differences in complex traits, such as intelligence and personality, in a specific population are due to genetic factors
- concordance rates: % of instances in which both twins show a trait when it is present in one twin
- Kinship studies: compare characteristics of family members (most common among identical twin studies)
- used to infer the role of heredity in complex human characteristics

- epigenesis: means development resulting from ongoing, bidirectional exchanges between heredity and all levels of the environment



Limitations of Heritability & Concordance:
1. doesn’t account for places where environmental factors are very similar leaving the differences between intelligence and more genetic in nature and vice versa
2. the accuracy of these rates depend on the extent to which the twin pairs used reflect genetic and environment variation in the population
3. they can be misapplied
4. they give us no precise information about how intelligence and personality develop or how individuals might respond to environments designed to help develop as far as possible


CHAPTER 3: Prenatal Development, Birth & the Newborn Baby:
- conception: every 28 days an ovum burst from ovaries through one of the fallopian tubes; as it travels its called the corpus luteum; if it doesn’t fertilize then the uterus lining is discarded 2 wks later

Pregnancy is in 3 phases:
Phase One:
- zygote: abt 2 wks; from fertilization until the tiny mass of cells drifts down and out of the fallopian tubes and attaches to the wall of the uterus (called a blastocyst)
- implantation occurs between the 7th and 9th day after fertilization
- amnion: encloses the developing organism in amniotic fluid, which helps keep the temperature constant and protect like cushion from mother’s movements
- chorion: this surrounds the amnion, from the chorion tiny fingerlike ville or blood vessels begin to emerge as the ville dig in to the uteran wall; the placenta develops, it permits food and oxygen to reach the baby
- umbilical cord: contains one large vein that delivers blood loaded w/ nutrients & 2 arteries that remove waste products

Phase Two:
- embryo: 2nd through 8th week of pregnancy; most rapid changes groundwork laid for all body structures and internal organs
Forms 3 layers of cells:
- ectoderm: nervous system and skin
- mesoderm: develop the muscles, skeleton, circulatory system & other internal organs
- endoderm: becomes the digestive system, lungs, urinary tract and glands

Phase Three:
- fetus: “growth and finishing” phase; 9th week until end of pregnancy
- everything becomes organized and connected; the fetus kicks and moves
- prenatal development is sometimes divided into 3 trimesters (1st trimester from conception to 12 wks)
- 2nd trimester: mother can feel movements; a white, cheeselike substance called vernix develops to protects its skin from chapping during the long months spent bathing in the amniotic fluid; white downy hair called lanugo also appears over the entire body, helping the vernix stick to the skin; at the end of the 2nd trimester most of the brain’s neurons (nerve cells that store and transmit information) are in place
- 3rd trimester: during this time the fetus has a chance of surviving outside the womb referred to as the age of viability; the cerebral cortex enlarges; neurological organization improves; fetus takes on the beginnings of a personality

- teratogen: refers to any environmental agent that causes damage during the prenatal period (depends on factors such as: dose, heredity, other negative influences and age)
- Outside influences:
Prescription drugs
Non-prescription drugs
Tobacco
Alcohol
Crack, heroine and cocaine
- Fetal Alcohol Syndrome (FAS): mental retardation, impaired motor coordination, attention, memory and language w/ physical abnormalities (widely spaced eyes, thin upper lip; short eyelid openings)
- Fetal Alcohol Effects (FAE): some abnormalities but not all (meant mom drank less)
- Other teratogens: radiation; environmental pollution; infectious disease call all cause defects or abnormalities
- Other maternal factors: nutrition: healthy weight gain for mom would be 25 to 30 lbs; need to avoid emotional stress; Rh factor compatibility: when the inherited blood types of the mother and fetus differ, occurrence relies on maternal age and previous births

Stages of childbirth:
1. dilation and effacement of the cervix (hours)
2. birth of the baby (20 – 50 mins)
3. delivery of the placenta

- cerebral palsy: impairments in muscle coordination that result from brain damage before, during, or just after birth
- infant mortality: an index used around the world to assess the overall health of a nation’s children. It refers to the number of deaths in the first year of life per 1,000 lie births
- newborn reflexes: inborn responses to a particular form of stimulation
- moro reflex: arch back, extend arms out and back, helps cling to mother
- states of arousal: degrees of sleep and wakefulness
- babies spend about 50% of sleep in REM mode; adults about 20%
- babies communicate through crying
- Sudden Infant Death Syndrome (SIDS): unexpected death, usually during the night of an infant under 1 yr of age and remains unexplained; may be from smoking in household or genetically weak
- Neonatal Behavioral Assessment Scale: looks at the baby’s reflexes, state changes, responsiveness to physical and social stimuli and other reactions
CHAPTER 5: Cognitive Development in Infancy and Toddlerhood
Piaget’s Cognitive Developmental Theory
• Piaget believed that infants and toddlers “think” with their eyes, ears, hands and other sensorimotor equipment. They cannot carry out many activities inside their heads
• Schemes: a specific structure, or organized way of making sense of experience, that changes with age.
• Two process account for change in schemes: adaptation and organization.
o Adaptation: the process of building schemes through direct interaction with the environment. Made up of two complimentary processes- assimilation and accommodation.
 Assimilation: the part of adaptation in which the external world is interpreted in terms of current schemes.
 Accommodation: the part of adaptation in which new schemes are created and old ones adjusted to produce a better fit with the environment.
 A state of equilibrium occurs when children are in a steady comfortable condition- they assimilate more than accommodate.
 They are in a state of disequilibrium when there is rapid cognitive change, and new info does not match current schemes- move away from assimilation toward accommodation.
o Organization: the internal rearrangement and linking together of schemes so that they form a strongly interconnected cognitive system. In information processing, the memory strategy of grouping together related items. Ex. Relating dropping to throwing
• Circular reaction: a means of building schemes in which infants try to repeat chance events caused by their own motor activity
o Circular reaction changes. First it centers around infants own body, then toward manipulation of objects, and then it becomes experimental and creative, aimed at producing novel effects in the environment.
Piaget’s Six Sensorimotor Substages
1. Reflexive schemes (birth-1month) - new born reflexes, babies suck, grasp, and look in much the same way, no matter what experiences they encounter.
2. Primary circular reaction (1-4months) - they start to gain voluntary control over their action, repeat chance bxs largely motivated by basic needs. Ex. Suck on fist, change the way they open their mouths
3. Secondary circular reaction (4-8months) – infants sit up and reach for and manipulate objects, they try to repeat events caused by their own actions
4. Coordination of secondary circular reactions (8-12months) – Intentional or goal directed behavior which is coordinating schemes deliberately to solve simple problems. Object permanence, the understanding that objects continue to exist when out of sight. Also, infants anticipate events or imitate bxs.
5. Tertiary circular reaction (12-18months) - repeat bxs with variation, provoking new results. They are better problem solvers.
6. Mental representation (18-24months) – internal depictions of information that the mind can manipulate. 1) Images, or mental pictures of objects, people and spaces and 2) concepts, or categories in which similar objects or events are grouped together. Deferred imitation- the ability to remember and copy the bx of model who are not present. Make-believe play- children act out everyday and imaginary activities.
• Violation of expectation method: a method in which researchers habituate infants to a physical event and then determine whether they recover to look longer at a possible event (a variation of the first event that conforms to physical laws) or an impossible event (a variation that violates physical laws). Recovery to the impossible event suggests that the infant is surprised at a deviation from reality and is aware of that aspect of the physical world. This suggests that infants display bxs earlier than Piaget believed.
• Core knowledge perspective: babies are born with a set of innate knowledge systems, or core domains of thought. Each of these prewired understandings permits a ready grasp of new, related information and therefore supports early, rapid development.
• Physical knowledge- includes object permanence, object solidity ( that one object cannot move through another object), and gravity (that an object will fall without support).
• Numerical knowledge – ability to distinguish small quantities
• Linguistic knowledge- etched into the structure of the human brain
• Psychological knowledge- understanding of mental states such as intentions, emotions, desires, and beliefs

Information Processing
• Researchers assume that we hold information in three parts of the mental system: the sensory register, working or short term memory, and long term memory.
• Mental strategies- procedures that operate on and transform info, increasing the chances that we will retain information and use it efficiently
• Sensory register- part of the mental system in which sights and sounds are held briefly before they decay or are transferred to working, or short term memory
• Working or Short term memory- the conscious part of the mental system, where we actively work on a limited amount of information to ensure that it will be retained
• Central executive- the conscious part of the working memory that directs the flow of information through the mental system by deciding what to attend to, coordinating incoming information with information already in the system, and selecting, applying, and monitoring strategies
• Long term memory- part of the mental system that contains our permanent knowledge base
• Attention: During the first year, infants attend to novel and eye-catching events. With toddlerhood children become increasingly capable of intentional bx. Attraction to novelty declines and sustained attention improves.
• Memory: As children get older their ability to remember things increases.
• Recognition: noticing when a stimulus is identical or similar to one previously experienced
• Recall: more challenging because it involves remembering something in absence of perceptual support. To recall, you must generate a mental image of the past experience.
• Categorization: As infants remember more info they store it in orderly fashion such as shape, size, food items, furniture, animals, vehicles, etc.
• Early categories Perceptual – based on similar overall appearance or prominent object part, such as legs for animals and wheels for cars.
• By the end of first year conceptual- based on common function and bx.


The Social Context of Early Cognitive Development
• Zone of proximal development (concept of Vygotsky): a range of tasks that the child cannot yet handle alone but can do with the help of more skilled partners.
• The adult provides guidance and support, then the child joins in the interaction and picks up mental strategies increasing competence. Adult steps back and lets the child acquire more responsibility. Cultural variations and social experience affects mental strategies.
Individual Differences in Early Mental Development
• Infant Intelligence Tests
• Hard to measure because they cannot answer questions or follow directions
• Predict later performance poorly, because they get distracted and become irritable therefore their true abilities cannot be accurately measured
• Development quotient: a score on an infant intelligence test based on perceptual and motor responses
• Early Environment and Mental Development
• Childcare is common and has an impact on mental development.
• Early Intervention for At-Risk Infants and Toddlers
• Children living in poverty are likely to show declines in IQ due to stressful home environment.
• Interventions include center based where children attend and organized childcare program or preschool program and receive nutritional, educational, and health services.
Language Development
• Three theories of language development
1. The Behaviorist Perspective
- Skinner proposed that language is acquired through operant conditioning.
- Parents reinforce babies words with smiles and hugs.
- Children also rely on imitation to acquire complex utterances such as words and phrases
- Con- young children repeat utterances that they have never heard before. Reinforcement and imitation are best viewed as support
2. The Nativist Perspective
- Chomsky proposed that a child’s amazing language skill is etched into the structure of the human brain.
- All children are born with language acquisition: an innate system that contains a set of rules common to all languages. It permits children, no matter which language they hear, to understand and speak in a rule-oriented fashion as soon as they pick up enough words.
- Studies of isolated and abused children who experienced little human contact in childhood reveal lasting deficits in language, especially grammar and communication skills- evidence indicating that childhood is a sensitive period of language learning.
- Con- Partial account for language; difficulty id. Single system of grammar that Chomsky believes underlies all languages; mastering sentence construction is a gradual process not immediate.
3. The Interactionist Perspective
- Interactions between inner capacities and environmental influences
- Native capacity, a strong desire to interact with others, and a rich language and social environment combine to help children build a communicative system.
- Overall, biology, cognition, and social experience operate differently with respect to various aspects of language.
• Getting ready to talk
• Cooing and Babbling: around 2 months, babies begin to make vowel like noises called cooing because of their pleasant “oo” quality. Gradually, consonants are added and around 4 months babbling appears, in which infants repeat consonant vowel combinations in long strings.
• Babbling seems to develop because of maturation, but to further babies must hear human speech. Delayed for hearing impaired and deaf children
• Underextension: an early vocabulary error in which a word is applied too narrowly, to a smaller number of objects and events and events that is appropriate.
• Overextension: an early vocabulary error in which a word is applied to broadly, to a wider collection of objects and events than is appropriate. Illustrates the distinction between language production and language comprehension
• Telegraphic Speech: toddlers’ two word utterances that, like a telegram, leave out smaller and less important words
• Referential Style: a style of early language learning in which toddlers produce many words that refer to objects. They use language mainly to name things.
• Expressive Style: a style of early language learning in which toddlers frequently produce pronouns and social formulas, such as stop it, than you, and I want it. They use language mainly to talk about the feelings and needs of themselves and other people.
• Child directed speech: combinations of parenting bxs that occur in a wide range of situations, thereby creating an enduring child rearing climate

CHAPTER 6: Emotional & Social Development in Infancy & Toddlerhood
Erikson's Stages:
- Basic Trust vs. Mistrust: Freud called it the oral stage; a healthy outcome depends on the quality of the caregiver's behavior during this feeding stage
- Autonomy vs. Shame & Doubt: Freud called the anal stage; healthy when parents provide young children with suitable guidance and reasonable choices and let them be more independent

Basic Emotions:
- are universal in humans and other primates and have a long evolutionary history of promoting survival, and can be directly inferred from facial expressions. They include happiness, interest, surprise, fear, anger, sadness, and disgust
- 3 basic emotions have received the most research:
- Happiness: between 6 to 10 wks babies develop a broad grin called the social smile; 3 to 4 mths laughter occurs
- Anger and Fear: 6 to 8 mths anger & fear appear; stranger anxiety; survival mechanism

Emotional Development
Temperament: (Thomas & Chess) NOTE: 35% of children don’t fall into any category
1. Easy child (40%) quickly establishes regular routines, cheerful, adapts easily
2. Difficult child (10%) is irregular and slow to accept new experiences, tends to react negatively and intensely.
a. Sparked most interest. High risk for infants for adjustment problems, anxious and withdrawal types of bx, and aggression seen more in this temperament style.
3. Slow to warm-up (15%) inactive, show mild, low key reactions to environmental stimuli, negative mood, and adjust slowly to new experiences.
a. Don’t present many problems in early years. Tend to show excessive fearfulness and slow constricted bx in late preschool years.
Traits studied in temperament research: activity level, distractibility, approach/withdrawal, attention span, intensity of reactions, responsiveness, mood, affect. Etc.
Also: inhibited or shy child, uninhibited or social child
Temperament is thought to be fairly stable over time.

Goodness of Fit model: explains how temperament and environment can together produce favorable outcomes. Goodness of fit involves creating child-rearing environments that recognize each child’s temp while encourage more adaptive functioning (184)

Exchange of Emotions: Emotions play a powerful role in organizing the attainments that Erikson regarded as so important: Social relationships, exploration of the environment, and discovery of the self. (p. 175)

Development of Attachment: Defined: Attachment is the strong, affectional ties we have with special people in our lives that lead us to experience pleasure and joy when we interact with them and to be comforted by their nearness during times of stress (185).

• Freud Psychoanalytic: Feeding as primary context for forming attachments
• Erikson Neo-Freudian: Emphasizes comfort contact while feeding, caresses, warm smiles, tender words
• Harlow: Behaviorism: Drive-reduction explanation of attachment. Contact comfort. Can explain why infants attach to more than one person and even to a blanket.
• Lorenz Ethological: Emotional tie as survival mechanism. Infants endowed with built-in bx that protect and provide for infant. Imprinting with the baby geese
• Bowbly Ethological: Set of innate signals baby sends to adult. True affection develops over time. Bowbly says that out of these 4 stages children construct an enduring affection for caregivers. This serves as an internal working model for expectations and availability of attachment figures in times of stress. And guides future relationships.
Bowbly’s FOUR Phases:
1. Pre-attachment: birth to 6 wks
a. signals: crying, smiling, grasping, gazing
2. Attachment in the making: (6wks – 6-8 mos)
a. develop sense of trust
3. clear-cut attachment: (6-8 mos – 18-2yrs)
a. display separation anxiety, Use parent as secure base
4. Formation of reciprocal rlshp: (18 mos – 2 yrs and on)
a. Rapid growth in representation and language increases
understanding between toddler and parent.
SEE Attached for full strange situation practice exercises! Strange Situation: Ainsworth (1978)

Things that effect attachment in children: Pg 188-194
Does the baby have an opportunity to attach to a caregiver? “Institutionalized babies” left between ages 3-12 months at an orphanage: wept and withdrew from surroundings, lost weight, and had difficulty sleeping. Also showed emotional difficulties/depression. Later displayed emotional and social problems: excessive desire for adult attention and affection, over friendly to strangers, had few friendships.

Sensitive Care giving: responding promptly, consistently, and appropriately to infants.

Interactional synchrony: separated securely attached from insecurely attached infants. Best described as a sensitively tuned “emotional dance” in which caregiver responds to infant signals in a well-timed, appropriate fashion. Baby & Mother “match” emotional states, especially the positive ones. Laughing, smiling, etc.

• Quality of attachment is usually stable for middle SES children.
• Some insecurely attached infants will move into secure attachments if parents are positive and have good support in place
• Securely attached babies maintain their attachment more often than do insecurely attached infants.
• Longitudinal study found that preschool teachers viewed children who were securely attached as having high self esteem, socially competent, cooperative, and popular.
o Viewed avoidant attached: isolated, disconnected
o Resistant attached: disruptive and difficult.
o Findings may indicate that securely attached improves cognitive, emotional and social competence in later years, but more evidence is needed.
 
 
 
18 September 2006 @ 07:09 pm
STUDY GUIDE – TEST #2
DEVELOPMENTAL PSYCHOLOGY

Obesity in childhood:
- obesity: a greater-than-20% increase over average body weight, based on the child’s age, sex and physical build
- 15% of Canadian and 25% of American children are obese
- becoming common in developing nations
- over 80% become overweight adults
- high blood pressure and high cholesterol levels appear in childhood and are precursors to heart disease, certain cancers and early death

Causes:
- overweight children tend to have overweight parents
- genetics only counts for the tendency to gain weight
- low SES is associated because they buy high-fat, low cost foods
- parents either anxiously overfeed or are too restrictive this prevents children from learning how to regulate their own energy intake and they in turn develop maladaptive eating habits
- or rewards are given through sweets which puts a higher value on them
- overweight children are also less physically active (they usually spend more time watching TV)

Consequences:
- because physical attractiveness is a powerful predictor of social acceptance in Western societies obese children are not well liked
- both children and adults rate obese youngsters as unlikable, stereotyping them as lazy, sloppy, ugly, stupid, self-doubting and deceitful
- more depressed and display more behavior problems than their peers
- these psychological consequences combined w/ continuing discrimination reduce life changes in close relationships and employment

Treating obesity:
- difficult to treat because it is a family disorder
- most effective interventions involve family and are focused on changing behaviors (lifestyle) not just dieting
- schools can reduce it by ensuring physical activity and providing healthier meals

Self-esteem (middle childhood):
- children in middle childhood have at least 4 self-esteems (academic competence, social competence, physical/athletic competence, and physical appearance)
- they develop these four based on their experiences in different settings
- they are combined to form a general psychological image of themselves – an overall sense of self-esteem
- separate self-esteems do not contribute equally, perceived physical appearance correlates more strongly with overall self-worth than any other self-esteem factor
- the emphasis that society and the media places on appearance has major implications for young people’s overall satisfaction with the self
- see diagram (page 316)

















Early vs. Late Maturation:
- boys are girls are viewed differently
- early maturing boys are seen as relaxed, independent, self-confident, and physically attractive; they are more popular, hold more leadership positions and tend to be athletic stars
- late maturing boys are not well liked, adults and peers view them as anxious, overly talkative, and attention seeking
- early maturing girls are unpopular, withdrawn, lacking in self-confidence, and anxious and held few leadership positions; they more likely to engage in deviant behavior; they are more likely to hang out with older peers that encourage them into activities they are not ready to handle emotionally (partly because of school set up i.e. K-8 or 6-8th grade)
- late maturing girls are viewed better and seen as physically attractive, lively, sociable, and leaders at school
- 2 factors account for these trends: 1) how closely the adolescent’s body matches the cultural ideals of physical attractiveness; 2) how well young people “fit in” physically with their peers
- those in a physical status unlike their peers feel “out of place” and experience differences in adjustment
- however, later in life there is a turn-about in well-being, those who were admired in adolescence (early maturing boys and late maturing girls) become rigid, conforming, and somewhat discontented adults
- whereas, the outcasts (late maturing boys and early maturing girls) who were stress-ridden as teenagers often develop into adults who are independent, flexible, cognitively competent, and satisfied with the direction of their lives


Piaget’s stages of cognitive development (early childhood – adolescence)

Preoperational stage (2-7 yrs: early childhood)
Make-believe play:
- development of make-believe play
- pretend with less realistic toys
- becomes less self-centered
- includes other peers: sociodramatic play

Limitations of preoperational stage:
- egocentrism: failure to distinguish the symbolic view points of others from one’s own (3-mountain problem on pg 218)
- they don’t understand conservation (physical characteristics of objects remain the same even if the outward appearance changes, i.e. liquid measure test)
- centration: focus on one aspect of a situation, neglecting other important features (like ignoring the part where the experimenter pours the same liquid into a different shaped glass)
- irreversibility: inability to mentally go through a series of steps in a problem and then reverse direction, returning to the starting point

Concrete Operational Stage (7 to 11 yrs – middle childhood)
- decentration: focusing on several aspects of a problem and relating to them
- reversibility: the capacity to think through a series of steps and then mentally reverse directions, returning to the starting point
- classification: they pass Piaget’s class inclusion problem (yellow flowers and blue flowers = all flowers on pg 220) they are more aware of classification hierarchies
- seriation: ability to order items along a quantitative dimension, such as length or weight; they can also seriate mentally, an ability called transitive inference (logical reasoning: if stick A is longer than stick B and stick B is longer than stick C than stick A should be longer than stick C)
- spatial reasoning: they can perform mental rotation which is to give directions through another’s point of view (the opposite of egocentrism)
- limitations to concrete operational stage: children in middle childhood tend to think in an organized, logical fashion only dealing with concrete information they can perceive directly, their mental operations work poorly with abstract ideas
- horizontal decalage: development within a stage, explains the gradual mastery of logical concepts

Formal Operational Stage (11 yrs & up – adolescence):
- they develop the capacity for abstract, scientific thinking
- middle childhood “operates on reality” while adolescence “operates on operations”
- hypothetico-deductive reasoning: when faced with a problem, they start with a general theory of all possible factors that might affect the outcome and deduce from it specific hypotheses (or predictions) about what might happen. Then they test these hypotheses in an orderly fashion to see which ones work in the real world
- pendulum problem: asks them to figure out what influences the speed with which the pendulum swings through its arc, adolescents offer several different explanations but through testing discover that it really is the length of the string that determines speed
- propositional thought: adolescents can evaluate the logic of propositions (verbal statements) without referring to real-world circumstances (red and green poker chip test on pg. 364)


Parenting styles and making punishment effective:

Authoritative style: most successful approach, involves high acceptance and involvement, adaptive control techniques, and appropriate autonomy granting; authoritative parents are warm, attentive, and sensitive to their child’s needs. Emotionally fulfilling parent-child relationship, close connection. At the same time they exercise firm, reasonable control and insist on mature behavior and give reasons for their expectations (Children of authoritative parents are usually high in self-esteem, upbeat, maintain self-control, task persistence, cooperative and more social and moral maturity)

Authoritarian style: parents with this style are low in acceptance and involvement, high in coercive control, and low in autonomy granting; they appear cold and rejecting; they frequently degrade their child by putting them down, yelling, criticizing and commanding. If the child disobeys they resort to force and punishment (Children of authoritarian parents are anxious and unhappy, they tend to become hostile when frustrated, boys show high rates of anger and defiance; girls are dependent lacking in exploration and overwhelmed by challenging tasks)

Permissive style: parents are warm and accepting but rather than being uninvolved they are overindulging or inattentive. They engage in little control of their child’s behavior. Instead of gradual autonomy granting they allow the child to make many of their own decisions at an age when they are not capable of doing so (Children of permissive style parents are impulsive, disobedient and rebellious, they are overly demanding and dependent and show less persistence on tasks)

Uninvolved style: combines low acceptance and involvement with little control and general indifference to autonomy granting. Often these parents are detached and depressed and so overwhelmed by life stress that they have little time and energy for children. In extreme forms this could be considered child maltreatment (i.e. neglect).










Making punishment effective:
- inductive reasoning: which helps the child notice feelings by pointing out the effects of the child’s misbehavior on others (psychoanalytic perspective that supports conscience formation)
- harsh discipline that relies too heavily on threats of punishment or love w/drawal makes children so anxious and afraid that they cannot think clearly enough to figure out what they should do, as a result these practices don’t get children to internalize moral rules
- modeling: observing and imitating people who demonstrate appropriate behavior (social learning theory, children need models that display warmth and responsiveness, are competent and powerful, and are consistent in their assertions and their behavior)
- alternatives: time-outs remove child from immediate setting until they act appropriately useful alternative to spanking
- 3 ways to increase effectives of punishment:
1) consistency
2) warm parent-child relationship
3) explanations (help children recall misdeed and relate it to expectations for future bx)
- positive discipline: encourages good conduct by building a positive relationship w/ the child, offering models of appropriate bx, and praising them when they behave well. Parents who engage in positive discipline also reduce opportunities for misbehavior (i.e. bringing activities on long train ride)

Family influences in middle childhood:
Parent-Child Relationships & Siblings:
- time spent w/ parents declines
- as children demonstrate that they can manage daily activities and responsibilities, effective parents shift control from adult to child but do not let go entirely, they engage in coregulation: a transitional form of supervision in which they exercise general oversight while permitting children to be in charge of moment-by-moment decision making
- coregulation grows out of a cooperative relationship between parent and child—one based on give-and-take and mutual respect
- siblings are important sources of support for school age children even though sibling rivalry increases in middle childhood
- only children do not suffer in development; they do as well if not better and this could be that they have a closer relationship with their parents who exert more pressure for mastery and performance

Divorce:
- about 45% of American marriages end in divorce and about half involve children
- at any given time about 1/4th of children live in single parent households
- divorce leads to new living arrangements, accompanied by changes in housing, income and family roles and responsibilities
- often new family relationships develop (with second marriages)
- with the distress in the home discipline may become harsh and inconsistent and sometimes the noncustodial parent can be permissive and overindulgent
- younger children may blame themselves and take the marital breakup as a sign that parents may abandon them
- most children show improved adjustment by 2 yrs after divorce
- the overriding factor in positive adjustment following divorce is effective parenting—particularly how well the custodial parent handles stress and shields the child from conflict (using authoritative style parenting)
- blended families can pose conflicts, moms with custody have an easier time with boys than girls; fathers who have custody have a hard time with both but eventually it works out and as long as the relationship is positive then they develop normally
- parents can help children adjust to divorce by: 1) shielding them from conflict; 2) provide them with as much continuity, familiarity, and predictability as possible; 3) explain the divorce and tell children what to expect; 4) emphasize the permanence of the divorce; 5) respond sympathetically to children’s feelings; 6) promote continuing relationship w/ both parents

Organized sports:
- school-age children, games with rules become very common
- gains in perspective taking ↑ ability to understand roles of several players in a game
- sometimes kids invent games and these experiences help children form more mature concepts of fairness and justice
- adult-organized sports fill many hours that children used to devote to spontaneous play, some researchers worry that this endangers children’s development. However, so far most research indicates that for most children these experiences do not result in psychological damage

- PROS:
1) adult-structured athletics prepare children for realistic competition-the kind they may face as adults
2) regularly scheduled games and practices ensure that children get plenty of exercise and fill free time that might be devoted to less constructive pursuits
3) children get instruction in physical skills necessary for future success in athletics
4) parents and children share an activity that both can enjoy

- CONS:
1) children who join teams so early that the skills demanded are beyond their abilities soon lose interest
2) coaches who criticize rather than encourage and who react angrily to defeat prompt intense anxiety in some children
3) high parental pressure sets for the stage for emotional difficulties and early athletic dropout, not elite performance
4) adult involvement can make games too competitive, placing too much pressure
5) when adults control, children learn little about leadership and fair play
6) when coaches assign players then children lose the opportunity to experiment with rules and strategies
7) competitive sports are less fun than child-organized games; they resemble “work” more than play


Social Status Categories:
- peer acceptance: refers to likability—the extent to which a child is viewed by a group of agemates, such as classmates, as a worthy social partner
- peer acceptance is measured through children’s responses of peers’ likability, their responses reveal 4 different categories:
1) popular children: more positive votes
a) prosocial children: who combine academic and social competence
b) popular-antisocial children: largely consist of “tough” boys who are athletically skilled but poor students, they are aggressive but cool because of their ability and shrewd but devious social skills
2) rejected children: are actively disliked, few friends
a) rejected-aggressive children: show high rates of conflict, hostility, and hyperactive, inattentive, and impulsive behavior, they are deficient in perspective taking and blame others for there social difficulties
b) rejected-withdrawn children: are passive and socially awkward, they are timid and overwhelmed by social anxiety, they hold negative expectations for how peers will treat them
3) controversial children: display a blend of positive and negative social behaviors; they are hostile and disruptive but they also engage in positive, prosocial acts. Although some dislike them, they have qualities that protect them from social exclusion

4) Neglected children: surprisingly are usually well adjusted, they engage in low rates of interaction, the majority are just as socially skilled as average children, they do not report feeling lonely or unhappy and when they want they can break away from the usual pattern of playing by themselves

Victims and Bullies:
- peer victimization: in which certain children become targets of verbal and physical attacks or other forms of abuse
- majority of victims reinforce bullies by giving in to their demands, crying, assuming defensive postures and failing to fight back
- biologically based traits (an inhibited temperament and a frail physical appearance) contribute to their behavior
- victimized children have histories of resistant attachment, overly intrusive & controlling child rearing & over protective mothering; these parenting bxs prompt anxiety, low self-esteem, & dependency resulting in a fearful demeanor that radiates vulnerability
- about 10% of children and adolescents are harassed by aggressive agemates
- most bullies are boys but some girls can use relational hostility
- victimization leads to a variety of adjustment problems: including depression, loneliness, low self-esteem, anxiety and avoidance of school
- developing a school code against bullying, enlisting parents’ assistance in changing bullies’ and victims’ bx, and moving aggressive children to another class or school can greatly reduce peer victimization, and help them develop better social skills


Teen Pregnancy:
3 factors heighten the incidence of adolescent pregnancy:
1) effective sex education reaches too few teenagers
2) convenient, low-cost contraceptive services for adolescents are scarce
3) many families live in poverty, which encourages young people to take risks

- teens have both life conditions and personal attributes that interfere with their ability to parent effectively
- teen mothers are more likely to be poor, their experiences often include low parental warmth and involvement, poor school performance, alcohol and drug use, adult models of unmarried parenthood, limited education, and unemployment and residence in neighborhoods where other adolescents also display these risks

Lives of pregnant teenagers are troubled in 3 ways:
1) educational attainment unlikely: only 50% get hs diploma or GED
2) marital patterns: at greater risk for divorce, spend more time as single parents
3) economic circumstances: most are on welfare, limited finances

Prevention strategies:
- teaching skills for handling sexual situations through creative discussion and role-playing techniques, which permit teenagers to confront sexual situations similar to those they will encounter in everyday life
- promoting the value of abstinence to teenagers not yet sexually active
- providing information about contraceptives and ready access to them

- there is some controversy over providing contraceptives to teens; some people fear that it may give the OK to do it but in Western Europe they have clinics available for this and their rates of sex are no higher than the US but pregnancy, childbirth and abortion rates are lower

Differences in Education (p. 308-309 Asia vs. US):
- Asian kids are better academically bcuz natural resources are limited therefore progress in science & technology are essential to economic well-being, bcuz a well-educated work force is necessary to meet this goal, children’s mastery of academic skills is vital
- Asian countries invest more in children’s education
- US attitudes toward academic achievement are far less unified
- Asian believe all children can master challenging academic tasks
- American parents & teachers attribute it more to native ability
- Asian families encourage more activities at home that promote commitment to academics
- Americans do not spend as much time helping with their children’s homework
- Asians view achievement as a moral obligation
- American young people regard working hard academically as a matter of individ. choice
- Asian education teaches the same nationally mandated, high quality instruction
- American teachers spend a more time on repetitive material
- Asian schools have longer school yrs & spend more of a school day to academic pursuits

Differences between child care and preschool settings:
- preschool: is a program with planned educational experiences aimed at enhancing development of 2 to 5 yr olds.
- childcare: identifies a variety of arrangements for supervising children of employed parents, ranging from care in someone else’s or the child’s own home to some type of center-based program
- the line between the two is fuzzy, parents often confuse them
- some preschools have child-centered programs (where children learn through play) or academic programs (more structured and teachers use formal lessons, etc.)
- Project Head Start: provides children w/ a yr or two of preschool, along with nutritional and health services, parental involvement is essential to Head Start philosophy
- Crucial ingredients to high-quality childcare include: group size; caregiver-child ratio; caregiver’s educational preparation; caregiver’s personal commitment to learning about and caring for children.
 
 
 
18 September 2006 @ 07:09 pm
SHORT ANSWER QUESTIONS:

MIDDLE-AGED CHILDREN AND THEIR RELATIONSHIP WITH AGING PARENTS:
Frequency and Quality of Contact:
- a widespread myth is that adults of past generations were more devoted to their aging parents than are adults of the present generation
- the reason is because fewer aging adults live with now than in the past because of a desire to be independent, made possible by gains in health and financial security
- proximity increases with age where both move towards each other
- many adult children become more appreciative of their parents’ strength and generosity
- in non-Western world, older adults most often live w/ their married children (Asian usually live w/ eldest son)
- the closer the relationship when they were younger, the more help given and received; even in distant relationships, children will support parents out of sense of family duty
Caring for Aging Parents:
- generations are “top-heavy” ↑ older adults w/ less children available to take care of them
- today’s generation is called the “sandwich generation” because they are “sandwiched, or squeezed, between the needs of aging parents and financially dependent children
- adult daughters most likely to provide support
- parents’ prefer same-sex caregivers and daughters feel a stronger sense of obligation
- male children usually handle more masculine roles while female children take on the household, more feminine tasks, as children get older the sex doesn’t matter as much
- the difference between caregiving for parents and children is that children become increasingly independent whereas old adults decline drastically and costs rise
- parental caregiving has emotional and physical health consequences, it leads to role overload, hostility, anxiety about aging, and rates of depression as high as 30-50%
- social support is highly effective in reducing caregiver stress (caregivers should not quit their jobs to take care of their parents because it isolates them)

Theories of Psychosocial Development:
Erikson:
- stages (discontinuous)
- psychosocial conflict
- based on interviews of men aged 35-45
- Early Adulthood: intimacy vs. isolation: Intimacy is one's ability to relate to another human being on a deep, personal level. An individual who has not developed a sense of identity (stage 5) usually will fear a committed relationship and may retreat into isolation.
- Middle Adulthood: generativity vs. stagnation: where people consider their contributions to family, community, work, and society. Generativity is guiding and encouraging future generations, leaving a lasting contribution to the world through creative or artistic output, looking beyond oneself to the continuation of one’s life through others. Stagnation is when people focus on the triviality of their life, and feel they have made only a limited contribution to the world
- Late Adulthood: ego integrity vs. despair: involves coming to terms with one’s life. Adults who arrive at a sense of integrity feel whole, complete, and satisfied with their achievements

Levinson:
- seasons (discontinuous)
- conflict and stability
- life cycle/life structure: the stable period is the time when a person makes crucial choices in life, builds a life structure around the choices and seeks goals within the structure; the transitional period is the end of a person's stage and the beginning of a new stage
- mid-life crisis
- Early Adulthood: Levinson’s Tasks: exploring the possibilities of adult life (dream) and developing a stable life structure/establishing their role in society (life structure)
- Middle Adulthood: Levinson’s Time of Crisis: 4 conflicts – being young vs. old; destructive vs. constructive; masculine vs. feminine; and attached vs. separated. Those who are unsuccessful dealing with mid-life crisis enter a period of stagnation
- late adult transition (60-65 years); late adulthood (65 years – death)

Vaillant: denied a strict age-related schedule of change; focus on career and intimacy; smoother transition than Levinson; ego integrity


THE COLLEGE YEARS (EARLY-ADULTHOOD):
- developmental testing ground, a time when full attention can be devoted to exploring alternative values, roles, and behaviors
- students experience “culture shock” – encounters w/ new ideas and beliefs, new freedoms and opportunities, and new academic and social demands
- about 70% enroll in a higher institution
- attitudes and values broaden, become better at reasoning and identifying strengths and weaknesses of opposing sides of complex issues
- they become interested in the arts and learn more about ethnic and cultural diversity
- they develop a greater self-understanding, enhanced self-esteem, and a firmer sense of identity influenced by the person’s involvement in academic and nonacademic activities, the richness and diversity of a campus setting
- residence hall living is one of the most consistent predictors of cognitive change because it maximizes involvement n the educational and social systems of the institution
- those who drop out usually have trouble adapting because of lack of motivation, poor study skills, financial pressures, or emotional dependence on parents

CHOOSING A VOCATION (PG 436-439)
Selecting a vocation:
1) fantasy period: (early and middle childhood) young children gain insight into career options by fantasizing about them
2) tentative period: (early and middle adolescence) adolescents start to think about careers in more complex ways, at first they evaluate vocational options in terms of their interests, later as they become more aware of personal and education requirements for different vocations, they take into account their abilities and values.
3) realistic period: (late adolescence and early adulthood) by the early 20’s, the economic and practical realities of adulthood are just around the corner, and young people start to narrow their options. At first, many do so through further exploration, gathering more information about possibilities that blend with their personal characteristics. Then they enter a final phase of crystallization in which they focus on a general vocational category. Within it, they experiment for a period of time before settling on a single occupation

Factors influencing vocational choice:
Personality:
1) investigative person: who enjoys working w/ ideas and is likely to select a scientific occupation
2) social person: who likes interacting w/ people and gravitates toward human services
3) realistic person: who prefers real-world problems and work w/ objects and tends to choose a mechanical occupation
4) artistic person: who is emotional and high in need for individual expression
5) conventional person: who likes well-structured tasks and values material possessions and social status
6) enterprising person: who is adventurous, persuasive, and a strong leader and is drawn to sales and supervisory position or politics

- family influences: vocational choices correlate strongly w/ jobs of their parents; higher SES pick better paying jobs because of their parents’ careers and because their parents can afford to offer more opportunities
- teachers: often report that teachers influence career selection
- gender stereotypes: men tend to choose strongly gender-typed careers, women are exploring more male-dominated occupations but it is slow going this is because of gender-stereotyped messages and not female inability
- for this reason we need programs to sensitize high school and college personnel to the special problems women face in developing and maintaining high vocational aspirations
- those women who continue to achieve have 4 experiences in common:
1) supportive college environment that values their accomplishments and enhance their experiences in the curriculum
2) frequent interaction w/ faculty and professionals in their chosen fields
3) opportunities to test their abilities in a supportive environment
4) models of accomplished women who have successfully dealt w/ family-career role conflict

- young people benefit from greater access to career information
- those who do not pursue college educations, are unlikely to get jobs at levels other than what they had as students

NUTRITION AND EXERCISE IN EARLY-ADULTHOOD:
Nutrition:
- greater food choices and heavy scheduled life puts adults at great risk for obesity
- about 20% are obese (greater than 20% increase over average body weight)
- 41 % are overweight
- caused by consuming more calories than needed; BMR – Basal Metabolic Rate the amount of energy the body uses at rest
- adults should begin ASAP because it causes high blood pressure, circulatory difficulties, stroke, adult-onset diabetes
- Treatment needs to be lifestyle/behavior change like:
1) a well-balanced diet lower in calories and fat, plus exercise
2) training participants to keep an accurate record of what they eat
3) social support
4) teaching problem-solving skills
5) extended intervention (longer treatments)
- should avoid saturated fat, causes the deposits that clog the arteries
Exercise:
- reduces body fat and builds muscle
- fosters resistance to disease
- linked to reduced incidence of cancer at all body sites except the skin
- less likely to develop heart disease
- research suggests about 30 minutes most days a week


ESSAY QUESTIONS:

RETIREMENT/LEISURE IN LATE-ADULTHOOD:
- some move into it gradually, taking bridge jobs that serve as a transition between full-time and part-time hours
Decision to retire:
1) affordability of retirement is usually the 1st consideration in the decision to retire; individuals who are healthy and whose vocational life is central to self-esteem are likely to keep working, especially those in professional occupations
2) societal factors affect retirement because young less costly workers easily replace older more expensive workers
3) gender and ethnicity plays a role; women retire earlier than men; in other Western nations, higher minimum pension allow older adults to retire earlier

Adjustment to retirement:
- gives up part of their identity and self-esteem
- is thought to be a precursor to decline in health when really retirement occurs after a decline in health
- staying active and socially involved are major determinants of retirement satisfaction
Adjustment Factors:
- workplace factors such as financial worries about having to give up one’s job predicts stress following retirement
- psychological factors such as personal control over life events places a factor, retiring for internally motivated things reduces stress of adjustment, those in well-educated, high-status careers fair better because the satisfactions derived from challenging, meaningful work readily transfer to nonwork pursuits
- social support reduces stress associated w/ retirement
- good marriage promotes adjustment to retirement because it can buffer the uncertainty with retirement

Leisure Activities:
- honeymoon period: a period of trying out new activities, many find that leisure interests and skills do not develop suddenly. Instead, most carry on or expand the activities they enjoyed before retirement
- involvement in leisure activities is related to better physical and mental health and reduced mortality (it has to be more than just participating, it has to be meaningful for them to gain the benefits associated w/ leisure activities)
- with age, frequency and variety of leisure pursuits tends to decline; after age 75, mobility limits engaging in leisure activities and the people become more sedentary and home based, elders is residential communities continue more activities because they are more conveniently available
- seniors usually engage in activities that are personally gratifying so only about 15% are attracted by the organized activities in community senior centers
- older adults make a vital contribution to society through volunteer work (hospitals, schools, charitable organizations, senior centers, and other community settings)
- younger, better educated, and financially secure seniors are likely to volunteer
- older adults report greater awareness of and interest in public affairs and vote at a higher rate than any other age group

CENTENARIANS:
- most view elderly as frail but in the last 40 years, Centenarians have increased tenfold
- women centenarians greatly outnumber men by 4 to 1
- 60 to 70% have physical or mental impairments that interfere w/ independent functioning but the rest lead active, autonomous lives, they are known as robust centenarians
- robust centenarians are particularly interesting because they represent the ultimate potential of the human species
- several longitudinal studies were conducted to study centenarians, they are diverse in years of education, economic well-being, and ethnicity but their physical conditions and life stories are similar…
Similarities of Centenarians:
1) Health: genetic advantage, ancestors lived to old age; their children appear physically young for their age. The majority of robust centenarians have escaped age-related chronic illnesses, such as heart disease, cancer, diabetes and dementia. They typically have efficiently functioning immune systems and few brain abnormalities; most women give birth to normal children after the age of 40. Most are of average or slender build and practice moderation in eating. Don’t smoke and have good teeth.

2) Personality: highly optimistic, instead of dwelling on fear and tragedy they focus on a better tomorrow; less anxious and fearful the higher their self-rated health and psychological well-being; they score high on toughmindedness, independence, emotional security, and openness to experience; they mention close family bonds and a long and happy marriage

3) Activities: usually have a history of community involvement – working for just causes they that are central to their growth and happiness; their current activities often include stimulating work, leisure pursuits, and learning, which may help sustain their good cognition and life satisfaction

Applying the principles of Psychosocial Development to Centenarians:
Erikson’s Theory: Ego Integrity versus Despair
 they have a sense of integrity feel whole, complete, and satisfied with their achievements.
 view one’s life in the larger context of all humanity
 they strive for generativity and ego integrity in everyday behavior.





Other Theories of Psychosocial development in Late Adulthood
 Successful development in the later years involves greater integration and deepening of the personality.
Peck’s Theory: Three Tasks of Ego Integrity
- Ego Differentiation versus work-role preoccupation: (Results from retirement. Requires aging people who have invested heavily in their careers to find other ways of affirming their self-worth) Centenarians continue to engage in stimulating activities
- Body transcendence versus body preoccupation: (Older adults need to transcend physical limitation by emphasizing cognitive and social powers, which offer alternative, compensating rewards) Centenarians are in good health and take care of themselves
- Ego Transcendence versus ego preoccupation: (Middle-aged people realize that life is finite, the elderly are reminded of death as siblings, friends, and peers in their community die. Must find a constructive way of facing this reality through investing in a longer future than their own lifespan. Attaining ego integrity requires a continuing effort to make life more secure, meaningful, and gratifying for those who will go on after one dies) Centenarians are optimistic and emotionally secure

Labouvie-Vief’s Theory: Emotional Expertise: Explored the development of adult’s reasoning about emotion.
 Pragmatic: a tool for solving real world problems.
 Reminiscence: Telling stories about people and event from the past
 Life review: A person calls up, reflects on, and reconsiders past experiences.
 Labouvie-Vief’s Theory to Centenarians means: because they are healthy, optimistic, and continue to engage in stimulating work and learning they are likely to have good emotional reasoning


MALTREATMENT OF ELDERLY INDIVIDUALS:
- about 3 to 7% of elders are maltreated by family members, friends, and professional caregivers
Elder maltreatment takes the following forms:
1) Physical Abuse: intentional infliction of pain, discomfort, or injury, through hitting, cutting, burning, physical force, restraint, sexual assault, and other acts
2) Physical Neglect: intentional or unintentional failure to fulfill caregiving obligatins, which results in lack of food, medication or health services, or elders left alone or isolated
3) Psychological abuse – verbal assaults, humiliation, and intimidation
4) Financial Abuse – illegal or improper exploitation of the elder’s property or financial resources, through theft or use without the elder’s consent

- difficult to determine when neglect occurs, how do we define maltreatment
- most abusers are family members-spouses (usually men) followed by children of both sexes and then other relatives
- abuse in nursing homes is a major concern


Risk Factors:
1) Dependency of the victim: if the are very old, frail and mentally and physically impaired elders are more vulnerable to maltreatment
2) Dependency of the perpetrator: many abusers are dependent emotionally and financially on their victims; this dependency can be experienced as powerlessness and lead to aggressive, exploitative behavior
3) Psychological Disturbance and Stress of the Perpetrator: abusers are more likely than other caregivers to have psychological problems and to be dependent on alcohol or other drugs, often they are socially isolated have difficulties at work, or are unemployed with resulting financial worries
4) History of Family Violence: elder abuse is often part of long history of family violence; adults who were abused as children are at an increased risk for abusing elders
5) Institutional Conditions: more likely to occur in nursing homes that are run down and overcrowded and that have staff shortages, minimal staff supervision, high staff turnover, and few visitors

Preventing Elder Maltreatment:
- challenging, victims may fear retribution, wish to protect abusers who are spouses, sons, or daughters, or feel embarrassed that they could not control the situation
- prevention programs offer caregivers counseling, education and respite services
- sometimes trained volunteers “buddies” make visits to the home
- public education is vital to encourage reporting suspected cases and improved understanding of the needs of older people
- countering negative stereotypes of aging reduces maltreatment, since recognition of elders’ dignity, individuality, and autonomy is incompatible w/ acts of harm

MARRIAGE AND PARENTHOOD:
Marriage:
- younger adults delay marriage more than a half-century ago
- it is the joining of two entire family systems
- because of changing gender roles and living farther away from parents, couples now have to work harder to define their relationship
- age of marriage is the most consistent predictor of marital stability, younger couples more likely to divorce
- traditional marriages: involving clear division of husband’s and wife’s roles, still exist in Western nations. The man is the head of household; his primary responsibility is the economic well-being of his family. The woman devotes herself to caring for her husband and children and to creating a nurturant, comfortable home
- egalitarian marriages: husband and wife relate as equals, and power and authority are shared. Both partners try to balance the time and energy they devote to their occupations, their children, and their relationship

Factors Related to Marital Satisfaction:
Factors related to marital satisfaction Happy Marriage Unhappy Marriage
Family background Partners similar in SES, education, religion, and age Partners very different in SES, education, religion, age
Age at marriage After age 23 Before age 23
Length of courtship At least 6 months Less than 6 months
Timing of first baby After 1st year of marriage Before or within 1st year of marriage
Relationship to extended family Warm and positive Negative, wish to maintain distance
Marital patterns in extended family Stable Unstable, frequent separations and divorce
Financial and employment status Secure Insecure
Personality characteristics Emotionally positive, good conflict resolution skills Emotionally negative and impulsive, poor conflict resolution skills

- many young people have a mythical image of marital bliss (like my partner should read my mind; marital satisfaction increases through the 1st year; a couple’s sex life is the single best predictor of marital satisfaction) as couples learn this they become disappointed and the marriage becomes less satisfying

Parenthood:
- people wait later to have children and we have less per family now than in the past
- the choice of parenthood is affected by a complex array of factors, including financial circumstances, personal and religious values, and health conditions

Advantages and Disadvantages of Parenthood mentioned by Contemporary Couples:
















- after arrival of the baby, traditional roles are taken & less time for their relationship; usually no strain but if it is a troubled marriage then children can cause further distress
- waiting to become parents permits couples to pursue occupational goals and gain life experience and men are willing to participate
- people have less children increasing more parent-child interaction; parents of fewer children have more patience and are less punitive
- nowadays men and women are less sure about how to rear children than in the old days
- good parenting is crucial for the welfare of the next generation and society yet cultures do not always place a high priority on parenting
- many parenting programs yield positive outcomes, including improved parent-child interaction, more flexible parenting attitudes, and heightened awareness by parents of their roles as educators of their children. These courses teach child-rearing values, improve family communication, understand how develop, and apply more effective parenting strategies
- child rearing is important to the future of society

SINGLEHOOD, COHABITATION, CHILDLESSNESS, DIVORCE & REMARRIAGE:
Singlehood:
- not living with an intimate partner
- rates have increased
- because they marry later, many women and men are single
- ethnicity plays a role, unemployment among black men is high preventing them for being able to support a family
- advantages include mobility and freedom; disadvantages are loneliness, the dating grind, limited sexual and social life, reduced sense of security, and feelings of exclusion from the world of marriage couples

Cohabitation:
- refers to the lifestyle of unmarried couples who have an intimate, sexual relationship and share a residence
- more preferred mode of entry into a committed intimate partnership
- for some it serves as a preparation for marriage (a time to test the relationship and get used to living together) and for others it is an alternative to marriage (an arrangement that offers the rewards of sexual intimacy and companionship along with the possibility of easy departure if satisfaction declines
- couples who cohabit before marriage are more prone to divorce than married couples who did not cohabit (especially so among multiple cohabitators or those who don’t jointly share expenses)
- often alternative to low-SES couples because of their uncertain earning power and plan to do so when their financial situation improves
- most American couples cohabit to avoid legal obligations

Childlessness:
- some are involuntarily childless because they do not have a partner or they have fertility problems
- some are voluntarily childless because they do not want to give up their lifestyle or the woman is pursing a prestigious career
- many were only or first-born children whose parents encouraged achievement and independence
- they are content w/ their lives, unless they are involuntarily childless and then are likely to be dissatisfied and depressed

DIVORCE AND REMARRIAGE:
Divorce:
- most divorces occur within 7 years of marriage so most involve children
- pursuer/withdrawer problem; anger and resentment or they lead separate lives
- younger age at marriage, not attending religious services, being previously divorced, and having parents who had divorced increase chances of divorce in part because these problems are linked to marital difficulties
- economically disadvantaged couples who suffer multiple life stresses are especially likely to split up
- after divorce, both men and women are depressed and anxious and display impulsive behavior (and lasts about 2 years)
- finding a new partner contributes most to the life satisfaction of divorced adults, more crucial for men, who are better adjusted in the context of marriage than on their own. Despite loneliness and reduced income, most women prefer their new life to an unhappy marriage
- those that are still attached to their ex and women who did not have an identity outside the marriage have more difficulty adjusting

Remarriage:
- on average, people marry w/in 4 years of divorce, men faster than women
Remarriages are especially vulnerable to break up because:
- although people often remarry for love, practical matters (financial security, help in rearing children, relief from loneliness, and social acceptance) figure more heavily into a 2nd marriage than the first these concerns do not provide a sound footing for a lasting partnership
- also some people transfer the negative patterns of interaction and problem solving learned in their 1st marriage to the second
- people who have already had a failed marriage are more likely to view divorce as an acceptable solution when marital difficulties resurface
- remarried couples experience more stress from stepfamily situations
- it takes 3 to 5 years for blended families to develop the connectedness and comfort of intact biological families
- counseling helps couples adapt
 
 
 
18 September 2006 @ 07:07 pm
Chapter 16: Emotional and Social Development in Middle Adulthood

Erikson:
Generativity vs. Stagnation: involves reaching out to others in ways that give to and guide the next generation. At this stage, commitment extends beyond oneself (identity) and one’s life partner (intimacy) to a larger group – family, community, or society. The generative adult combines the need for self-explanation with the need for communion, integrating personal goals with the welfare of the larger social world. Highly generative people appear especially well-adjusted, low in anxiety and depression and high in self-acceptance and life satisfaction

Generative adults tell life stories:
- adults high and low in generativity reconstruct their past and anticipate their future in strikingly different ways
- commitment story: (high generativity) in which adults give to others as means of giving back to family, community and society; in themes of redemption is prominent
- themes of contamination: (low generativity) where good scenes turn bad

Other Theories of Psychosocial Development in Midlife:
Levinson’s Seasons of Life:
- midlife transition: around age 40, people evaluate their success in meeting early adulthood goals
- modifying the life structure: gender similarities and differences; give up youthful qualities find age-appropriate ways; double-standard of aging; women find it harder than men to accept being older; men and women are more accepting of opposite gender characteristics
- life structure in social context: when poverty, unemployment, and lack of a respected place in society dominate then energies are directed toward survival rather than pursuit of a satisfying life structure

LEVINSON’S 4 DEVELOPMENTAL TASKS OF MIDDLE ADULTHOOD
TASK DESCRIPTION
Young-old Seek new ways of being young and old; given up youthful qualities, retaining & transforming others, and finding positive meaning in being older
Destruction-Creation w/ greater awareness of mortality, focus on ways he or she has acted destructively (past hurtful acts toward parents, intimate partners, children, friends, rivals) these are countered by a strong desire to become more creative (making products of value to the self and others by participating in projects that advance human welfare)
Masculinity-Femininity Come to terms w/ both parts of self, creating better balance; men become more empathetic and caring; women more autonomous, dominant and assertive
Engagement- Separateness Create better balance between engagement w/ the external world and separateness; for men, means pulling back from ambition and achievement; for women, means moving towards greater involvement in the work world and wider community



Vaillant’s Adaptation to Life:
- “keepers of meaning”
- “passing the torch”
- Older people are guardians of traditions, laws, and cultural values
- He found no evidence of midlife crisis whereas Levinson found that inner turmoil causes midlife crisis
- Vaillant claims midlife as a slow and steady change where Levinson sees it as a drastic change
- Vaillant saw midlife as more positive and where Levinson saw it as involving inner turmoil

Is there a midlife crisis?:
- midlife crisis: self-doubt and stress especially great during the forties, that prompts major restructuring of the personality
- wide individual differences in response to midlife (earlier for men than women)
- sometimes experienced as a relief rather than crisis
- concern w/ mortality and life evaluation is common but only a minority alter their life structure

Stage or Life Events Approach:
- Erikson, Levinson & Vaillant suggest it is stagelike
- Middle adulthood is characterized by both continuity and stagewise change
- Although some experts argue it is more the combined result of growing older and social experiences

Stability and Change in Self-Concept and Personality:
- possible selves: future-oriented representations of what one hopes to become and what one is afraid of becoming. Possible selves are the temporal dimension of self-concept – what the individual is striving for and attempting to avoid
- may be a strong motivator of action in midlife, as more meaning becomes attached to time
- bcuz the future no longer holds limitless opportunities, adults adjust their hopes and fears so they can preserve mental health
- unlike current self-concept – possible selves can be defined and redefined by the individual as needed

Self-Acceptance, Autonomy & Environmental Mastery:
- middle-aged adults tend to offer more complex, integrated descriptions of themselves
- more self-acceptance, more autonomous and high in environmental mastery (capable of managing a complex array of tasks easily and effectively)
- middle-age is referred to as “the prime of life”

Coping Strategies:
- increases and more effective because of integrated self-descriptions which indicate an improved ability to reflect on strengths and weaknesses and blend them into an organized picture
- greater confidence and years of experience of handling life problems may also contribute


Gender Identity:
- studies report an increase in “masculine” traits in women and “feminine” traits in men
- women become more forceful and men more sensitive and caring
- consistent w/ Levinson’s theory of gender identity becoming more androgynous
- parental imperative theory: evolutionary view of identification w/ traditional gender roles is maintained during the active parenting years to help ensure survival of children. Men become more goal-oriented, whereas women emphasize nurturance. After the children reach adulthood, parents are free to express the “other-gender” side of their personalities
- decline in sex hormones may contribute to androgyny in later life
- the warmth & assertiveness needed for parents may contribute
- androgyny in midlife results from a complex combination of social roles & life conditions; can predict high self-esteem

What Factors Promote Psychological Well-Being in Midlife?
- good health and exercise
- sense of control of personal life investment
- positive social relationships
- a good marriage
- success in handling multiple roles

Individual Differences in Personality Traits:
- “big five” personality traitis: neuroticism, extroversion, openness to experience, agreeableness and conscientiousness (see chart pg. 523)
- Studies show neuroticism, extroversion, and openness to experience decline from teenage years to middle age, whereas agreeableness and conscientiousness increase
- Study showed personality trait stability increases during early and middle adulthood

Relationships at Midlife:
Marriage and Divorce:
- middle age households well off economically compared w/ other age groups
- marital satisfaction is a strong predictor of midlife psychological well-being
- 10% of divorces take place after 20 yrs of marriage
- Midlifers who divorce adapt better than younger people because they have gained more practical problem-solving and effective coping skills
- Marital breakup is a strong contributor to the feminization of poverty: a trend in which women who support themselves or their families have become the majority of the adult poverty population, regardless of age and ethnic group

Changing Parent-Child Relationships:
- children who are “off-time” developmentally (not showing expected signs of independence & accomplishment can prompt parental strain
- lower SES families, the children do not leave home as early
- throughout middle adulthood, parents continue to give more assistance to children than they received esp. when children are unmarried or facing difficulties
- mothers become kinkeeper: gathering the family for celebrations and making sure everyone stays in touch


Ways Middle-Aged Parents Can Promote Positive Ties with Their Adult Children
Suggestion Description
Emphasize positive communication Let your children know your respect, support, and interest; this communicates affection and always conflict to be handled in a constructive context
Avoid unnecessary comments that are a holdover from childhood Adult children, appreciate an age-appropriate relationship; (i.e. don’t make comments about their safety, eating and cleanliness
Accept the possibility that some cultural values and practices and aspects of lifestyle will be modified in the next generation In constructing an identity, most adult children have gone through a process of evaluating the meaning of cultural values and practices for their own lives; traditions and lifestyles cannot be imposed on adult children
When an adult child encounters difficulties, resist the urge to “fix” things Accept the fact that no meaningful change can take place w/o the willing cooperation of the adult child; stepping in and taking over communicates a lack of confidence and respect; find out if they want your help/advice first
Be clear about your own needs and preferences When it is difficult to arrange for a visit, baby-sit, or provide other assistance, say so and negotiate a reasonable compromise rather than letting resentment build


Grandparenthood:
Meanings:
1) valued elder (wise)
2) immortality through descendants (leaving behind 2 generations
3) reinvolvement w/ personal past (pass family history)
4) indulgence (having fun w/ grandkids w/o parental responsibilities)

- relationship changes from affectionate and playful to advising, warm and caring
- grandparents play greater role in lower SES families

The Skipped-Generation Family:
- kids living w/ grandparents but apart from parents
- most face difficulties w/ financial or adjustment strain
- studies show that compared to children of divorced, single-parent or blended families, children reared by grandparents were better behaved in school, less susceptible to physical illness, and were doing well academically

Middle-Aged Children and Their Aging Parents:
- fewer aging adults live w/ younger generations now than in the past because of a desire to be independent, made possible by gains in health and financial security
- in non-western countries, most elder adults live w/ their married children
- sandwich generation: today’s middle-aged adults with ill or frail parents often face competing demands of children (some of whom are under age 18 and still at home) and employment. They are “sandwiched” or squeezed, between the needs of aging parents and financially dependent children
- daughters are more often caregivers

RELIEVING THE STRESS OF CARING FOR AN AGED PARENT
Strategy Description
Use effective coping strategies Use problem-centered copying to manage parent’s behavior and caregiving tasks; delegate responsibilities to other family members; recognize the parent’s limits while still calling capacities they do have; use emotion-centered copying to reinterpret the situation in a positive way; avoid denial of anger, depression, and anxiety in response to the caregiver work burden which heightens stress
Seek social support Confide in family members and friends about the stress of caregiving, seek encouragement and help; avoid quitting work to care for parent since that leads to social isolation
Make use of community resources Contact community organizations to seek info and assistance, in the form of in-home respite help, home-delivered meals, transportation and adult day-care
Press for workplace and public policies that relieve the emotional and financial burdens of caring for an aging parent Encourage your employer to provide elder care benefits, such as flexible work hours and caregiver leave w/o pay; communicate w/ lawmakers and other citizens about the need for additional govt funding to help pay for elder care; emphasize the need for improved health insurance plans that reduce financial strain

Siblings:
- contact and support declines in early to middle adulthood
- despite this they feel closer, often in response to major life events
- in industrialized nations, sibling relationships are voluntary, however, in village societies they are generally involuntary and basic to family functioning

Friendships:
- men typically talk about sports, politics and business
- women focus on feelings and life problems
- w/ both sexes, # of friends declines w/ age probably bcuz people become less willing to invest in nonfamily ties unless they are very rewarding

Relationships Across Generations:
- findings show that despite the social changes, supportive ties among younger and older individuals remain strong
- most do not express resentment about govt benefits to other age groups, instead a norm of equity characterizes their responses
- values, opinions and behaviors reveal “hidden bridges” between generations
Vocational Life:
- work continues to be a salient aspect of identity and self-esteem in middle adulthood
- older employees have lower rates of absenteeism, turnover, and accidents and show no change in work productivity
- incorrect beliefs about limited learning capacity, slower decision making and resistance to change and supervision make the transition from adult worker to old worker unfavorable

Job Satisfaction:
- research shows job satisfaction ↑ in midlife - key characteristics: involvement in decision-making, reasonable workloads and good physical working conditions
- burnout: can result, it is a condition in which long-term job stress leads to mental exhaustion, a sense of loss of personal control, and feelings of reduced accomplishment
- burnout is associated w/ excessive work assignments for available time and lack of encouragement and feedback from supervisors
- linked to asbsenteeism, turnover, poor job performance and impaired health

Career Development:
- job training and on-the-job career counseling are less available to older workers
- with age, growth needs decline somewhat in favor of security needs, consequently learning and challenge may have less intrinsic value to many older workers

Gender & Ethnicity: The Glass Ceiling:
- glass ceiling: invisible barrier to advancement up the corporate ladder
- exists because women and ethnic minorities have less access to mentors, role models and informal networks that serve as training routes

Career Change at Midlife:
- most midlife career changes are not radical, they typically involve leaving one line of work for a related one
- when extreme changes occur it usually means personal crisis

Unemployment:
- has greater impact on midlifers’ health
- huge loss of income bcuz they spend more time unemployed
- feel “off-time” with their social clock
- social support helps reduce stress
- most midlifers who are laid off do not duplicate the status and pay of their previous positions

Planning for Retirement:
- average age 62
- planning important bcuz it leads to 2 important work-related rewards: income and status

INGREDIENTS FOR EFFECTIVE RETIREMENT PLANNING
ISSUE DESCRIPTION
Finances Ideally start w/ 1st paycheck, minimum it should begin 10 to 15 yrs before retirement
Fitness fitness is important bcuz good health is crucial for well-being in retirement
Role adjustment Retirement is harder for some people who strongly identify w/ their work role; preparing for a radical role adjustment reduces stress
Where to live Pros and cons of moving should be considered carefully because where one lives affects access to health care, friends, family, recreation, entertainment and part-time employment
Leisure activities A retiree gains an additional 50 hrs a week of free time; careful planning of what to do w/ that time has a major impact on psychological well-being
Health insurance Finding out abt govt health ins. options helps protect quality of life after retirement
Legal affairs Preretirement period is an excellent time to finalize a will & begin estate planning
 
 
 
18 September 2006 @ 07:07 pm
TEST #1 REVIEW:

• DSM-IV-TR main focus was to correct factual errors, update info & ICD codes. No substantive changes were made to the criteria sets.
• PTSD and Acute Stress D/O require a “traumatic event” (life-threatening) and response involving fear, helplessness, and horror (one of the few in which etiology is needed for dx) RULE OUT ADJUSTMENT DISORDER!!!
• GAF Scales 1-10 the individual is performing poorly they are in danger of severely hurting self or others while GAF in the 91-100 range suggests superior functioning
• DSM I & DSM II were based on psychiatric opinion
• Training, but not experience leads to greater reliability and validity in diagnosis and test interpretation.
• The literature reviews of the DSM were not criticized for not being systematic.
• The DSM does allow for dual diagnosis of OCD & OCPD and social phobia and APD
• GABA Abnormality is NOT a major theory of panic disorder! (Etiological theories include: biological – genetics; norepinephrine abnormality; and cognitive (misinterpreting or overreacting to internal physiological events))
• Major goal of the DSM-IV was for communication (educational); research and treatment (clinical). Not for determining etiologies!
• Those with phobias are usually aware that their fear is irrational.
• Distance from bombing, how many hours watching it on TV and losing someone they knew in the 9/11 terrorist attack all played a part in increasing their level of stress
• Money/Greed are NOT characteristics of OCD (sexuality, violence & aggression, doubt, order and contamination are)
• OCD is the only panic disorder in which the rates are more evenly distributed amongst males and females
• Personality Disorder is not a comorbid to PTSD
• Types of Panic attacks include: unexpected; situationally bound; situationally predisposed & limited sxs NOT physiologically cued!
• About 1/3 (95% of clinical sample) of those diagnosed with Panic Disorder have it with Agoraphobia.
• Psychosurgery is still done in severe cases of OCD
• Agoraphobia is defined as anxiety about and avoidance of public places or situations in which escape may be difficult
• Preparedness theory proposes that humans have a predisposition to acquire certain fears (i.e. snakes, spiders, etc)
• Serotonin is the neurotransmitter most affected by Stress D/O and OCD
• Obsessions are persistent thoughts, ideas, impulses or images that invade consciousness; Compulsions are repetitive and rigid behaviors or mental acts that a person feels compelled to perform in order to prevent or reduce anxiety.
• Behaviorists theorize that phobias are learned through classical conditioning and reinforced through operant conditioning
• Some of the additional proposed Axes in DSM include: Defensive Functioning Scale (DFS); Global Assessment of Relational Functioning (GARF); and Social and Occupational Functioning Assessment Scale (SOFAS)
• Ego-syntonic means behaving in ways that you think it is okay to behave (i.e. OCPD) while Ego-dystonic is behaving in ways that goes against your grain (i.e. OCD)
• Specifiers & types for Anxiety Disorders include: Animal Types, Natural Type, Blood Injection Type; Situational Type and Other Type for Specific Phobias. For PTSD the specifiers include: Acute (less than 3 mths), Chronic (more than 3 mths) or Late Onset (sxs develop 6 mths after the trauma); For OCD the specifier: is With Poor Insight. For Social Phobia includes specifier: Generalized (meaning they fear most performance/social situations)
• On the DSM Multiaxial system Provisional diagnosis means: used when there is strong presumption that the full criteria will ultimately be met for a disorder but not enough information is available or dx depends on duration of illness; Principal diagnosis means: the condition chiefly responsible for the admission of the individual; NOS means: meets general guidelines but not specific criteria to meet specific diagnosis or there is uncertainty about etiology; Deferred means set aside until further investigation or not enough evidence to make a diagnosis.
• The 3 broad categories of PTSD include: 1) re-experiencing the traumatic event; 2)avoidance & reduced responsiveness; 3) increased arousal, activity (irritability, difficulty sleeping, heightened startle response).
• Factitious and Malingering Disorder are similar in that they are consciously feigning illnesses for some type of gain however, factitious is for internal while Malingering is for external gain. (Factitious = Munchausen’s by Proxy vs. Malingering = Court custody case, avoiding jail time, etc.)
• Generalized Anxiety Disorder criteria includes: Must have 4 or more symptoms which include: restlessness, keyed up or on edge feelings, easily fatigued, difficulty w/ concentration, irritability, muscle tension or sleep problems. These symptoms must occur for at least 6 mths
• Remember to rule out Agoraphobia and Panic Disorder when assessing Social Phobia
• Remember MR is an AXIS II diagnosis
• Remember how to assess a patient and write out there diagnoses on the multiaxial assessment below (e.g. the mentally retarded man with Specific Phobia Blood Injection Type, diabetes, Lack of social support and no GAF rating – how do you write that on the axes?)
• Schwartz discovered cognitive behavioral therapy for OCD
• The Task Force on the DSM-IV conducted a three-stage empirical process that included:
1) comprehensive reviews and systematic reviews of the published literature
2) data reanalyses of already collected data sets
3) extensive issue-focused field trials

Multiaxial Assessment:
• AXIS I – Clinical Disorders (Clinical Syndromes – acute medical disorder) Causes significant distress or dysfunction
• AXIS-II – Personality Disorders ( also for maladaptive personality features and defense mechanisms) and Mental Retardation
• AXIS-III – General Medical Conditions (that are potentially relevant to the understanding or management of the individual’s mental disorder) Axis I might be the cause of Axis III or Axis III might be the cause of Axis I; Axis III should be considered in treatment of Axis I
• AXIS-IV – Psychosocial and environmental problems (occupational, social, relationship problems; may be negative or positive; may have caused or worsened AXIS I/II; be a result of AXIS I/II; need attention)
• AXIS V – Global Assessment of Functioning – uses the clinician’s judgment to report the individual’s overall level of functioning; useful in planning treatment and measuring its impact and in predicting outcome; Two parts – rating symptom severity and psychosocial functioning; if discordant you should always identify the worse of the two; use ratings of current functioning best for reflecting need for treatment

DIFFERENTIAL DIAGNOSIS:
• Six Steps:
1) Are the presenting symptoms real (conscious feigning for external purposes vs. factitious disorder for internal gain aka malingering vs. munchausens by proxy)
2) Rule out substance etiology
3) Rule out general medical condition
4) Determine the primary diagnosis(es)
5) Adjustment Diagnosis vs. NOS (for sxs that cause distress or impairment but don’t meet criteria or pattern for specific d/o or if symptoms involve a “maladaptive response” to a stressor adj d/o)
6) No mental disorder? (determine “clinically significant” distress or impairment, may be influenced by cultural or clinical context)

Training is valuable…why isn’t experience?
• Cognitive errors don’t allow for new info to be incorporated or used because of:
1) biases; 2) heuristics; 3) memory
• Lack of feedback – the nature of the psych

Biases:
• Attentional bias (gender, race, age, ses, etc)
• Confirmatory bias (attending to info that confirms our thinking)
• Illusory Correlation – belief that events are correlated when they really aren’t (like Digits Span and depression)
• Hindsight Bias
• Overpathologizing

TEST #2 REVIEW:

• Cyclothymia was historically thought to be a psychosis and personality d/o
• Most w/ binge eating d/o are overweight or obese but not all overweight people have BED
• Most w/ Munchausen's by Proxy are mothers
• Cyclothymic D/O does not meet all criteria even when in "hypomanic phase"
• Major Depressive Episode is usually chronic
• Munchausens is not a PD and not coded on AXIS II
• ECT is still used to treat depression
• Males make up about 5-10% of Bulemia and Anorexia cases
• MAO Inhibitors were the 1st generation of antidepressants with the greatest side effects. SSRIs are newest line of drugs.
• Martin Seligman's cognitive-behavioral view of Dysthymic D/O was "learned helplessness" which he believed occurred when the person believes she has no control over the consequences in her life.
• The psychodynamic view of Somatoform D/O suggests that unconscious conflicts carried forth from childhood arouses anxiety and converts this anxiety into more "tolerable" physical sxs.
• Bulimia with purging is the vomiting while the nonpurging type includes laxatives and excessive exercise
• The biological view of Dysthymic D/O suggests that Cortisol (stress hormone) and Melatonin (Dracula hormone) are too high
• Attachment theory of Hypochrondriasis suggests that theorists believe symptom manifestation can be a result of caregiver's lack of attention to their child's attachment needs during times of illness. As adults, these individuals may elicit physical complaints as an indirect or subversive way to receive care.
• The neurotransmitter involved with Eating D/O is serotonin
• The prevalent theory of eating d/o is socio-cultural; greater prevalence in industrialized societies
• You can be diagnosed with 2 forms of depression (Double Depression)
• Bipolar is NOT more prevalent in Western societies
• Intense Hunger is NOT a characteristic of Binge Eating
• Beck's cognitive theory is that depressed people experience a triad of feelings: self (worthless), environment (helpless) and the future (hopeless).
• Muscle Dysmorphia (opposite of anorexia) for body builders who obsess about working out
• Trichtotillomania is an Impulse Control D/O
• The serotonin theory in mood d/o's suggests that low levels cause the disturbance while the noephinephrine theory suggests an over-activity of the neurotransmitter causes mood disturbance
• Types of compensatory behaviors in Bulimia include laxatives, vomiting and excessive exercise
• Pessimistic explanatory style – depressed people tend to attribute negative events to internal, stable & global causes

Robins and Guze have enumerated 5 phases of construct validation which include the following:

1) clinical description (identification of cardinal features, core sxs, assoc. sxs etc)
2) laboratory studies (gathering data on biological markers for particular d/os)
3) delimitation from other disorders (specifying exclusion criteria so that the index diagnostic is homogeneous)
4) follow-up study (necessary to show that individuals w/ same diagnosis have a similar course to one another)
5) family study (ascertain whether or not a putative d/o runs in families)

• All personality disorders are diagnosed on Axis II except Multiple Personality Disorder (DID)
• Personality disorders can be diagnosed before age 18 except Antisocial Personality Disorder

TEST 3 REVIEW FOR FINAL:

1.With the exception of antisocial personality disorder, to diagnose a
person under the age of 18 the features must be present for at least
one year. ASPD cannot be diagnosed until 18.
2.Depending on the type, male: female ratio for ADHD is 2:1 to 9:1 boys
to girls.
3.Axis II includes personality disorders (excluding Multiple
personality disorder).
4.Borderline personality disorder is characterized by instability of
interpersonal relationships. Other characteristics include recurrent
suicidal gestures, self harm, real or imagined abandonment, and
impulsivity. The disorder tends to wane as the person ages. About 75%
is female. Bipolar disorder is a common differential.
5.Conduct disorder more common in males. Males tend to manifest this
condition in childhood whereas girls are more likely to have a teenage
onset. ODD has more boys in childhood, but after puberty there is an
equal ratio of boys to girls.
6.Research suggests that there is an abnormality in the gene(s)
affecting the brain's metabolism of neurotransmitters such as dopamine,
serotonin, and norepinephrine effectively causing Tourette’s Disorder.
7.There is not an adult-onset in ADHD, it must be present in childhood.
ADHD may be prescribed more and more in our culture due to American’s
instant gratification life style.
8.Echolalia-the pathological, parrotlike, and apparently senseless
repetition (echoing) of a word or phrase just spoken by another person.
Palilalia- repeating the same words over and over again.
9.Individuals with Dissociative Identity Disorder frequently report
having experienced severe physical and sexual abuse, especially during
childhood and confirmed by objective evidence. 3 to 9 times more
frequent in women to men.
10.Coprolalia-uncontrolled obscene language that accompanies Tourette’s
syndrome. Only about 10% of Tourette’s cases.
11.Cluster A personality disorders are considered odd and eccentric,
Paranoid, schizoid, schizotypal. Cluster B are considered dramatic and
impulsive, Antisocial, borderline, narcissistic, histrionic. Cluster C
anxious, fearful, avoidant, depenent, obsessive compulsive.


12.The etiology of schizophrenia includes: too much dopamine, viral
problems, and abnormal brain structure with enlarged ventricles. Low
socioeconomic status can be a contributing factor. El Dopa, a
precursor to dopamine collects and produces too much dopamine. This
was discovered researching Parkinsons disease. Auditory hallucination
is most common.
13.Theories for personality disorders are strongly based in
psychodynamic theory.
14.Hallucination-Perception of visual, auditory, tactile, olfactory, or
gustatory (taste) experiences without an external stimulus and with a
compelling sense of their reality, usually resulting from a mental
disorder or as a response to a drug.
Delusion-A false belief strongly held in spite of invalidating
evidence, especially as a symptom of mental illness: delusions of
persecution (bizarre-person’s culture would regard as totally
implausible, delusional jealousy-one’s sexual partner is unfaithful,
erotomanic-another person is in love with the individual,
grandiose-inflated worth,power,knowledge, identity, of
reference-events, objects,environment have a particular and unusual
significance, somaticpertains to the appearance or function of one’s
body).
Illusion-An erroneous perception of reality.
17. DID personalities can be mutually amnesic (no memory of each
other), mutually cognizant (each is aware of the other and may have a
positive or negative relationship), or one-way amnesic disorder (some
are aware of others but the knowledge is not reciprocal).
19. A dissociative fugue may be present when a person impulsively
wanders or travels away from home and upon arrival in the new location
is unable to remember his/her past. The individual's personal identity
is lost because that person is confused about who he/she is. The travel
from home generally occurs following a stressful event. The person in
the fugue appears to be functioning normally to other people. However,
after the fugue experience, the individual may not be able to recall
what happened during the fugue state. The condition is usually
diagnosed when relatives find their lost family member living in
another community with a new identity.
20. psychosis- a break with reality. Can be present in depression,
bipolar, schizophrenia, drug and alcohol abuse, the narrowest def
includes delusions and hallucinations Broader definitions include
disorganized speech, catatonic behavior).
21. Episodic memory includes specific learning episodes or experience.
Semantic memory includes general knowledge not tied to learning
experiences.
23.Autism is characterized by lack of verbal response, lack of interest
in multiple activities, excessive motor activity.


24. loose associations (derailment) a pattern of speech where ideas
slip off one track to another completely unrelated or vaguely
unrelated. Neologism is a made up word(s) that are present during
psychosis.
Autistic children experience a paradox of stimulation. Autistic
children have sensory integration issues. When these children are over
stimulated, pressure calms them down.
29. Catatonic stupor is marked
motor immobility, catatonic agitation manifests in excessive motor
activity, catatonic negativism is motiveless resistance to being moved.
30. localized amnesia- the individual fails to recall events that
occurred during a circumscribed period of time.
Selective amnesia- the person can recall some, but not all, of the
events during a circumscribed period of time.
Generalized amnesia- failure of recall encompasses the persons entire
life./Continuous amnesia- the inability to recall events subsequent to a
specific period of time up to and including the present.
Systematized amnesia- loss of memory for certain categories of
information.
32. personality-enduring patterns of perceiving, relating to, and
thinking about the environment and oneself.
42. Downward drift- schizophrenia can cause sufferers to drift
downward. Their education level and employment are lower than their
parents. They cycle downward socially.
Diathesis Stress model-people are biologically predisposed to disorders
that manifest when psychological stress is present.
43.predromal phase of schizophrenia is the beginning phase, the person
starts to deteriorate, look depressed, poor hygiene. The active phase
looks like schizophrenia, hallucinations, delusions present. The
residual phase is the ending phase, you still see symptoms but not as
intense.
47.Distinctions between Dissociative amnesia and Amnesia d/t head
trauma:
DA-there is a traumatic event in which the person loses memory for some
specific time frams, type of memory lose is typically episodic, does
not usually involve problems with new learning.
AHT-there is an organic factor, typically resulting in loss of
consciousness. Both episodic and semantic memory loss. The memory
loss typically involves new memories.
ODD vs. CD
ODD’s disruptive behaviors are less severe than CD and do not include
aggression toward people or animals, destruction of property, or a
pattern of theft or deceit. Usually all the features of ODD are
present for conduct disorder. CD individual have little empathy and
concern for other’s feelings. They are aggressive individuals and
response aggressively to others, lack guilt or remorse. ODD people are
defiant and hostile toward authority figures. They lose there temper
with adults, refuse to comply to others, and blame others for their own
mistakes.

ADD hyperactive/impulsive vs. inattentive type
Innattentive:
-fails to give close attention to details
-often has difficulty sustaining attention in tasks
-often does not follow through on instructions
-often has difficulty organizing tasks and activities
-dislikes takes that require sustained mental effort
-often loses things
-easily distracting by extraneous stimuli
-is often forgetful

hyperactive/impulsive:
-fidgets and squirms
-leaves seat hen they should remain seated
-runs about excessively
-has difficulty playing leisure activities quietly
-“on the go” or as if “driven by a motor”
-ta;ls excessively
impulsivity
-blurts out answers before turn
-difficulty waiting turn
-interrupts others

Autism vs. Aspergers
Autism:
Mental retardation has high comorbidity
Delay in language
Exclusive lack of reciprocity
Problems with social adaptation activity/interests

Aspergers:
Comorbid MR not likely
No delays in cognition before 3, no severe language deficit
Lack of reciprocity is usually more one-sided
Problems with social adaptation activity/interests

Type I vs type II schizophrenia
I-positive symptoms are characteristic
Good response to traditional antipsychotics/Better prognosis
II-negative symptoms/Poorer prognosis
 
 
 
PSYCHOTIC DISORDERS:

Schizophrenia:

Diagnostic Criteria: (positive sxs are distortion of normal functions while negative sxs are loss or diminution of normal functions)
- Criterion A: a/k/a “active phase” (positive and negative sxs) must have 2 or more of the following for at least 1 mth period
1) delusions
2) hallucinations
3) disorganized speech (frequent derailment or incoherence)
4) grossly disorganized or catatonic behavior
5) negative symptoms (i.e. affective flattening, alogia, or avolition)

- Criterion B: social/occupation dysfunction
- Criterion C: Duration (continuous signs of disturbance persist for at least 6 mths – must include at least 1 mth of symptoms in Criterion A)
- Criterion D: Schizoaffective & Mood disorder exclusion – no major depressive episodes, manic or mixed episodes occurred concurrently and no mood episodes occurred concurrently
- Criterion E: Substance/general medical condition exclusion
- Criterion F: Relationship to a Pervasive Developmental Disorder – if hx or autism or other PDD then additional diagnosis is made only if prominent delusions or hallucinations are present for at least 1 mth

Classification for longitudinal course:
1. Episodic w/ Interepisode Residual Symptoms (w/ Prominent Negative Symptoms)
2. Episodic w/ No interepisode Residual Symptoms
3. Continuous (w/ Prominent Negative Symptoms)
4. Single Episode In Partial Remission (w/ Prominent Negative Symptoms)
5. Other or Unspecified Pattern

Subtypes:
1. Paranoid type (preoccupation w/ 1 or more delusions or frequent auditory hallucinations)
2. Disorganized type (disorganized speech; disorganized behavior; flat/inappropriate affect)
3. Catatonic type (motor immobility; excessive motor activity; extreme negativism)
4. Undifferentiated type (meet Criterion A but not the paranoid, catatonic or disorg. type)
5. Residual type (at least 1 episode occurred; lacks positive sxs (delusions, etc) but has negative sxs)


Associated features:
- inappropriate affect (common in Disorganized type)
- Anhedonia (loss of interest or pleasure)
- Dysphoric mood
- Disturbances in sleep pattern
- Not eat bcuz of delusional beliefs
- Psychomotor activity (pacing, rocking, etc)
- Difficulty in concentration, attention & memory
- Usually have poor insight
- Approx 10% commit suicide (20% to 40% attempt it)
- Somatic concerns, depersonalization, derealization
- Anxiety or phobias are common
- Higher incidence or assaultive or violent behavior
- High comorbidity w/ substance related d/os
- 80% to 90% are smokers
- Schizo type personality d/o may precede onset of schizophrenia
- Anxiety, OCD and Panic high w/ schizophrenia

Etiology:
- decreased brain tissue
- focal abnormalities in temporal lobe
- decreased thalamic volume

Associated GMCs:
- minor physical anomalies
- physically awkward
- motor abnormalities secondary to neuroleptic treatment
- nicotine dependence

Culture, Age, Prevalence & Course Features:
- r/o cultural or religious practices
- more diagnosed in African Americans & Asian Americans (cultural bias or true rates?)
- onset late teens and mid 30’s (rare before teens)
- can begin after 45 yrs age
- course typically chronic
- schizophrenia is expressed differently in women & men (onset for men 18 to 25 yrs old and for women 25 to mid 30 yrs) M:W ratio
- prevalence – approx 0.5% to 1.5% of population
- median age of onset for 1st psychotic episode is early to mid 20’s for men and late 20’s for women

Differential Diagnosis:
- Psychotic D/O Due to GMC
- Delirium
- Dementia
- Substance-Induced Psychotic D/O
- Substance-Induced Delirium
- Substance-Induced Persisting Dementia
- Mood D/O with Psychotic Features (if sxs occur exclusively during periods of mood disturbance)
- Schizoaffective Disorder
- Schizophreniform Disorder
- Brief Psychotic Disorder
- Delusional Disorders
- Schizo (type) Personality Disorders

Schizophreniform Disorder:

- symptoms and features same as schizophrenia
- Differences: duration & functioning
- duration 1 to 6 mths
- social or work dysfunction not required
- When the pt is currently experiencing these sxx (and no history of schizophrenia) the dx
is provisional (the dx cannot be certain until 6 mths mark)

Associated Features:
- similar to schizophrenia
- although dysfunction is not needed for dx, most experience this
- culture, age, gender factors are similar for schizophrenia; however…

Cultural difference in prevalence:
- some evidence that patients recover from psychotic d/os more quickly in developing countries
- in fact, prevalence is much higher in developing countries (some rates as high as schizophrenia)
- In U.S. and developed countries, it is typically 1/5 rate of schizophrenia

Course & Specifiers:
- approx 1/3 recover
- most of the remaining 2/3 go on to receive schizophrenia or schizoaffective d/o dx
- “With Prognostic Features” – two of the following needed: good premorbid functioning, onset w/in 4 weeks, confusion at height of episode, absence of blunt/flat affect
- “Without Good Prognostic Features”

Brief Psychotic Disorder:

- sudden onset of delusions, hallucinations, disorganized speech or “grossly disorganized or catatonic behavior”
- duration: 1 day (i.e. <) 1 mth
- full return to premorbid functioning

Associated Features:
- prevalence is rare
- intense confusion and emotion
- high risk for suicide
- personality d/o that may ? predispose person to break
- need to r/o specific cultural issues

Course & Specifiers:
- mean onset is late 20s to early 30s
- full remission w/in 1 mth of onset
- recurrent episodes are rare
- “With Marked Stressors” a/k/a “Brief Reactive Psychosis” in DSM-III-R
- “Without Marked Stressors”
- “Without Postpartum Onset” w/in four weeks of birth

Differentials:
- among schizophrenia, schizophreniform & brief psychotic d/o
- due to GMC
- Substance induced
- Delirium
- Mood D/Os (If psychotic sxs occur exclusively during mood sxs, Mood Disorder w/ Psychotic Features)
- Factitious D/O & Malingering
- Personality D/O

Schizoaffective Disorder:

- meets sxs for both active phase (Crit.A) of schizophrenia and Major Depressive Episode or Manic Episode or Mixed Episode
- duration of MDE must be 2 wks; 1 wk for Manic or Mixed
- duration of active phase of schizophrenia at least 1 mth
- Subtypes: Bipolar Type (Manic, Mixed present) or Depressive Type (MDE only)

Features:
- less common than schizophrenia
- age of onset early adulthood
- prognosis better than schizophrenia but worse than Mood disorders

Differentials:
- Psychotic D/O Due to GMC
- Delirium
- Dementia
- Substance Induced
- Schizophrenia
- Mood D/O Psychotic Features
- Delusional D/O

Delusional Disorder:

- presence of 1 or more delusions that persist for at least 1 mth
- do not dx is pt meets criteria A for schizophrenia
- psychosocial functioning is variable
- appear normal when delusional ideas are not discussed or acted on
- uncommon in clinical settings 0.03% prevalence rate
- age of onset adolescence to late in life
-

Subtypes:
- Erotomanic Type (central theme is that another person is in love w/ the individual)
- Grandiose Type (central theme is the conviction of having some great talent or insight or discovery)
- Jealous Type (central theme is that the their spouse or lover is unfaithful)
- Persecutory Type (most common - central theme is that the individual is being conspired against)
- Somatic Type (central theme involves bodily functions or sensations (i.e. foul odor, etc))
- Mixed Type (when no one delusional theme predominates)
- Unspecified Type (when the dominant delusional belief cannot be clearly determined)

Differentials:
- Delirium
- Dementia
- Psychotic D/O Due to GMC
- Substance Induced Psychotic D/O
- Schizophrenia/Schizophreniform D/O
- Mood D/O With Psychotic Features
- Hypochrondriasis (if the person can entertain that the possibility of the feared disease is not present)
- Body Dysmorphic D/O
- OCD
- Paranoid Personality D/O

Shared Psychotic Disorder:

- delusion develops in an individual in the context of a close relationship w/ another person who already has an established delusion
- the delusion is similar to content to that of the person who already has the established delusion
- the disturbance is not better accounted for by another Psychotic D/O (e.g. schizophrenia) or a Mood Disorder With Psychotic Feature and is not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a GMC

Psychotic Disorder Due to a GMC:

- prominent hallucinations or delusions
- evidence, hx or findings that it is a direct physiological consequence of a GMC
- not better accounted for by another mental d/o
- does not occur exclusively during the course of a delirium
- Subtypes: With Delusions or With Hallucinations

Substance-Induced Psychotic Disorder:

- prominent hallucinations or delusions (do not include hallucinations if person has insight that they are substance induced)
- evidence of sxs during or w/in a month of Substance Intoxication or Withdrawal or that medication use is etiologically related
- not better accounted for by Psychotic D/O
- does not occur exclusively during the course of a delirium

Subtypes & Specifiers:
- With Delusions
- With Hallucinations
- With Onset During Intoxication
- With Onset During Withdrawal

Differentials:
- Substance Intoxication or Withdrawal With Perceptual Disturbances
- Hallucinogen Persisting Perception Disorder
- Delirium
- Primary Psychotic Disorder
- Psychotic D/O Due to GMC

Psychotic D/O Not Otherwise Specified:

- includes psychotic symptomatology but inadequate info to make specific diagnosis or about which there is contradictory info or psychotic disorders that do not meet the criteria for any specific psychotic disorders


DISSOCIATIVE DISORDERS:

Dissociative Amnesia:

- inability to recall important info (usually of a stressful nature) about one’s life
- cannot be attributed to an organic problem
- usually precipitated by a traumatic event


Types:
- Localized (most common – limited period of time is forgotten)
- Selective (some but not all events during a limited time period are remembered)
- Generalized (period of forgotten events continues so that new info is quickly forgotten – rare)
- Systemized (certain categories of info are lost – rare) - episodic memory is affected; semantic memory typically remains unchanged

Dissociative Fugue:

- details of life; identity are forgotten
- person moves to a different location
- may establish a new identity
- can last days & involve a move to a nearby location or it can involve mths to years and involve a move to a distant location
- usually precipitated by a stressful event and loss of memory involves episodic memory only
- brief fugues are often reversible; the person regains identity and memory and may lose memory of the fugue state; more complex fugues involve more difficulty with recovery

Dissociative Identity Disorder:

A. Person portrays 2 or more personalities
1. Subpersonalities repeatedly take control
2. episodic amnesia- forgetting biographical information, and events that happened
B. Diagnostic Features
1. Primary or host personality is typically “passive, dependent, guilty, and depressed
2. More dominant personalities have more memories, and less dominating personalities may make themselves know through hallucinations and writings
3. Switching- often sudden and triggered by stress
4. Some have two to more than 100 personalities
5. ½ have 10 or fewer
6. Therapist may get the person to switch on command
7. Relationships of subs
8. Mutually amnesic- they have no memory of each other
9. Mutually cognizant-each is aware of the other and their relationship may be positive or negative
10. MOST COMMON- one way amnesic disorder- some are aware of others, but the knowledge is not reciprocal (dominating personalities are most aware of the others)

C. Associated Features
1. History of physical or sexual abuse
2. Highly hypnotizable/suggestible
3. Self-injurious behaviors, suicidal ideations/attempts
4. Physiological reaction may vary across subs (Blood pressure vs blood glucose reaction to insulin)
5. 3-9 times more frequent in women
6. Women mean identities = 15
7. Men mean identities = 8
8. Prevalence is on the rise
9. Average time before onset and diagnosis: 6-7 years
10. Chronic and more common among 1st degree biological relatives
D. Comorbid Symptoms and Disorders
1. Conversion and somatic symptoms
2. stress-induced medical issues: headaches, migraines, irritable bowel syndrome, and asthma
3. Comorbids: mood disorder, substance related, eating disorder, sexual
E. Differential
1. Dissociative features include: PTSD, ASD (acute stress disorder), and Somatization Disorder
2. If dissociation is restricted to criteria under these disorders, do not add disociative disorder.
3. DID takes precedence over diagnosis of dissociative fugue, dissociative amnesia, trance, and depersonalization disorder
4. General Medical Condition (e.g. seizure disorders) and substance induced (e.g. alcohol)
F. Psychotic Disorders
1. Bipolar
2. Facticious- have symptoms, but not for external reward
3. Malingering
4. Cross-cultural issues
5. Amok
6. Falling out

Depersonalization Disorder:
- repeated experiences of feeling detached from oneself
- reality testing remains intact
- derealization also common
- can be seconds to years
- trauma history
- chronic course

Dissociative Disorder NOS:
- category for disorders which the predominant features is a dissociative symptom that does not meet the criteria for any specific Dissociative Disorder


PERSONALITY DISORDERS:
- What makes a diagnosis?
1. A pervasive and maladaptive pattern involving problems in cognition, emotion, interpersonal relation or impulse control (need at least 2 areas)
2. Latest onset is young adulthood
3. Usually don’t diagnose before 18
i. Anti-social definitely can’t be diagnosed before 18
- Theory and Diagnosis
ii. Psychodynamic: theory pervades Personality disorder
iii. Coded on AXIS II
iv. The controversy of the diagnosis
a. Can code MR, defense mechanism
b. Controversy: many of the criteria has to be met, but individuals can look different because of the criteria they met, which is called polynmeumonic
c. A lot of people propose a continuum
d. Big 5 most popular trait theory
- Clusters
v. A: odd, eccentric
vi. B: dramatic, impulsive
vii. C: anxious, fearful
- Cluster A and Personality Disorders
viii. Rarely seek treatment
ix. Not a lot of research
a. May have brief psychotic episodes
b. Has to be at least 1 day (brief)
c. Schizophrenic form is 1mo-6mos

Paranoid Personality Disorder:

a. Pattern of distrust and suspiciousness
b. Shun close relationships because they suspect everyone intends to harm them
c. Finds hidden meanings everywhere
d. Very sensitive
e. Critical of others; don’t see their faults
f. Not bizarre or delusional
g. More men than women: 0.5%-2.5% of population

Causes:
- little empirical investigation
- Psychodynamic view (traced to demanding parents – rigid fathers & over-controlling mothers; child, thus, becomes overly vigilant and views the environment as hostile


Schizoid Personality Disorder:
- detached from social relationships
- restricted range of emotional expression
- prefer to be alone
- take little interest in acquaintanceships and sexual relationships
- rarely show their feelings
- choose isolated occupations
- more men than women

Causes:
- Psychoanalytic theory defense reaction – unsatisfied basic need for human contact
- Cognitive theorists say that people with Schizoid Personality Disorder suffer from cognitive deficits (thinking is vague, empty; unable to scan & perceive messages appropriately)

Differentials:
- AXIS I ****(Autism and Asperger’s)****

Schizotypal Personality Disorder:
- interpersonal deficits
- acute discomfort in close relationships
- cognitive or perceptual distortions
- behavioral eccentricities
- seek isolation and are lonely
- ideas of reference (unrelated things have personal meaning)
- body illusions
- digressive speech
- not complete break from reality
- Comorbid – Major Depression
- rule out cultural rituals and issues
- more common in men

Explanations:
- similar to schizophrenia (“refridgerator mothers”)
- poor family communication
- deficits in attention
- research links schizotypal to biological factors (tied to schizophrenia…dopamine, enlarged brain ventricles with some genetic base)
- also related to mood disorders

Cluster B: Dramatic, Impulsive:
- (a/k/a emotional or erratic)
1. causes are not well understood
2. treatments range from ineffective to modestly effective


Antisocial Personality Disorder (a/ka/ psychopathy):

- most empirical research
- often referred to as “psychopaths” or “sociopaths”
- display pervasive pattern or disregard for and violation of other people’s rights
- must be at least 18 yrs of age
- however, sxs can be traced before age 15, including truancy, running away, mistreating animals or people
- 3 common elements of a serial killer: cruelty to animals, bed wetting, and….

Characteristics:
- repeatedly deceitful
- cannot work well at jobs/frequent moves and job changes
- irresponsible with money
- impulsive
- irritable and aggressive
- little regard for safety and others
- 3x more common in men (under diagnosis in women?)
- Alcoholism & substance abuse common

Theories:
- Psychodynamic: increased childhood stress, parent w/ Antisocial PD
- Behaviorism: modeling
- Cognitive: difficulty with others point of view
- Genetic: biological predisposition to criminality; biological abnormalities ANS & CNS react more slowly in APD
- Thrill seekers – seek out more stressful situations to get a rush
- Parenting & biological most important theories/ higher in lower ses & big cities

Borderline Personality Disorder:

- major shifts in moods
- unstable self-image
- instability of interpersonal relationships
- marked impulsivity
- by early adulthood and present
- to distinguish between Personality Change Due to GMC is age of onset
- DSM-IV added criteria about transient, stress-related paranoid ideation or severe dissociative symptoms
- Co-occurs w/ Mood Disorders (Major Depression; Bipolar D/Os; Dysthymia)



Histrionic Personality Disorder:

- excessively emotional
- attention seekers
- very theatrical and dramatic when explaining everyday things
- vain, self-centered, demanding
- overreact to minor things
- may attempt suicide as a manipulative gesture to get attention
- may exaggerate illness or weakness
- typically provocative & sexually inappropriate

Associated Features:
- obsessed with own looks
- dramatize relationships
- previously gender biased but now equally men & women
- Comorbid w/ Somatization; Conversion & Major Depression (AXIS I)

Explanations:
- Psychodynamic – parents may be cold or controlling; feeling unloved or needy; lack of attention from mother may cause dependence on father = flirtations and dramatic with men
- Cognitive – lack of substance and extreme suggestibility
- Social/cultural – may not fit in societal norms & expectations of women/exaggerating femininity

Narcissistic Personality Disorder:

- grandiose sense of self-importance
- exaggerate achievements, talents
- choosy about the people & institutions they are closely associated with
- rarely maintain stable and long term relationships
- seldom receptive to feelings of others; believe others to be envious of them
- 75% of cases are men (DSM says 50-75% are men)
- Underlying low self-esteem or fragile ego?
- More rare than schizophrenia

Explanations:
- Psychodynamic: cold & rejecting parents – they tell themselves that they are perfect to defend against the anxiety
- Cognitive: being treated too positively or negatively by the parents or being called “different”
- Sociocultural: era of narcissism

Cluster C: anxious, fearful
- the treatments for this cluster work much better than for the others

Dependent Personality Disorder:

- persistent need to be taken care of
- clingy & submissive
- fear separation; can’t make decisions
- need reassurance
- feelings of personal inadequacy
- helplessness
- lack confidence; adapt to others

Associated Features:
- many experience: distress, loneliness, depression, self-criticism, low self-esteem
- risk for: depressive & anxiety disorders
- men=women
- most frequently reported in outpatient clinics

Etiology:
- Psychodynamic: unresolved conflicts of oral stage; sets stage for life long need for nurturance
- Cognitive: I am inadequate/I am helpless; I must find someone to protect me.
- Chronic physical illness or childhood separation anxiety may be common precursors to DPD
 
 
 
EATING DISORDERS:

Anorexia Nervosa
• Refuses to maintain 85% of body weight (must lose 15% below ideal body weight)
• Intense fear of getting fat
• Disturbances in body image, excessive influence of weight/shape, denial of seriousness of problem.
• Absence of at least 3 consecutive menstrual cycles
• Restricting and Binge-Eating/Purging subtypes

**A lot of anorexics start out restricting and then move into a bulemic category
**Usually family members encourage medical attention

Demographics:
• Mean age is 17 yrs old
• Mostly in industrialized societies
• Majority female
• Majority Caucasian
• Primarily in middle upper class
• Prevalence among late adolescent & young adult females (Lifetime prevalence = 0.5% to 1.0%) More commonly see Eating Disorder NOS
• Increase risk in 1st degree biological relatives
• Mortality rates reported as high as 1 out of 5

Physical Signs:
• Emaciated
• Lanugo hair
• Discolored and/or dry skin
• Decrease in subcutaneous fat
• Hair loss
• Bradycardia, hypotension
• Hypothermia
• Decrease in estrogen, loss of menses
• Edema, especially w/ refeeding (swelling)

Associated medical complications:
• Arrthymias
• Cardiomyopathy
• Congestive Heart Failure
• Gastrointestinal dysfunction
• Mild anemia
• Osteoporosis/Ostopenia
• Ovarian cysts
• Gray matter deficits

Associated Psych features:
• AXIS I: depression/anxiety (e.g. social phobia & OCD)
• AXIS II: obsessiveness/dependency/Cluster C & Cluster A

Recent etiological theories:
• Biological factors: serotonin & leptin (Don’t give SSRIs because it keeps them from gaining weight)
• Psychological factors: AXIS I & AXIS II
• Social factors: prevalence is higher in industrialized societies & higher in certain subcultural groups

Bulemia Nervosa:

• Recurrent episodes of binge eating & compensatory behaviors to prevent weight gain
• 2x a week for 3 mths
• Excessive influence on weight/shape
• Purging and non purging (restricting or exercise) subtypes
• Normal or above average weight

Demographics:
• Modal age between mid-adolescence and age 20
• Great diversity in ses, ethnicity
• Majority female
• Prevalence among teen and young adult
• Females 1.0% - 2.7%
• Increased frequency in first degree relatives

Physical Signs:
• Scars on hands
• Puffy cheeks (dehydration or gastrointestinal problem)
• Gastritis
• Bradycardia, hypotension
• Edema, especially after cessation of purging
• Menstrual irregularity
• Dental Problems

Medical Complications:
• Fluid and electrolyte abnormalities
• Dehydration
• Muscle weakness, fatigue
• Arrthymias
• Seizures (contraindicated Zyban & Wellbutrin)
• Cardiac & skeletal myopathies
• Gastrointestinal problems (reflux, gastritis, hiatal hernia, gastric dilation)

Associated Features:
• AXIS I: depression, anxiety (social phobia), substance abuse/dependence
• AXIS II: Cluster B, impulsiveness, dependency

Recent Etiological Theories:
• Biological Factors
- restricted intake
- disturbed satiety
- serotonin
• Social Factors
- increased incidence
- prevalence is higher in industrialized societies
- prevalence is higher in certain subcultural groups

**(FDA approved drug – Prozac; SSRIs are commonly used for Bulemia)

Eating Disorder NOS:
• disorders of eating that do not meet full criteria for any specific eating disorder
• examples (females who meet criteria for AN but not all criteria or chewing and spitting out food)

Binge-Eating Disorder:
• Recurrent episodes of binge eating w/o compensatory behaviors
• Large amount of food, shameful, hiding it from other people
• 2x for six months
• Eating in secrecy, person experiences distress, most are obese or overweight
• Higher rate in men than AN & BN

SOMATOFORM DISORDERS:

Somatization Disorder:
• Pattern of recurring, multiple, clinically significant somatic complaints
• Somatic complaint clinically significant if results in medical treatment & causes significant impairment
• Begins before age 30 and occur for several years
• Cannot be explained by any GMC or substance effects and/or if there is a GMC the complaints are in excess of what is expected for the patient's hx, condition and lab findings
• Must meet 4 criterions: 1) four pain symptoms: a hx of pain related to at least 4 different sites of function (head, abdomen, back, joints, extremities, chest, rectum, etc); 2) two gastrointestinal symptoms: hx of at least 2 gastrointestinal sxs other than pain (i.e. nausea, bloating, vomiting, diarrhea and intolerance of several different foods; 3) one sexual symptom: hx of at least 1 sexual or reproductive sxs other than pain (e.g. sexual indifference, erectile, or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy); 4) one pseudoneurological symptom: hx of at least 1 sx or deficit such as impaired coordination or balance, paralysis or localized weakness, difficulty swallowing or lump in throat, urinary retention, hallucination, loss of touch or pain sensation, double vision, blindness, deafness, seizures.
• Symptoms are not intentionally produced or feigned (like factitious or malingering)

Associated features:
• Complaints are colorful, exaggerated but lack specific factual information
• Inconsistent historians & often seek treatment from several physicians concurrently
• Undergo numerous examinations, treatments
• Major Depressive D/O; Panic D/O; Substance Related D/O are frequently associated
• Histrionic, Borderline, and Antisocial Personality D/O most closely associated AXIS II disorders

**Lab findings are remarkable for the absence of findings to support the subjective complaints

Associated Physical Exam & GMC:
- Physical exam remarkable for lack of objective findings to fully explain subjective complaints
- Most pts are diagnosed w/ so-called functional disorders (i.e. irritable bowel syndrome)

Specific Culture & Gender Features:
- Differ across cultures
- Symptom review should be adjusted to culture
- Rare in men in the U.S. but high in Greek & Puerto Rico suggesting culture affects sex ratio

Prevalence, Course & Pattern:
• Lifetime prevalence rates 0.2% - 2% among women and less than 0.2% in men
• Chronic but fluctuating disorder that rarely remits completely
• Typically met before 25 years, initial sxs are often present by adolescence
• Menstrual difficulties may be one of earliest sxs in women; sexual sxs often associated w/ marital discord
• 10-20% of first degree female biological relatives; males relatives of women w/ disorder show increased risk of Antisocial Personality D/O and Substance Related D/O

Differential Diagnosis:
• Nonspecific & overlap w/ a multitude of GMCs
• 3 features that suggest a diagnosis of Somatization D/O rather than a GMC include: 1) involvement of multiple organ systems; 2) early onset & chronic course w/o development of physical signs or structural abnormalities; 3) absence of lab abnormalities that are characteristic of the suggested GMC (still r/o GMC that is characterized by vague, multiple confusing somatic sxs)
• Schizophrenia w/multiple somatic delusions
• Anxiety D/O; Panic D/O; Generalized Anxiety D/O; Mood D/O (particularly Depressive D/O) Pain Disorder Associated w/ Psychological Factors; Sexual Dysfunction; Conversion Disorder or Dissociative D/O and Hypochrondriasis; Factitious D/O w/ predominantly physical signs and sxs or Malingering.

Undifferentiated Somatoform Disorders:
• 1 or more physical complaints that persist for 6 mths or longer
• Frequent complaints include: chronic fatigue, loss of appetite, or gastrointestinal or genitourinary sxs
• Either the symptoms cannot be fully explained by any known GMC or the direct effects of a substance or when there is a GMC the complaints exceed what is to be expected
• Sxs must cause significant distress or impairment
• Diagnosis is not made when the sxs are better accounted for by another Mental D/O
• Sxs are not intentionally produced or feigned

Culture, Age & Gender Features:
- frequent in young women of low ses but such sxs are not limited to any age, gender, or sociocultural group

Course:
- unexplained physical sxs is unpredictable
- eventual diagnosis of GMC or another Mental D/O is frequent

Differential Diagnosis:
• Somatization D/O (requires multiplicity of sxs over several years duration & onset before 30)
• Somatoform D/O NOS (for sxs less than 6 mths)
• Major Depressive Disorder
• Anxiety Disorders
• Adjustment Disorders
• Factitious or Malingering

Conversion Disorder:
• Presence of sxs or deficits affecting voluntary motor or sensory function that suggest a neurological or other GMC (sxs referred to as “pseudoneurological”)
• Psych factors are judged to be associated w/ the sxs or deficit based on preceding conflict or stressor
• Sxs are not intentionally produced or feigned
• Not diagnosed if sxs or deficits are fully explained by a neurological or other GMC, or substance effects, or culturally sanctioned behavior or experience
• Must be clinically significant w/ marked distress & impairment
• Not diagnosed if sxs are limited to pain or sexual dysfunction, occur exclusively during the course of Somatoform D/O or not better accounted for by another Mental D/O

- Motor sxs or deficits include impaired coordination or balance, paralysis or localized weakness, aphonia, difficulty swallowing or a sensation of a lump in the throat and urinary retention.
- Sensory sxs or deficits include loss of touch or pain sensation, double vision, blindness, deafness, and hallucinations. May also include seizures or convulsions.
- Medically naïve tend to present w/ more implausible sxs; sophisticated people have more subtle sxs that more closely simulate a neurological or other GMC
- Rule out GMC or other neurological condition
- Can take years to become evident
- Typically follow the individual’s conceptualization of a condition; “paralysis” may be associated w/ an inability to do something; Sxs are often inconsistent
- May be misdiagnosed; could be medical condition like: multiple sclerosis, myasthenia gravis, idiopathic or substance induced dystonias
- 1/3 w/ Conversion D/O have a neurological condition
- Conversion is derived from the hypothesis that the individual’s somatic sxs represent a symbolic resolution of an unconscious psychological conflict (psychodynamic theory), reducing anxiety (“primary gain”) Might derive “secondary gain” from the conversion symptom like external benefits are gained and responsibilities evaded but unlike Factitious D/O & Malingering the sxs are not generated to obtain the benefits.

Subtypes:
• With Motor Symptoms or Deficit
• With Sensory Symptoms or Deficit
• With Seizures or Convulsions
• With Mixed Presentations (if more than 1 category is present)

Associated Features & Mental D/O:
• Pts may show la belle indifference (relative lack of concern about the nature or implications of the symptom) or may present in a dramatic fashion
• Pts are suggestible based on external cues; dependency and adoption of sick role may be fostered in the course of treatment
• Associated D/O: Dissociative D/O; Major Depressive D/O, and Histrionic, Antisocial, Borderline, and Dependent Personality D/O
• Absence of expected findings that suggest Conversion D/O
• Expected objective signs are rarely present bcuz Conversion D/O sxs do not conform

Specific Culture, Age & Gender Features:
• More common in lower ses & people less knowledgeable about med & psych concepts
• Higher rates in developing regions and then decline after increased development
• Specific cultures have ideas about acceptable & credible ways to express distress
• Sxs children under age 10 are usually limited to gait probs & seizures
• More frequent in women varying 2:1 to 10:1; seen more in men in context of industrial accidents & military


Prevalence:
• Vary from 11/100,000 to 500/100,000 in general population samples; it has been reported up to 3% of pt referrals to mental health clinics and 1% to 14% in general medical inpatients

Course:
• Late childhood to early adulthood, rarely before 10 yrs or after 35 years
• 3% of outpatient referrals to MHC
• More frequent in relatives w/ Conversion D/O & monozygotic twins

Differential Diagnosis:
• GMC, substance induced etiologies
• Other Somatoform Disorders
• Schizophrenia, Psychotic D/Os
• Mood Disorder, Panic Attack
• Dissociative D/Os
• Factitious D/Os, Malingering

Etiology:
• Psychodynamic Theory: hiding unacceptable sexual feelings by unconsciously converting them into physical symptoms; unconscious conflicts carried forth from childhood arouses anxiety and converts this anxiety into more “tolerable” physical symptoms; primary gain; secondary gain
• Behavioral Theory: physical sxs bring rewards (positive reinforcement) and sufferers learn to display sxs more prominently; removes us from unpleasant work situation (negative reinforcement)
• Cognitive Theory: forms of communication or means to express extreme emotions (e.g. anger, fear) that would otherwise be difficult to convey into a “physical language.”

Pain Disorder:
• Includes pain as main focus of clinical attention where psychological factors may have role in onset, severity, exacerbation or maintenance

Subtypes:
• With psychological factors – Acute/Chronic
• With both psychological factors and GMC – Acute/Chronic
• With a GMC (not a mental disorder)

Diagnostic Criteria:
• A – pain at one or more anatomical locations & is the principle focus of clinical presentation & is sufficient severity to call for clinical attention
• B – pain causes clinically significant stress or impairment
• C – Psychological factors are judged to have important role in the onset, severity, exacerbation or maintenance of pain
• D – Rule out Factitious D/O or Malingering
• Pain is not better accounted for by Mood, Anxiety or Psychotic D/O and does not meet criteria for Dyspareunia

Is this Diagnosis Valid?
- physical causes are hard to determine for DSM-IV users that are not medically trained
- Inclusive vs. Exclusive Decision Model
- Psychogenic pain is an “empty concept” – Sullivan feels psychiatrists should focus on diagnosing mood and anxiety disorders that have effective treatments

Etiology:
• Guze found that somatization & Pain D/Os run in families (mostly among female relatives)
• Not clear if genetic but children may model parents somatic behaviors
• Parents that somatize often ignore their children’s needs, therefore they act ill to receive attention
• Cognitively, a person may misinterpret or dramatize their sxs bcuz they experience sensations more intensely than others, this may be reinforced by attention they receive from doctors and family

Associated Features:
• Pain may disrupt aspects of daily life
• Opioid or benzodiazepine dependence or abuse
• ¼ of pts prescribed opioids for chronic pain may develop abuse or dependence
• Those whose pain is associated w/ depression or terminal illness are at increased risk for suicide
• Pain may lead to inactivity & less social activity, in turn breaking down physical endurance which may lead to further pain
• Pain disorder is associated w/ sleep disturbances

Prevalence and Course:
• Prevalence unclear but Pain D/O associated w/ both psych factors and a GMC are more common than other 2
• The longer acute pain is present, more likely will turn into chronic & persistent pain
• Individual may go years before seeing mental health professional

Hypochrondiasis:
• Disorder involving chronic worry that one has a physical disease for which there is no evidence for and one frequently seeks medical attention
• Specifier: With Poor Insight (does not realize excessive or unreasonable)

Differential Diagnosis:
• Somatization D/O
• Dyspareunia
• Conversion D/O
• Other mental d/os
• Factitious D/O and Malingering

Diagnostic Criteria:
• A – preoccupation w/ fears of developing or having a serious disease based on the person’s misinterpretation of bodily sxs
• B – preoccupation persists despite appropriate medical eval & reassurance
• C – belief is not of delusional intensity (Delusional Disorder, Somatic Type)
• D – preoccupation causes clinically significant distress or impairment
• E – Duration is at least 6 mths
• F – preoccupation is not better explained by a GAD, OCD, Panic D/O, MDE, Separation Anxiety or other Somatoform D/O

Etiology:
• Cognitive/Behavior theories
- selective attention is thought to be the 1st link in the cycle of health anxiety reactions
- people w/ high health anxiety selectively attend to info that appears to confirm the idea of having an illness and to ignore other opposing evidence that suggest good health
• Attachment Theories
- theorists believe symptom manifestation can be a result of caregiver’s lack of attention to their child’s attachment needs during times of illness
- As adults, these individuals may elicit physical complaints as an indirect or subversive way to receive care

Associated Features:
• Fears of aging or death
• Have no better health habits than normal individuals
• “Doctor shopping”
• Strongly avoid psych explanation and referrals to mental health professionals
• Social relationships may be damaged bcuz individuals demand special treatments
• Past serious illness or injuries in childhood or in one’s family may be associated with hypochrondriasis

Prevalence and Course:
• 1% to 5% in general population
• Can begin at any age, but the most common age of onset is in adulthood
• Chronic, waxing and waning sxs, complete recovery sometimes occurs

Differential Diagnosis:
• GMC
• Short somatic sxs that take place in childhood
• Health concerns in old age
• Generalized Anxiety D/O
• Major Depressive D/O
• OCD
• Panic D/O
• Body dysmorphic Disorder
• Specific phobia, disease type

Body Dysmorphic Disorder:
• A disorder that involves excessive concern that some part of one’s body is defective
• Was originally an atypical somatoform disorder in DSM III
• Was introduced as a separate diagnosis, BDD, which has remained in the DSM-IV-TR

Diagnostic Criteria:
• A – preoccupation w/ imagined defect in appearance, if the physical anomaly is minimal, the pt will have excessive concern
• B – preoccupation cause clinically significant distress or impairment
• C – preoccupation is not better accounted for by another mental disorder (AN)

Etiology:
• Some feel it is a form of OCD
• Psychodynamic theorists believe it to be a result of displaced anxiety
• Parental influence?

Associated Features:
• Look in mirrors many hours a day
• Excessive grooming
• Both occur to extinguish anxiety or to reassure individual
• Sometimes, individuals alternate between checking and avoiding mirrors
• Dieting, changing clothes
• Cover up the defect
• May think defect is fragile
• Poor insight
• Think others are staring at their defect
• Avoid activities, job interviews
• Stress may lead to suicide ideation, attempts, or successful attempts

BDD and Plastic Surgery:
- individuals often seek out dental or surgical treatments, sometimes perform self surgery
- 6% to 15% get cosmetic surgery
- These attempts usually lead to new concerns or more surgeries
- They are often unsatisfied w/ surgery
- Revisit to Muscle Dysmorphia – the idea that one’s body is not lean or muscular enough

Somatoform Disorder NOS:
• Disorders that have somatoform sxs but do not meet criteria for any of the specific Somatoform D/Os
- pseudoycesis
- d/o involving nonpsychotic hypochrondrial sxs of less than 6 mths
- d/o involving unexplained physical complaints of less than 6 mths duration that are not due to another mental disorder

**Should somatoforms disorders be reorganized?

Factitious Disorder:
• faking for internal gain, consciously faking like Munchausen's by Proxy.
• Go to lengths to show they are ill, go through painful testing
• Medical hx reported in a vague way, elaborate and dramatic about it (Cluster B – dramatic)
• Annoyed when confronted, cut ties w/ practitioner who questions them
• Feels compelled to do it and feels distressed by the fact that they keep doing it
• More typical in women; starts in young adulthood
• Lancelot Article in 1977 – Dr. Meadow first named Munchausen's by Proxy

MOOD DISORDERS (Pg 345):

Major Depressive Episode:
- Anyone can sing the blues
- Abnormal vs. normal shifts in mood (?severity ?duration)
- Duration must be 2 wks for major depressive episode
- Must 5 out of 9 symptoms: depressed mood most of the day; markedly diminished interest or pleasure in all or almost all activities; significant weight loss when not dieting or weight gain; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthlessness or excessive guilt; diminished ability to think or concentrate; and recurrent thoughts of death.
- Sxs do not meet criteria for mixed episode
- Sxs cause clinically significant distress or impairment
- Sxs are not due to the direct physiological effects of a substance
- Sxs are not better accounted for by bereavement (no longer than 2 mths following loss)

Major Depressive Disorder:
• MDD must meet criteria for single episode and recurrent episode
• No hx of mania
• Can't have depression and bipolar depression

Prevalence:
- 10% to 25% women (2:1 W:M)
- 5% - 12% men

Differences:
- Culture (more somatic complaints w/ Asians)
- Age (equal rates w/ youth by puberty – more women)
- Gender

Course:
- "untreated" episode typically lasts 4 or more mths
- most fully recover after this episode
- ½ will have 2 or more episodes

**The more episodes you have the more likely you are to have another

Associated Features:
- Suicide
- Chronic pain/health problems
- Dysthymia
- Substance Use
- OCD and panic (serotonin & noepinephrine - major neurotransmitters in depression & comorbid)
- Eating D/Os
- Borderline

Differentials:
- Due to GMC (hypothyroid and brain injury)
- Dementia (age <65 risk increases; premorbid functioning; onset)
- Due to Substance (cocaine w/drawal; other stimulant w/drawal; steroid use)
- Bereavement (loss of important other; sxs begin & remit w/in 2 mths; sxs do not create marked dysfunction "morbid preoccupation w/ worthlessness")
- Adjustment D/O (stressor is needed; sxs do not meet criteria for MD episode; "normal" sadness)

Diagnosing Subtypes:
• Recurrent – 2 or more episodes
• Seasonal – specific time frame; predominantly has seasonal type in northern places; onset and remission at specific times mainly fall or winter and remit in spring.
• Catatonic – severe psychomotor retardation
• Post-partum – w/in 4 wks after birth; onset is key; some emotional lability
• Melancholic – person who has antedonia; early morning wakening; a lot of guilt; lack of reactivity; worse in a.m.; appetite suppression and weight loss
• Chronic (plus 2 yrs)

Specifiers:
• Mild
• Moderate
• Severe w/o psychotic features
• Severe w/ psychotic features
• In Partial Remission (less sxs or less than 2 mths time)
• In Full Remission (no sxs for 2 mths)
• Mood congruent and not mood congruent
• Atypical – increased sleep, increased eating & weight, increased sensitivity, increased weighted limb feeling, more common w/ seasonal pattern, more common in young feeling, earlier onset and more chronic

Manias:

Manic Episode vs. Hypomanic Episode
1 wk or hospitalization vs. 4 days

- A: distinct period of abnormally and persistently elevated, irritable mood
- B: 3 more of the following: inflated self-esteem; decreased need for sleep; more talkative than usual; flight of ideas; increase in goal-oriented activity; excessive involvement in pleasurable activities
- C: sxs do not meet criteria for a mixed episode
- D: mood disturbance is sufficiently severe to caused marked impairment
- Sxs are not due to the direct physiological effects of a substance

Psychotic features would not come with hypomanic
Same # of features but hypomanic sounds less severe

Bipolar I – manic
Bipolar II – hypomanic

Mixed Episode:
- needs to have both manic to depressive symptoms on the same day
- meet criteria for MDE & mania nearly each day for a week
- causes marked distress & not due to substance or a GMC

Dysthymic Disorder:
• Depressed mood for most of the day for at least 2 yrs
• Presence of 2 or more sxs: poor appetite or overating; insomnia or hypersomnia; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; feelings of hopelessness
• During 2 yrs period never been w/o symptoms from A & B (above)
• No MDE present during the 1st 2 years
• No manic, hypomanic or mixed episode
• Disturbance does not occur exclusively during the course of chronic psychotic d/o
• Sxs are not due to substance or GMC
• Sxs cause clinically significant distress or impairment
• Specifiers: Early onset (before age 21) and Late Onset (after age 21)
• With Atypical features

**READ Page 411 – Page 428 re: specifiers for mood disorders: important for test 2
** Read Construct Validity of DPD for Test 2 – pay close attention to Spectrum Model – what are the five steps in determining if something is construct valid?
**Study additional handouts for Exam #2
Robins and Guze have enumerated 5 phases of construct validation which include the following:

1) clinical description (identification of cardinal features, core sxs, assoc. sxs etc)
2) laboratory studies (gathering data on biological markers for particular d/os)
3) delimitation from other disorders (specifying exclusion criteria so that the index diagnostic is homogeneous)
4) follow-up study (necessary to show that individuals w/ same diagnosis have a similar course to one another)
5) family study (ascertain whether or not a putative d/o runs in families)
 
 
 
18 September 2006 @ 07:01 pm
BEHAVIOR PATHOLOGY
STUDY SHEET EXAM #1

DSM-IV

Introduction:
• Product of 13 Work Groups – designed to increase participation by experts in each of the respective fields
• Work Groups reported to the Task Force w/ 27 members
• Each Work Group had 5 (or more) members – their reviews were critiqued by various other advisors
• Many experts involved to ensure that the DSM-IV had the widest pool of info that would be applicable across cultures
• Many consultations between developers of DSM-IV and ICD-10 to increase compatibility
• Liasions between organizations
• Distributed DSM-IV Options book to get additional data & opinion

History:
• 1st attempt to gather info on mental illness in the U.S. was the recording of the frequency of one category –“idiocy/insanity” in the 1840 census
• By the 1880 census – 7 categories were distinguished:
1) mania; 2) melancholia; 3) monomania; 4) paresis; 5) dementia; 6) dipsomania; 7) epilepsy
• In 1917, the Committee on Statistics of the APA formed plan for gathering uniform statistics across mental hospitals
• DSM-I created in 1952 from surveys of APA members; made to match ICD-6
• The term “reaction” was used in the DSM-I as influenced by Adolf Meyer’s psychobiological view that m/d represented reactions of the personality to psychological, social & biological factors
• DSM-II matched the ICD-8; deleted “reaction” but similar vague criteria as in DSM-I; “empirical validation” again limited to an opinion survey
• DSM-III published in 1980; matching ICD-9 but seen as superior (translated into 13 languages)
• DSM-III had 14 advisory committees w/ attempt to focus on research related to diagnosis validity; DSM-III had conflicting and inconsistent info and criteria was not entirely clear
• Because of the lack of empirical research in the DSM-III many decisions based on reliability and clinical judgment; included more descriptions, attempt to be more objective and atheoretical w/ the introduction of explicit diagnostic criteria, multiaxial system and a descriptive approach that attempted to be neutral w/ respect to theories of etiology
• DSM-III set the stage for later empirical study
• In 1987, the DSM-III-R was released; work group was charged to clean up criteria sets; Field trials using DSM-III criteria emphasized validity, which proved to be higher than expected; more attention to concurrent validity
DSM-IV (1994):

• Matching ICD-10; more attention to cultural factors; focus on documentation of empiricism (DSM-IV Sourcebook)
• Primary Criteria for revision: 1) empirical support (vs. expert opinion); 2) clinical utility; 3) ICD-10 compatibility; 4) clinical theory – common sense (still some in DSM)
• The Task Force on the DSM-IV conducted a three-stage empirical process that included:
1) comprehensive reviews and systematic reviews of the published literature
2) data reanalyses of already collected data sets
3) extensive issue-focused field trials

Literature Reviews:
 Each review specified:
1) documentation of review process
2) the review method
3) the results of the review
4) the various options for resolving the issue (w/ advantages & disadvantages)
 Goal of the Lit reviews (150 done) was to provide comprehensive & unbiased info and to ensure the DSM-IV reflects the best available clinical and research literature

Data Reanalyses:
 Used when lit review alone could not clarify criteria demonstrated
 Useful in evaluating performance of current criteria sets & piloting proposals for new criteria

Field Trials:
 Concerned with: acceptability of diagnosis; feasibility of using this criterion set; the coverage of all the symptoms; how generalizable is the data set; construct validity – multiple validity
 Field Trial Methodology: surveys; videotape reliability studies; focused field trials ***Reliability tended to be lower w/ case studies than with an interview that’s why they did the videotape studies
 Focus on Specificity (Is it there or not?) vs. Sensitivity (What is it?) in field trials
 12 field trials had each approx. 100 subjects at several different sites
 Compared several past and proposed criteria sets to see which had best reliability and validity
 Final stage included public requests prior to final revision
 DSM-IV Sourcebook includes reference record of the clinical and research support for the various decisions reached by the Task Force and Work Groups
DSM-IV-TR:
• Most important use as an educational tool; the “official nonmenclature” across fields, orientations and settings; Purpose of DSM-IV is for communication (educational), research and treatment (clinical)
• The DSM-IV-TR was created to bridge the span between the DSM-IV & DSM-V
• The goals of the DSM-IV-TR was to: 1) correct any factual errors that were identified in the DSM-IV text; 2) review the DSM-IV text to ensure all was up-to-date; 3) to make changes to reflect the new info since the reviews were completed in 1992; 4) make improvements to enhance the educational value; 5) to update the ICD-9 codes that had changed since 1996.
• No substantive changes in the criteria sets were considered nor any proposals
• Text Revision began in 1997 w/ the appt of DSM-IV Text Revision Work Groups corresponding to the original DSM-IV Work Group structure
• Concentrated on literature post 1992; changes listed in Appendix D

Definition of Mental Disorder:
 Mental disorders lack a consistent operational definition
 “No definition adequately specifies precise boundaries for the concept of mental disorder
 In the DSM, mental disorders are conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom. It must be considered a manifestation of a behavioral, psychological or biological dysfunction in the individual.
 Common misconception is that classification of mental disorders classifies people when actually the disorders are being classified (a “schizophrenic” is now “an individual with schizophrenia”)

Issues in the Use of DSM-IV:
• DSM-IV is a categorical classification that divides mental disorders into types based on criteria sets w/ defining features
• DSM is meant to be used as a guideline not in a cookbook fashion
• Individuals sharing a diagnosis are likely to be heterogeneous even in regard to the defining features
• Should still exercise clinical judgment (esp. because of boundary cases) noting importance of reliable & valid methods to assist w/ diagnosis

Use of Clinical Judgment:
• Making an accurate diagnosis
• Training, but not experience, leads to greater reliability and validity in diagnosis and test interpretation (also important is data collection)

Training Matters:
• Clinicians are better than beginning grad students
• Over time grad students are more accurate after completion of training but little improved thereafter

Training is valuable…why isn’t experience?
• Cognitive errors don’t allow for new info to be incorporated or used because of:
1) biases; 2) heuristics; 3) memory
• Lack of feedback – the nature of the psych


Biases:
• Attentional bias (gender, race, age, ses, etc)
• Confirmatory bias (attending to info that confirms our thinking)
• Illusory Correlation – belief that events are correlated when they really aren’t (like Digits Span and depression)
• Hindsight Bias
• Overpathologizing

Heuristics:
• Simple rules that guide decisions
• Availability heuristic – relates to memory, salient or easily recalled features of the case

Memory:
• Likely to recall events that related in the way they should or believed to
• After diagnosis, clinicians are more likely to recall symptoms that relate to the diagnosis (even when not present) and to forget presenting symptoms unrelated to that diagnosis
• When details are recalled incorrectly, it’s unlikely that experience will lead to better accuracy

Feedback:
• Not a lot of opportunities for feedback in psychology

Use of DSM-IV in Forensic Settings:
• Risks that diagnostic info will be misused bcuz of conflict between the questions concerning the law and those surrounding the diagnosis
• “mental disease” is not always sufficient for the legal definition “mental defect”

Ethic and Cultural Considerations:
• Special efforts made to DSM-IV to incorporate in use of culturally diverse populations in the U.S. & internationally
• DSM-IV includes 3 types of info specifically related to cultural considerations: 1) a discussion in the text of cultural variations in the clinical presentations of those disorders; 2) a glossary of culture-bound syndromes; 3) an outline for cultural formulation designed to assist the clinician in systematically evaluating and reporting the impact of the individual’s cultural context.

Coding and Reporting Procedures:
• Official coding system is the ICD-9 (International Classification of Diseases – 9th Revision)
• Use of codes fundamental for record keeping and used for insurance filing
• Subtypes and specifiers are included for increased specificity
• Principal diagnosis is the main focus of the attention or treatment
• Provisional diagnosis is a strong presumption that the full criteria will ultimately be met for disorder but not enough info available to make firm diagnosis (also used when relying on duration of the illness)
• DSM-IV describes each disorder under the following headings:
1) Diagnostic features
2) Subtypes and/or specifiers
3) Recording procedures
4) Associated features and disorders (a) associated descriptive features & mental disorders; (b) associated lab findings; (c) associated physical examination & general medical conditions
5) Specific, culture, age & gender features
6) Prevalence
7) Course
8) Familial pattern
9) Differential diagnosis

Multiaxial Assessment:
• AXIS I – Clinical Disorders (Clinical Syndromes – acute medical disorder) Causes significant distress or dysfunction
• AXIS-II – Personality Disorders ( also for maladaptive personality features and defense mechanisms) and Mental Retardation
• AXIS-III – General Medical Conditions (that are potentially relevant to the understanding or management of the individual’s mental disorder) Axis I might be the cause of Axis III or Axis III might be the cause of Axis I; Axis III should be considered in treatment of Axis I
• AXIS-IV – Psychosocial and environmental problems (occupational, social, relationship problems; may be negative or positive; may have caused or worsened AXIS I/II; be a result of AXIS I/II; need attention)
• AXIS V – Global Assessment of Functioning – uses the clinician’s judgment to report the individual’s overall level of functioning; useful in planning treatment and measuring its impact and in predicting outcome; Two parts – rating symptom severity and psychosocial functioning; if discordant you should always identify the worse of the two; use ratings of current functioning best for reflecting need for treatment
• Additional proposed Axes or alternatives to Axis V – Defensive Functioning Scale (DFS pg 807); Global Assessment of Relational Functioning (GARF pg 814); Social and Occupational Functioning Assessment Scale (SOFAS pg 817)

DIFFERENTIAL DIAGNOSIS:
• Six Steps:
1) Are the presenting symptoms real (conscious feigning for external purposes vs. factitious disorder for internal gain aka malingering vs. munchausens by proxy)
2) Rule out substance etiology
3) Rule out general medical condition
4) Determine the primary diagnosis(es)
5) Adjustment Diagnosis vs. NOS (for sxs that cause distress or impairment but don’t meet criteria or pattern for specific d/o or if symptoms involve a “maladaptive response” to a stressor adj d/o)
6) No mental disorder? (determine “clinically significant” distress or impairment, may be influenced by cultural or clinical context)
ANXIETY DISORDERS:
• Most common
• About 19% of U.S. adults suffer from at least 1 of the 6 anxiety disorders in a given year
• Most comorbid anxiety
• Societal costs about $42 billion a year
• About 80% have more than 1 disorder; 55% have 2 disorders caused by the other
• About 26% have 2 or more independent anxiety disorders
• Symptoms of panic attack: periodic, discrete bouts that occur abruptly and reach a peak w/in 10 minutes; must have at least 4 somatic symptoms present (i.e. heart palpitations, shortness of breath, choking, chills or hot flushes, nausea or abdominal discomfort)

Panic Disorder:

• Must have at least 2 unexpected or “out of the blue” panic attacks aside from situationally bound or situationally predisposed and behavior must be markedly changed and/or dysfunctional for at least one month after an unexpected attack
• Panic attacks are pretty common
• Associated Features: intermittent anxiety (fear about attacks) and hypochrondial features, excessive use of healthcare and comorbidity with depression or other anxiety disorders
• With and Without Agoraphobia; Lifetime = 1-2%; clinical samples = 10% and medical samples = 10-60%; onset is usually between late adolescence to mid 30’s; frequency and severity of attacks vary; course of disorder – chronic, wax and wane
• Treatment appears effective in majority
• Medical differentials for Anxiety Disorder include:
1) Coronary ischemia; mitral valve prolapse; cardiac arrthymias
2) Pulmonary embolism
3) Hypoglycemia
4) Temporal lobe epilepsy
5) Esophageal spasm
6) Asthma
7) Thyroid disease
8) Caffeine
9) Substance abuse
• Psych differentials include:
1) Specific phobia
2) Social phobia
3) Obsessive-compulsive disorder
4) PTSD
5) Agoraphobia

• Agoraphobia – anxiety about and avoidance of public places or situations in which escape may be difficult or help may be unavailable; 2:1 (w:m)
• Panic Disorder With Agoraphobia: in community samples, at least 1/3 of those w/ panic also have agoraphobia (greater than 95% in clinical samples). Onset of agoraphobia is within 1 year of panic disorder; 3:1 (w:m)
Agoraphobia Without History of Panic Disorder:
• Fear involves “panic-like” symptoms or limited symptoms
• Never met criteria for panic disorder
• More common in women
• Most don’t seek treatment until it is so debilitating or their significant other forces them to go (social support groups on the internet)

Etiological Theories of Panic:
- Genetic Link – twins; 1st degree bio relatives 8x greater risk
- Norepinehrine system abnormality (locus ceruleus; yohimbine; drug therapy – antidepressants, benzos)
- Cognitive – panic is experienced only by people who misinterpret or overreact to internal, physiological events

Generalized Anxiety Disorder:
• “free floating anxiety” about 5% of the population (lifetime)
• Common 1st onset in child or teen; more diagnosed in women
• Must have 4 or more symptoms which include: restlessness, keyed up or on edge feelings, easily fatigued, difficulty w/ concentration, irritability, muscle tension or sleep problems. These symptoms must occur for at least 6 mths
• Person may not define anxiety as excessive
• Comorbid for depression & other anxiety
• Somatic nature of symptoms (Asians are more somatic; Americans have more psych sxs)
• Take culture into account and differentiate nonpathological anxiety
• Hard to treat
• Etiological theories: genetics; cognitive – maladaptive assumptions or thinking methods lead to GAD, irrational thoughts lead to irrational emotions – research supports that maladaptive thoughts lead to anxiety; sociocultural – more likely in persons under real threat situations and societal changes, race, poverty are all related

Social Phobia:
• Severe, persistent and irrational fear[s] of social or performance situations in which embarrassment may occur (used to be viewed as an aspect of agoraphobia)
• Phobia – persistent and unreasonable fear about an object, activity or situation.
• Pt usually is aware that the fear is irrational (w/exception of children); somatic symptoms often occur; cycle of fear and social skills/performance
• Associated features: low-self esteem, hypersensitive, inassertive; poorer social skills or anxiety impedes achievement, limited social support, comorbid depression, other anxiety, substance abuse, eating disorders
• Specifiers: SP alone – may fear 1 or many performance/social area; “Generalized” meaning they fear “most” performance/social situations, thought to be more severe w/ greater distress & dysfunction
• About 8% of population more common in women, onset usually in child or teen years, may have a fluctuating course
• Differential diagnosis – Panic d/o; agoraphobia; Separation Anxiety Disorder or Avoidant Personality Disorder

Specific Phobia:
• Persistent fear of a specific object or situation (excluding public places and social situations)
• Must have clinically significant impairment for diagnosis
• About 9% in community (much lower in clinics bcuz they avoid the situation); 2:1 (w:m)
• Typical onset in childhood or early adolescence; Minor spontaneously remit
• Etiology: genetic, social (often person has witnessed some trauma or negative repercussion related to the object/situation); behavioral (people w/ phobias learn to fear/object situation through conditioning classical or operant conditioning); behavioral-biological (humans are predisposed to acquire certain fears)
• Specifier: animal type; natural type; blood injection type; situational type; other type

Stress Disorders:
• Acute Stress Disorder (ASD) – symptoms begin w/in 4 weeks and last no more than a month but sxs must last at least 2 days
• Post Traumatic Stress Disorder (PTSD) – symptoms may begin at any time after the trauma and last longer than a month
• Differential lies in onset and course; may include difference in symptom severity
• Specifiers for PTSD: Acute (less than 3 mths); Chronic (most than 3 mths) or Late Onset (sxs develop after 6 mths after the trauma)
• ASD & PTSD: both need “traumatic event” (life threatening) and response involving fear, helplessness and horror
• It is one of the few disorders in which etiology is needed for diagnosis
• Similar symptoms: re-experiencing the traumatic event; avoidance & reduced responsiveness (ASD separates those two); increased arousal, anxiety (irritability, difficulty sleeping, heightened startle response)
• Associated features: guilt and anger may be seen, psychotic features are rare, comorbid, depression, substance abuse/dependence, other anxiety
• Traumas such as: combat, disasters & abuse are particularly likely to lead to ASD or PTSD
• Lifetime prevalence for PTSD about 8%, unknown for ASD; 2:1 (w:m)
• Waxing & waning of symptoms is less common here than other anxiety disorders; symptoms typically begin w/in first 3 mths many recover w/in that time as well; for those w/ longer duration may recover faster w/ treatment
• Psych Differentials: between ASD & PTSD; Stress disorder and Adjustment Disorder; Stress Disorder and malingering


Obsessive-Compulsive Disorder:
• Obsessions – persistent thoughts, ideas, impulses or images that invade consciousness (contamination, order, doubt, sex, aggression)
• Compulsions – repetitive and rigid behaviors or mental acts that a person feels compelled to perform in order to prevent or reduce anxiety (checking, cleaning, putting in order, praying, chanting)
• Has to consume more than 1 hr of the persons day
• Associated features: obsessions or compulsions must be excessive, unreasonable, difficult to dismiss, distressful, time-consuming and interfering
• 2% of the population; only anxiety disorder w/ 1:1 ratio women to men, fluctuating course, comorbid w/ depression & eating disorder, OCPD & Tourette’s
• OCPD – neat organized but not necessarily have excessive compulsions and it is more about the person
• Bio-perspective: low activity of serotonin; abnormal brain functioning in the orbital regional of the frontal cortex & caudate nuclei; basil ganglia lesions
• Bio-Therapy – SSRI inhibitors (antidepressants); psychosurgery (last resort)
• Behavioral – focuses on compulsions, exposure and response prevention; between 60-90% partial improvement
• Cognitive perspective – blame and neutralizing thoughts, why do some people find such thoughts disturbing to begin with?
• Cognitive therapy – exposure through thoughts, addressing the underlying dysfunction and beliefs
• One Specifier: With Poor Insight – for the people who do not realize that their obsessions are extreme
 
 
 
18 September 2006 @ 07:00 pm
CHAPTER 1: Introduction to Group Work
Advantages to Groups:
- flexibility
- economical alternative (serve any need; cheaper)
- alternative (big increase bcuz insurance companies push them)
- broader service provision
- effectiveness (better than individual therapy bcuz of members providing feedback)

Four types of Group Work:
1. psychoeducational: basically teaching
2. counseling groups: preventive groups focused on growth
3. therapeutic: mental illness
4. task/work groups: mostly employment settings, not to change individual others)

Multicultural context:
- groups are inherently multicultural
- race: presumed, genetic, biological and physical characteristics shared within a group
- ethnicity: shared (history) sociocultural heritage of religion, history, or common ancestry
- culture: includes ethnographic, status, and affiliation variables
- minority: differential and unequal treatment of an oppressed group due to discrimination by the dominant more powerful majority
- universal: emphasizes ways people from different cultural groups are similar rather than different
- focused: emphasizes ways people from different cultural groups are different rather than similar
- be self-aware
- understand that people may have trouble doing group work (like cultures)


CHAPTER 2: Group Leadership
- key to success as a group leader is the commitment to the never ending struggle to become more effective as a human being

Personality & Character:
- presence: emotionally moved by the joy and pain that others experience; being emotionally aware helps them be emotionally involved with others
- personal power: need to fee a sense of power to facilitate members movement toward empowerment; gauge how your power is working, use it well to empower others in the group
- courage: taking risks in the group and admitting mistakes, being brave as a leader helps to empower others
- willingness to confront oneself: promote self-investigation in clients; self-awareness, we all make mistakes and being able to recognize it
- Sincerity & authenticity: sincere interest in the well-being and growth of others; belief in the group and being real and genuine
- Sense of identity: before they can help others they need to have a clear sense of their own identity; strong sense of who you are, high self-awareness
- Belief in the group process & enthusiasm: deep belief in the value in the group process is essential to the success of the group, enthusiasm in what you're doing
- inventiveness & creativity: helps keep leaders open to new experiences and to lifestyles and values that differ from their own, new ways of communicating, new activities, a lot of "on-the-spot: work in groups

Additional qualities:
- optimism: optimistic that group will be able to achieve goals; foster instillation of hope in group members
- capacity for empathy & caring: warmth, caring, compassion, essential for establishing trust and safety (hard to fake!)
- ability to deal with narcissim and shame: need healthy ego & openness and criticism from group and self
- capacity to be aware of multiple levels of interaction: comfort with complexity, flexibility, spontaneity, creativity, tolerance for ambiguity and strength to resist temptation to control interactions
- ability to manage fear and anxiety: (mostly the leaders')

Special Problems for beginners:
- initial anxiety
- too little/too much disclosure
- challenges w/ the system: struggle to retain dignity and integrity in a system where the administrators are primarily concerned with custodial care or putting out "crisis fears" and are relatively indifferent to the pursuit groups therapy or counseling

Group leadership skills:
- active listening: paying attention to both verbal and nonverbal ends of communication
- restating: paraphrasing and adding something to it to clarify the meaning
- clarifying: simplifying statements by focusing on core of message includes both thinking and feeling levels
- summarizing: pulling together important elements of a group interaction or session especially needed at the end of the session
- questioning: avoid 3rd degree, use open-ended questions that lead to self-exploration (avoid why?)
- interpreting: offer possible explanations concerning certain patterns of behavior
- reflecting feelings: communicating understanding of the content of feelings
- confronting: challenging members to look at discrepancies
- supporting: providing encouragement and reinforcement
- empathizing: identifying with clients by assuming their frame of reference
- facilitating: opening up clear and direct communication within the group; helping members assume increasing responsibility for direction
- initiating: promoting participation and introducing new directions
- setting goals: planning specific goals for the group process and helping participants define concrete and meaningful goals
- evaluating: appraising ongoing process and dynamics
- giving feedback: expression of concrete and honest reactions based on observations
- suggesting: offering advice and info, directions, ideas for new behavior
- protecting: safeguarding members from unnecessary psychological risks
- disclosing oneself: revealing one's reactions to here-and-now events in the group
- modeling: demonstrating desired behaviors through actions
- linking: connecting members' work to common themes in the group
- blocking: intervening to stop counterproductive group behavior
- terminating: preparing group to close session to end existence

Diversity Competence
- self-awareness necessary
- open stance
- must be willing to modify strategies to fit needs of others

Arredondon (1996) came up with multicultural framework:
1) awareness of beliefs & attitudes
2) knowledge
3) skills

Beliefs & Attitudes
- aware of own biases, values & assumptions about human behavior
- do not let personal probs interfere w/ work
- welcome diverse value orientations

Knowledge
- specifically know about their own culture and heritage
- strive to understand the worldview of their clients
- possess knowledge about the historical backgrounds, traditions, values of the groups w/ whom they are working

Skills & Interventions Strategies
- use methods and strategies and define goals that are consistent of the life experiences and cultural values of their clients
- they do not force their clients to fit into one counseling approach
- they are willing to seek out educational, consultative & training experiences to enhance their ability to work with culturally diverse clients

Recognize your limitations
- unrealistic to expect you will know everything

OPENING & CLOSING SESSIONS:
Opening:
1) participants can be asked to briefly state what they want to get from a session
2) give way to discussions and the previous session or unresolved issues
3) report on progress or difficulties the clients experienced during the week
4) group leader talks about observations from previous mtgs or some thoughts they have had
5) have older members share with any newcomers
(Sometimes structured exercises can be used to start a group)

Closing:
1) allow time for integration, reflection, what participants may do now between the next session
2) leaders can check in before the session is over (like ½ way through)
3) the leader brings unity to the group through closing & consolidating what was learned
4) do not close issues – just the session
5) summarizing
6) focus on positive feedback
7) members can report on their homework assignments
8) talk about agenda for next session
9) participants can talk about how they perceived the session
10) group leaders can express their own reactions to the session and make some observations
11) remind members of any who are leaving the group

Co-Leading Groups:
Main advantages:
1. Group members benefit from two different insights, possibly two different theory orientations, two different life experiences and perspectives
2. They can compliment each other – combined strengths
3. If one is male and the other female, they can recreate roles (mother/father)
4. Co-leaders serve as role models w/ respect to how they relate to each other & the group.
5. They can provide feedback to each other.
6. Each leader can grow from observing, working with, and learning from the other.
7. They can offer linking – while one leader works with a particular member, the other can scan the group to get a sense of how other members are involved
8. If one is absent, the other can continue.
9. Members get feedback from two instead of just one.

Disadvantages: Two different leaders may not share the same perceptions or interpretations and that can be ok if they can create and maintain an effective working relationship. They must trust each other, be open and direct with each other and work cooperatively instead of competitively. They must also be secure enough not to need to prove themselves. If trust is lacking, members will know and will sense the absence of harmony and the group will be negatively affected.

CHAPTER 3: Ethical and Professional Issues in Group Practice
Informed Consent:
- describe purpose of the group
- describe ground rules of group, format, and procedures
- determine if gp is appropriate for members through initial interview
- give members chance to ask questions about group
- discuss cultural issues
- discuss the training of the leader
- discuss logistics of group (frequency, duration, etc)
- discuss psychological risks
- discuss confidentiality and when it may be broken
- discuss what can and cannot be gained from group participation
- discuss responsibility of leader and members
- discuss rights of members
- discuss whether sessions will be taped or supervised (if group is to be taped, discuss right of members to ask that session not be taped as well as impact it may have on process)

Issues in Involuntary Groups:
*informed consent more important (rights, what to expect, etc)
*leaders may choose to give involuntary members a choice after an initial mandatory amount of sessions (ex: members must attend for three sessions, then can decide if they wish to continue group) If this is chosen, leaders must remind members of the consequences of choosing to terminate ( jail, expulsion from school, etc)
*leaders can “reframe” the thought “I HAVE to come to group” (ex: attendance is a choice, but remind of consequences)
*likely more time would be spent on what members can gain from group than w/ voluntary mbrs

Exceptions to Confidentiality:
- any disclosure or suggestion about intent to harm others or self justifies a break in confidentiality on the part of the leader. (DUTY TO WARN)
- disclosure of abuse/neglect of children or elderly justifies a break in confidentiality
- leader can guarantee that they will maintain confidentiality, but cannot guarantee that other members will do so (unique to group process)

Psychological Risks in Groups
- groups can be powerful catalysts for personal change
- these life changes can be disruptive, hostile, destructive
- leaders should discuss the potential life changes and helping group members explore their readiness to deal with such changes

Out-of-group Socializing
- can be harmful, can be beneficial
- best thing to do is bring topic up for discussion and explore the negative impact

Uses and Misuses of Group Techniques:
- leaders must give a rationale for using specific techniques (tell members what the technique should do for them). A strong foundation in theory helps with this.
- leaders must not use techniques with which they are not familiar; doing so is not in the best interest of the members and may indicate a leader that is trying to meet their own hidden agendas or may be indicative of a misuse of power
- Leaders must be ready for the consequences associated with use of a specific technique (ex: intense emotional reaction)
- leaders must be aware of how far clients are ready to be pushed (eg: don’t push for an emotional reaction if none is actively present)
- be aware of the effect techniques have on multi cultural populations (es: if a member has been taught not to express emotion in public, techniques that are likely to bring this out may be avoided) Do not impose your values on clients.

Three Adjuncts to the Training of Group Counselors:
1. Personal psychotherapy for group leaders (increase self-awareness)
2. Self-exploration groups for leaders (help resolve personal conflicts &  self-understanding)
3. Participation in Experiential Training Workshops (help develop skills necessary for effective intervention)

Liability and Malpractice:
- if members can prove there was not an effort to minimize psychological or personal harm
- leader should be aware of the code of ethics and any changes to the code
- leaders should:
1. allow members to make an informed consent about attending group (this is different for mandatory groups)
2. have informed consent signed and dated by each member
3. stay within your area of expertise (eg: don’t work with PTSD clients if your training is in smoking cessation!)
4. keep an open line of communication with members
5. avoid dual relationships with clients
6. participate in continuing education

CHAPTER 4: Early Stages in the Development of a Group
Stage 1: Pre-group Formation:
- need written proposal (topic)
- announcing the group (needs clarity re: goals)
- screening & selecting members
Leader Functions:
- identify general goals
- develop written proposal & announce the group
- conduct pregroup interviews
- make decisions concerning the selection of members
- organize practical details necessary to launch a successful group
- get parental permission (if appropriate)
- prepare psychologically for leadership tasks
- arrange for preliminary group session
- make provisions for informed consent and exploring w/ participants the potential risks

Practical Concerns:
- open vs. closed groups
- voluntary vs. involuntary membership
- homogenous vs. heterogenous
- meeting place (what setting?)
- group size
- frequency & length of meetings
- short term vs. long term goals

Use of Pregroup Meeting or Initial Session:
- Corey (2004) believes in systematic preparation
- Use initial meeting as a group screening device
- Structure group including specifying norms & procedures (important for ethnic & minority clients)

Stage 2: Initial Stage – Orientation & Exploration:
Characteristics:
- establishing trust and safety
- developing ground rules & guidelines
- teach basics of group process
- identify goals & responsibilities
- assist members in expressing their fears & expectations
- being open with members and being psychologically present for them
- help members establish concrete personal goals
- assist members to share what they are thinking and feeling
- assessing the needs of the group
- addressing possible problems
- getting all acquainted
Leader Functions:
- teaching members general guidelines
- developing rules and guidelines
- teach basics of process
- being open and present for members
- clarify division of responsibility
- deal openly w/ members concerns & questions
- provide a degree of structure to avoid excessive floundering
- assess the needs of the group
- teach members basic interpersonal skills (i.e. active listening & responding)


Stage 3: Transition Stage – Dealing with Resistance:
Characteristics:
- anxiety and defensiveness: these feelings give way to genuine openness and trust; anxiety grows out of fear of letting others see oneself on a level beyond the public image
- conflict and struggle for control: before it can be worked through it must be recognized
- challenging the group leader: often participants' first significant step toward autonomy; keep the lines of communication open and avoid slipping into "leader role"
- resistance: treat it as an inevitable of group process; emphasis should be on actual behaviors rather than on labels (i.e. monopolizer); members can be categorized as "problem-type"
- learning how to work through conflict and confrontation
- feeling reluctant to get fully involved in working on their personal concerns because they are not sure others in the group will care about them
- learning how to express themselves so that others will listen to them
Leader Functions:
- teach members the importance of recognizing and expressing their anxieties
- help participants recognize the ways in which they react defensively & create resistance
- teach members the value of recognizing & dealing openly w/ conflicts in the group
- point out struggle for control; teach them to accept responsibility
- assist members in dealing w/ independence & interdependence
- encourage members to keep in mind what they want from group & how to ask for it
- provide a model for members by dealing directly and honestly w/ any challenges to you as a person or professional
- monitor your own reactions to members who display problematic behavior; explore your own countertransference


CHAPTER 5: Later Stages in the Development of A Group
Stage 4: Working Stage – Cohesion & Productivity:
Characteristics:
- level of trust and cohesion is high
- communication in the group is open and there is accurate expression of the group experience
- members interact with one another freely and directly
- members are willing to risk threatening material and to make oneself known to others
- conflict among members is recognized and dealt with directly and effectively
- confrontation occurs without labeling others in judgmental ways
- participants feel supported in attempts to change and are willing to risk new behavior
- members feel hopeful they do not feel helpless
- Productive groups consist of trust and acceptance, empathy and caring, intimacy, hope, freedom to experiment, catharsis, cognitive restructuring, commitment to change, self-disclosure, effective confrontation, and beneficial feedback. Nonproductive groups would obstruct the processing of these goals
Leader functions:
- provide systematic reinforcement of desired group behaviors that foster cohesion and productive work
- look for common themes (linking) among members' work
- continue to model appropriate behavior
- interpret the meaning of behavior patterns at appropriate times
- be aware of the therapeutic factors that produce change and intervene

Stage 5: Final Stage – Consolidation & Termination:
Characteristics:
- summarizing (consolidation)
- concerns about ending
- increased anxiety and dependency
- give/receive feedback
- generalization/application
- accountability (what's next)
- resolve unfinished business
- arrange follow-up
- contrast 1st meeting to ending
Leader Functions:
- reinforce changes members made and ensure members have info about resources to enable them to make further change
- assist members in determining how they will apply specific skills
- assist participants to develop a conceptual framework that will help them understanding, integrate, consolidate, and remember they have learned in group

Stage 6: Postgroup Issues – Evaluation & Follow-up:
- make sure help member evaluate the effectiveness of their group experience
- f/u session to assess the outcomes of the group
- individual f/u sessions to assess how well they have accomplished their personal goals
 
 
 
18 September 2006 @ 06:59 pm
CHAPTER 6: The Psychoanalytic Approach to Groups
 Sigmund Freud made significant contributions to understanding an individual’s psychosexual development during early childhood
 Erick Erickson psychosocial perspective provides a comprehensive framework for understanding the individual’s basic concerns at each stage of life from infancy through old age.
 Alexander Wolf, a psychiatrist and psychoanalyst is credit with first applying psychoanalytic techniques and principles to groups
 The goal of the analytic process is restructuring the client’s character and personality system and maturation in relationship with self and others (Means: make unconscious conflicts conscious and examine them; reliving and resolving intrapsychic/interpersonal conflicts; recreation of original family)
 Group applications use techniques such as free association, dreams, transference, and historical determinants of present behavior
 Mullan and Rosenbaum speak of the process re-creating one’s family as the regressive reconstructive approach to psychoanalytic group therapy. Regressive reconstruction: refers to regression into each member’s past to achieve the therapeutic goal of personality reconstruction, which is characterized by social awareness and the ability to be creatively involved in life. Members reexperience conflicts that originated in the family context
 Influence of the past- Problems of adult living have their origin in early development. However, the past and present intertwine. The use of history is essential because it can be seen as form of resistance & they suggest that talking about events in one’s childhood is not as useful as dealing w/ the past in relation to here-&-now interactions w/in the group.
 The Unconscious- One of Freud’s most significant contributions. Consists of those thoughts, feelings, motives, impulses, and events that are kept out of awareness of the conscious ego. The therapist helps the client make the unconscious repressed experiences conscious, and the client realizes that the anxiety is not intolerable, and is freed from the tyranny of past repressions. The unconscious can be made more accessible to awareness by working with dreams, by using free association methods by learning about transference, by understanding the meaning of resistance, and by employing the process of interpretation.
 Anxiety- Anxiety is a feeling of dread and impending doom that results from repressed feelings, memories, desires, and experiences bubbling to the surface of awareness. Anxiety stems from the threat of unconscious material breaking through the wall of repression. It is usually vague and general.
 Ego-defense mechanisms – They protect the ego from threatening thoughts and feelings. Conceptually, the ego is that part of the personality that performs various conscious functions, including keeping in contact with reality. Help maintain a sense of personal adequacy. There are several defense mechanisms:
• Repression- involves excluding from consciousness threatening or painful thoughts and desires
• Denial- effort to suppress unpleasant reality
• Regression- involves returning to a less mature developmental level
• Projection- attributing our own unacceptable thoughts, feelings, behaviors, and motives to others
• Displacement- a redirection of some emotion such as anger from a real source to a substitute person or object
• Reaction Formation- behaving in a manner that is opposite to one’s real feelings
• Rationalization- an attempt to justify our behavior by imputing logical and admirable motives to it
 Resistance – Defined as the individual’s reluctance to bring into conscious awareness threatening unconscious material that has been previously repressed or denied. Unconscious attempt to defend the self against the high degree of anxiety that the client fears would result if the material in the unconscious were uncovered. One way to resolve this is using free association, an uncensored and uninhibited flow of ideas produced by the client that offers clues about the person’s unconscious conflicts. Examples of resistance:
• Maintaining an attitude
• Behaving uncooperatively
• Use of group for mere socializing
 The have in common the fear of recognizing and dealing with that part of oneself that is locked in the unconscious. To work through this a therapist must address the client’s immediate problems as they are manifested through resistive behaviors
 Transference – The client’s unconscious shifting to the therapist of feelings attitudes, and fantasies that stem from reactions to significant persons from the client’s past. Therapist helps client understand the feelings, and gain insight. Transference can be manifested in a group by trying to win the therapist approval.
 Countertransference – Consists of the therapist’s unconscious emotional responses to a client, resulting in a distorted perception of the client’s behavior. Kutash and Wolf described it as “unconscious, involuntary, inappropriate, and temporarily gratifying response to the patient’s transference demands. As part of the psychoanalytic approach therapists are required to undergo psychoanalysis to become aware of their own dynamics that can obstruct the therapeutic tasks.
Bemak and Epp identified 5 typical countertransference patterns that a group counselor may experience
*Becoming emotionally withdrawn and remaining unavailable to the group
*Passivity
*Being overly controlling
*Regressing to maladaptive behaviors based on one’s own unresolved personal issues
*Being paternalistic and adopting a role as a rescuer
 Role and Functions of the Group Leader –
- establish therapeutic alliance
- facilitate exploration of transference
- make interpretations to pursue unconscious motivations
- investigate historical roots of unconscious motivations
- process resistance
- enhance self-exploration by drawing attention to subtle aspects of behavior
There is a working relationship whereby the therapist communicates commitment, caring, interest, respect, and human concern for the patient. Leader gives support, helps members face and deal with resistances within themselves and the group, and attracts members’ attention to subtle aspects of behavior and through questions helps them explore themselves in greater depth.
 Application: The therapeutic process –
- free association: communicating whatever comes to mind
- interpretation: pointing out and explaining underlying meaning
- dream analysis: "royal road to the unconscious"
- insight: awareness of the causes of present difficulties
- working through (final phase): increased consciousness and integration of the self
Process focuses on re-creating, discussing, and interpreting past experiences and on working through defenses and resistances that operate at the unconscious level. Clients need to relive and reconstruct their past and work through repressed conflicts to understand how the unconscious affects them in the present. Classical practitioners used the “detached observer.’
 Advantages – Members are able to establish similar relationships that existed in their families, experience transference, gain insight to how resistance and defenses work, dependency on authority is not great,

Erikson's Stages of Development:
Stage 1—Infancy—Trust versus Mistrust (Birth to 12 Months)
A common theme explored in groups is the feeling of being unloved and uncared for and the simultaneous acute need for someone who will deeply care and love. Group members may recall early feelings of abandonment, fear, and rejection, and many of them have become fixated on the goal of finding a symbolic parent who will accept them.

Group leaders can assist these clients to express the pain they feel and to work through some of the barriers that are preventing them from trusting others and fully accepting themselves. Therapists use their knowledge of developmental stages to understand patterns in which the members may be “stuck.” The group leader’s comments, questions, and interpretations can then be framed to help the members resolve fixations and crises linked to specific developmental stages.

Stage 2—Early Childhood-Autonomy versus Shame & Doubt (12 months-3 years)
Many of those who seek help in a group have not learned to accept their anger and hatred toward those they love. They need to get in touch with the disowned parts of themselves that are at the bottom of these conflicting feelings.

In the safe environment of a group, they can gradually learn ways of expressing their locked-up feelings, and they can work through the guilt associated with some of these emotions. Groups offer many opportunities for catharsis (expressing pent-up feelings) and for relearning.

Stage 3-The Preschool Age-Initiative versus Guilt (3-6 years)
Members struggle with issues related to sex-role identity. Many have incorporated stereotypical notions of what it means to be a woman or a man, and they have consequently repressed many of their feelings that don’t fit these stereotypes. A group can be the place where individuals challenge such restricting views and become more whole.

Groups offer the chance to express these concerns openly, to correct faulty learning, to work through repressed feelings and events, and to begin to formulate a different view of oneself as a female or male sexual being. Groups give the clients permission to have feelings and to talk honestly about them.

Stage 4-Adolescence—Identity versus Identity Confusion (12-18 years)
A central struggle involves the process of separation and individuation. Although challenging the leader often signals a move toward independence, attacking a leader may well be a symptom of rebellion against parents or any other authority.

Leaders need to be aware of their own dynamics, especially when they are confronted by members. Leaders will be less likely to react defensively if they understand the transference nature of this behavior.

Stage 6-Young Adulthood—Intimacy versus Isolation (18-35 years)
Members struggle with concerns of interpersonal intimacy, talk about their unfulfilled dreams, question the meaningfulness of their work, wonder about the future, and reevaluate the patterns of their lives to determine what changes they need to make. Group gives the opportunity to take another look at their dreams and life plans and determine the degree to which their lives reflect these aspirations.

If members are not aware of their tendencies to keep themselves distant from others, they could easily try to mold the therapy group into their family-of-origin group, which had injunctions against intimacy.

Stage 7-Middle Age-Generativity versus Stagnation (35-60 years)
Members are often challenged to make new assessments, adjustments, and choices to open up new possibilities and reach new levels of meaning. It takes caring and skilled leadership to inspire people to look for new meanings and to “invent themselves” in novel ways.

Stage 8-Later Life-Integrity versus Despair (above 60 years)
These issues can be applicable not only for older adults but for younger adults as well (fear of getting older—being alone, financial dependency). Group leaders can help these people realize that perhaps the only way to deal constructively with these fears is to prepare now for a satisfying life as they grow old.


CHAPTER 7: Adlerian Group Counseling
 Adler contended that neurosis was the result of a person’s retreat from the required tasks in life with the symptoms serving an ego-protective or safeguarding function to protect the individual from perceived failure in a life task. Adler focused on the struggle of the individuals to become all that they might be.
 Overview of the Adlerian View of the Person
• Adler’s system emphasizes the social determinants of behavior rather than its biological aspects; its goal directedness rather than its origins in the past; and its purposeful, rather than its unconcscious nature.
• The “socioteleological” approach implies that people are primarily motivated by social forces and are striving to achieve certain goals. Adler’s view is that we create for ourselves an idiosyncrative view of selv, life, and others from which we then create goals, both short term and long term that motivate our behavior and influence our development.
• The search for significance is related to our basic feelings of inferiority w/ regard to others, which motivates us to strive toward ever-greater mastry, superiority, power & ultimately, perfection. Inferiority feelings can thus be the wellspring of creativity; perfection can never be reached but it’s the ultimate goal of life.
• Adler stresses self-determination and consciousness as the center of personality instead of the unconscious.
• Individuals are not victims of fate, but creative, active, choice-making and meaning making beings whose every action has purpose and is directed toward some goal.
• People are significantly influenced by their perceptions & interpretations of the past
• Adler’s approach is a growth model. Their work is viewed as an educational process- helping people learn better ways to meet the challenges of life, tasks, providing direction, helping people change their mistaken notions, and offering encouragement to those who are discouraged.
 Holism
• Adlerian view is based on a holistic view of the person
• Individuals are always more than the sum of their parts. Adler stressed understand the whole person- not just parts but and indivisible whole.
• The focus is more on interpersonal factors, and viewing the person in relationship to social systems.

 Teleology
• All forms of life are characterized by a trend toward growth and expansion. Humans live by goals and purposes, they are moved by anticipation of the future, and create meaning.
• Adler’s basic assumption was that we create meaning four ourlives and based on this private logic we develop gaols, both immediate and long term, which motivate both behavior and development.
• Three aspects of time are dynamically interrelated: our behavioral decisions are based on the conclusion we have made from what we have experienced in the past, which wee use to then provide a framework for understanding our present situation, and for choosing, alsbeit unconsciously, the goals toward which we move
 Phenomenology
• Humans are creative beings who decide on their actions based on their subjective perception of the world, which include individual views, beliefs, perceptions, and conclusions instead of objective reality
 Creativity and Choice
• Humans are self-determining beings, and not solely defined by heredity and the environment
• People express themselves in ways that are consistent with their past experiences, present attitudes, and future anticipations
• Adlerians practice is based on the assumption that people are creative, active, and self-determining
 Social Interest and Community Feeling
• The feeling of being connected to all of humanity- past, present, and future- and to being involved in making the world a better place.
• Social interest refers to one’s community feeling, and is the individual’s positive attitutde toward other people and the world, which leads to courage, optimism, and a true sense of belongingness.
• Adler contends that individuals must master three universal tasks: friendships, establishing intimacy, and contributing to society as well as the self and spiritual tasks.
• Adlerians reject prescreening because it tends to destroy heterogeneity and works against accepting different levels of imperfection common in larger society, and welcome those who need it most
 Inferiority/Superiority
• To compensate for feelings of inferiority, we strive for superiority, or move from a felt minus position in life to a perceived plus position
• Inferiority feelings, therefore, can be the wellspring of creativity; and life goals of perfection, and can draw us forward into new possibilities for which our past has not otherwise prepared us
 Role of Family
• Family atmosphere is the climate of relationships among family members
• Family constellation is the social configuration of the family group, the system of relationships in which self-awareness develops, which is maintained by the individual, parents and siblings, and any others living in the household
• Emphasis is placed on the family process, which plays a role in developing personality during childhood. Helps clients gain a fuller understanding of the family influence
 Style of Life
• Basic concept of self in relation to the world- our personal orientation toward social living- is expressed in a discernible pattern that characterizes our existence
• This drawn from family atmosphere and constellation, and no two peoples style of life is the same
• People develop a unique approach to life while striving for meaningful goals.
• People operate using private logic, which helps to explain how all our behavior fits together so that there is some consistency to our actions. Everything we do is related to our fictional goal of perfection, which is referred to as fictional finalism- the imagined central goal that gives direction to behavior and unity to the personality.
• Childhood interpretation can lead to a faulty style of life based on mistaken notion in our private logic. Although we are not determined by our past, we are significantly influenced by our perceptions and interpretation of past events
 Behavioral Disorders
• Emotional and behavioral disorders are seen as failures in life
• Clients do not suffer from a disease but from discouragement and a failure to solve the problems and tasks set by life
 Role and Functions of the Group Leader
• Leaders promote an egalitarian, person-to-person relationship
• Leaders serve as models for members, who often learn more from what leaders do in the group than from what they say
• Lead each group as if it were the last
• Provide structure for the sessions by assisting members to define personal goals, they conduct psychological assessments of individuals in the group, they offer interpetation, and they guid group assessment
• Four key tasks: establish and maintain group relationship; examine the patterns and purposes of group members’ actions and behaviors; disclose to individuals the goals pursued and the private logic that supports these goals; and implement a reeducation experience that tends to increase members’ community feeling and social interest.
 STAGES OF ADLERIAN GROUPS
 Stage 1: Establishing and Maintaining Cohesive Relationships with Members
• Establishing a good therapeutic relationship based on cooperation and mutual respect, empathy and creating acceptance, setting goals and making commitments
• Members responsible for their own participation, state goals, and explore trust issues
• Work toward mutually agreed up goals
• Good techniques to use include questioning, reflection, clarification, and listening
 Stage 2: Analysis and Assessment
• Understanding one’s lifestyle and seeing how it is affecting one’s current functioning in all the tasks of life
• Process assessment techniques include examining such areas as the members’ family constellation, birth order, relationship difficulties, early recollections, dreams, & artwork which produce clues of the client’s goals, purposes & lifestyle
• Another assessment procedure is early recollections along with the feelings and thoughts that accompanied the childhood incidents. The provide and understanding of how we view and feel about ourselves, how we see the world, what our life goals are, what motivates us, what we believe in, and what we value.
• Reveals patterns of basic mistakes: overgeneralizations; false or impossible goals of security; misperceptions of life and its demands; minimization or denial of one’s basic worth; and faulty values.
• Adlerians also make use of “The Question” “how would life be different if_______?” Responses indicate organic or psychological problems
• Counselors main tasks is to integrate and summarize data from the lifestyle investigation and to interpret how the mistaken notions and personal mythologies are influencing the client
 Awareness and Insight
• Insight is a special form of awareness that facilitates a meaningful understanding within the counseling relationship and acts as a foundation for change.
• Change begins with present centered awareness, a recognition that one has options or choices in regard to both perception and behavior
• Awareness is heightened by feedback and support of group members
• Helps members understand why they are functioning as they are, explore basic mistakes
• Interpretations are used to help members gain insight
• The ultimate goal of this process is that participants will come to a deeper psychological understanding of themselves; by understanding their role in creating the problem, ways the problem is maintained, and ways to improve the problem
 Reorientation
• Consists of both the leaders and the members working together to challenge erroneous beliefs about self, life, and others. The emphasis is on considering alternative beliefs, behaviors, and attitudes
• Members are encouraged to take action based on what they have learned from the group, establish realistic goals, learn problem solving and decision making skills, and act as if they are the persons they want to be
• Encouragement = “building of courage” derived from strengths