Physical Disorders and Health Psychology

Physical Disorders and Health Psychology

Chapter 9: Physical Disorders and Health Psychology •psychosomatic medicine- psych factors affect physical function •behavioral medicine- applied to prevention, diagnosis and treatment of medical problems •health psychology- psych factors that are important to the maintenance and promotion of health opsych and social factors: •(1) affect biological processes •(2) long-standing behavior patterns put ppl at risk for certain disorders o50% of deaths from top 10 leading causes in US can be traced to lifestyle behaviors •poor eating habits, smoking, lack of exercise, General Adaption Syndrome (GAS)- Selye oalarm- response to immediate danger or threat oresistance- mobilize coping mechanisms to respond oexhaustion- body suffers permanent damage •chronic stress may cause permanent body damage and contribute to disease •stress= physiological response to stressor •HPA Axis ohypothalamus- pituitary gland- adrenal gland oimportant for stress ocortisol= stress hormone •baboon case study odominant males have less stressful lives due to predictability + controllability olower males experience stress from bullying, higher cortisol levels osense of control important stress, anxiety, depression related osimilar underlying physiological processes oself-efficacy: sense of control and confidence that one can cope with stress or challenges •stress can lead to decreased immune system functioning oincreased rates of infectious diseases, mono, colds, flu, •Immune system oeliminates antigens- foreign maerials, bacteria, viruses, parasites o2 main parts: •humoral> B cells, antibodies neutralize antigens •cellular> T cells, destroy viral infections + cancerous processes owhite blood cells do most of the work (leukocytes) microphages= first line of defense •autoimmune disease oimmune system overactive, attacks body cells •rheumatoid arthritis- too many suppressor T cells, body subject to invasion by antigens •HIV- human immunodeficiency virus ?AIDS-related complex first: minor health problems before AIDS diagnosis w. pneumonia, cancer, dementia, wasting syndrome… ? treated w/ highly active antiretroviral therapy •reducing stress, social support, CBT help •psychoneuroimmunology (PNI) opsych influences on neurological responding implicated in immune response •Cancer psychoncology- psych influences in development of cancer otherapy can help treatment to reduce stress, improve mood, alter important health behaviors, supportive relationships •reduce cancer recurrence and dying •influence support + development of cancer o“benefit finding”- deepening spirituality, changes in life priorities, closer ties to others, enhanced sense of purpose opsych procedures important to manage stress especially w/ children who undergo surgery •Cardiovascular problems ocompromise heart, blood vessels and control mechanisms cardiovascular disease ostrokes ocerebral vascular accidents- temporary blockages of blood vessels to brain cause temporary/ permanent damage ohypertension- high blood pressure, risk factor for other heart probs •blood vessels constrict, heart works harder, pressure •essential hypertension- no verifiable physical cause •“silent killer” •blacks more at risk than whites •genetic influences •anger + hostility increase blood pressure ocoronary heart disease •heart disease in #1 cause of death in western cultures •blockage of arteries supplying blood to heart muscle chest pain •plaque •deficiency of blood to a body part •heart attack- death of heart tissue when artery clogged •stress, anxiety, anger contribute (+lack of coping skills and low social support) •myocardial stunning- heart failure as a result of severe stress oType A behavior pattern •excessive competitive drive, sense of pressured for time, impatience, high E, angry outbursts •at risk for CHD (although cultural diffs significant) oType B behavior pattern •more relaxed, less concerned about deadlines, seldom pressured, •Reserve capacity model associations among environments of low socioeconomic status, stressful experiences, psychosocial resources, emotions and cognitions> increase risk for CHD •Pain oacute- follows an injury, disappears once injury heals ochronic- begins w/ acute episode but does not go away osubjective term pain vs. pain behaviors= manifestations of exp oemotional component= suffering oseverity of pain doesn’t predict reaction b/c of psych factors •Phantom limb pain oppl who have lost an arm or leg feel excruciating pain in the missing limb •operant control of pain pain behavior under control of social consequences oie critical family members may become sympathetic •gate control theory of pain onerve impulses from painful stimuli travel to spinal column then to brain odorsal horns of spinal column= gate osmall fibers open gate, large fibers close •brain inhibits pain oendogenous opiods- naturally exist within body> endorphins oshut down pain, runner’s high after exercise, •men and women exp pain differently omen have stronger endogenous opiod systems owomen have additional pain-regulating mechanisms odiff areas more prone to pain Chronic fatigue syndrome (CFS) olack of E, fatigue, variety of aches and pains oneurasthenia- lack of nerve strength, old diagnosis oprevalent in western world and China •Pain can kill you… oincreases rate at which certain cancers metastasize ocan weaken immune system response by reducing natural killer cells opain> stress>vicious cycle •Biofeedback omake patients aware of specific physiological functions that ordinarily not be consciously aware of •heart rate, blood pressure, muscle tension in specific areas, electroencephalogram rhythms, patterns of blood flow •(1) conscious awareness (2) learn to control them oinstill sense of control over pain •progressive relaxation obecome acutely aware of tension, relax specific muscle groups •transcendental meditation ofocus attention on repeated syllable, or mantra •relaxation response- silently repeat mantra to minimize distraction by closing mind to intruding thoughts •Coping mechanisms oprescription drugs, reduced effectiveness over time odenial oimproved attitudes, realistic appraisals thru CBT •4 leading causes of death in Us oheart disease, cancer, stroke, respiratory disease AIDS prevention ocontraception ochanging high-risk behavior is only effective prevention strategy •smoking is epidemic in china omyths: tobacco is symbol of personal freedom, important for social interactions, health effects can be controlled, important to economy, •Stanford Three Community Study o1 community- assessed risk factors for CHD and smoking o2 community- media blitz on risk factors o3 community- face to face interventions, most successful at reducing CHD risk factors Chapter 10: Sexual and Gender Identity Disorders gender identity disorder- psych dissatisfaction w/ one’s biological sex, disturbance in identity •sexual dysfunction- difficult to function while having sex, ie no orgasm •paraphilia- arousal due to inappropriate objects/ individuals ophilia- strong attraction opara- abnormal •male female sex differences omen masturbate more and admit it ofemales associate sex w/ romance + intimacy rather than male physical gratification omen have diff attitude toward casual premarital sex omen show more sexual desire/arousal omen’s self-concept characterized more by power, independence, aggression owomen’s sex beliefs are more plastic/ changeable women emphasize relaitonships •sexual self schemas- core beliefs about sexuality •Cultural differences oSambia in Papua New Guinea •adolescent boys encouraged to engage in homosexual oral sex b/c semen valued… wtf •Homosexuality omight run in families, genetic component? odifferential hormone exposure in utero ogreater probably of being left handed or ambidextrous olonger ring finger than index ofraternal birth order hypothesis- each additional older brother increased odds of being gay by one third •Gender identity disorder oa persons physical gender is not consistent with persons sense of identity tapper in a body of the wrong sex otranssexualism odifferent from transvestic fetishism- sexually aroused by wearing clothing of opposite sex odifferent from intersex individuals- hermaphrodites, born with ambiguous genitalia, hormonal or physical abnormalities oautogynephilia- when gender identity disorder begins with strong sexual attraction to fantasy of oneself as a female, then progresses to becoming a woman ogenetic component suspected •gender nonconformity oboys behaving femininely or females behaving masculinely •sex reassignment surgery controversial to directly alter gender identity to match physical anatomy oin order to qualify, must live in opposite sex role for 1-2 yrs to be sure omust be stable psychologically, financially, socially ogynecomastia- growth of breasts •intersex individuals- born w/ physical charactersitics of both sexes o5 sexes: •males •females •herms •merms- more male than female but have some femal genitalia •ferms- ovaries but possess some male genitalia •Sexual dysfunction oinability to become aroused or reach orgasm o3 stages of sexual response cycle: desire, arousal, orgasm opremature ejaculation vaginismus- painful contractions in vagina during attempted penetration olifelong or acquired ogeneralized or situational odue to psych factors or medical condition •Hypoactive sexual desire disorder olittle or no interest in any type of sexual activity •sexual aversion disorder othought of sex or brief casual touch may evoke fear, panic or disgust •male erectile disorder and female sexual arousal disorder oproblem is not desire, problem is physically becoming aroused •inhibited orgasm oinability to achieve orgasm despite adequate desire and arousal (common in women) ofemale orgasmic disorder- difficulty reaching orgasm retarded ejaculation- cumming delayed oretrograde ejaculation- shoot back into bladder rather than forward •premature ejaculation- more common, 20% of males •sexual pain disorders odesire, arousal, orgasm present opain so severe that behavior disrupted odyspareunia- no medical reason found for pain •vaginismus- pelvic muscles in outer third of vagina involuntarily spasm oripping, burning, tearing sensations during sex •Assessing Sexual behavior o(1) interviews- and questionnaires o(2) thorough medical eval- rule out medical conditions o(3) psychophysiological assessment penile strain gauge- picks up changes as penis expands •vaginal photoplethysmograph- measures light reflected from vaginal walls •Causes of sexual disorders obiological contributions •nuerological diseases •diabetes •arterial insufficiency- constricted arteries •venous leakage- blood flows out too quickly for a good boner •prescription drugs ?anti-hypertensive medications for high blood pressure ?antidepressants ?SSRIs mess w/ arousal and desire •elicit drugs- cocaine •cigarettes opsych contributions •anxiety- can increase or decrease desire •distraction men who are dysfunctional report less sexual arousal •inducing positive or negative mood directly affects arousal •performance anxiety, 3 parts: ?arousal, cognitive processes, negative affect •erotophobia- negative cognitive set about sexuality, viewed as negative or threating ? learned early in childhood from families, religious authorities ? early sexual trauma, rape victims •script theory- we all operate by following “scripts” that reflect social and cultural expectations and guide our behavior •sexual myths/ misperceptions •Treatment for sexual dysfunction education is very effective, dispel myths and ignorance about sexual response cycle otherapy, increase communication b/t dysfunctional partners osensate focus and nondemand pleasuring- exploring and enjoying each others bodies thru touching, kissing, hugging, massaging •1st phase no genitals or boobs •2nd phase genitals but no sex or orgasm •3rd sex once aroused osqueeze technique- squeezing tip of penis to reduce arousal and gain control over ejaculation omasturbation training and porn! omedical treatments •oral medication (Viagra) •injection of vasoactive substances directly into the penis? •surgery •vacuum device therapy •Paraphilia if exists, individuals normally exhibit multiple paraphillic patterns oassociated w/ deficiencies in consensual adult sexual arousal, social skills, sexual fantasies •frotteurism orubbing against someone in a crowded public place until point of ejaculation •festishism operson sexually attracted to nonliving objects o(1) inanimate object o(2) source of specific tactile stimulation… rubber o(3) body part… foot •voyeurism obeing aroused by observing unsuspecting individuals undressing or naked •exhibitionism osexual gratification from exposing genitals to strangers orisk + anxiety can increase arousal oassociated w/ lower levels of edu transvestic fetishism osexual arousal from cross-dressing •sexual sadism oinflicting pain or humiliation •sexual masochism osuffering pain or humiliation •hypoxiphilia- oself strangulation to reduce flow of oxygen to brain to enhance orgasm •pedophilia osexual attraction to kids oincest when own family •Psychological treatment ocovert sensitization- carried out in imagination of patient, associate sexually arousing images w/ reasons why behavior is harmful or dangerous •orgasmic reconditioning opatients instructed to masturbate to usual fantasies but substitute more desirable ones just before ejaculation •Drug treatments “chemical castration”- eliminates sexual desire + fantasy by greatly reducing testosterone levels ocyproterone acetate + medroxyprogesterone ouseful for dangerous sexual offenders who do not respond to alternative treatmens Chapter 11: Substance-related and Impulse-control disorders •impulse control disorders- inability to resist acting on a drive or temptation osteal, gamble, set fires, pull out hair •polysubstance abuse- using multiple substances •substance use oingestion of psychoactive substances in moderate amounts that does not impair social, educational or occupational functioning •intoxication- getting high or drunk oimpairs judgment, mood changes, lowered motor ability •substance abuse ohow much ingested is problematic •addiction- substance dependence ophysiologically dependent on the drug requires increasing amounts to experience same effect (tolerance) onegative physical response when substance no longer ingested (withdrawal) oNicotine is arguably most addictive drug in the world, more so than meth! •5 substance categories o(1) depressants- sedation + relaxation… alcohol o(2) stimulants- active + alert… caffeine o(3) opiates- analgesia + euphoria… morphine o(4) hallucinogens- alter sensory perception… weed, LSD (5) other drugs- don’t fit neatly into categories… steroids •Depressants odecrease central nervous system activity, reduce levels of physiological arousal omost likely to produce dependence, tolerance, withdrawal oalcohol •reduces inhibition, motor coordination, reaction time, judgement •esophagus>stomach>small intestines>bloodstream>heart (+other major organs)> liver •influences GABA receptors –anxiety •influences glutamate system- excitatory, memory, blackouts •withdrawal delirium- frightening hallucinations, body tremors •liver disease, pancreatitis, cardiovascular disorders, brain damage •dementia- loss of intellectual abilities Wernicke-Korsakoff syndrome- loss of muscle coordination, confusion, unintelligible speech •fetal alcohol syndrome- when pregnant mothers drink, fetal growth retardation, behavior problems, learning difficulties, physical signs •alcohol dehydrogenase- enzyme that breaks down alcohol •3 million ppl dependent in US ostages of alcoholism •pre alcoholic- drinking occasionally, few consequences •prodromal stage- drinking heavily, outward signs of a problem •crucial stage- loss of control, binges •chronic stage- primary daily activities involve drinking odrinking at early age is predictive of later abuse alcohol linked to violent behavior oBarbiturates •sedatives, help ppl sleep •highly addictive •overdosing> suicide •influence GABA obenzodiazepines •reduce anxiety •highly prescribed in US •alcohol amplifies effect oStimulants •most commonly used psychoactive drugs in US •amphetamine use disorders ?reduce appetite ?narcolepsy, ADHD, Ritalin ?stimulants illegally abused by college students… no shit •crystal meth •MDMA- ecstasy ococaine use disorders •alertness, euphoria, increase blood pressure + pulse, insomnia, loss of appetite •paranoia, heart probs nicotine use disroders •withdrawal- depression, insomnia, irritability, anxiety, increased appetite •more prone to depression •Opioids oopiate natural chemicals in opium poppy have narcotic effect o“downers” •Hallucinogens ochange sensory perception osight, sound, feelings, taste, smell omarijuana oLSD •Other drugs oSpecial K osteroids oPCP •Family and genetic influence •neurobiological influence opleasure pathway in brain mediates experience of reward odopamine- pleasure oGABA- inhibitory NT •Psych dimensions opositive reinforcement negative reinforcement- use drugs to cope/escape from bad feelings and difficult life circumstances oopponent-process theory- an increase in positive feelings will be followed shortly by an increase in negative feelings and vice versa •cognitive factors oplacebo effect oexpectancy theory •social dimensions opeer pressure omarketing omoral weakness model of chemical dependence- drug use is seen as a failure of self-control in the face of temptation odisease model of dependence- drug dependence cause by an underlying physiological disorder •cultural factors oacculturation- adapt to new culture omachismo •neuroplasticity brains tendency to reorganize itself by forming new neural connections ocontinued use of substance…. decreased desire for nondrug experiences •Treatment obiological •agonist substitution- take a safe drug that has a chemical makeup similar to the addictive drug ? methadone instead of heroin ?cross-tolerance: they act on same NTs •substitution ?nicotine gum instead of cigs •antagonist drugs- block or counteract effects of psychoactive drugs •aversive treatment- prescribe drugs that make ingesting abused substance extremely unpleasant opsychosocial •therapy •inpatient facilities •alcoholics anonymous- 12 steps •controlled use- controversial covert sensitization- negative associations by imagining unpleasant scenes •contingency management- decide on reinforces that will reward certain behaviors •community reinforcement approach •motivational interviewing- empathetic and optimistic counseling •CBT •relapse prevention •Impulse control disorders ointermittent explosive disorder- episodes where act on aggressive impulses •serious assaults or destruction of property •influenced by NT levels okleptomania •recurrent failure to resist urge to steal things not needed for personal use or monetary value •high comorbidity with mood disorders opyromania •irresistible urge to set fires pathological gambling otrichotillomania •pulling out ones hair from anywhere on body oothers •compulsive shopping-oniomania •skin picking •self mutilation •computer addiction Chapter 12: Personality Disorders •personality disorders- enduring patterns of thinking about ones environment and self that are exhibited in a wide range of social and personal contexts oinflexible, maladaptive and cause significant impairment or distress ohigh comorbidity •Axis I= current disorder •Axis II= chronic problem •5 Factor model oextroversion- talkative + assertive vs passive and reserved oagree-ableness- kind trusting vs hostile selfish conscientiousness- organized thorough, reliable oneuroticism- even tempered vs nervousness moody oopenness to experience- imaginative curious •Cluster A: odd or eccentric oparanoid oschizoid oschizotypal •Cluster B: dramatic, emotional, erratic oantisocial (m)- irresponsible, reckless behavior oborderline (f) ohistrionic (f)- excessive emotionality and attention seeking onarcissistic •Cluster C: fearful, anxious oavoidant odependent oobsessive compulsive •Biases ocriterion gender bias- criteria biased oassessment gender bias- assessment measures biased