DIAGNOSTIC REVIEWER
ABPSY
Shenairah Cuarto
ABNORMAL PSYCHOLOGY
INTRODUCTION AND HISTORY OF ABPSY
I.
Defining Psychopathology
• Psychopathology – Study of the nature, symptomatology,
development, and treatment of psychological disorders
- Challenges to the study of psychopathology: (1) Maintaining
objectivity, (2) Avoiding preconceived notions, (3) Reducing stigma
• Science-Practitioner model - mental health professionals take a
scientific approach to their clinical work
• Clinical description - represents the unique combination of
behaviors, thoughts, and feelings that make up a specific disorder
• Presents – what is the presenting problem of the client?
• Prevalence - how many people in the population as a whole have
the disorder?
• Incidence - how many new cases occur during a given period, such
as a year?
• Onset – how’s the beginning of the disorder
o acute onset - they begin suddenly
o insidious onset - develop gradually
• Course – disorders follow a somewhat individual pattern
o Chronic course - they tend to last a long time
o Episodic course - likely to recover and to suffer a recurrence
o Time-limited course - will improve without treatment in a
relatively short period
• Etiology – What contributes to the development of
psychopathology?
• Treatment Development – How can we help to alleviate
psychological suffering? (Includes pharmacologic, psychosocial,
and/or combined treatments)
• Prognosis – The anticipated course of a disorder (e.g., good or
guarded)
• Treatment Outcome Research – How do we know that we have
helped?
II. Key Characteristics of Mental Disorder in DSM definition
• Dysfunction (Psychological dysfunction)
- Breakdown in cognitive, emotional, or behavioral functioning
- Internal mechanism is unable to perform its usual function
- I.e. Cognitive dysfunction in individual experiencing delusion with
thought processes not consistent to reality.
• Distress (Personal distress)
- A person’s behavior may be classified as disordered if it causes
him or her great distress.
• Disability of Impairment
- Impairment in some important area of life (e.g., work or personal
relationships)—can also characterize mental disorder.
- Impairment is set in the context of a person’s background
• Deviance (Violation of social norms)
- Reaction is outside cultural norms
- Something is considered abnormal because it occurs infrequently;
- It deviates from the average.
• Diagnostic and Statistical Manual
- Widely accepted system; Used to classify psychological problems
and disorders
- Contains Diagnostic Criteria for Behaviors That – Fit a pattern –
Cause dysfunction or subjective distress – Are present for a
specified duration – And for behaviors that are not otherwise
explainable
• Abnormality (Psychological disorder/Psychological abnormality)
- describes behavioral, psychological, or biological dysfunctions
that are unexpected in their cultural context and associated with
present distress and impairment in functioning, or increased risk
of suffering, death, pain, or impairment.
- Mental illness -least preferred term
• Normality - a process; stages of development
Ideal- no perfectly normal
III. History of Mental Disorders
A. Demonology
- The doctrine that an evil being or spirit can dwell within a
person and control his or her mind and body thereby can be
treated by: Exorcism - the ritualistic casting out of evil spirits.
• Trephination - cutting holes to the skull in the belief that evil
spirits may come out
• Hydrotherapy - patients were shocked back to their senses by
being submerged in ice-cold water.
B. Early biological explanations
➢ Hippocrates (5th century) - Mental disturbances have
natural (not supernatural) causes.
- Four humors: blood (sanguine), black bile (melancholia),
yellow bile (choleric), & phlegm (phlegmatic)
C. Dark Ages
- Church gained in influence, and the papacy was declared
independent of the state. Christian monasteries, through
their missionary and educational work, replaced physicians as
healers and as authorities on mental disorder
- Monks cared and prayed for mentally ill; concocted potions
- Persecution of witches (13th century)
• Witchcraft - was viewed as instigated by Satan, was seen as a
heresy and a denial of God.
– Those accused of witchcraft (many were mentally ill) should
be tortured
• Lunacy trials – (England, 13th century)
- Attributes insanity to misalignment of moon and stars.
- Municipal authorities assumed responsibility for care of
mentally ill
- Trials held to determine sanity
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DIAGNOSTIC REVIEWER
ABPSY
Shenairah Cuarto
F.
- The trials were conducted under the Crown’s right to
protect the people with mental illness
• Mass Hysteria
– characterized by large-scale outbreaks of bizarre behavior.
– In Europe, whole groups of people were simultaneously
compelled to run out in the streets, dance, shout, rave, and
jump around in patterns as if they were at a particularly wild
party late at night (still called a rave), but without the music.
– The behavior was known by several names, including Saint
Vitus’s Dance and tarantism.
D. Renaissance and Rise of Asylums
- Characterized as a time of extreme cultural and scientific
growth, and a decline of religious influence.
- Rise of Asylums and specializations in mental health care.
• Johann Weyer - first physician to specialize in illnesses of
the mind.
• Gheel Belgium - First religious mental health facility
• Bethlehem Hospital, Spain - First medical mental Asylum
• Asylum- Establishments for the confinement and care of
mentally ill
• St. Mary of Bethlehem – one of the first mental institutions
- Origin of the term bedlam
- Eventually became one of London’s great tourist
attractions
- Early medical treatment could be harmful
➢ Benjamin Rush recommended drawing copious
amounts of blood and believed that the could be
cured by being frightened.
E. Nineteenth century: Reform and Moral Treatment
➢ Philippe Pinel and Jean-Baptiste Pussin (18th-19th
Century)
– Pioneered humanitarian treatment at LaBicetre
– Pinel is said to have begun to treat the patients as sick
human beings rather than as beasts
– He unchained the patients and allowed them to move
freely about the hospital grounds
➢ William Tuke (1732–1819)
- was bringing similar reforms to northern England.
- In 1796 he founded the York Retreat, a rural estate where
about 30 mental patients lived as guests in quiet country
houses and were treated with a combination of rest, talk,
prayer, and manual work
➢ Dorothea Dix (1802-1887)
– Crusader for prisoners and mentally ill; Urged
improvement of institutions
– Worked to establish 32 new, public hospitals
– Known as mental hygiene movement.
Contemporary thought: Biological Approaches
➢ Louis Pasteur (1860s) - established the germ theory of
disease, which set forth the view that disease is caused by
infection of the body by minute organisms.
• General paresis – Degenerative disorder with
psychological symptoms and individuals with GP also have
syphilis
– 1905 discovery of microorganism that causes syphilis
– Since general paresis had biological cause, other mental
illness might also.
➢ Francis Galton (late 1800s) - lead to notion that mental
illness can be inherited
• Behavioral genetics – Extent to which behavioral
differences are due to genetics
• Eugenics – Promotion of enforced sterilization to eliminate
undesirable characteristics from the population
– Many state laws (late 1800s and early 1900s) prohibited
marriage and required mentally ill to be sterilized
– Such laws were upheld by the U.S. Supreme Court in 1927
– By 1945, more than 45,000 people with mental illness in
the United States had been forcibly sterilized
Early Biological Treatments
• Insulin-coma therapy (Manfred Sakel, 1927) – Inducing a coma
with large dosages of insulin
• Electroconvulsive Therapy (ECT), Cerletti and Bini (1938) –
Applying electric shocks that produce epileptic seizures to the
sides of the human head
• Prefrontal lobotomy, Egas Moniz (1935) – A surgical procedure
that destroys the tracts connecting the frontal lobes to other
areas of the brain
– Often led to listlessness, apathy, and lack of some cognitive
abilities
G. Early Foundations: Psychological Approaches
➢ Emil Kraepelin - Pioneered classification of mental illness
based on biological causes
- Published 1st psychiatry text (1883)
- Mental illness as syndrome – Cluster of symptoms that cooccur
- Proposed two major syndromes (1) Dementia praecox (2)
Manic-depressive psychosis
➢ Franz Mesmer (1734-1815) – Treated patients with hysteria
using “animal magnetism”
– Early practitioner of hypnosis called mesmerism
➢ Jean Martin Charcot (1825–1893) – hysteric symptoms could
be removed through hypnosis
– It’s a problem with the nervous system and had biological
cause, he was also persuaded by psychological explanations.
➢ Josef Breuer (1842-1925) – Used hypnosis to facilitate
catharsis, the case of Anna O.
• Catharsis - Release of emotional tension triggered by
reliving and talking about event
• In 1895, Breuer and a younger colleague, Sigmund
Freud (1856–1939), jointly published Studies in
Hysteria, partly based on the case of Anna O.
➢ Sigmund Freud and Psychoanalysis (1856-1939)
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ABPSY
Shenairah Cuarto
• Psychoanalytic theory – Human behavior determined by
unconscious forces.
– Psychopathology results from conflicts among these
unconscious forces.
IV. Current Paradigms in Psychopathology
A. The Genetic-Environment Paradigm - This paradigm shows how
behavior, abnormal behavior and psychopathology are being
influenced by the interaction of the genes and the environment.
- Genes do not dictate behavioral outcomes
- Genetic factors create a predisposition or likelihood—not a
certainty—that certain behaviors or disorders will develop.
• Heredity - is an important predisposing causal factor for a
number of different disorders – such as depression,
schizophrenia, and alcoholism
• Gene-environment interaction - means that a given person’s
sensitivity or reaction to an environmental event is influenced
by genes.
• Depression and Serotonin transporter gene(5-HTT). - They
found that those individuals who had either the short-short
allele or the shortlong allele combinations of the 5-HTT gene
and were maltreated as children were more likely to have
depression as adults
B. Neuroscience Paradigm - Examines the contribution of brain
structure and function to psychopathology
• Brain dysfunction: (1) psychophysiology – neural pathway, (2)
neuropathology – brain damage, shrinkage, or enlargement
Mechanisms
• Neurons – basic unit of nervous system
• Neurotransmitter - Chemicals that allow neurons to send a
signal across the synapse (gap) to another neuron.
o Excitatory - cause it to “fire off the message
o Inhibitory - block or prevent the chemical message
• Reuptake - Reabsorption of leftover neurotransmitter by
presynaptic neuron
• Possible mechanisms  Excessive or inadequate levels 
Insufficient reuptake  Excessive number or sensitivity of
postsynaptic receptors
*correction in neurotransmitter table
• Low levels of dopamine – Parkinson’s disease
• High levels of dopamine – Schizophrenia, mania
• Pseudoparkinsonism – side effect of dopamine to individuals
with schizophrenia
Nervous System
a. Central Nervous System (CNS)
• Brain
- Hindbrain
• Medulla - plays roles in vital life-support functions such as
heart rate, respiration, and blood pressure
• Pons - transmits information about body movement and is
involved in functions related to attention, sleep, and
relaxation
• Cerebellum - regulates balance and motor (muscle) behavior
- Midbrain
• Tectum – important in sensory processing such as hearing and
vision
• Tegmentum – also involves structures responsible for certain
movements
• Substantia Nigra - gives rise to a dopamine-containing
pathway that facilitates readiness for movement
- Forebrain
• Thalamus - relays sensory information (such as tactile and
visual stimulation) to the higher regions of the brain
• Hypothalamus - plays a key role in many vital bodily functions,
including regulation of body temperature, concentration of
fluids in the blood, and reproductive processes, as well as
emotional and motivational state
• Limbic system - plays important roles in emotional processing
and memory.
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ABPSY
Shenairah Cuarto
• Basal ganglia - lie at the base of the forebrain and are involved
in regulating postural movements and coordination
• Cerebral cortex - is the surface of the cerebrum is convoluted
with ridges and valleys. It involves in thinking, planning, and
executive center of the brain, as well as the seat of
consciousness and the sense of self
LOBES OF CEREBRAL CORTEX
• Frontal - reasoning, problem solving, working memory
• Parietal - Receipt of sensations of touch, pressure, pain,
temperature and body position
• Temporal - discrimination of sounds
• Occipital – Vision
❖ Hippocampus shrinks – memory is fragmented
❖ Other brain damages:
- Medial temporal lobe – (1) anterograde amnesia –
impairs new learning and memory (2) retrograde amnesia
– impaired memory that was acquired before damage.
- Broca’s area: Broca’s dysphasia - extreme difficulty
forming words and sentences, and may speak with
difficulty or not at all.
- Wernicke’s area: Fluent aphasia - a person can speak
phrases that sound fluent (have a lot of words) but lack
meaning
b. The Peripheral Nervous System (PNS)
- is a network of neurons connecting the brain to our sense
organs—our eyes, ears, and so on—as well as our glands
and muscles
- These neural pathways allow us to both sense the world
around us and act on it by using our muscles to move our
limbs
c. Somatic Nervous System
- transmits messages from our sensory organs to the brain
for processing, leading to the experience of visual,
auditory, tactile, and other sensations.
d. Autonomic Nervous System
- regulates the glands and involuntary processes
• Sympathetic Nervous System - Heartbeat acceleration,
pupil dilation, gastrointestinal inhibition, electrodermal
activity increases
• Parasympathetic Nervous System - Heartbeat
deceleration, pupil constriction, gastrointestinal
activation
e. Neuroendocrine System
- HPA axis (hypothalamus-pituitary-adrenal cortex) is
central to the body’s response to stress, and stress figures
prominently in many of the disorders
• Neuroscience treatment
Antidepressant
Antipsychotic
Benzodiazepenes
C. Psychological Paradigm
a. Psychodynamic views
- the roots of psychological problems involve unconscious
motives and conflicts that can be traced back to childhood
• Normality - The ego is strong enough to control the instincts
of the id and to withstand the condemnation of the
superego.
• Abnormality - abnormal behavior patterns represent
symptoms of these dynamic struggles taking place within
the unconscious mind
- Some unconscious impulses may “leak” producing anxiety
or leading to psychological disorders
b. Learning-based models
- Focuses on the role of learning in explaining both normal
and abnormal behavior.
- Abnormal behavior represents the acquisition, or
learning, of inappropriate, maladaptive behaviors.
- Abnormal behavior is learned in much the same way as
normal behavior
- human behavior is the product of our genetic inheritance
and environmental or situational influences
- Classical and Operant conditioning
• Social-Cognitive Theory - Expanded traditional learning
theory by including roles for thinking, or cognition, and
learning by observation
c. Cognitive models
- study the cognitions—the thoughts, beliefs, expectations,
and attitudes—that accompany and may underlie
abnormal behavior
• Information-Processing Models - Psychological disorders
may represent disruptions or disturbances in how
information is processed.
- Blocking or distortion of input or faulty storage, retrieval,
or manipulation of information can lead to distorted
output
• ABC Approach – Activating event, Belief,
Consequences
• Cognitive Distortions
Selective abstraction - People may selectively
abstract (focus exclusively on) the parts of their
experiences that reveal their flaws and ignore
evidence of their competencies.
Overgeneralization - People may overgeneralize
from a few isolated experiences.
Magnification - People may blow out of
proportion, or magnify, the importance of
unfortunate events
Absolutist thinking - is seeing the world in blackand-white terms, rather than in shades of gray
d. Humanistic models
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DIAGNOSTIC REVIEWER
ABPSY
Shenairah Cuarto
-
Emphasizing the personal freedom human beings have in
making conscious choices that imbue their lives with a
sense of meaning and purpose.
- Rogers held that abnormal behavior results from a
distorted concept of the self.
- Parents can help children develop a positive self-concept
by showing them unconditional positive regard
- Children will learn to develop conditions of worth; that is,
they will think of themselves as worthwhile only if they
behave in certain approved ways.
- The result can be a distorted self-concept: the children
become strangers to their true selves
e. Sociocultural Perspective
- Seek causes of abnormal behavior in the failures of society
rather than in the person
- Social ills, such as poverty, racism, and prolonged
unemployment, contributing to the development of
abnormal behavior; relationships among abnormal
behavior and ethnicity, gender, culture, and
socioeconomic level
f. Biopsychosocial perspective
- examines contributions of multiple factors spanning
biological, psychological, and sociocultural domains, as
well as their interactions, in the development of
psychological disorders
• Diathesis-Stress model of disorder
- Diathesis - Underlying predisposition (biological or
psychological); Increases one’s risk of developing
disorder
- Stress - Environmental events; May occur at any point
after conception; Triggering event
V. Classification and Diagnosis of Abnormal Behavior
• Diagnosis - The classification of disorders by symptoms and signs.
- Facilitates communication among professionals
- Advances the search for causes and treatments
- Cornerstone of clinical care
• Diagnostic and Statistical Manual of Mental Disorders (DSM-5) –
published by American Psychological Association
MAJOR CHANGES IN DSM-5
- Removal of the Multiaxial System
- In place of the first three axes of DSM-IV-TR, clinicians are simply
to note psychiatric and medical diagnoses
- Organizing Diagnoses by Causes - The DSM-IV-TR diagnoses are
clustered into chapters based on similarity of symptoms. In the
DSM-5, the chapters are reorganized to reflect patterns of
comorbidity and shared etiology
- Enhanced Sensitivity to the Developmental Nature of
Psychopathology - In DSM-IV-TR, childhood diagnoses were
considered in a separate chapter.
- New diagnoses (14) – i.e. Disruptive Mood Dysregulation
Disorder; Premenstrual Dysphoric Disorder; Disinhibited Social
Engagement Disorder
- Clearer criteria
- Ethnic and cultural considerations in diagnosis
CULTURAL CONCEPTS OF DISTRESS
• Dhat – (India) to refer to severe anxiety about the discharge of
semen.
• Shenjing shuairuo – (China) a syndrome characterized by
fatigue, dizziness, headaches, pain, poor concentration, sleep
problems, and memory loss.
• Taijin kyofusho (Japan) – The fear that one could offend others
through inappropriate eye contact, blushing, a perceived body
deformation, or one’s own foul body odor
• Comorbidity - refers to the presence of a second diagnosis.
Comorbidity is the norm rather than the exception
• Categorical classification - Presence/absence of a disorder (Either
you are anxious or you are not anxious)
• Dimensional classification – Rank on a continuous quantitative
dimension; Degree to which a symptom is present (How anxious are
you on a scale of 1 to 10)
❖ DSM-5 preserves a categorical approach to diagnosis
• Idiographic approach to diagnosis – considers personality, cultural
background, and circumstances
• Nomothetic approach to diagnosis – uses statistics and tests
ANXIETY DISORDERS
• Anxiety - is defined as apprehension over an anticipated problem
• Fear - is a reaction to immediate danger.
- Both involve physiological arousal (sympathetic nervous system)
- Both can be adaptive: Fear (fight or flight), Moderate anxiety
(preparedness)
GENERAL CRITERIA
- Symptoms must interfere with important areas of functioning or
cause marked distress.
- Symptoms are not caused by a drug or a medical condition.
- The fears and anxieties are distinct from the symptoms of another
anxiety disorder.
I. Specific Phobia
- Marked and disproportionate fear consistently triggered by
specific objects or situations
- The object or situation is avoided or else endured with intense
anxiety
- Symptoms persist for at least 6 months.
II. Social Anxiety Disorder
- Marked and disproportionate fear consistently triggered by
exposure to potential social scrutiny
- Exposure to the trigger leads to intense anxiety about being
evaluated negatively
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DIAGNOSTIC REVIEWER
ABPSY
Shenairah Cuarto
III.
IV.
V.
VI.
VII.
- Trigger situations are avoided or else endured with intense
anxiety
- Symptoms persist for at least 6 months
Panic Disorder
- Recurrent uncued panic attacks
- At least 1 month of concern about the possibility of more
attacks, worry about the consequences of an attack, or
maladaptive behavioral changes because of the attacks.
• Uncued panic attack - Occurred unexpectedly without
warning
• Cued panic attack – triggered by a specific situation
- is a sudden attack of intense apprehension, terror, and feelings
of impending doom, accompanied by at least four other
symptoms.
• Physical symptoms - labored breathing, heart palpitations,
nausea, upset stomach, chest pain, feelings of choking and
smothering, dizziness, lightheadedness, sweating, chills, heat
sensations, and trembling.
• Other symptoms – depersonalization, derealization
Agoraphobia
- Disproportionate and marked fear or anxiety about at least 2
situations where it would be difficult to escape or receive help
in the event of incapacitation, embarrassing symptoms, or
panic-like symptoms such as being outside of the home alone;
traveling on public transportation; being in open spaces such
as parking lots and marketplaces.
- These situations consistently provoke fear or anxiety
- These situations are avoided, require the presence of a
companion, or are endured with intense fear or anxiety 
Symptoms last at least 6 months
Generalized Anxiety Disorder
- Excessive anxiety and worry at least 50% of days about a
number of events or activities
- The person finds it hard to control the worry
- The worry is sustained for at least 6 months
- The anxiety and worry are associated with at least three (or one
in children) of the following: restlessness or feeling keyed up or
on edge; easily fatigued; difficulty concentrating or mind going
blank; irritability; muscle tension; sleep disturbance
Separation Anxiety Disorder
- Excessive fear of separation from home or attachment figures
- Worries for self and for attachment figures to be separated due
to loss, being kidnapped, or accidents
- Sustained for at least 4 weeks in children, 6 months for adults
Selective Mutism
- Consistent failure to speak in specific social situations
- Interferes with educational or occupational achievement and
social communication
- Disturbance lasts at least 1 month but not the 1st month of
school
- Not attributable to lack of knowledge in language
❖ Comorbidity of Anxiety Disorders
- More than half of people with one anxiety disorder meet the criteria
for another anxiety disorder during their life and is more
pronounced in GAD
- ¾ of those anxiety disorder meet criteria for another disorder
- 60% meet criteria for major depression
- Other disorders commonly comorbid with anxiety
Substance Abuse
Personality Disorders
Medical Disorders e.g. coronary heart diseases
❖ Gender and Sociocultural Factors
- Women are at least twice as likely as men to be diagnosed with
an anxiety disorder
• Taijin kyofusho (Japan) - fear of displeasing or embarrassing
others
• Koro (South and East Asia) - a sudden fear that one’s genitals
will recede into the body
• Susto (Latin America and Latinos) fright illness, the belief that a
severe fright has caused the soul to leave the body
❖ Etiology/Risk Factors of Anxiety Disorders
• Genetics – twin studies (20-40% for SAD and GAD; 50% for
Panic Disorder)
• Neurobiological
- Fear Circuit Activity: Amygdala – active, Medial
prefrontal cortex – less active
- Neurotransmitters:
Serotonin and Gaba – poor
functioning, Norepinephrine – higher than normal
• Behavioral – Fear conditioning: classical conditioning and
operant conditioning
• Personality
- Behavioral inhibition - a tendency to become agitated
and cry when faced with novel or unfamiliar settings
- Neuroticism - Tendency to react to events with greater
than-average negative affect.
• Cognitive
- Sustained negative beliefs about the future
- Low internal locus of control
- High attention to signs of threat
❖ Treatments to Anxiety Disorder
• Exposure therapy approaches
o Systematic desensitization - the client is first taught
relaxation skills. Then the client uses these skills to relax
while undergoing exposure to a list of feared situations
developed with the therapist— starting with the least
feared and working up to the most feared
o Behavioral view of exposure - is that it works by
extinguishing the fear response
o Cognitive view of exposure treatment - helps people correct
their mistaken beliefs that they are unable to cope with the
stimulus.
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DIAGNOSTIC REVIEWER
ABPSY
Shenairah Cuarto
o Virtual reality - is sometimes used to simulate feared
situations such as flying, heights, and even social
interactions
o CBT Exposure - exposure should include as many features of
the feared object as possible.
- Skin picking may be triggered by feelings of anxiety or
boredom, may be preceded by an increasing sense of
tension (either immediately before picking the skin or when
attempting to resist the urge to pick), and may lead to
gratification, pleasure, or a sense of relief when the skin or
scab has been picked.
❖ Etiology of Obsessive-Compulsive Related Disorders
• Genetics – heritability ranging from 30-50%
• Neurobiological – Hyper activity in brain regions: 
Orbitofrontal Cortex, Caudate Nucleus, Anterior Cingulate
• Cognitive
o Yedasentience – sense of being enough; people with OCD
fail to gain the internal sense of completion.
o Thought suppression - People who report more thought
suppression also report more obsessive symptoms
o Mistrust of memory - describe feeling a lack of confidence
about their memories
- People with BDD appear to focus on details more than on
the whole
- People with HD demonstrate an extreme emotional
attachment to their possessions. They report feeling
comforted by their objects.
• Behavioral – Operant (compulsions are reinforced to reduce
anxiety)
❖ Treatment of OCD and Related disorders
• Exposure and Response Prevention
OBSESSIVE-COMPULSIVE RELATED DISORDERS
GENERAL CRITERIA
• Obsessions - An experience of having repetitive thoughts, images,
and urges that are persistent and uncontrollable
- Often appear irrational
- Prone to extreme doubts, procrastination, and indecision
• Compulsions – are repetitive and excessive behaviors (e.g., hand
washing, ordering, checking) or mental acts (e.g., praying,
counting, repeating words silently) that the person feels driven to
perform to reduce the anxiety caused by obsessive thoughts or to
prevent some calamity from occurring.
I. Obsessive-Compulsive Disorder
- Presence of obsessions or compulsions or both
- The obsessions or compulsions are time-consuming (e.g., take
more than 1 hour per day)
II. Body Dysmorphic Disorder
- Preoccupation with one or more perceived defects in appearance
- The person has performed repetitive behaviors or mental acts
(e.g., mirror checking, seeking reassurance, or excessive
grooming) in response
- Preoccupation is not restricted to concerns about weight or body
fat
- The preoccupation with appearance can interfere with many
aspects of occupational and social functioning.
III. Hoarding Disorder
- Persistent difficulty discarding or parting with possessions,
regardless of their actual value
- Perceived need to save items
- Distress associated with discarding
- The symptoms result in the accumulation of a large number of
possessions that clutter active living spaces to the extent that
their intended use is compromised unless others intervene.
IV. Trichotillomania (Hair-Pulling Disorder)
- Recurrent pulling out of one’s hair, resulting in hair loss.
- Repeated attempts to decrease or stop hair pulling.
- It may be triggered by feelings of anxiety or boredom, may be
preceded by an increasing sense of tension then may lead to
gratification, pleasure, or a sense of relief when the hair is
pulled out.
V. Excoriation Disorder (Skin-Picking)
- Recurrent skin picking resulting in skin lesions.
- Repeated attempts to decrease or stop skin picking.
I.
TRAUMA-RELATED DISORDERS
Post-Traumatic Stress Disorder
- Symptoms last for more than a month
A. Stressor (1 required)
- exposed to: death, threatened death, actual or threatened
serious injury, or actual or threatened sexual violence, in the
following way(s):
• Direct exposure
• Witnessing the trauma
• Learning that a relative or close friend was exposed to a
trauma
• Indirect exposure to aversive details of the trauma, usually
in the course of professional duties (e.g., first responders,
medics)
B. Intrusion symptoms (1 required)
•
•
•
•
•
Unwanted upsetting memories
Nightmares
Flashbacks
Emotional distress after exposure to traumatic reminders
Physical reactivity after exposure to traumatic reminders
C. Avoidance (one required)
- Avoidance of trauma-related stimuli after the trauma, in the
following way(s):
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• Trauma-related thoughts or feelings
• Trauma-related external reminders
D. Negative alterations in cognitions and mood (two required)
- Negative thoughts or feelings that began or worsened after the
trauma, in the following way(s):
• Inability to recall key features of the trauma
• Overly negative thoughts and assumptions about oneself or
the world
•
•
•
•
•
Exaggerated blame of self or others for causing the trauma
Negative affect
Decreased interest in activities
Feeling isolated
Difficulty experiencing positive affect
E. Alterations in arousal and reactivity
- Trauma-related arousal and reactivity that began or worsened
after the trauma, in the following way(s)
• Irritability or aggression
• Risky or destructive behavior
• Hypervigilance
• Heightened startle reaction
• Difficulty concentrating
• Difficulty sleeping
Two specifications:
• Dissociative Specification - In addition to meeting criteria for
diagnosis, an individual experiences high levels of either of the
following in reaction to trauma-related stimuli:
o Depersonalization. Experience of being an outside observer of
or detached from oneself
o Derealization. Experience of unreality, distance, or distortion
(e.g., "things are not real").
• Delayed Specification. Full diagnostic criteria are not met until at
least six months after the trauma(s), although onset of symptoms
may occur immediately.
II. Acute Stress Disorder
- Fairly similar to those of PTSD, but the duration is shorter.
- Symptoms occur between 3 days and 1 month after a trauma.
III. Reactive Attachment Disorder (childhood disorder)
- Before age 5 at least 9 months
A. consistent pattern of inhibited, emotionally withdrawn
behavior toward adult caregivers, manifested by both of the
following:
- The child rarely or minimally seeks comfort when
distressed.
- The child rarely or minimally responds to comfort when
distressed.
B. A persistent social and emotional disturbance characterized
by at least two of the following:
- Minimal social and emotional responsiveness to others.
- Limited positive affect.
- Episodes of unexplained irritability, sadness, or fearfulness
that are evident even during nonthreatening interaction
with adult caregivers.
C. The child has experienced a pattern of extremes of
insufficient care as evidenced by at least one of the
following:
- Social neglect or deprivation in the form of persistent lack
of having basic emotional needs for comfort, stimulation,
and affection met by caregiving adults.
- Repeated changes of primary caregivers that limit
opportunities to form stable attachments (e.g., frequent
changes in foster care.)
- Rearing in unusual settings that severely limit opportunities
to form selective attachments (e.g. institutions with childto-caregiver-ratios.)
IV. Disinhibited Social Engagement Disorder (childhood disorder)
- Developmental age of at least 9 months
A. A pattern of behavior in which a child actively approaches and
interacts with unfamiliar adults and exhibits at least two of the
following:
- Reduced or absent reticence in approaching and interacting
with unfamiliar adults.
- Overly familiar verbal or physical behavior
- Diminished or absent checking back with adult caregiver after
venturing away, even in unfamiliar settings.
- Willingness to go off with an unfamiliar adult with minimal or
no hesitation.
B. The behaviors in Criterion A are not limited to impulsivity (as in
attention-deficit/hyperactivity disorder) but include socially
disinhibited behavior.
C. The child has experienced a pattern of extremes of insufficient
care as evidenced by at least one of the following:
- Social neglect or deprivation in the form of persistent lack of
having basic emotional needs for comfort, stimulation, and
affection met by caregiving adults.
- Repeated changes of primary caregivers that limit
opportunities to form stable attachments (e.g., frequent
changes in foster care).
- Rearing in unusual settings that severely limit opportunities to
form selective attachments
V. Adjustment Disorder
- the presence of emotional or behavioral symptoms in response
to an identifiable stressor(s) occurring within 3 months of the
onset of the stressor(s)
- Distress and impairment are related to the stressor and are not
an escalation of existing mental health disorders
- The reaction isn’t part of normal bereavement
- Once the stressor is removed or the person has begun to adjust
and cope, the symptoms must subside within six months.
❖ Epidemiology of Trauma-related Disorders
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- ASD does predict a higher risk of developing PTSD within 2
years
- Comorbid disorders are other anxiety disorders, major
depression, substance abuse, and conduct disorder
- Two-thirds had history of Anxiety disorder
- Women are twice as likely to develop PTSD
• Ataque de nervios - originally identified in Puerto Rico, involves
physical symptoms and fears of going crazy in the aftermath of
severe stress and thus is similar to PTSD.
❖ Etiology of TRD
• Genetics - PTSD appears related to genetic risk for anxiety
disorders
• Neurobiological
- High levels of activity in fear circuit such as amygdala
- Diminished activation of the medial prefrontal cortex
- Smaller hippocampal volume
- Supersensitivity to cortisol
• Childhood exposure to trauma and tendencies to attend
selectively to cues of threat
• Operant conditioning contributes to the maintenance of the
avoidance behavior
• High severity of trauma = more likely to develop PTSD
• Traumas caused by humans are more likely to cause PTSD than
are natural disasters
• Dissociation as coping – trying to avoid thinking about trauma =
more likely to develop PTSD
• Protective factors: high intelligence, strong social support
❖ Treatment for PTSD
• Exposure therapy – direct (in vivo) or imaginal
• Cognitive therapy – enhance beliefs about coping abilities
• Cognitive processing therapy - is designed to help victims of
rape and childhood sexual abuse dispute tendencies toward
self-blame and guilt.
• Treatment of ASD in onset may prevent PTSD
MOOD DISORDERS
- Involve disabling disturbances in emotion—from the extreme
sadness and disengagement of depression to the extreme elation
and irritability of mania.
- 2 Broad types: (1) Depressive disorders – depressive symptoms (2)
Bipolar disorders – manic and depressive symptoms
DEPRESSIVE DISORDERS
I. Major Depressive Disorder
- The individual must be experiencing five or more symptoms during
the same 2-week period and at least one of the symptoms should be
either (1) depressed mood or (2) loss of interest or pleasure.
1. Depressed mood most of the day, nearly every day.
2. Markedly diminished interest or pleasure in all, or almost all,
activities most of the day, nearly every day.
3. Significant weight loss when not dieting or weight gain, or
decrease or increase in appetite nearly every day.
4. A slowing down of thought and a reduction of physical
movement (observable by others, not merely subjective
feelings of restlessness or being slowed down).
5. Fatigue or loss of energy nearly every day.
6. Feelings of worthlessness or excessive or inappropriate guilt
nearly every day.
7. Diminished ability to think or concentrate, or indecisiveness,
nearly every day.
8. Recurrent
thoughts
of
death, recurrent
suicidal
ideation without a specific plan, or a suicide attempt or a
specific plan for committing suicide.
• Episodic depression - Symptoms tend to dissipate over time
• Subclinical depression - Sadness plus 3 other symptoms for 10
days
- Significant impairments in functioning even though full
diagnostic criteria are not met
II. Premenstrual Dysphoric Disorder
A. In most menstrual cycles during the past year, at least 5 of the
ff. symptoms were present in the final week before the menses,
improved within few days of menses onset, and became
minimal in the week after menses.
B. At least 1 of the ff:
- Affective lability
- Irritability
- Depressed mood, hopelessness, self-deprecating thoughts
- Anxiety
C. At least 1 of the ff:
- Decreased interest in usual activities
- difficulty in concentration
- marked lack of energy
- Marked change in appetite; overeating or specific food
cravings
- Hypersomnia or insomnia
- A sense of being overwhelmed or out of control
- Physical symptoms such as breast tenderness or swelling;
joint or muscle pain, a sensation of “bloating” or weight gain
III. Disruptive Mood Dysregulation Disorder (childhood disorder)
- onset before 10 years
- Diagnosis should not be made before age of 6 or after age of 18.
A. Severe recurrent temper outbursts manifested verbally (e.g.,
verbal rages) and/or behaviorally (e.g., physical aggression
toward people or property) that are grossly out of proportion in
intensity or duration to the situation or provocation.
B. The temper outbursts are inconsistent with developmental
level.
C. The temper outbursts occur, on average, three or more times
per week.
D. The mood between temper outbursts in persistently irritable or
angry most of the day, nearly every day, and is observable by
others (e.g., parents, teachers, peers).
E. Criteria A–D have been present for 12 or more months.
F. Criteria A and D are present in at least two of the three settings
(i.e., at home, at school, with peers), severe in at least 1.
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IV. Persistent Depressive Disorder (Dysthymia)
A. Depressed mood for most of the day, for more days than not,
as indicated by either subjective account or observation by
others, for at least 2 years.
Note: In children and adolescents, mood can be irritable and
duration must be at least 1 year.
B. Presence, while depressed, of two (or more) of the following:
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness.
C. During the 2-year period (1 year for children or adolescents) of
the disturbance, the individual has never been without the
symptoms in Criteria A and B for more than 2 months at a time.
• Double depression - applies to those who have a major
depressive episode superimposed on a longer-standing
dysthymia.
BIPOLAR DISORDERS
- Manic symptoms are the defining feature of each of these
disorders.
- Differentiated by how severe and long-lasting the manic symptoms
are.
- most people who experience mania will also experience depression
during their lifetime.
- An episode of depression is not required for a diagnosis of bipolar I,
but it is required for a diagnosis of bipolar II disorder.
I. Bipolar I Disorder
- The manic episode may have been preceded by and may be
followed by hypomanic or major depressive episodes.
• Manic episode - A distinct period of abnormally and persistently
elevated, expansive, or irritable mood and abnormally and
persistently increased goal-directed activity or energy, lasting at
least 1 week and present most of the day, nearly every day
- Requires hospitalization; sometimes includes psychosis
- During the period of mood disturbance and increased energy or
activity, 3 (or more) of the following symptoms (4 if the mood
is only irritable) are present to a significant degree and
represent a noticeable change from usual behavior:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (e.g., feels rested after only 3
hours of sleep)
3. More talkative than usual or pressure to keep talking Flight
of ideas or subjective experience that thoughts are racing
4. Distractibility (i.e., attention too easily drawn to
unimportant or irrelevant external stimuli), as reported or
observed
5. Increase in goal-directed activity (either socially, at work or
school, or sexually) or psychomotor agitation (i.e.,
purposeless, non-goal-directed activity)
6. Excessive involvement in activities that have a high
potential for painful consequences (e.g., engaging in
unrestrained buying sprees, sexual indiscretions, or foolish
business investments)
II. Bipolar II Disorder
- Criteria have been met for at least one hypomanic episode and
at least one major depressive episode
- There has never been a manic episode
• Hypomanic episode - The episode is not severe enough to
cause marked impairment in social or occupational functioning
or to necessitate hospitalization.
- Elevated mood lasting at least 4 consecutive days
- No psychotic symptoms
- The person with hypomania may feel more social, flirtatious,
energized, and productive.
III. Cyclothymic Disorder (Cyclothymia)
- Milder, chronic form of bipolar disorder
- Lasts at least 2 years
- Numerous periods with hypomanic-like and depressive-like
symptoms
❖ Etiology of Mood Disorders
BIOLOGICAL DIMENSION
• Genetics – Depressive
- Has relative with depressive disorder - has 2 to 3 times
chances
- Twin studies yield heritability of 37% for MDD
• Genetics – Bipolar: heritability of 93%
• Neurobiological
o Neurotransmitters
- MDD - Low levels of norepinephrine, dopamine, and
serotonin
- Mania - High levels of norepinephrine and dopamine, low
levels of serotonin
o Brain structure – Depressive and Bipolar
- Amygdala (elevated), Subgenual anterior cingulate
(elevated)
- Hippocampus (diminished), Dorsolateral prefrontal cortex
(diminished)
• Neuroendocrine system
- Overactivity of HPA axis – triggers release of cortisol (stress
hormone)
o Cushing’s syndrome – Symptoms include depression;
causes oversecretion of cortisol
SOCIAL FACTORS
• Life events - 42-67% report a stressful life event in year prior to
depression onset
• Diathesis-stress model – lack of social support and interpersonal
problems trigger depression
PSYCHOLOGICAL FACTORS
• Psychodynamic
o Depression - Loss of loved person (object) perceived as
rejection/self-hatred
- Rigid superego serves to punished oneself
o Mania - Viewed as defense against underlying depression
- Feelings of worthlessness are converted by means of
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denial, reaction formation and projection to grandiose
delusions
• Personality
o Neuroticism – tendency to react with higher levels of negative
affects
- Predicts onset of depression (Jorm et al., 2000)
• Cognitive
o Beck’s Theory of Depression – negative triad (negative view of
self, world, and future)
o Hopelessness theory - People whose attributional style leads
them to believe that negative life events are due to stable and
global causes
o Rumination theory - tendency to repetitively dwell on sad
experiences and thoughts
• Predictors of Mania – (1) Reward sensitivity – high response to
rewards, (2) Sleep deprivation
❖ Treatment of Mood Disorders
• Interpersonal Psychotherapy (IPT) – focuses on current
relationships
• Cognitive therapy - Replace negative thoughts with more
neutral or positive thoughts
• Mindfulness based cognitive theory (MBCT) – meditation
• Behavioral activation - Increase participation in positively
reinforcing activities
• Psychoeducation
SUICIDE
- People in depressive episode are more likely to commit suicide.
• Suicide ideation: thoughts of killing oneself
• Suicide attempt: behavior intended to kill oneself
• Suicide: death from deliberate self-injury
• Non-suicidal self-injury: behaviors intended to injure oneself
without intent to kill oneself
• Epidemiology – 9% people has suicidal ideation once in life
- 2.5% have made at least 1 attempt
- Men are four times more likely than women to kill themselves
- Women are more likely than men are to make suicide attempts
that do not result in death
❖ Types of Suicide
• Altruistic – greater societal good
• Egoistic – loss of social support
• Anomic – sudden and unexpected changes
• Fatalistic – loss of control over destiny
SCHIZOPHRENIA AND RELATED DISORDERS
SYMPTOM DOMAINS IN SCHIZOPHRENIA
A. Positive symptoms
• Delusions - beliefs contrary to reality and firmly held in spite of
disconfirming evidence
o Though insertion - may believe that thoughts that are not his or
her own have been placed in his or her mind by an external source
o Though broadcasting - may believe that his or her thoughts are
broadcast or transmitted, so that others know what he or she is
thinking
o Grandiose delusions - an exaggerated sense of his or her own
importance, power, knowledge, or identity.
o Ideas of reference - incorporating unimportant events within a
delusional framework and reading personal significance into the
trivial activities of others.
o Persecutory delusions - most common form of delusional
disorder; person fears they are being stalked, spied upon,
obstructed, poisoned, conspired against or harassed by other
individuals
o Delusional jealousy – (morbid or pathological jealousy) develops
due to a fear that a spouse or partner is being unfaithful.
o Erotomania - firmly convinced that a person he or she is fixated
upon is in love with them
• Hallucinations - The experience of sensory events without any input
from the surrounding environment; often auditory than visual
- They believe voices are coming from somewhere or someone
else but it is probably their own thoughts they are “hearing”
o Auditory (hear), Visual (see), Olfactory (smell), Gustatory (taste),
Tactile or somatic (feel), Proprioceptive (flying or floating)
o Hypnagogic – hallucinations before falling asleep (normal)
o Hypnopompic – hallucinations while waking up (normal)
B. Negative symptoms
• Avolition - refers to a lack of motivation and a seeming absence
of interest in or an inability to persist in what are usually routine
activities
• Asociality - severe impairments in social relationships
• Blunted Affect - refers to a lack of outward expression of emotion.
• Alogia - refers to a significant reduction in the amount of speech
• Anhedonia - A loss of interest in or a reported lessening of the
experience of pleasure
o consummatory pleasure - refers to the amount of pleasure
experienced in-the-moment or in the presence of something
pleasurable
o anticipatory pleasure - refers to the amount of expected or
anticipated pleasure from future events or activities.
C. Disorganized symptoms
• Disorganized Speech - refers to problems in organizing ideas and
in speaking so that a listener can understand.
o loose associations, or derailment – in which case the person
may be more successful in communicating with a listener but
has difficulty sticking to one topic
o tangentiality—that is, going off on a tangent instead of
answering a specific question.
• Disorganized Behavior - agitation, dress in unusual clothes, act
in a childlike or silly manner, hoard food, or collect garbage
D. Disorganized movement
• Catatonia – decreased reactivity to environment
• Negativism – resistance to instructions
• Mutism and stupor – lack of verbal and motor response
• Catatonic experiences – purposeless and excessive activity
PHASES OF SCHIZOPHRENIA
• Prodomal phase – symptoms are not recognized (depressive-like)
• Active phase – also knows as “acute schizophrenia”. Has telltale
symptoms of psychosis
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• Residual phase - Fewer obvious symptoms (psychosis is muted)
SCHIZOPHRENIA CRITERION
A. 2 or more of the ff. for at least 1 month or longer period of time. At
least one of them must be 1, 2, or 3.
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms
- Some signs must last for continuous period of 6 months with 1
month of sx that meet criterion A (active symptoms).
- During residual periods, only negative symptoms may be present
• Schizophreniform disorder – symptoms of schizophrenia that only
lasts from 1 to 6 months
• Brief Psychotic Disorder – positive symptoms that last from 1 day
to 1 month and is often brought on by extreme stress, such as
bereavement
• Schizoaffective disorder - comprises a mixture of symptoms of
schizophrenia and mood disorders
- At least 1 major mood episode (depressive or manic)
- Concurrent with criterion A of schizophrenia
- Delusions and hallucinations are present for 2 weeks in absence
of mood episode (di nagsasabay)
❖ Differential diagnosis – MDD w/ psychotic features
- BD w/ psychotic features
• Delusional disorder - is troubled by 1 or more delusions for 1 month
or longer; impairments in psychosocial functioning
• Attenuated psychosis syndrome – has psychotic-like symptoms but
reality testing is somehow maintained and intact
❖ Etiology of Schizophrenia
BIOLOGICAL
• Dopamine theory
- Increased limbic dopamine activity (positive symptoms)
- Decreased frontal dopamine activity (negative symptoms)
• Neurotransmitters
o Norepinephrine – increased
o GABA – decreased
o Serotonin – both hypersorotonemia and hyposerotonemia
o Glutamate – hypofunction
• Brain structure
o Enlarged ventricles – loss of cells
o Reduced activity in prefrontal cortex (speech, executive function)
o Broca’s area (speech production) – most active during
hallucinations
PSYCHODYNAMICS
- Disintegration of ego
- Schizophrenogenic mother – cold and rejecting mother in
upbringing
• Major Primitive Defenses
o Delusional projection - Frank delusions about external reality
o Psychotic Denial - Rejection of reality and facts that are
already verified
o Psychotic Reaction Formation - Turning a disturbing idea or
impulse into its opposite
o Psychotic Distortion - Gross impairment in perceiving reality
differently than others
PSYCHOLOGICAL
• Reactive to stress
• Sociogenic hypothesis – stress of poverty causes disorder
• Social Selection Theory - mental illness can inhibit socioeconomic
attainment and lead people to drift into the lower social class or
never escape poverty
• Study of expressed emotions (EE) - three characteristics: critical
comments, hostility, and emotional overinvolvement
DEVELOPMENTAL
- Lower scores on the IQ test in childhood predicted the onset of
schizophrenia in young adulthood
❖ Treatment for Schizophrenia
• Medications – use of antipsychotic drugs or neuroleptics
• Psychological
o Social Skills Training
o Family therapy
o Cognitive behavior therapy (CBT)
o Psychoeducation
PERSONALITY DISORDERS
CLUSTER A (Odd, eccentric)
I. Paranoid Personality Disorder (PPD)
A. Global mistrust and suspicion of others motives which
commences in adulthood. Must have at least 4 of the seven sub
features:
1. The person with PPD will believe others are using, lying to, or
harming them, without apparent evidence thereof.
2. They will have doubts about the loyalty and trustworthiness of
others
3. They will not confide in others due to the belief that their
confidence will be betrayed.
4. They will interpret ambiguous or benign remarks as hurtful or
threatening, and
5. Hold grudges
6. In the absence of objective evidence, believe their reputation
or character are being assailed by others, and will retaliate in
some manner and
7. Will be jealous and suspicious without cause that intimate
partners are being unfaithful.
❖ Differential diagnosis – Schizophrenia (other psychotic sx are
not present)
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II. Schizoid Personality Disorder (SPD)
A. A persistent pattern of disinterest from social interactions and
a limited variety of expression of emotions in a close personal
settings, starting in early adulthood and there in an array of
contexts, as shown by at least four (or more) of the ff.:
1. neither wants nor likes close relationships, counting being part
of a family
2. almost constantly picks solitary activities
3. has little if any, thought in engaging in any sexual experiences
4. seldom derives pleasure from any activities
5. has no close friends other than immediate relatives
6. appears apathetic to the admiration or disapproval of others
7. shows emotional coldness, detachment, or flattened affectivity
❖ Differential diagnosis:
- Autism Spectrum Disorder- No repetitive behaviors in schizoid
pd.
- Avoidant personality disorder- Avoidant pd wants to initiate
contact but fears rejection. Schizoid pd just don’t want any
relationships at all.
III. Schizotypal Personality Disorder (STPD)
A. A pervasive pattern of social and interpersonal deficits marked by
acute discomfort with, and reduced capacity for, close
relationships as well as by cognitive or perceptual distortions and
eccentricities of behavior, beginning by early adulthood and
present in a variety of contexts, as indicated by five or more of the
ff.:
1. Ideas of reference - but not delusions of reference (which are
similar but held with greater conviction)
2. Odd beliefs or magical thinking (eg, believing in clairvoyance,
telepathy, or a sixth sense; being preoccupied with paranormal
phenomena)
3. Unusual perceptional experiences including bodily illusions (eg,
hearing a voice whispering their name)
4. Odd thought and speech (eg, that is vague, metaphorical,
excessively elaborate, or stereotyped)
5. Suspicions or paranoid ideation
6. Incongruous or constricted affect
7. Odd, eccentric, or peculiar behavior and/or appearance
8. Lack of close friends or confidants, except for 1st-degree
relatives
9. Excessive social anxiety that does not lessen with familiarity and
is related mainly to paranoid fears and not negative judgments
of self
❖ Differential diagnosis: Schizophrenia- schizotypal pd do not
include extreme psychotic symptoms present in people with
schizophrenia
CLUSTER B (Dramatic, erratic)
I. Antisocial Personality Disorder
A. Disregard for and violation of others rights since age 15, as
indicated by three (or more) of the seven sub features:
1. Failure to obey laws and norms by engaging in behavior which
results in criminal arrest, or would warrant criminal arrest
2. Lying, deception (repeated lying), use of aliases, and
manipulation, for profit or self-amusement,
3. Impulsive behavior or failure to plan ahead
4. Irritability and aggression, indicated by repeated physical fights
or assaults
5. Blatantly disregards safety of self and others,
6. A pattern of irresponsibility as indicated by repeated failure to
sustain work behavior or financial obligations
7. Lack of remorse for actions
B. Individual is at least 18 years
C. There is evidence of conduct disorder with onset before age of 15
❖ Differential diagnosis:
- Narcissistic pd: Both are selfish and unemphatic but narcissistic
pd are not as aggressive as antisocial pd.
- Criminal behavior: criminality requires a gain, antisocial pd are not
purposeful.
II. Borderline Personality Disorder
A. Pervasive pattern of instability in interpersonal relationships, selfimage, and emotion, as well as marked impulsivity beginning by
early adulthood and present in a variety of contexts, as indicated
by five (or more) of the following:
1. Chronic feelings of emptiness
2. Emotional instability in reaction to day-to-day events (e.g.,
intense episodic sadness, irritability, or anxiety usually lasting
a few hours and only rarely more than a few days)
3. Frantic efforts to avoid real or imagined abandonment
4. Identity disturbance with markedly or persistently unstable
self-image or sense of self
5. Impulsive behavior in at least two areas that are potentially
self-damaging (e.g., spending, sex, substance abuse, reckless
driving, binge eating)
6. Inappropriate, intense anger or difficulty controlling anger
7. Pattern of unstable and intense interpersonal relationships
characterized by extremes between idealization and
devaluation (also known as "splitting")
8. Recurrent suicidal behavior, gestures, or threats, or selfharming behavior
9. Transient, stress-related paranoid ideation or severe
dissociative symptoms.
❖ Differential diagnosis:
- Depression. Bipolar: can co-occur; caution: overdiagnosis.
Check the pattern.
- Separation anxiety disorder: both fears separation but S.A.D. do
not include problems in identity, self-mutilation, and
interpersonal conflicts.
III. Histrionic Personality Disorder
A. A pervasive pattern of excessive emotionality and attention
seeking, beginning by early adulthood and present in a variety of
contexts, as indicated by 5 (or more) of the following:
1. Is uncomfortable in situations in which he or she is not the
center of attention
2. Interaction with others is often characterized by
inappropriate sexually seductive or provocative behavior
3. Displays rapidly shifting and shallow expression of emotions
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4. Consistently uses physical appearance to draw attention to
self
5. Has a style of speech that is excessively impressionistic and
lacking in detail
6. Shows self-dramatization, theatricality, and exaggerated
expression of emotion
7. Is suggestible (i.e. - easily influenced by others or
circumstances)
8. Considers relationships to be more intimate than they actually
are
❖ Differential diagnosis:
- Antisocial pd: both are manipulative but histrionic pd emotionally
exaggerated and do not include aggressive tendencies that
antisocial pd has.
- Narcissistic pd: both are attention seekers but narcissistic pd is
more concerned with “superiority” than attention itself.
IV. Narcissistic Personality Disorder
A. Significant impairments in personality functioning manifest by:
1. Impairments in self-functioning (a or b):
a. Identity: Excessive reference to others for self-definition and
self-esteem regulation; exaggerated self-appraisal
b. Self-direction: Goal-setting is based on gaining approval from
others; personal standards are unreasonably high in order to
see oneself as exceptional, or too low based on a sense of
entitlement; often unaware of own motivations. AND
2. Impairments in interpersonal functioning (a or b):
a. Empathy: Impaired ability to recognize or identify with the
feelings and needs of others; excessively attuned to reactions of
others
b. Intimacy: Relationships largely superficial and exist to serve
self-esteem regulation; mutuality constrained by little genuine
interest in others‟ experiences and predominance of a need for
personal gain
B. Pathological personality traits in the following domain:
1. Antagonism, characterized by:
a. Grandiosity: Feelings of entitlement, either overt or covert;
self-centeredness; firmly holding to the belief that one is better
than others; condescending toward others.
b. Attention seeking: Excessive attempts to attract and be the
focus of the attention of others; admiration seeking.
CLUSTER C (anxious, fearful)
I. Avoidant Personality Disorder
A. A pervasive pattern of social inhibition, feeling of inadequacy, and
hypersensitivity to negative evaluation as indicated by four or
more of the ff.:
1. Avoids occupational activities involving significant
interpersonal contact, due to fears of criticism, disapproval,
or rejection
2. Is unwilling to get involved with people unless certain of
acceptance
3. Shows restraint within intimate relationships due to fears of
shame or ridicule
4. Preoccupied with fears of receiving criticism or rejection in
social situations
5. Inhibited in new interpersonal situations due to feelings of
inadequacy
6. Considers self as inferior to others, socially inept, or
personally unappealing
7. Is unusually reluctant to take personal risks or to engage in
any new activities because they may prove embarrassing
❖ Differential diagnosis:
- Social anxiety disorder: low self-esteem is more pervasive in
avoidant pd than in social anxiety.
- Agoraphobia: Avoidance in agoraphobia is due to panic, not by
rejection.
II. Dependent Personality Disorder
A. An excessive and pervasive need to be taken care of, submissive,
clinging, needy behavior due to fear of abandonment as indicated
by 5 or more of the ff.:
1. Difficulty making routine decisions without input,
reassurance, and advice from others.
2. Requires others to assume responsibilities which they should
be attending to.
3. Fear of disagreeing with others and risking disapproval.
4. Difficulty starting projects without support from others.
5. Excessive need to obtain nurturance and support from others,
to the point of volunteering to do things that are unpleasant
6. Feels vulnerable and helpless when alone.
7. Desperately seeks another relationship when one ends.
8. Unrealistic preoccupation with being left alone and unable to
care for themselves.
❖ Differential diagnosis: Separation anxiety in adults: Dependent pd
fears separation because they feel that they are unable to take
care of themselves while separation anxiety fears that something
bad may happen to their loved ones.
III. Obsessive-Compulsive Personality Disorder (OCPD)
A. A pervasive pattern of preoccupation with orderliness,
perfectionism, and mental and interpersonal control, at the
expense of flexibility, openness, and efficiency, beginning by early
adulthood and present in a variety of contexts, as indicated
by 4 (or more) of the following:
1. Is preoccupied with details, rules, lists, order, organization, or
schedules to the extent that the major point of the activity is
lost
2. Shows perfectionism that interferes with task completion
(e.g. - is unable to complete a project because his or her own
overly strict standards are not met)
3. Is excessively devoted to work and productivity to the
exclusion of leisure activities and friendships (not accounted
for by obvious economic necessity)
4. Is over conscientious, scrupulous, and inflexible about
matters of morality, ethics, or values
5. Is unable to discard worn-out or worthless objects even when
they have no sentimental value
6. Is reluctant to delegate tasks or to work with others unless
they submit to exactly his or her way of doing things
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ABPSY
Shenairah Cuarto
7. Adopts a miserly spending style toward both self and others;
money is viewed as something to be hoarded for future
catastrophes
8. Shows rigidity and stubbornness
❖ Differential diagnosis:
- OCD: True obsessions and compulsions in OCD. Dual diagnosis
is possible.
- Hoarding disorder: When hoarding is extreme and prolonged,
dual diagnosis is possible.
❖ Treatment for personality disorders
•
Psychotherapy (Psychoanalytic/psychodynamic therapy,
Dialectical behavior therapy, Cognitive behavioral therapy,
Group therapy, Psychoeducation)
NEURODEVELOPMENTAL DISORDERS
BASIC INFO ON NEURODEV DISORDERS
- Onset is in developmental period
- Both categorical and dimensional
- Neurodevelopmental disorders frequently co-occur with one another.
I. Intellectual Developmental Disorder
A. Deficits in intellectual functions
- Reasoning, problem-solving, planning, abstract thinking,
judgment, academic learning
- Confirmed by clinical assessment and standardized intelligence
testing
- Scores of approximately 2 SD or more below the population
mean, including a margin for measurement error (generally ± 5
points).
- Requires an IQ score of less than 70
B. Deficits in adaptive functioning
- Failure to meet developmental and sociocultural standards for
independence and social responsibility.
• Conceptual (academic) domain - involves competence in
memory, language, reading, writing, math reasoning,
acquisition of practical knowledge, problem solving, and
judgment in novel situations, among others.
• Social domain - involves awareness of others’ thoughts,
feelings,
and
experiences;
empathy;
interpersonal
communication skills; friendship abilities; and social judgment,
among others.
• Practical domain - involves learning and self-management
across life settings, including personal care, job responsibilities,
money management, recreation, self-management of behavior,
and school and work task organization.
❖ Etiology of IDD: Genetics and Physiological
• Prenatal
o Genetic syndromes (chromosomal disorder)
o Inborn errors of metabolism
o Brain malformations
o Maternal disease (placental disease)
o Environmental influence (alcohol, drugs, toxins)
• Perinatal (labor and delivery-related)
o Neonatal encephalopathy (disturbed neurological function)
o Postnatal: hypoxic ischemic injury (limited blood flow),
traumatic brain injury, infections, demyelinating disorders,
seizure disorders (e.g., infantile spasms), severe and chronic
social deprivation, and toxic metabolic syndromes and
intoxications (e.g., lead, mercury).
II. Autism Spectrum Disorder (ASD)
A. Persistent deficits in social communication and social interaction
across multiple contexts, as manifested by ALL of the following:
1. Deficits in social-emotional reciprocity (abnormal social
approach and failure of normal back-and-forth conversation).
2. Deficits in nonverbal communicative behaviors used for
social interaction (also includes abnormalities in eye contact
and body language or deficits in understanding and use of
gestures; to a total lack of facial expressions)
3. Deficits in developing, maintaining, and understanding
relationships (difficulties adjusting behavior to suit various
social contexts; to difficulties in sharing imaginative play or in
making friends; to absence of interest in peers)
B. Restricted, repetitive patterns of behavior, interests, or activities,
as manifested by at least two of the following:
1. Stereotyped or repetitive motor movements, use of objects,
or speech (e.g., echolalia, simple motor stereotypies, lining up
toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or
ritualized patterns or verbal nonverbal behavior (e.g.,
extreme distress at small changes, difficulties with transitions,
rigid thinking patterns, greeting rituals, need to take same
route or eat food every day).
3. Highly restricted, fixated interests that are abnormal in
intensity or focus (e.g, strong attachment to or preoccupation
with unusual objects)
4. Hyper- or hyporeactivity to sensory input or unusual interests
in sensory aspects of the environment (e.g., apparent
indifference to pain/temperature, adverse response to
specific sounds or textures, excessive smelling or touching of
objects, visual fascination with lights or movement).
❖ Etiology: Heritability – 37% to 90%
III. Attention-Deficit Hyperactivity Disorder (ADHD)
A. A persistent pattern of inattention and/or hyperactivityimpulsivity that interferes with functioning or development, as
characterized by (1) and/or (2):
1. Inattention: Six (or more) of the following symptoms have
persisted for at least 6 months:
a. Often fails to give close attention to details or makes
careless mistakes in schoolwork, at work, or during other
activities
b. Often has difficulty sustaining attention in tasks or play
activities
c. Often does not seem to listen when spoken to directly
(e.g., mind seems elsewhere)
d. Often does not follow through on instructions and fails to
finish schoolwork, chores, or duties in the workplace
e. Often has difficulty organizing tasks and activities
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f.
Often avoids, dislikes, or is reluctant to engage in tasks
that require sustained mental effort
g. Often loses things necessary for tasks or activities
h. Is often easily distracted by extraneous stimuli (for older
adolescents and adults, may include unrelated thoughts).
i. Is often forgetful in daily activities
2. Hyperactivity and impulsivity: Six (or more) of the following
symptoms have persisted for at least 6 months:
a. Often fidgets with or taps hands or feet or squirms in seat.
b. Often leaves seat in situations when remaining seated is
expected
c. Often runs about or climbs in situations where it is
inappropriate. (Note: In adolescents or adults, may be
limited to feeling restless.)
d. Often unable to play or engage in leisure activities quietly.
e. e. Is often “on the go,” acting as if “driven by a motor” (e.g.,
is unable to be or uncomfortable being still for extended
time, as in restaurants, meetings; may be experienced by
others as being restless or difficult to keep up with).
f. Often talks excessively.
g. Often blurts out an answer before a question has been
completed (e.g., completes people’s sentences; cannot wait
for turn in conversation).
h. Often has difficulty waiting his or her turn (e.g., while
waiting in line).
i. Often interrupts or intrudes on others
B. Several inattentive or hyperactive-impulsive symptoms were
present prior to age 12 years.
C. Several inattentive or hyperactive-impulsive symptoms are
present in two or more settings (e.g., at home, school, or work;
with friends or relatives; in other activities).
❖ Etiology: Heritability – 74%
❖ Differential diagnosis
- Oppositional Defiant Disorder: Individuals with oppositional
defiant disorder may resist work or school tasks that require
self-application because they resist conforming to others'
demands.
- Intermittent explosive disorder: Both impulsive; ADHD do not
include aggression to others; IED do not typically start during
childhood.
- Intellectual disability: ADHD can co-occur esp. if there is
inattention/ hyperactivity.
- Anxiety disorders: Both with inattention; ADHD do not include
rumination.
- Depression: Both with inattention; ADHD do not include
hopelessness.
SLEEPING AND EATING DISORDERS
STAGES OF SLEEP
Stage 1: drowsiness, alpha rhythm (5 to 10 minutes)
Stage 2: light sleep (heart rate slows, and body temperature
decreases) – body prepares to deep sleep
Stage 3 and 4: deep sleep stages – slow-wave or delta sleep
• Non-REM sleep: 90-120 mins.
• Normal sleep cycle: 1, 2, 3, 4, 3, 2, REM
Stage 5: Rapid Eye Movement (REM)
- heart rate and respiration speed up and become erratic, while the
face, fingers, and legs may twitch.
- Intense dreaming (paradoxical sleep)
- The first period of REM typically lasts 10 minutes, with each
recurring REM stage lengthening, and the final one lasting an
hour.
NON-ORGANIC SLEEP DISORDERS
- Primary factor is emotional causes and not due to physical disorders
- Psychogenic condition
A. Dyssomnia - predominant disturbance is in amount, quality, or
timing of sleep due to emotional causes
• Insomnia
- A condition of unsatisfactory quantity and/or quality of sleep
- Sleep disturbance has occurred at least three times per week
for at least 1 month
- Testing includes overnight polysomnography and multiple sleep
latency testing (MSLT)
- Treatment: good sleep hygiene, behavioral therapy, and
medications
• Hypersomnia / Hypersomnolence
- a condition of either excessive daytime sleepiness and sleep
attacks or prolonged transition to the fully aroused state upon
awakening.
- Disturbance lasting for more than 1 month
- In the absence of auxiliary symptoms of narcolepsy or clinical
evidence of sleep apnea.
- Treatment: Psychological (avoid night work), Pharmacological
(stimulants, antidepressants, monoamine oxidase inhibitors)
• Narcolepsy
- sleeping at the wrong time
- Sleep intrudes into wakefulness, causing clients to fall asleep
almost instantly
- Sleep is brief but refreshing
• Circadian Rhythm Sleep Disorder
- A lack of synchrony between the sleep-wake schedule and the
desired sleep-wake schedule for the individual's environment,
- Resulting in a complaint of either insomnia during major sleep
period or hypersomnia during the waking period are
experienced nearly every day for at least 1 month or recurrently
for shorter period of time.
B. Parasomnia - abnormal episodic events occurring during sleep
• Somnambulism (sleep walking) - A state of altered consciousness
in which phenomena of sleep and wakefulness are combined.
Upon awakening, there is usually no recall of the event. Can even
involve dressing and eating
• Sleep terrors (night terrors) - Nocturnal episodes of extreme
terror and panic associated with intense vocalization, motility,
and high levels of autonomic discharge. The individual sits up or
gets up, usually during the first third of nocturnal sleep, with a
panicky scream
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Shenairah Cuarto
• Nightmares - The awakening from sleep with dream experience
which is very vivid and usually includes themes involving threats
to survival, security, or self-esteem. Occurs during REM sleep.
EATING DISORDERS
I. Anorexia Nervosa
A. Restriction of energy intake leading to significant weight loss or,
in children, a lack of weight gain, leading to a body weight at least
15% below the normal or expected weight for age and height.
B. Intense fear of gaining weight or becoming fat, even though
underweight.
C. Disturbance in the way in which one's body weight or shape is
experienced, undue influence of body weight or shape on selfevaluation, or denial of the seriousness of the current low body
weight.
Subtypes:
• Restricting type - accomplished primarily through dieting, fasting,
and/or excessive exercise
• Binge-eating/purging type – binge and purging followed by selfinduced vomiting or the misuse of laxatives, diuretics, or enemas
II. Bulimia Nervosa
A. Recurrent episodes of binge-eating
- Eating large amount of food in a discrete period of time (e.g.,
within any 2-hour period)
- A sense of lack of control over eating during the episode
B. Compensatory behaviors
- self-induced vomiting; misuse of laxatives, diuretics, or other
medications; fasting; or excessive exercise.
C. Both binge-eating and compensatory behavior occur on at least
once a week for 3 months
III. Binge-eating Disorder
A. Recurrent episodes of binge-eating
- Eating large amount of food in a discrete period of time (e.g.,
within any 2-hour period)
- A sense of lack of control over eating during the episode
B. The binge-eating episodes are associated with three (or more) of
the following:
• Eating much more rapidly than normal.
• Eating until feeling uncomfortably full.
• Eating large amounts of food when not feeling physically
hungry.
• Eating alone because of feeling embarrassed by how much
one is eating.
• Feeling disgusted with oneself, depressed, or very guilty
afterward.
C. Binge-eating occurs at least once for 3 months
OTHER EATING DISORDERS
• Pica - Persistent eating of nonnutritive, nonfood substances over a
period of at least 1 month
• Rumination disorder - Repeated regurgitation of food over a period
of at least 1 month. Regurgitated food may be re- chewed, reswallowed, or spit out.
• Avoidant/Restrictive Food Intake Disorder (ARFID)
- An eating or feeding disturbance (e.g., apparent lack of interest in
eating or food; avoidance based on the sensory characteristics of
food; concern about aversive consequences of eating) as manifested
by persistent failure to meet appropriate nutritional and/or energy
needs.
DISSOCIATIVE DISORDERS
- Formerly called as dissociative fugue
• Dissociative amnesia - An inability to recall important
autobiographic information (should be in memory), usually of a
traumatic or stressful nature, that is inconsistent with ordinary
forgetting.
TYPES:
o Localized amnesia – failure to recall events during a specific
period of time
o Selective amnesia – some, but not all events can be recalled
during a period of time.
o Generalized amnesia – complete amnesia for one’s life history.
o Global amnesia – complete amnesia includes one’s personality
or identity
• Depersonalization or Derealization disorder
A. The presence of persistent or recurrent experiences of
depersonalization, derealization, or both:
o Depersonalization - Experiences of unreality,
detachment, or being an outside observer with respect to
one’s thoughts, feelings, sensations, body, or actions
o Derealization - Experiences of unreality or detachment
with respect to surroundings (objects are unreal)
B. Reality testing is still intact
• Dissociative Identity Disorder
- Two or more distinct identities or personality states are
present, each with its own relatively enduring pattern of
perceiving, relating to, and thinking about the environment
and self.
- Amnesia must occur, defined as gaps in the recall of everyday
events, important personal information, and/or traumatic
events.
SUBSTANCE USE DISORDER
DRILL ITEMS AND ANSWER KEY ONLY
• Hallucinogen Persisting Perception Disorder - client is reexperiencing one or more of the perceptual symptoms that
were experienced while intoxicated with the hallucinogen.
• Phencyclidine Intoxication – 2 or more symptoms appear in 2
hours
• Hashish – This is a concentrated extraction of the cannabis plant
that is also commonly used.
• Ecstasy – 3,4-methylenedioxymethamphetamine
• Phencyclidine - first developed as dissociative anesthetics that
produce feelings of separation from mind and body.
• Stimulant - agent used to temporarily increase the functional
activity or efficiency of a person.
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• Sedative - A drug that calms and/or relaxes.
• Hypnotic – sleep-inducing agent
• Substance Use Disorder - Defined as “a problematic pattern of
using alcohol or another substance that results in impairment in
daily life or noticeable distress”
• Substance-related Disorders - occurs when the recurrent use of
alcohol and/or drugs causes clinically and functionally
significant impairment, such as health problems, disability, and
failure to meet major responsibilities at work, school, or home.
• Gambling Disorder - It is the disorder that is involved in the
chapter that occurs without the use of substance
• Abuse and dependence - 2 terms that were removed in the 5th
edition of DSM-5 regarding Substance-related Disorders
• 11 – number of criteria for Substance Use Disorder
• Phencyclidine intoxication - The client would be experiencing
Vertical or horizontal nystagmus and tachycardia within 1-3 or
more hours.
• Geometric Hallucinations, intensified colors – perceptual
symptoms while intoxicated
• Tobacco - It is a tall erect annual tropical American herb
cultivated for its leaves.
• Caffeine - The most common psychoactive drug
• 4-6 hours – approximate caffeine half-life
• More than 250mg dose – caffeine dose considered as high and
intoxicating
• AIDS – advance type of HIV infection
• Antiretroviral Therapy – prescribed treatment for HIV infection
• Frontotemporal NCD - is a neurocognitive disorder in which it
can either have behavior or language decline as its
distinguishing feature.
• Parkinson’s disease - prevalence rate is approximately 0.5%
between ages 65 and 69 to 3% at age 85 years and older in the
U.S.A.
• Fall – most common cause of traumatic brain injury
• Prion disease - Its motor features are ataxia or myoclomous and
biomarker evidence
• Persistent delirium - lasts for weeks or months
• Major NCD - newly named entity replaced the term
dementia in DSM-5
• 10-30% - range of prevalence in older individuals presenting to
emergency departments, where the delirium often indicates a
mental illness.
• Genetic testing – primary laboratory test for the determination
of Huntington’s disease
• Bradykinesia – slowing of voluntary movement
• Chorea – involuntary jerking movements
• Dopamine – low levels associated to Parkinson’s disease
NEUROCOGNITIVE DISORDERS
DRILL ITEMS AND ANSWER KEY ONLY
• Other specified delirium - situations in which the clinician
chooses to communicate the specific reason that the
presentation does not meet the criteria for delirium or any
specific neurocognitive disorder
• Attenuated delirium syndrome - This syndrome applies in cases
of delirium in which the severity of cognitive impairment falls
short of that required for the diagnosis, or in which some, but
not all, diagnostic criteria for delirium are met
• Delirium - a serious disturbance in mental abilities that results
in confused thinking and reduced awareness of your
environment. It is defined as an organically-caused decline from
a previously attained baseline level of cognitive function.
• Dementia - It is a progressive neurological disorder caused by
the degeneration of dopaminergic neurons within the
substantia nigra, a subcortical area related to voluntary motor
movement, and nigrostriatal pathway, a neural tract heading to
the striatum from the substantia nigra.
• Weight loss – physical change of Huntington’s disease
• Unspecified NCD - category is used in situations in which the
precise etiology cannot be determined with sufficient certainty
to make an etiological attribution.
• Vascular and neurocognitive disorder - This disorder shows
evidence of significant cognitive decline from a previous level of
performance in one or more cognitive domains like language,
learning, memory, etc.
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