Archana Dixit MD, MRCOG

• Consultant Obstetrician and Gynaecologist
• West Middlesex University Hospital NHS Trust
• Isleworth, Middlesex, UK

Excessive pruning of neural cell bodies in adolescence may be a cause of some cases of schizophrenia white coat hypertension xanax purchase lanoxin mastercard. Measures of concordance for schizophrenia in identical twins indicate substantial heritability blood pressure and exercise buy generic lanoxin canada. Some of the specific genes that appear to be involved have effects that are consistent with brain chemistry theories of the disorder heart attack zippo lighter purchase genuine lanoxin. Predisposition may also arise from early environmental injury to the brain-including prenatal viruses or malnutrition blood pressure normal zone 0.25mg lanoxin with mastercard, birth complications arteriovenous malformation 0.25 mg lanoxin, or early childhood head injury blood pressure medication fluid retention cheap lanoxin 0.25mg amex. Stressful life experiences and aspects of the family environment can bring on the active phase of schizophrenia or worsen symptoms in predisposed people. Recovery from schizophrenia has been found to occur at higher rates in developing countries than in developed countries. Differences in living conditions and cultural attitudes and the lower use of antipsychotic drugs in developing countries may all play a role. People have different personality traits, and psychologists have spent much time and effort describing these traits. It is sometimes difficult to differentiate personality disorders from somewhat extreme but "normal" personality traits on the one hand and serious forms of mental illness, such as schizophrenia, social anxiety disorder, or obsessive-compulsive disorder on the other hand. We should note that there are limitations and problems with this classification system. Many patients meet criteria for more than one personality disorder, many have personality disorders that do not fall neatly in to one of the 10 categories, and personality dysfunction may reflect maladaptive extremes of normal personality trait dimensions. Within each cluster, what means do clinicians use to differentiate the symptoms of one disorder from those of others Cluster A: "Odd" Personality Disorders this cluster of disorders has much in common with schizophrenia, especially its delusional component. In fact, people with a diagnosis of a Cluster A personality disorder often have close relatives with schizophrenia or are diagnosed themselves with schizophrenia (Chemerinski & Siever, 2011). Paranoid Personality Disorder As the name connotes, people with this disorder are deeply distrustful of other people and are suspicious of their motives. They frequently believe that people are "out to get them" and read hostile intentions in to the actions of others (Turkat et al. Most of these attributions are inaccurate, but not so off base as to be considered delusional. They frequently blame others for their failures and tend to bear grudges (Rotter, 2011). He took an early retirement from his accounting job a year ago because he could not get along with his supervisor, who he believed was faulting him about his accounts and paperwork. Many are "loners" who make no effort to initiate or maintain friendships, often including sexual relations and interactions with their families. People with schizoid personality disorder tend to be self-centered and are not much influenced by either praise or criticism. This disorder is relatively rare, occurring in fewer than 1 percent of people in the population (Paris, 2010). They often see significance in unrelated events, especially as they relate to themselves, and some people with this disorder believe they have special abilities, such as extrasensory perception or magical control over other people. People with this disorder have poor attentional focus, making their conversations vague, often with loose associations (Millon, 2011). They find it difficult to get and keep jobs and often lead idle, unproductive lives. Schizotypal personality disorder occurs in about 2 to 4 percent of all people, and it is slightly more common in men than in women (Paris, 2010). Cluster B: "Dramatic" Personality Disorders this cluster includes four examples, the common link being that individuals with these disorders display highly emotional, dramatic, or erratic behavior that makes it difficult for them to have stable, satisfying relationships. Antisocial Personality Disorder People with this disorder consistently violate or disregard the rights of others and are sometimes referred to as sociopaths or psychopaths. They frequently lie, seem to lack a moral conscience, and behave impulsively, seemingly disregarding the consequences of their actions (Kantor, 2006; Millon, 2011). As a result of their reckless behavior and disregard for others, they frequently find themselves in trouble with the law. At one point he said the pain had been present for 3 days, whereas at another point it was "many years. Neurological and mental status examinations were within normal limits except for some mild agitation. The patient resisted a plan for further diagnostic tests or a follow-up clinic appointment, saying unless he was treated immediately "something really bad could happen. Attempted suicide is common in people with borderline personality disorder, with, according to some estimates, about 75 percent of people with the disorder attempting suicide at least once in their lives and approximately 10 percent succeeding (Gunderson, 2011). Histrionic Personality Disorder People with histrionic personality disorder continually seek to be the center of attention-they behave as if they are always "on stage," using theatrical gestures and mannerisms-and are often described as vain, self-centered, and "emotionally charged," displaying exaggerated moods and emotions. People with this disorder constantly seek attention and approval from others and are concerned with how others will evaluate them, often wearing provocative clothing to attract attention. They have a difficult time delaying gratification and may overreact in order to get attention, sometimes to the point of feigning physical illness. Males and females are equally likely to be classified as having histrionic personality disorder, with between 2 and 3 percent of people in the population having the disorder (Paris, 2010). P is a 20-year-old female undergraduate student who requested psychological counseling at the college health services for "boyfriend problems. She is an attractive, welldressed woman adorned with make-up and nail polish, which contrasts sharply with the very casual fashion of most coeds on campus. During the initial interview she was warm and charming, maintained good eye contact, yet was mildly seductive. At two points in the interview she was emotionally labile, shifting from smiling elation to tearful sadness. Her boyfriend had accompanied her to the evaluation session and asked to talk to the clinician. They seek admiration from others, tend to lack empathy, and Some researchers think that family values in Western societies promote narcissism. They exaggerate their abilities and achievements and expect others to see the same exceptional qualities in them that they see in themselves. They often make good first impressions (their social skills tend to be relatively good), but these are rarely maintained (Campbell & Miller, 2011). This is due in part to their perceived arrogance, but also to their general lack of interest in other people (Ritter et al. It is estimated that approximately 1 percent of people in the population show narcissistic personally disorder, with 75 percent of them being men (Dhwan et al. Cluster C: "Anxious" Personality Disorders the common thread for this final cluster of personality disorders is fear and anxiety. People with anxious personality disorders have much in common with people who suffer from depression and anxiety disorder; the difference is one of degree. Avoidant Personality Disorder People with this disorder are excessively shy; they are uncomfortable and inhibited in social situations. Their extreme fear of rejection causes them to be timid and fearful in social settings and often results in their avoiding social contact, making it impossible for them to be accepted. People with avoidant personality disorder rarely take risks or try out new activities, exaggerating the difficulty of tasks before them (Rodenbaugh et al. Avoidant personality disorder is similar to generalized anxiety disorder discussed earlier in this chapter (p. Approximately 1 to 2 percent of people in the population are afflicted with this disorder, men and women with comparable frequency (Paris, 2010). Dependent Personality Disorder People with dependent personality disorder show an extreme need to be cared for. They are clingy and fear separation from significant people in their lives, believing they cannot care for themselves. People with dependent personality disorder fear upsetting relationship partners (their partners may leave them if they do), and as a result tend to be obedient, rarely disagreeing with them and permitting them to make important decisions for them (Millon, 2011). They often feel lonely, sad, and distressed, putting them at high risk for anxiety, depression, and eating disorders (Bornstein, 2007). They are prone to suicidal thoughts, especially when a relationship is breaking up. It is estimated that between 2 and 3 percent of people in the population suffer from dependent personality disorder, with about the same number of men and women having the disorder (Paris, 2010). Obsessive-Compulsive Personality Disorder Like people with obsessive-compulsive disorder, people with obsessive-compulsive personality disorder are preoccupied with order and control, and as a result are inflexible and resist change. They are so highly focused on the details of a task that they often fail to understand the point of an activity. They tend to set excessively high standards for themselves and others, exceeding any normal degree of conscientiousness (Samuel & Widiger, 2011). They often have difficulty expressing affection, and as a result their relations are frequently shallow and superficial. Approximately 1 to 2 percent of people in the population show obsessive-compulsive personality disorder, with about twice as many men having the disorder as women (Paris, 2010). Biological explanations, such as possible genetic and neurotransmitter causes, have been proposed for some personality disorders. For example, some studies report a genetic connection for paranoid personality disorder (Kendler et al. Experiences in childhood have been shown to be related to schizotypal, antisocial, borderline, and dependent personality disorders (see Comer, 2014); and sociocultural explanations have been proposed for narcissistic (family values in Western societies promote narcissism; Campbell & Miller, 2011) and histrionic (some cultures are more accepting of extreme behavior than others; Patrick, 2007) personality disorders. As with other forms of mental disorders, it is almost certain that there are multiple causes of any single personality disorder, with genes, operating in interaction with the environment at all levels (for example, family, culture), influencing brain structure (formation of synapses, pruning of neurons, abundance of neurotransmitter receptors) and function (through presence of neurotransmitters such as dopamine, serotonin, and glutamate). Cluster A ("odd") personality disorders include paranoid, schizoid, and schizotypal types, all characterized by some degree of delusions and erratic behavior. Cluster B ("dramatic") personality disorders include antisocial, borderline, histrionic, and narcissistic types and are characterized by highly emotional, dramatic, or erratic behavior. Cluster C ("anxious") personality disorders include avoidant, dependent, and obsessive-compulsive types and are characterized by fear and anxiety. Reflections and Connections Here are three final ideas that may help you organize your thoughts as you reflect on what you have read in this chapter: 1. The multiple causes of mental disorders By this time in your study of psychology, you are no doubt used to the idea that human feelings, thoughts, and actions emerge from the interplay of many causes. This idea also applies to the feelings, thoughts, and actions that lead to the diagnosis of a mental disorder. The differences among us that are considered disorders-no less than the differences that are considered normal-are caused by differences in our genes and in our past and present environments. Any claim to have found the cause of generalized anxiety, depression, schizophrenia, or another major class of disorder is of doubtful validity. Thinking of disorders in terms of extremes of normal processes has also helped scientists understand them better. An evolutionary view of mental disorder the evolutionary theme running through this book maintains that behavior is generally functional: It promotes survival and reproduction. One partial answer may be that mental disorders are a cost the species pays for the general advantages that come with diversity. The previous chapter, on personality, dealt with individual differences within the range generally considered healthy, or not disordered, and the case was made that natural selection may have favored diversity because those who are different from average can exploit unfilled niches and reap their rewards. Such diversity stems from variations in genes and from behavioral mechanisms that are capable of being modified through experience. Variation in capacity for anxiety, or compulsiveness, or sadness may be beneficial within a certain range; but the coin tosses that distribute genes and experiences will sometimes produce those characteristics at pathological levels. One way to review this chapter would be to think about each disorder in relation to the three classes of causes-predisposing, precipitating, and perpetuating-that were introduced near the beginning of the chapter. Note, too, that similar stressful events can result in different kinds of symptoms-and different diagnosed disorders-for different individuals or at different times for any given individual. The continuum between normality and abnormality Although a diagnosis of a mental disorder is categorical (all or none), the symptoms on which diagnoses are made are not; they vary in degree throughout the population. Thus, any decision as to whether a particular person does or does not have a mental disorder is based on arbitrary criteria describing how severe or prolonged each symptom must be in order to call the syndrome a disorder. As you review each disorder described in the chapter, think about its symptoms in relation to the moods, emotions, thoughts, and behaviors that all of us manifest to some degree. Doing so helps remove some of the mystique from the concept of mental disorder and helps us identify with people whose Find Out More Floyd Skloot (2005). In 1988, at age 41, Floyd Skloot lost much of his memory, linguistic ability, and ability for coherent thought as a result of a viral infection that destroyed parts of his brain. In 2003 he published a book, In the Shadow of Memory, describing his slow but active struggle to reconstruct his sense of self as he regained some of his mental capacities. The book offers a fascinating glimpse in to the world of dementia, from a poetic soul who himself has experienced some of the effects of dementia. In this autobiography, Kay Jamison-a leading researcher of mood disorders- describes her own experiences as a sufferer of bipolar disorder. The book includes an especially vivid description of her first full-blown manic episode, which happened in her first year as an assistant professor, and a moving discussion of how she came to terms with the disorder and has managed to live with it. Elyn Saks is an accomplished scholar, an esteemed professor of law, who has suffered throughout her adult life from schizophrenia. In this remarkable autobiographical account she describes the terrors she has experienced during psychotic episodes. We learn here what it is like to experience commands coming from within, bizarre perceptual distortions, and periods of chaotic thoughts. We also learn about the high degree of support from others and determination from self that is required for a person with this disorder to live a productive and satisfying life, despite the continued disruptions. In this page-turner, you can see how the brutality of war impacts the men and women who carry it out and why the return home can be so difficult for many of them. The 5th edition is critical for any current or future psychologist, psychiatrist, nurse, or medical doctor.

Having an open mind: the impact of openness to experience on interracial attitudes and impression formation hypertension glaucoma discount lanoxin online mastercard. Effects of adult attachment and presence of romantic partners on physiological responses to stress blood pressure ranges for athletes buy 0.25mg lanoxin amex. Sibling differentiation in adolescence: Implications for behavioral genetic theory blood pressure pediatric order online lanoxin. The educational opportunities that lie in self-directed age mixing among children and adolescents blood pressure prescriptions buy lanoxin visa. Some educational benefits of freely chosen age mixing among children and adolescents blood pressure medication used to treat adhd discount lanoxin 0.25mg. Interpersonal context as an influence on sexual timetables of youths: Gender and ethnic effects blood pressure of 150/100 order lanoxin australia. Is conditioning a useful framework for understanding development and treatment of phobias Presentation at the Evolution and Individual Differences Symposium conducted at the annual meeting of the Human Behavior and Evolution Society, London, England. Efficacy of transcranial magnetic stimulation targets for depression is related to intrinsic functional connectivity with the subgenual cingulate. Patterns of brain electrical activity during facial signs of emotion in 10-month-old infants. Attachment stability from infancy to adulthood: Meta-analysis and dynamic modeling of developmental mechanisms. A dynamical systems approach to conceptualizing and studying stability and change in attachment security. Nongenomic transmission across generations in maternal behavior and stress response in the rat. The role of positive emotions in positive psychology: the broaden-and-build theory of positive emotions. Individual differences in executive functions are almost entirely genetic in origin. Intact implicit and reduced explicit memory for negative self-related information in repressive coping. Age differences in social preferences among Taiwanese and mainland Chinese: the role of perceived time. Self-recognition in chimpanzees and man: A developmental and comparative perspective. Charting the acquisition of semantic knowledge in the case of developmental amnesia. Peer influence on risk taking, risk preference, and risky decision making in adolescence and adulthood: An experimental study. When you and I are "we," you are not threatening: the role of self-expansion in social comparison. Major histocompatibility complex alleles, sexual responsivity, and unfaithfulness in romantic couples. Patterns of interaction in adolescent romantic relationships: Distinct features and links to other close relationships. Learning addition and subtraction: Effects of number words and other cultural tools. The prefrontal cortex: Anatomy, physiology, and neuropsychology of the frontal lobe. Self-control relies on glucose as a limited energy source: Willpower is more than a metaphor. An adaptationist perspective on social learning, social feeding, and social foraging in Norway rats. Social influences on food choices of Norway rats and mate choices of Japanese quail. Social factors in the poison avoidance and feeding behavior of wild and domesticated rat pups. Social influences on foraging in vertebrates: Causal mechanisms and adaptive functions. Associative and propositional processes in evaluation: An integrative review of implicit and explicit attitude change. Cerebral specialization and interhemispheric communication: Does the corpus callosum enable the human condition A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain. Even before formal instructions, Chinese children outperform American children in mental arithmetic. Preferred stimulation levels in introverts and extraverts: Effects on arousal and performance. Parental corporal punishment and associated child behaviors and experiences: A meta-analytic and theoretical review. Behavioral inhibition: Stability and associations with adaptation from childhood to early adulthood. Speech recognition materials and ceiling effects: Considerations for cochlear implant programs. Thinking lightly about others: Automatic components of the social inference process. Grouping has a negative effect on both subjective contours and perceived occlusion at T-junctions. Texting epic fail: Empirical evidence that text messaging during class disrupts comprehension of lecture material. Repressive coping style, acute stress disorder, and posttraumatic stress disorder after myocardial infarction. Duplex vision: Separate cortical pathways for conscious perception and control of action. A prospective study of memory for child sexual abuse: New findings relevant to the repressed-memory controversy. Forming attitudes that predict behavior: A meta-analysis of the attitude-behavior relation. Computer learning by memory-impaired patients: Acquisition and retention of complex knowledge. Differetial trajectories of age-related changes in components of executive and memory processes. Neurocognitive impairments in schizophrenia: Their character and role in symptom formation. Young children extend novel words at the basic level: Evidence for the principle of categorical scope. Electrophysiological evidence for developmental changes in the duration of sensory memory. Conditioned opponent processes in the development of tolerance to psychoactive drugs. A functional neuroimaging study of sound localization: Visual cortex activity predicts performance in early-blind individuals. Out of sight, out of mind, out of site: Schooling and attention-deficit/hyperactivity disorder. The value of Psychology 101 in liberal arts education: A psychocentric theory of the university. Patterns of age mixing and gender mixing among children and adolescents at an ungraded democratic school. Playing in the zone of proximal development: Qualities of self-directed age mixing between adolescents and young children at a democratic school. Enumeration versus multiple object tracking: the case of action video game players. Threeyear outcomes of deep brain stimulation for highly resistant obsessivecompulsive disorder. Cultural apprenticeship and cultural change: Tool learning and imitation in chimpanzees and humans. A unified theory of implicit attitudes, stereotypes, self-esteem, and self-concept. Measuring individual differences in implicit cognition: the Implicit Association Test. A comparison of the physical growth and development of American-born and native Japanese children. Selective attention and attention switching: Toward a unified developmental approach. Genetic and environmental influences on the rate of communicative development in the first year of life. The effect of personal relevance and approach-related action expectation on relative left frontal cortical activity. Social behavior and personality development: the role of experiences with siblings and with peers. Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: A 15-year multi-follow-up study. A theoretical model of the development of jealous: Insight through inquiry in to jealousy protest. Subcortical brain volumes relate to neurocognition in schizophrenia and bipolar disorder and Grilo, C. The nature of environmental influences on weight and obesity: A behavior genetic analysis. Decreased testosterone in regularly menstruating women with decreased libido: A clinical observation. Reciprocal altruism and food sharing decisions among Hiwi and Ache hunter-gatherers. The moral reasoning of young adults: Political-social behaviour, family background and personality correlated. Adverse effects of atypical antipsychotics: Differential risk and clinical implications. Intelligence and changes in regional cerebral glucose metabolic rate following learning. Consolidation of human memory over decades revealed by functional magnetic resonance imaging. Cingulate and temporal lobe fractional anisotropy in schizotypical personality disorder. Escape and avoidance conditioning of human subjects without their observation of the response. Are antidepressants useful in the treatment of minor depression: A critical update of the current literature. Positive and negative characteristics of marital interaction and their association with marital satisfaction in middle-aged and older couples. Secondary sexual characteristics and menses in young girls seen in office practice: A study from the Pediatric Research in Office Settings Network. Humans have evolved specialized skills of social cognition: the cultural intelligence hypothesis. A nonconformist account of the Asch experiments: Value, pragmatics, and moral dilemmas. Polarized norms and social frames of reference: A test of the self-categorization theory of group polarization. Classical conditioning provides paternity advantage for territorial male blue gouramis (Trichogaster trichopterus). The nosologic relationship between generalized anxiety disorder and major depression. Genetic and environmental sources of covariation between generalized anxiety disorder and neuroticism. Altruistic cooperation during foraging by the Ache, and the evolved human predisposition to cooperate. Aerobic fitness and cognitive development: Event-related brain potential and task performance indices of executive control in preadolescent children. Pavlovian conditioning and addictive behavior: Relapse to oral selfadministration of morphine. Dream consciousness: Our understanding of the neurobiology of sleep offers insight in to abnormalities in the waking brain. Do psychiatric patients do better clinically if they live with certain kinds of families Family relationships and major mental disorder: Risk factors and preventive strategies. Observational learning of tool use in children: Investigating cultural spread through diffusion chains and learning mechanisms through ghost displays. Experimental studies of traditions and underlying transmission processes in chimpanzees. Causal knowledge and imitation/ emulation switching in chimpanzees (Pan troglodytes) and children (Homo Sapiens). The effects of maternal positive, neutral, and negative affective communications on infant responses to new toys. Stimulation of human periaqueductal gray for pain relief increases immunoreactive beta-endorphin in ventricular fluid. Perceptions of social behavior: Evidence for differing expectations for interpersonal and intergroup interactions. How work roles influence perception: Structural cognitive processes and organizational behavior. Generalized anxiety disorder and major depressive disorder comorbidity in the national survey of mental health and well-being.

If asked what happened a few hours ago or yesterday or at their last birthday party blood pressure normal variation purchase lanoxin from india, they can recount little or nothing pulse pressure less than 30 lanoxin 0.25 mg amex. Yet arrhythmia in cats buy genuine lanoxin on-line, despite this blood pressure medication valsartan buy lanoxin pills in toronto, they developed speech blood pressure low symptoms buy generic lanoxin 0.25 mg on line, reading hypertension arterielle 0.25 mg lanoxin otc, vocabulary, and other verbal capacities within the normal range. They all attended mainstream schools and learned and remembered facts well enough to perform passably on school tests. When they were presented with new factual information in controlled studies, they later remembered a good deal of that information but did not remember the episodic experience of learning it. Their abilities are consistent with other evidence that the hippocampus is essential for episodic-memory encoding but not for semantic-memory encoding (Eichenbaum, 2003). Other Evidence of Semantic Memory Without Episodic Memory It may at first seem surprising that people can remember new information without remembering the experience of learning that information. Older people are especially familiar with the phenomenon of knowing without knowing how they know. In old age, the capacity to form new episodic memories generally declines more rapidly than does the capacity to form new semantic memories (Johnson et al. During their first 4 years of life, children acquire an enormous amount of semantic information-including word meanings and facts about their world-that will stay with them throughout their lives. But children under 4 are relatively poor at recalling specific episodes in their lives, and none of us in adulthood can recall much about our own childhood prior to about age 4 (West & Bauer, 1999). Apparently the human ability for episodicmemory encoding develops more slowly and unravels more quickly than that for semantic-memory encoding. The inability to remember events from infancy and early childhood is not just due to the length of time between experiencing the event and trying to recall it. Even 4- and 5-year-old children fail to remember events in their lives from just 1 and 2 years earlier. Yet, some people can provide one or two vivid memories of life as an infant, including one of your authors (David Bjorklund): My memory is of me as a sick baby. Most people cannot remember anything from the first few years of their lives, but this does not mean that this information is being repressed. She listened carefully and then told me that I had never had the croup; my younger brother Dick had the croup as an infant. My "memory" was a reconstruction-and of an event I had only observed, not one I had actually experienced. Most people who have recollections from infancy and early childhood can be explained as mine was-a reconstruction based on what one heard, experienced, or imagined later. There have been several explanations, but most modern ones focus on how early memories were encoded and represented and how we try to remember them years later (Howe et al. For instance, Gabrielle Simcock and Harlene Hayne (2002) showed 27- to 39-month-old children a sequence of actions in their homes about a "Magic Shrinking Machine. Children with higher verbal scores at the initial testing were able to remember aspects of the event 6 and 12 months later, whereas children of the same age but with poorer language skills were not. Overall, the research evidence indicates that infantile amnesia reflects important changes that occur during early childhood-changes that permit autobiographical memory and that separate our species from all others. The relatively poor episodic memory at both ends of the life span may be related to prefrontal cortical functioning (Li et al. The prefrontal cortex develops more slowly in childhood and tends to suffer more damage in old age than does the rest of the brain. People with prefrontal cortical damage typically experience a much greater loss in episodic-memory encoding than in semantic-memory encoding (Wheeler, 2000). This brain area, which is much larger in humans than in other species and is crucial for planning and complex thought, may be essential for our sense of self, including our sense of our own past experiences. We-unlike any other animal, or at least much more so than any other animal-reminisce about our past, think about our position in the present, and project ourselves in to the future as we make plans and contemplate their consequences. In fact, one explanation for infantile amnesia is that, until about age 4, children do not have a well-developed sense of self (Howe et al. Such abilities are intimately tied to our capacity to form episodic memories (Schacter et al. This evolutionarily recent addition to the mammalian cognitive machinery is apparently more fragile-more destructible by aging and injuries-than is the more ancient semantic-memory system or the still more ancient implicit-memory system (Tulving, 2002; Wheeler et al. Explicit and Implicit Memory Neuropsychological Evidence Information in explicit (declarative) memory can be brought in to consciousness, whereas information in implicit (nondeclarative) memory cannot, though it can influence thought and behavior. Subclasses of implicit memory include the learning that arises from classical conditioning, procedural memories (such as how to play a guitar chord), and priming. Network models describe long-term memory as a vast web of associations that vary in strength. Activation can spread along associative pathways in a way that enables memory retrieval and thought. Infantile amnesia, the inability to remember events from early childhood, is attributed to differences in how early memories were encoded and represented and how we try to remember them years later. Children under 4 and older adults generally exhibit poorer episodic memory than semantic memory, which may be related to immaturity of or damage in the prefrontal cortex. Encoding Information in to Long-Term Memory As you read a book, or attend to a conversation, or admire scenery, some of the sensory information that reaches your conscious mind enters your long-termmemory store, allowing you to recall it later. Why does some but not all of the information that reaches the short-term store get encoded in to the long-term store As we discussed earlier, verbal information can be maintained in working memory simply by repeating it over and over. People who participate in a digitspan test, holding a list of digits in mind by reciting them over and over, rarely remember the digits even a minute after the test is over. Everyday life also has many examples of the failure of repetition to promote long-term memory. Long ago a psychologist named Edmund Sanford (1917/1982) illustrated this point by describing his own poor memory of four short prayers that he had read aloud thousands of times over a 25-year period as part of his daily religious practice. He found, when he tested himself, that he could recite, on average, no more than three or four successive words of each prayer from memory before having to look at the printed text for prompting. I myself (Peter Gray) have looked up certain telephone numbers dozens of times and held them in working memory long enough to dial them, without ever encoding them in to long-term memory. The ones I remember are the ones I thought about in some way that helped me encode them in to long-term memory. The activities that are effective for maintenance are not necessarily effective for encoding. Research suggests that some of the most effective activities for encoding involve elaboration, organization, and visualization. Keith Morris/Alamy Elaboration Promotes Encoding Most of what we learn and remember in our everyday lives does not come from consciously trying to memorize. The more deeply we think about something, the more likely we are to remember it later. To think deeply about an item is to do more than simply repeat it; it is to tie that item to a structure of information that already exists in long-term memory. Psychologists who study this process call it elaboration, or elaborative rehearsal. The immediate goal of elaboration is not to memorize but to understand, yet attempting to understand is perhaps the most effective of all ways to encode information in to long-term memory. Memory techniques centering on elaborative rehearsal capitalize on the human tendency to remember things that conform to some sort of logic, even if the logic is fictional. There is no obvious logic to the fact that stone formations hanging down in a cave are called stalactites while those pointing up are called stalagmites. In one experi60 ment, for example, the best memory for a list of objects occurred in the group of subjects 40 who were asked to think about how each 20 object might help them to survive if they were stranded in the grasslands of a foreign 0 country (Nairne et al. In both of these experiments, those given the thought instructions performed better on a subsequent test of memory than did those who were asked to memorize the words or lines deliberately. This was despite the fact that the thought groups, unlike the memorize groups, did not know that the experiment was concerned with memory and that they would be tested later. The Value of Elaboration for School Learning In a study of fifth graders, John Bransford and his colleagues (1982) found that students who received high marks in school were far more likely to use elaborative rehearsal than were those who received lower marks. The researchers gave the children written passages to study for a later test and asked them to explain what they did as they studied each passage. For example, one passage described two different kinds of boomerangs, a returning kind and a nonreturning kind, each used for different purposes. Academically successful students often reported that they rehearsed the material by asking themselves questions about it. Less successful students, in contrast, usually studied the passages simply by rereading them. In one long-standing program aimed at helping students perform better in college, students are taught to write down questions about every textbook section that they read as they read it and about the lecture notes they take as they take them. In a series of field experiments, students who were taught these techniques subsequently achieved higher grades in their college courses than did otherwise comparable students who received either subject-matter tutoring or no special help (Heiman, 1987). Constantly ask yourself questions such as these: Do I understand the idea that the author is trying to convey here In the process, you will also generate questions that you might want to ask other students or your instructor. Organizing items to be remembered is itself a means of elaboration; you must think about the items, not just repeat them, in order to organize them. Moreover, organization can improve memory by revealing or creating links among items that would otherwise be perceived as separate. One way to increase the number of items one can retain in the short-term store is to group adjacent items that are at first perceived as separate, thus making them a single item. This procedure, known as chunking, decreases the number of items to be remembered and increases the amount of information in each item (Miller, 1956). You could make your task still easier if you then chunked these five abbreviations in to one sentence: "The M. In the first example, the five notes are chunked in to one meaningful sentence, and in the second the seven systems are chunked in to two meaningful words. By reducing the number of separate items, and by attaching more meaning to each item, chunking provides an advantage both for maintaining information in working memory and for encoding it in to long-term memory. The Role of Chunking in Expert Memory We are all much better at forming longterm memories for information that is within rather than outside our realm of expertise. For example, master chess players can look for just a few seconds at a chess game in progress and form a long-term memory of the locations of all the pieces on the board (de Groot, 1965). Similarly, football coaches have excellent memories for diagrams of football plays (Garland & Barry, 1991), architects have excellent memories for floor plans (Atkin, 1980), and physicians have excellent memories for information gained in diagnostic interviews of patients (Coughlin & Patel, 1987). Ander Ericsson and his colleagues have posited the existence of a special kind of longterm memory, called long-term working memory (Ericsson & Delaney, 1999; Ericsson & Kintsch, 1995). Such memories are encoded in to long-term storage in a manner that makes the entire structure of information easily accessible to working memory, at least until the problem is solved or the task is finished. Such memories are not lost as a result of interruptions, as short-term working memories are, so they allow the person to go back to a previous task after time spent on another task (Oulasvirta & Saariluoma, 2006). The graph shows the memory performance (averaged over 13 experiments) of chess players of various skill levels who studied either a game board or a random board for 10 seconds or less. This knowledge provides a foundation for the efficient chunking of new items of information. Chess games normally progress in certain logical ways, so logical relationships exist among the pieces, which experts can chunk together and remember as familiar formations rather than as separate pieces. If the chess pieces are arranged randomly rather than in ways that could occur in a real game, masters are no better, or little better, than novices at remembering their locations (Gobet et al. Experts in other realms also lose their memory advantage when information is presented randomly rather than being grouped in ways that make sense to them (Vicente & Wang, 1998; Weber & Brewer, 2003). Hierarchical Organization Promotes Encoding the most useful format for organizing some kinds of information is the hierarchy. In a hierarchy, related items are clustered together to form categories, related categories are clustered to form larger (higher-order) categories, and so on. In an experiment demonstrating the advantage of hierarchical organization for long-term memory, Andrea Halpern (1986) gave subjects a chart listing 54 wellknown song titles to be memorized. In some cases the chart was organized in a hierarchical manner, with songs arranged according to meaningful categories and subcategories. In other cases a similar chart was used but organized randomly, with no systematic relation among categories, subcategories, and song titles. When tested later for their memory of the song titles, subjects who had studied the organized chart recalled accurately many more titles than did those who had studied the disorganized chart. During the test the former group of subjects would first recall a category name and then the songs that had been listed under that name. As was pointed out in Chapter 1, the information in this textbook (like that in nearly all textbooks) is hierarchically arranged: Each main heading refers to a set of related ideas, and each subheading refers to a smaller subset of ideas within the larger set. As an illustration, a hierarchical sketch of the section you are now 31 What is a hierarchical organization, and how can such an organization facilitate encoding in to long-term memory Such a chart is an aid to thought and memory because it reveals the logical connections among the items of information. Notice that the top node indicates in key words the theme of the section, the nodes subordinate to it indicate the main ideas pertaining to that theme, and the comments under them indicate the examples or evidence provided for each idea. Such a summary would be a far more efficient aid in helping you commit the information to memory for a test than would a string of terms and names that does not preserve the connections of ideas to each other or of ideas to evidence. The section reviews of this textbook also preserve the hierarchical organization of ideas and evidence within each section (as discussed in Chapter 1). Visualization Promotes Encoding Our discussion of encoding so far has centered mostly on memory for verbal information. But we can also encode pictures or visual scenes in to long-term memory, apparently in a nonverbal form, which can be recalled later in to the visuospatial sketchpad of working memory. Visual and verbal memories interact and supplement one another in our everyday experience. If we asked you to describe your living room, you would probably summon a pictorial memory of that room and then find the words to describe it. A good deal of research suggests that people can improve their memory for verbally presented information if they encode that information visually as well as verbally. One study, for example, demonstrated that memory for information in news stories improves if relevant pictures accompany the stories (Prabu, 1998).

In fact blood pressure bottom number high purchase lanoxin with american express, each wave must travel the length of the basilar membrane to the site where it reaches its peak blood pressure 300 150 order 0.25mg lanoxin with amex. One such phenomenon is asymmetry in auditory masking hypertension guideline update jnc 8 discount lanoxin 0.25 mg amex, which is especially noticeable in music production blood pressure chart infants buy generic lanoxin 0.25 mg on-line. Auditory masking refers to the ability of one sound to mask (prevent the hearing of) another sound arrhythmia medical definition buy lanoxin 0.25 mg without a prescription. Auditory masking is asymmetrical in that lowfrequency sounds mask high-frequency sounds much more effectively than the reverse (Scharf blood pressure monitor cvs purchase cheap lanoxin online, 1964). For example, a bassoon can easily drown out a piccolo, but a piccolo cannot easily drown out a bassoon. The wave produced by a lowfrequency bassoon note encompasses the entire portion of the basilar membrane that is encompassed by the piccolo note (and more). Thus, if the bassoon note is of sufficient amplitude, it can interfere with the effect of the piccolo note; but the piccolo note, even at great amplitude, cannot interfere with the effect that the bassoon note has on the more distal part of the membrane because the wave produced by the piccolo note never travels that far down the membrane. Another effect of the traveling-wave mechanism concerns the pattern of hearing loss that occurs as we get older. We lose our sensitivity to high frequencies to a much greater degree than to low frequencies. Thus, young children can hear frequencies as high as 30,000 Hz, and young adults can hear frequencies as high as 20,000 Hz, but a typical 60-year-old cannot hear frequencies above about 15,000 Hz. This decline is greatest for people who live or work in noisy environments and is caused by the wearing out of hair cells with repeated use (Kryter, 1985). Another Code for Frequency Although the traveling-wave theory of frequency coding has been well validated, it is not the whole story. For frequencies below about 4,000 Hz (which include most of the frequencies in human speech), perceived pitch depends not just on which part of the basilar membrane is maximally active but also on the timing of that activity (Moore, 1997). The electrical activity triggered in sets of auditory neurons tends to be locked in phase with sound waves, such that a separate burst of action potentials occurs each time a sound wave peaks. Consistent with what is known about normal auditory coding, modern cochlear implants use both place and timing to produce pitch perception (Dorman & Wilson, 2004). These devices break a sound signal in to several (typically six) different frequency ranges and send electrical pulses from each frequency range through 28 How does the timing of action potentials code sound frequency Pitch perception is best when the electrical signal sent to a given locus of the membrane is pulsed at a frequency similar to that of the sound wave that would normally act at that location. That is, each neuron there is maximally responsive to sounds of a particular frequency, and the neurons are systematically arranged such that high-frequency tones activate neurons at one end of this cortical area and low-frequency tones activate neurons at the other end. Ultimately, the pitch or set of pitches we hear depends largely on which neurons in the auditory cortex are most active. As is true of other sensory areas in the cerebral cortex, the response characteristics of neurons in the primary auditory cortex are very much influenced by experience. When experimental animals are trained to use a particular tone frequency as a cue guiding their behavior, the number of auditory cortical neurons that respond to that frequency greatly increases (Bakin et al. Heredity determines the general form of the tonotopic map, but experience determines the specific amount of cortex that is devoted to any particular range of frequencies. Our capacity to distinguish pitch depends not just upon the primary auditory cortex, but also upon activity in an area of the parietal lobe of the cortex called the intraparietal sulcus, which receives input from the primary auditory cortex. This part of the brain is involved in both music perception and visual space perception. In one research study, people who described themselves as "tone deaf" and performed poorly on a test of ability to distinguish among different musical notes also performed poorly on a visual-spatial test that required them to mentally rotate pictured objects in order to match them to pictures of the same objects from other viewpoints (Douglas & Bilkey, 2007). Perhaps it is no coincidence that we (and also people who speak other languages) describe pitch in spatial terms-"high" and "low. Making Sense of Sounds Think of the subtlety and complexity of our auditory perception. With no cues but sound, we can locate a sound source within about 5 to 10 degrees of its true direction (Hudspeth, 2000a). To comprehend speech, we hear the tiny differences between plot and blot, while ignoring the much larger differences between two different voices that speak either of those words. All sounds set up patterns of waves on our basilar membranes, and from those seemingly chaotic patterns our nervous system extracts all the information needed for auditory perception. Locating Sounds the ability to detect the direction of a sound source contributes greatly to the usefulness of hearing. When startled by an unexpected rustling, we reflexively turn toward it to see what might be causing the disturbance. Such localization is also a key component of our ability to keep one sound distinct from others in a noisy environment. People can attend to one voice and ignore another much more easily if the two voices come from different locations in the room than if they come from the same location (Feng & Ratnam, 2000). Sound localization depends at least partly, and maybe mostly, on the time at which each sound wave reaches one ear compared to the other. A sound wave that is just slightly to the left of straight ahead reaches the left ear a few microseconds (millionths of a second) before it reaches the right ear, and a sound wave that is 90 degrees to the left reaches the left ear about 700 microseconds before it reaches the right ear. Some of these neurons respond most to waves that reach both ears at once; others respond most to waves that reach one ear some microseconds-ranging from just a few on up to about 700-before, or after, reaching the other ear. Sound A Analyzing Patterns of Auditory Input In the real world (outside of the laboratory), sounds rarely come in the form of pure tones. The sounds we hear, and from which we extract meaning, consist of highly complex patterns of waveforms. How is it that you identify the sweet word psychology regardless of whether it is spoken in a high-pitched or low-pitched voice, or spoken softly or loudly You identify the word not from the absolute amplitude or frequency of the sound waves, but from certain patterns of change in these that occur over time as the word is spoken. Beyond the primary auditory area are cortical areas for analyzing such patterns (Lombar & Malhotra, 2008; Poremba et al. For example, some neurons in areas near the primary auditory area respond only to certain combinations of frequencies, others only to rising or falling pitches, others only to brief clicks or bursts of sound, and still others only to sound sources that are moving in a particular direction (Baumgart et al. In macaque monkeys, some cortical neurons respond selectively to particular macaque calls (Rauschecker et al. In the end, activity in some combination of neurons in your cerebral cortex must provide the basis for each of your auditory experiences, but researchers are only beginning to learn how that is accomplished. Neurons receiving input from the two ears are sensitive to this difference, which provides a code for sound localization. Without moving the head, it is difficult to distinguish a sound in front of the head from one that is at the same angle in back of the head, but a head rotation quickly resolves that problem. Phonemic Restoration: An Auditory Illusion In certain situations our auditory system provides us with the perception of sounds that are not really present as physical stimuli. Phonemes are the individual vowel and consonant sounds that make up words, and phonemic restoration is an illusion in which people hear phonemes that have been deleted from words or sentences as if they were still there. The perceptual experience is that of really hearing the missing sound, not that of inferring what sound must be there. Richard Warren (1970) first demonstrated this illusion in an experiment in which he removed an s sound and spliced in a coughing sound of equal duration in the following tape-recorded sentence at the place marked by an asterisk: the state governors met with their respective legi*latures convening in the capital city. People listening to the doctored recording could hear the cough, but it did not seem to coincide with any specific portion of the sentence or block out any sound in the sentence. Even when they listened repeatedly, with instructions to determine what sound was missing, subjects were unable to detect that any sound was missing. Not surprisingly, phonemic restoration has been found to be much more reliable for words that are very much expected to occur in the sentence than for words that are less expected (Sivonen et al. Which sound is heard in phonemic restoration depends on the surrounding phonemes and the meaningful words and phrases they produce. The restored sound is always one that turns a partial word in to a whole word that is consistent in meaning with the rest of the sentence. Most remarkably, even words that occur after the missing phoneme can influence which phoneme is heard. For example, people heard the stimulus sound *eel (again, the asterisk represents a cough-like sound) as peel, heel, or wheel, depending on whether it occurred in the phrase the *eel was on the orange, the *eel was on the shoe, or the *eel was on the axle (Warren, 1984). The illusory phoneme was heard as occurring at its proper place, in the second word of the sentence, even though it depended on the words that followed it. One way to make sense of this phenomenon is to assume that much of our perceptual experience of hearing derives from a brief auditory sensory memory, which lasts for a matter of seconds and is modifiable. People hear a missing note in a familiar tune as if it were present (DeWitt & Samuel, 1990). In everyday life the sounds we listen to are often masked by bits of noise, never by bits of silence, so perhaps illusory sound restorations are an evolutionary adaptation by which our auditory system allows us to hear meaningful sound sequences in a relatively uninterrupted stream. When a burst of noise masks a phoneme or a note, our auditory system automatically, after the fact, in auditory memory, replaces that burst with the auditory experience that, according to our previous experience, belongs there. Auditory restoration nicely exemplifies the general principle that our perceptual systems often modify sensory input in ways that help to make sense of that input. We will present more examples of this principle in Chapter 8, which deals with vision. Basic Facts of Hearing Pitch Perception Making Sense of Sounds Physically, sound is the vibration of air or another medium caused by a vibrating object. The outer ear funnels sound inward, the middle ear amplifies it, and the inner ear transduces and codes it. Conduction deafness is due to middle ear rigidity; sensorineural deafness is due to inner ear or auditory nerve damage. Sounds set up traveling waves on the basilar membrane, which peak at different positions depending on frequency. The traveling-wave theory helps to explain the asymmetry of auditory masking and the typical pattern of age-related hearing loss. For frequencies below 4,000 Hz, the timing of action potentials also codes sound frequency. Most sounds are complex waveforms requiring analysis in cortical areas beyond the primary auditory area. The phonemic restoration effect illustrates the idea that context and meaning influence sensory experience. Even details are easier to remember if tied to larger themes, or arguments, than if seen as isolated facts. Here are two themes that ran through the chapter and may help you to organize your review: 1. The mechanisms of transduction and coding All sensory systems respond to physical stimuli by producing action potentials (the process of transduction), and all sensory systems do this in such a way as to preserve useful information about the stimulus (coding). For each sense discussed in this chapter- smell, taste, pain, and hearing-you might think about each of the following questions pertaining to transduction and coding: (a) To what type of physical stimulus does this sense respond, and what is the range of stimuli to which it responds The chapter does not answer all these questions (especially not the last) completely for each sense, but the questions provide a good framework for organizing and thinking about the information that is provided. They are not unbiased recorders of physical energies but biological tools designed to pick out from the sea of energy around us the information that is potentially most useful. We are sensitive to some kinds of energies and not others, and, within the kinds to which we are sensitive, our senses extract and enhance some relationships and not others. Here are some examples, described in the chapter, of how sensory processes can be understood in terms of their survival advantages: (a) Sensory adaptation (the decline in sensitivity to prolonged, constant stimuli) helps us to ignore stimuli that remain unchanged and to notice changes. Evolved mechanisms increase pain sensitivity at times of illness, when it is best to rest. The book includes such topics as drug sniffing (by humans as well as dogs), the role of scent in flavor, attempts to odorize movies, and the role of odor in evoking memories. Along the way, he discusses the many causes of pain and the many weapons in the arsenal against it, ranging from acupuncture and behavior therapy to drugs and surgery. In this fascinating book, based on her own research and that of others, Field describes the psychological functions of the sense of touch. Of greatest interest is research on the medical benefits of touch and massage, including growthpromoting effects of touch in infants. This delightful book, about the neuroscience and psychology of music, is written by a former musical performer and producer turned neuroscientist. It deals with questions of how our brains process musical sounds, how such sounds act upon emotional mechanisms in our brains, and the reasons for individual differences in musical preferences. In the final chapter, Levitin argues that music played an important evolutionary role in attracting mates and in binding people together in to cooperative groups. New York: Simon & Schuster Barb Stuckey works as a professional food inventor and knows the five flavor categories with profound fluency. She uses her own experiences to demonstrate the importance of our other senses in taste, what the five basic tastes involve, and how to balance them. In her easy-to-read book, Stuckey shows readers why we experience foods the way we do, why some people like bitter tastes and others prefer sweet, and she explains how we go from sensing food to perceiving flavor. Our eyes are our primary gateway for perceiving and understanding the physical world in which we survive. In reality, our visual perceptions are subjective, psychological experiences, which our brains create almost instantly, and continuously as long as our eyes are open, from clues that lie in the patterns of light reflected off objects. The machinery that underlies our ability to produce such perceptions is incredibly complex. Brain scientists have estimated that somewhere between 25 and 40 percent of the human brain is devoted exclusively or primarily to the analysis of input from the eyes (Gross, 1998; Sereno et al. It is no wonder that vision is the sense to which psychologists have paid by far the greatest attention. From there we go on to examine our abilities to perceive colors, patterns, objects, and depth in three-dimensional space. We conclude the chapter with a discussion of the fascinating phenomenon of multisensory perception. Most forms of earthly life are sensitive in one way or another to that light (Land & Furnald, 1992). Stimulation of these cells by light causes the worm to wriggle back down in to the earth, where it finds safety, moisture, and food. Young man: mediaphotos/E+/Getty Images; Landscape: Dmitry Rukhlenko/Image Source/Getty Images. Licensed Material is being used for illustrative purposes only; person depicted in the licensed material is a model.

Perpetuating causes are those consequences of a disorder that help keep it going once it begins blood pressure variation during the day cheap 0.25mg lanoxin visa. In some cases blood pressure chart low to high buy 0.25mg lanoxin mastercard, a person who behaves maladaptively may gain rewards pulse pressure under 30 discount lanoxin express, such as extra attention blood pressure chart age 60 order genuine lanoxin, which helps perpetuate the behavior blood pressure chart age 40 buy lanoxin overnight. For example blood pressure quiz pdf generic 0.25mg lanoxin otc, a sufferer of depression may withdraw from friends, and lack of friends can perpetuate the depression. Similar patterns of cumulative risk are found for physical and mental health outcomes (Evans, 2003). Expectations associated with a particular disorder may play a perpetuating role as well. In a culture that regards a particular disorder as incurable, a person diagnosed with that disorder may simply give up trying to change for the better. Possible Causes of Sex Differences in the Prevalence of Specific Disorders Little difference occurs between men and women in the prevalence of mental disorder when all disorders are combined, but large differences are found for specific disorders (American Psychiatric Association, 2013). Women are diagnosed with anxiety disorders and depression at rates that are nearly twice as great as those for men. Men are diagnosed with intermittent explosive disorder (characterized by relatively unprovoked violent outbursts of anger) and with antisocial personality disorder (characterized by a history of antisocial [harmful to others] acts with no sense of guilt) at rates that are three or four times those for women. Men are also diagnosed with substance-use disorders (including alcohol dependence and other drug dependence) at rates that are nearly twice as great as those for women. Diagnoses of anxiety disorders and of depression necessarily depend to a great extent on selfreporting. Men, who are supposed to be the "stronger" sex, may be less inclined than women to admit to anxiety and despondency in interviews or questionnaires. Supporting this view, experiments have shown that when men and women are subjected to the same stressful situation, such as a school examination, men report less anxiety than do women even though they show physiological signs of distress that are as great as, or greater than, those shown by women (Polefrone & Manuck, 1987). Diagnosticians may, to some degree, find a disorder more often in one sex than in the other because they expect to find it. In an experiment demonstrating such an expectancy bias, several hundred clinical psychologists in the United States were asked to make diagnoses on the bases of written case histories that were mailed to them (Ford & Widiger, 1989). Even today the word "hysterical" may come to mind more quickly when we view an angry woman than when we view an angry man. That same bias may contribute to the more frequent diagnosis of histrionic personality in women than in men. Each of these case histories was written in duplicate forms, for different clinicians, differing only in the sex of the person being described. Given the exact same case histories, the man was far more likely than the woman to receive a diagnosis of antisocial personality, and the woman was far more likely than the man to receive a diagnosis of histrionic personality. A number of well-controlled studies indicate that at least some sex differences in the prevalence of disorders are real-they cannot be explained by sex differences in reporting or by biased diagnoses (Klose & Jacobi, 2004). One way to explain such actual differences is to search for differences in the social experiences of men and women. Throughout the world, women are more likely than men to live in poverty, to experience discrimination, to have been sexually abused in childhood, and to be physically abused by their spouses-all of which can contribute to depression, anxiety, and various other disorders that occur more often in women than in men (Koss, 1990; Nolen-Hoeksema, 2001; Olff et al. There is also evidence that the typical responsibilities that women assume in the family, such as caring for children, are more conducive to anxiety and depression than are the typical roles that men assume (Almeida & Kessler, 1998; Barnett & Baruch, 1987). The two sexes not only tend to experience different sorts of stressful situations, but also tend to respond differently to objectively similar situations (Kramer et al. Women tend to "internalize" their discomfort; they dwell mentally (ruminate) on their distress and seek causes within themselves. This manner of responding, in either sex, tends to promote both anxiety and depression (Kramer et al. Men, in contrast, more often "externalize" their discomfort; they tend to look for causes outside of themselves and to try to control those causes, sometimes in ways that involve aggression or violence. It is not clear what causes these differences in ways of responding, but it is reasonable to suppose that they are, in part, biologically predisposed. Such differences are observed throughout the world, and there is evidence that male and female hormones influence the typically male and female ways of reacting to stressful situations (Olff et al. Predisposing causes include genetic influences, early environmental effects on the brain, and learned beliefs. Perpetuating causes include poor self-care, social withdrawal, and negative reactions from others. Some diagnoses are much more prevalent in women, and some others are much more prevalent in men. With muscles tense, the rabbit is poised to leap away at the fi rst sign that it has been detected; its heart races, and its adrenal glands secrete hormones that help prepare the body for extended flight if necessary. Here we see fear operating adaptively, as it was designed to operate by natural selection. We humans differ from the rabbit on two counts: Our biological evolution added a massive, thinking cerebral cortex atop the more primitive structures that organize fear, and our cultural evolution led us to develop a habitat far different from that of our ancestors. Anxiety disorders are those in which fear or anxiety is the most prominent disturbance. Nevertheless, because some of the symptoms of these two disorders are similar to those of anxiety disorders, we discuss them in this section. Genetic differences play a considerable role in the predisposition for all these disorders. Research with twins indicates that roughly 30 to 50 percent of the individual variability in risk to develop any given anxiety disorder derives from genetic variability (Gelernter & Stein, 2009; Gordon & Hen, 2004). In what follows, we will describe the main diagnostic characteristics and precipitating causes of each of these common types of anxiety disorders. Generalized Anxiety Disorder Generalized anxiety is called generalized because it is not focused on any one specific threat; instead, it attaches itself to various threats, real or imagined. Sufferers of generalized anxiety disorder worry more or less continuously, about multiple issues, and they experience muscle tension, irritability, and difficulty in sleeping. They worry about the same kinds of issues that most of us worry about- family members, money, work, illness, daily hassles-but to a far greater extent and with much less provocation (Becker et al. Roughly 6 percent of people in North America could be diagnosed as having this disorder at some time in their lives (Kessler et al. In predisposed people, the disorder often first appears at a diagnosable level following a major life change in adulthood, such as getting a new job or having a baby; or after a disturbing event, such as a serious accident or illness (Blazer et al. For example, they notice threatening words (such as "cancer" or "collapse") more quickly, reliably, and automatically than do other people, whereas they show no such differences in recognition of nonthreatening words (Mogg & Bradley, 2005). Such automatic attention to potential threat is referred to as hypervigilance, and there is evidence that such vigilance begins early in life and precedes the development of generalized anxiety disorder (Eysenck, 1992). Thus, hypervigilance may be a predisposing cause of generalized anxiety disorder as well as a symptom of the disorder. In most of us, connections from the prefrontal lobe of the cortex help to control the fear reactions, but neuroimaging studies suggest that these inhibitory connections are less effective in people who are predisposed for generalized anxiety (Bishop, 2009). A lifelong tendency toward hypervigilance is also found in many individuals who experienced unpredictable traumatic experiences in early childhood (Borkovec et al. In an environment where dangerous things can happen at any time, a high degree of vigilance is adaptive. Surveys taken at various times, using comparable measures, indicate that the average level of generalized anxiety in Western cultures has increased sharply since the middle of the twentieth century (Twenge, 2000). In a world of rapidly changing values and expectations, we have difficulty judging right from wrong or safe from unsafe. Such threats may be felt only dimly and lead not to conscious articulation of specific fears but to generalized anxiety. And, unlike the predator that scares the rabbit one minute and is gone the next, these threats are with us always. Phobias In contrast to generalized anxiety, a phobia is an intense, irrational fear that is very clearly related to a particular category of object or event. It may be of a particular type of animal (such as snakes), substance (such as blood), or situation (such as heights or being closed in). For a diagnosis to be given, the fear must be long-standing and sufficiently strong to disrupt everyday life in some way-such as causing one to leave a job or to refrain from leaving home in order to avoid encountering the feared object. Phobias are quite prevalent; surveys suggest that they are diagnosable, at some time in life, in somewhere between 7 and 13 percent of people in Western societies (Hofmann et al. Usually a phobia sufferer is aware that his or her fear is irrational but still cannot control it. People with phobias suffer doubly-from the fear itself and from knowing how irrational they are to have such a fear (Williams, 2005). Laboratory research shows that people with phobias are hypervigilant specifically for the category of object that they fear. For example, people with spider phobias can find spiders in photographs that contain many objects more quickly than can other people. Once they have spotted the object, however, they avert their eyes from it more quickly than do other people (Pflugshaupt et al. Phobias are usually of things that many people fear to some extent, such as snakes, spiders, blood, darkness, or heights (Marks, 1987); and social phobias may simply be extreme forms of shyness (Rapee & Spence, 2004). Also consistent with the idea that phobias lie on a continuum with normal fears is the observation that phobias are much more often diagnosed in women than in men (American Psychiatric Association, 2013). In the population as a whole, men and boys are much less likely than women and girls to report fears of such things as spiders and darkness. The sex difference in phobias could stem from the fact that boys are more strongly encouraged than are girls to overcome or to hide their childhood fears (Fodor, 1982). Phobias Explained in Terms of Evolution and Learning Relatively little is known about how phobias usually arise, but learning certainly plays some role in many, if not most, cases (Mineka & Zinbarg, 2006). Approximately 40 percent of people with phobias recall some specific traumatic situation in which they first acquired the fear (Hofmann et al. For example, people with dog phobias often recall an experience of being severely bitten by a dog. As described in Chapter 4, such experiences may be understood in terms of classical conditioning: the dog, in the example, is the conditioned stimulus for fear, and the bite is the unconditioned stimulus. In such trauma-producing situations, just one pairing of conditioned and unconditioned stimuli may be sufficient for strong conditioning to occur. Contrary to a straightforward learning theory of phobias, however, is the observation that people often develop phobias of objects that have never inflicted damage or been a true threat to them. For example, a survey conducted many years ago in Burlington, Vermont, where there are no dangerous snakes, revealed that the single most common phobia there was of snakes (Agras et al. This idea is helpful in understanding why phobias of snakes, spiders, darkness, and heights are more common than those of automobiles and electric outlets. Research has shown that people can acquire strong fears of such evolutionarily significant objects and situations more easily than they can acquire fears of other sorts of objects (Mineka & Zinbarg, 2006). Simply observing others respond fearfully to them, or reading or hearing fearful stories about them, can initiate or contribute to a phobia. With respect to snakes, anyway, young children, although not innately fearful of snakes, more easily associate them with fearful responses than other animals. A sight such as this might cause someone with a spider phobia to avoid sunflowers forever after. Although the children showed no fear of snakes when first watching the video, they looked longer at the snakes when they heard the fearful voice than when they heard the happy voice. There was no difference in their looking times to the two voices when they watched videos of other animals. These findings, along with others showing that monkeys more readily react fearfully after watching another monkey respond with freight to a snake than to a rabbit or a flower (Cook & Mineka, 1989), suggest that infants are prepared to acquire a fear of snakes. Neither children nor monkeys are born with this fear, but rather they seem to possess perceptual biases to attend to certain types of stimuli and to associate them with fearful voices or reactions. Suppose you have had a great deal of safe, prior experience with a type of object, such as snakes. In that case, if you are unfortunate enough to have a traumatic encounter with a snake, you are less likely to develop a snake phobia than are people whose first exposure to snakes was traumatic (Field, 2006). As discussed in Chapter 4, classical conditioning of fears is reduced or blocked if the conditioned stimulus is first presented many times in the absence of the unconditioned stimulus. People with phobias have a strong tendency to avoid looking at or being anywhere near the objects they fear, and this behavior pattern tends to perpetuate the disorder. To understand why this is so, recall from Chapter 4 that operant conditioning occurs through reinforcement following a behavior. When confronted with the feared object, even in the form of a photograph or television show, the person experiences anxiety. By avoiding the object, the person experiences the negative reinforcement of reduced anxiety ("Ah! Without exposure to snakes, there is little opportunity to overcome a fear of them. Panic Disorder and Agoraphobia Peter Cade/The Image Bank/Getty Images Panic A man who has just been attacked by a thief has a reason to feel panic. People with panic disorder feel panic such as this at unpredictable times, without provocation. Panic is a feeling of helpless terror, such as one might experience if cornered by a predator. In some people, this sense of terror comes at unpredictable times, unprovoked by any specific threat in the environment. Because the panic is unrelated to any specific situation or thought, the panic victim, unlike the victim of a phobia or an obsessive compulsion, cannot avoid it by avoiding certain situations or relieve it by engaging in certain rituals. Panic attacks usually last several minutes and are accompanied by high physiological arousal (including rapid heart rate and shortness of breath) and a fear of losing control and behaving in some frantic, desperate way (Barlow, 2002).

Order lanoxin. High Blood Pressure Medications and Erectile Dysfunction Dr.