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Erasmus Universiteit Rotterdam Psychology 1.6 Normal or Abnormal Summary (Lectures NOT included)
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1.6 Normal or Abnormal Block Summary
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Problem 1Phobias
Fear
Alarm reaction that occurs in response to immediate danger.
Involves a fight-or-flight response of the autonomic NS. (adoptive and primitive)
o If the response occurs in the absence of any obvious danger = panic attack.
Fear and panic have three similar qualities.
1) Cognitive/subjective component: I am going to die.
2) Physiological component: Increased heart rate, heavy breathing.
3) Behavioral component: Urge to flee and run away.
Anxiety
General feeling of apprehension about possible future danger.
Adaptive: can help us prepare for a future danger.
Does not trigger the fight-or-flight response directly but can prime a person for the
fight-or-flight response if the anticipated danger occurs.
Mild and moderate level of anxiety can enhance the learning and performance.
1) Cognitive component: Negative mood, worries about possible future danger.
Sense of being unable to predict the future threat and control it.
2) Physiological component: Tension, chronic over arousal, reflects readiness to
fight with the problem.
3) Behavioral component: Strong tendency to avoid situations where the danger
might be encountered.
Anxiety disorders: a psychological disorder characterized by an excessive or aroused
state and feelings of apprehension and uncertainty.
Response could be out of proportion to the event.
Easily attributable to a specific event.
Persist chronically and it is disabling. (causes constant emotional distress
1) Phobic disorders
Phobia: a persistent fear of some specific object that presents little or no actual
danger and yet leads to a great deal of avoidance.
More common in woman.
Animal phobias, blood-injection-injury phobias, dental phobias usually begin in
childhood.
Psychoanalytic point: Fears: repressed impulses from the id. It is too dangerous to
know the exact id object, so symbolism to an external object.
Learned point: Wolpe and Rachmann. Classical conditioning and generalization.
Vicarious conditioning: Watching a phobic person acting fearfully can distress the
observer and cause a phobia. If they saw non-fearful actions toward a stimuli they
are less likely to develop a phobia.
Specific phobia
o Fear of a specific object or situation.
o Phobic stimuli cause: immediate fear response, panic attack.
o They avoid the situation because of the unpleasant feeling and the thought of
something bad will happen.
, o Having a specific fear: increased attention, sympathy and some control over
other’s behaviors. (+) Phobia remains because of the operational conditioning.
o Blood-injection-injury phobia: Disgust and fear. Initial acceleration and sudden
drop in heart rate and blood pressure. Nausea, dizziness, fainting. (In normal
phobias; just acceleration) Hereditary, evolutionary: fainting stops the attack,
decreased blood pressure causes less blood loss.
o Escapability of the event (higher), fear (lower).
o Overestimation of danger (higher activity in amygdala), attention directly goes to
the phobic stimulus. (Cognitive bias)
o Evolutionary perspective: we fear natural things (snakes, spiders, heights,
enclosed spaces/prepared fears) more than we fear human things (guns,
motorcycles). We are evolutionary prepared to fear those things more.
o Fear relevant (snakes and spiders) and fear irrelevant (toys and flowers) stimuli.
(Differs in the number of phobias)
o Treatments: exposure theory (BEST), flooding, observational learning, applied
tension technique (causes increased heart-rate and less chance of fainting)
ANTIDEPRESSANTS NOT AFFECTIVE.
Social anxiety disorder
o Fear of social events. (Urinating in public, public speaking, eating/writing in public)
o Fear of potential negative evaluation, acting humiliating and embarrassing.
o Performance (public speaking) and non-performance situations (eating).
o Can cause avoidant personality disorder.
o More common in woman.
o Lower employment rates, lower SES.
o They generally form later in life rather than in childhood.
o Greater amygdala activation
o Learned behavior: Past humiliation or bullying after a social event.
o Emotionally cold parents, socially isolated or avoidant: more likely to form a
social phobia.
o Evolutionary context: Same species. Byproduct of dominant hierarchies. No fight-
or-flight response. Facial expressions, aggressiveness, dominance = fear in some
people, submissive, social phobias.
o Unpredictable and uncontrollable events can cause more social phobia.
o Cognitive biases: Thinking that other people will react negatively to them.
Interpreting ambiguous situations in a negative manner.
o Treatments: MOST EFFECTIVE: CBT with antidepressants. Observational learning
and systematic desensitization could also work. D-cycloserine GOOD.
Agoraphobia
o Fear of crowded spaces such as streets, malls.
o Fear of having a panic attack in crowds. Help might not be available.
o Not being able to control the situation.
o Fear of own bodily sensations. (sexual relationships, drinking caffeine,
exercise)
, o Starts in late teenage years. More common in woman. (Men: tough it out,
more assertive and instrumental approach)
o Biological components: panic disorders are mostly hereditary. Neuroticism.
Temperament.
o Behavioral components: Cognitive biases. Thinking that they’ll have a panic
attack in the situation.
o Treatments:
Medication Anxiolytics reduces short term panic. Antidepressants
does not reduce short stress but does not also cause physical
dependence. D-cyloserine.
Behavioral and cognitive treatments: cognitive restructuring
o Interoceptive exposure: deliberate exposure to feared
internal sensations.
o Panic control treatment: clients are educated about their
phobias and how to breathe normally during a phobic
stimulus. They are educated about the logical errors during
panic disorders and lastly they are exposed to fears and bodily
sensations to build up a tolerance.
If both cognitive behavior treatment and medication: when no
medication more likely to form the phobia again.
Counter conditioning.
BIOLOGICAL FACTORS
Neuroticism (differences between people): a proneness to experience negative
mood states. (determines the degree of fears)
High activation of limbic system. (Secretion of GABA, norepinephrine and serotonin)
Temperament levels.
Activation of amygdala.
Serotonin transporter gene: 2s: superior fear conditioning
PSYCHOLOGICAL FACTORS
Classical conditioning: Pairing fear and anxiety with a neutral stimuli.
People who have lack of control over their environment: more tend to develop
anxiety disorders.
Behaviorally inhibited toddlers (shy, timid): more risk of forming phobias.
Parenting styles: faulty, disoriented parenting.
Sociocultural environment: the experiences you have: depends on the culture.
TREATMENTS
Graduated exposure to feared cues. (systematic desensitization)
Cognitive restructuring: help the individual understand that his/her patterns of
thinking about anxiety-related situations and how they can be changed. Video
feedback= beneficial.
Exposure theory: Best treatment for specific phobias. (Small-animal phobias,
injection phobia, claustrophobia best = single long session) (Live exposure is better
than stimulation)
Participant modelling: a therapist interacts with the client and helps him overcome their
phobias.
, Problem 2
Paraphilias-Gender dysphoria-DSM
Paraphilias: people who are aroused by atypical sexual activities.
Paraphilic disorder: unusual sexual interests, and cause harm to individual and
others. (NO CONSENT)
Paraphilic coercive disorder: sexual pleasure from coercing others to non-
consensual sex.
Hypersexual disorder: excessive preoccupation with sexual fantasies and sexual
urges.
Fetishistic disorder
Usage of non-living objects or non-genital body parts for sexual gratification.
(commonly eroticized body parts are hair, toes, feet)
CAN OCCUR TOGETHER WITH SADOMASOCHISM.
Generally in males. (most could have fetishes but only %1 is diagnosed with the
disorder)
o Transvestic disorder: dressing in the clothes of the opposite sex as a mean of
becoming sexually aroused. (cross dressing act should cause distress)
Sexual sadism and sexual masochism (Sadomasochism)
Sexual sadism: person’s sexual fantasies and urges involve inflicting pain and
humiliation on the partner. (These urges should cause some distress or had caused a
non-consensual sexual act to diagnosed as sexual sadism disorder)
COMORBIDITY WITH NARCISSCISM, ANTI-SOCIAL PERSONALITY DISORDER.
LESS EMPATHY.
Sexual masochism: person’s sexual fantasies and urges involve suffering pain or
humiliation during sex. (more common in both men and female)
Voyeuristic disorders
Sexual arousal by watching another person undress, do things in nude.
Watching people having sex.
Exhibitionistic disorders
Exposing his or her genitals to involuntary observers. (could end with ejaculation)
Behavior should cause distress and the patient should have acted on his/her urges.
Arousal comes from observing the victim’s surprise, fear or disgust.
Behavior is often compulsive and impulsive: causes fear, excitement and sexual
arousal in the person who did the act.
LOWER LIFE SATISFACTION, GREATER USE OF PORNOGRAPHY.
Frotteurism
Sexual arousal by rubbing against the body to a nonconsenting person.
Public areas.
In order to be called as frotteuristic disorder: individual must have acted on his
impulses and should cause significant distress.
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