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Abnormal psychology outline reviewer pdf
Abnormal Psychology (University of the East (Philippines))
Studocu is not sponsored or endorsed by any college or university
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| Abnormal
A bnormal Psycholog
(Outline)d
By:
Claire Irish D. Borja
ReferenceB:arlowD.H, DurandHanodfmannS.G(201).8Abnormal psychology:
anintegrativeapptrhoeadc.hN, 8ew
York:NelsonEducation, Ltd.
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Abnormal Behavior in Historical
Context
UNDERSTANDING PSYCHOPATHOLOGY
What isPsychological Disorder?
Psychological Disorder It is a psychological
dysfunction within an individual that is associated with
distress or impairment in functioning and a response
that is not typical or culturally expected
1. Psychological Dysfunction- refers
to a breakdown in cognitive,
emotional, or behavioral functioning.
2. Distress or Impairment
3. Atypical or Not Culturally Expected
4. An accepted definition- 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.
Ancient Greece- the mind has often been called
thesoul or the psycheand considered separate from
the body.
(3) Three models:
The Science of Psychopathology
Psychopathology- is the scientific study
of psychological disorders.
- Within this field are specially trained
professionals, including clinical and
counseling psychologists, psychiatrists,
psychiatric social workers, and psychiatric
nurses, as well as marriage and family
therapists and mental health counselors.
1. Scientist-Practitioners- mental health
professionals take a scientific approach to
their clinical work
2. Clinical Description- represents the unique
combination of behaviors, thoughts, andfeelings
that make up a specifci disorder
Prognosis anticipated course of disorder
3. Causation, Treatment, and Etiology
Outcomes Etiology- study of origins, has to do
with why a
disorder begins (what causes it) and includes
biological, psychological, and social dimensions.
Historical Conceptions
Supernatural Model- the driving forces behindare
these agents, which might be divinities, demons,
spirits, or other phenomena such as magnetic fields
or the moon or the stars
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1.
2.
3.
the supernatural
the biological
the psychological
THE SUPERNATURAL TRADITION
Demons and Witches
last quarter of the 14th century, religious and
lay authorities supported these popular
superstitions and society as a whole began to
believe more stronglyin the existence and power
of demons and witches.
Catholic Church had split
Roman Church fought back against the evil in
the world
magic and sorcery to solve their problems.
Treatments included exorcism
Stress and Melancholy Treatments for Possession
reflected the enlightened view that insanity
was a natural phenomenon, caused by
mental or emotional stress, and that it was
curable
Mental depression and anxiety
were recognized asillnesses
Treatments for Possession
A creative therapist decided that hagni ng
people over a pit full of poisonous snakes
might scare evil spirits right out of their
body
Mass Hysteria
characterized by large-scale outbreaks of
bizarre behavior
the phenomenon of emotion contagion, in
which the experience of an emotion seems
to spread to those around us
Modern Mass Hysteria
problem, others will probably assume that
their own reactions have the same source. In
popular language, this shared response is
sometimes referred to asmob psychool gy.
The Moon and the Stars
the movements of the moon and stars had
functioning.
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-
lunatic, which is derived from the Latin word
.
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| Abnormal
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| Abnormal
Anxiety Disorder
-
Apprehension over an anticipated problem
Comorbid to Bipolar disorder, Substance Abuse,
Personality Disorder and also Medical Conditions
Separation Anxiety Disorder
Developmentally inappropriate and
excessive fear/anxiety in anticipating
or experiencing separation from the
individual to whom they are
attached.
Applied only under 18 (DSM IV-TR)
Symptoms present for at least 4weeks in
children/adolescents and 6 months or
more
in adults
Selective Mutism
Rare childhood anxiety disorder in which
a child unable to speak in certain
situation/people
Symptoms for at least 1 month not
st
month in school
SpecificPhobia
Disproportionate fear caused by
specific object/situation
At least 6 months
Object/situation is avoided/endured with
intense anxiety
Only under age 18 (DSM IV-TR)
Generalized Anxiety Disorder
Uncontrollably/persistent worrying about
minor things
At least 3 months (6 Months in DSM
IV- TR)
With muscle tension
Worry cognitive tendency to chew on
Agoraphobia
Anxiety about situations in which it
would be embarrassing or difficult to
escape if anxiety symptoms occurred
At least 6 months
Panic Disorder
Characterized by frequent panic
attacks that are unrelated to specific
situation and by worrying about having
more panic attacks
At least 1 month
Social Anxiety Disorder
Persistent, unrealistically intense fear
of social situations that might involve
being sanitized by exposed to unfamiliar
people.
At least 6FACTORS
months
SOCIOCULTURAL
Women twice likely as men
Problems vary from culture to culture
TAIJIN KYO-FUSHO Japan (fear
of
displeasing/
embarrassing
othres)
GENETIC FACTORS
Twin studies heritability suggest 2040% NEUROBIOLOGICAL FACTORS
Fear circuit involved amygdala (more activity)
Medial prefrontal cortex (less activity)
PERSONALITY FACTORS
Behavioral inhibition during infancy
Neuroticism
COGNITIVE FACTORS
Sustained negative beliefs about the future
- Perceived control
Attention to threat
-
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Trauma and Stressor-Related Disorders
-
STRESS a
psychological responses to adjusted demands
NO TRAUMATIC EXPERIENCE
Reactive Attachment Disorder
Disturbed, developmentally inappropriate
attachment behavior to the caregivers
Persistent social and emotional disturbance
At least 9months of age
Disinhibited Social Engagement
Overly familiar actively approached
and interacts with strangers or
unfamiliar adults
Willingness to go off
At least 9 months of age
Adjustment Disorder
- Emotional and behavioral symptoms with
significant impairment in functioning after
an identifiable stressor (mostly normal
stressors)
WITH TRAUMATIC EXPERIENCE
Posttraumatic Stress Disorder
Exposure to a traumatic events/
severe stressor (witnessed/personal0
cause an extreme response
At least 1 intrusion and 1
avoidance symptom
At least 3 (or 2 in children) negative
alterations in cognition and mood
and alteration in arousal and
reactivity
More than 1 month
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Obsessive-Compulsive and Related Disorders
Obsessions are intrusive and recurring thoughts images or
impulses that are persistent and uncontrollable usually
irrational
Compulsions repetitive, clearly excessive behavior or
mental acts that the person feels driven to perform to
reduce the anxiety caused by obsessive thoughts to
prevent some calamity from occurring
Obsessive-compulsive Disorder
Characterized by obsessions or
compulsions that are timeconsuming (requires 1 hour per
day)
Recognize as the product of their mind
Common in women than in men
*chronic
Begins in childhood
Body Dysmorphic Disorder
Preoccupied with an imagined, exaggerated
defect in their appearance
Hasperformed repetitive behaviors or
mental acts in response to the
appearance concerned
Slightly common in women than in men
but is very rare
Hoarding Disorder
Persistent difficulty discarding or
parting with possessions
Strong urges to save items
More often to women than in men
Excoriation (skin-picking disorder)
results in skin lesions and causes
significan
Trichotillomania (hair-pulling disorder)
Characterized by compulsive, mild to severe from
anywhere on the body; can results in hair loss to
ALOPECIA (bald spots on the scalp)
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Somatic Symptom and Related
Disorder
An excessive concern about physical
symptoms or health that had no known
physical cause
-
Somatic Symptom Disorder
Having a significant focus on physical
symptoms (pain, shortness or weakness
of breath) resulting to major distress
and problem in functioning
Excessive thoughts, feelings or
behaviors relating to physical
symptoms
At least 1 symptoms
More than 6 months
Usually begins by age of 30
Somatic delusion
- Delusion whose content pertains to bodily
functioning,
bodily
sensations
or
physical appearance. Usually the false
belief is that the body is somehow
diseased, abnormal o
excessively that you are or may seriously ill/ having
serious medical condition
At least 6 months
Begins early adulthood
Common in men than women
Conversion Disorder (Functional Neurological
Disorder)
A psychological condition that causes
symptoms that appear to be neurological (paralysis,
speech i mpaimr ent, tremors)
At least 2 sensory or motor
impairment symptoms
Caused by psychological reaction to
a highly stressful event
Women have higher risk
Incompatibility of evidence between
symptoms and recognized medical
condition
Factitious Disorder
Falsification of psychological/physical
symptoms or signs for secondary gain as
emotional attention and affection
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changed.
Illness Anxiety Disorder
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Psychological Factor Affecting Other Medical
Conditions
When a medical condition is adversely
affected by psychological/behavioral
factors either by making it worst or
stopping recovery
Factors include psychological distress
interpersonal problems, coping styles and
maladaptive health behavior
Malingering
There is personal gain in the
deception/ pretending to have
psychological/physical condition
Not considered mental illness
Dissociative Disorder
Dissociation- involves the failure of consciousness to
perform its usual role of integratingour cognitions,
emotions, motivations and other aspects of
experiences in our awareness
Dissociative Identity Disorder
Have at least 2 separate identities/
personalitie or alters-different modes of
being, thinking, feeling and acting that exist
indepenedntly of one another, emerged at
different time
2 of the alters recurrently take control
Inability of at least 1 to recall
important information
Dissociative Amnesia
-
-
Unable to recall important personal
information usually about some traumatic
experience
Fugue is a severe subtype
Localize/selective amnesia for specific events
Explicit memory conscious recall
of experiences
Depersonalization/Derealization Disorder
Depersonalization
Persistent or recurrent experiences of
ocesses or
body
Loss of sense of
self Derealization
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-
Persistent or recurrent experiences of
unreality of surroundings
Sensation that the word becomes real
Dissociative Fugue (DSM IV-TR)
Memory loss revolves around an
unexpected trip
They just take offand find themselves in a
new place but unable to remember how
they got
there
Mood Disorders
DEPRESSIVE DISORDERS cardinal symptoms of
depression include profound sadness and/or an
inability to experience pleasure
1.Disruptive Mood Dysregulation Disorder
- Severe recurrent temper outburst and persistent
negative mood
- Atleast 1 year
- Before age 10
2.Major Depressive Disorder
- Sad mood or loss of pleasure in usual activities
- At least 5 symptoms
- Nearly every day for at least 2 weeks
(episodic) recurring
- With suicidal thoughts
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=MANIA3.Persistent depression Disorder (Dysthymia)
↑serotonin
= ANTIDEPRESSANT
- Depressed
mood for most of the day
- At least 2 years in adult & 1year for children
and adolescents)
- At least 2 symptoms
4.Premenstrual Dysphoric Disorder
- Depressive or physical symptoms in the
week before menstruation
- Marked affective lability
5.Seasonal Affective Disorder
- Seasonal subtype of Mood
- Winter blues
- Depressionduring 2 consecutive winters
then clears during summers

-
BIPOLAR DISORDER people experiencing
 mania
thoughts
and depression during their lifetime
To Maniachew onstate
material
again elation/irritability
and again
of intense
Hypomania
1. Bipolar I Disorder
At least 1 lifetime manic episode
SOCIAL FACTORS
Stressful life events
Interpersonal problems within the families
Constant reassuranc-eseeking of care
PSYCHOLOGICAL FACTORS
Neuroticism
Negative thoughts and beliefs (pessimistic
& self-critical thoughts)
Hopelessness

Desirable outcomes will not occur

Ni response to change the situation
Rumination
Repeatedly dwell on sad experiences or

Tendency tobrood/regretfully ponder
why an episode happened
BIOLOGICAL TREATMENT
Electro cumulative therapy (ECT)
Repetitive Transcranial Magnetic Stimulation
(rTMS)
Vagus
Stimulation
2. Nerve
Bipolar
II Disorder
At least 1 lifetime major depressive
episode and one hypomanic episode
3. Cyclothymic Disorder
Frequent mild symptoms of
depression alternating with mild
symptoms ofmania
At least 2 years (1 year for children
and Adolescents)
*chronic
Rapid Cycling experiencing 4 or more episodes of
mania/depression in 1 year
-
NEUROBIOLOGICAL FACTORS
Genetic heritability among twins
Neurotransmitters
↓norepinephrine
↓dopamine
=DEPRESSION
↑norepinephrine
↑dopamine
THREE OTHER IMPORTANT INDICES
OF SUICIDAL BEHAVIOR ARE:
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Suicide
1.
suicidal ideation
(thinking seriously
about suicide)
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2.
suicidal plans (the formulation of a
specific method for killing oneself)
3. suicidal attempts (the person
survives) TYPES OF SUICIDE (Durkheim)
1. Altruistic Suicide for the benefit of
the community
e.gas the ancient custom of har-akiri in Japan,
in which an individual who brought dishonor
to himself or his family was expected to
impale himself on a sword.
2. Egoistic Suicide low social
integration. e.gOlder adults who kill
themselves after losing touch with their
friends or family fi t into this category.
3. Anomic suicides are the result of
marked disruptions or disappointments,
such as the sudden loss of a highprestigejob. (Anomie is feeling lost and
confused.)
Fatalistic Suicides result from a loss of
4.
1997 is an example of this type because
the lives of those people were largely inthe
hands of Marshall Applewhite, a supreme
and charismatic leader.
Feeding and Eating Disorders
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BULIMIA NERVOSA
-eating a larger amount of food typically more junk food than
fruits and vegetables than most people would eat under
BULIMIA NERVOSA - Out of control eating orsimilar circumstances.
-ashamed of both their eating issues and their lack of control
binges followed by sel-finduced vomiting, excessive
use of laxatives, or other attempts to purge (get
Purging technique-s
rid of) the food.
compensate for the binge eating and potential weight
gain, almost always.
Include self-induced vomiting immediately after eating.
ANOREXIA NERVOSA- The person eats only
Subtypes:
minimal amounts of food or exercises vigorously to
1. Purging type
offset food intake so body weight sometimes drops
2. Non purging type
dangerously.
Medical Consequences
CHRONIC BULIMIA with PURGING
1. Salivary gland enlargement caused by repeated
BINGE EATING DISORDER - Individuals may
vomiting, which gives the face chubby
binge repeatedly and find it distressing, but they do
appearance.
not attempt to purge the food.
2. Repeated vomiting also may erode the dental
enamel on the inner surface of the front teeth as
OBESITY - is not considered an official disorder
well as tear the esophagus.
in DSM, but we consider it herebecause it
3. Continued vomitingmay upset the chemical
thought to be one of the most dangerous
balance of bodily fluids, including sodium and
epidemics confronting public health authorities
potassium levels.
around the world today.
Electrolyte imbalance- results in serious
PICA eating of one or more nonnutritive food,
medical complications if unattended. (e.g.
nonfood substances on a persistent basis
cardiac arrthymia or disrupted heartbeat,
seizures and renal/kidney failure
RUMINATION DISORDER repeated
regurgitation of food occurring after feeding or
ANOREXIA NERVOSA
eating (re-chewed, re-swallowed and re-spit out)
- Proud of both their diets and their
extraordinary control.
AVOIDANT/ RESTRICTIVE FOOD INTAKE
- Intense fear of obesity and relentlessly pursue thinness.
DISORDER avoidance of restriction of food
*individuals with bulimia have a history of anorexia;
intake manifested by persistent failure to meet
that is, they once used fasting toreduce their body
appropriate nutritional and/orenergy needs
associated w/ one or more: 9weight loss, nutritional weight below desirable levels.
Medical Consequences
deficiency, dependence on enteral feeding/ oral
Cessation of menstruation
nutritional supplements and marked interfere w/
Medical signs and
psychosocial functioning
symptoms: 1.Dry skin
2.
Brittle hair and nail
3.Sensitivity to or intolerance of cold temperature.
Ego dystonic with stress and anxiety
Lanugo
Ego syntonic without stress and
1. Downy hair on the limbs and cheeks
anxiety
Cardiovascular problems
Electrolyte imbalance
BINGE- EATING DISORDER
Experience marked distress because of
binge eating but do not engage in extreme
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compensatory behaviors and therefore cannot
be diagnosed with bulimia.
Found in weigh control programs
CAUSES OFEATING DISORDERS
A. Social Dimensions
For young women:
 Looking good than being healthy
 Self-worth, happiness and success are
largely determining by BODY measurements
and fats.
1.
2.












Difficulty tolerating any negative emotion
(mood intolerance)
Dietary restraint if cultural pressures to be
thin are is important as they seem to be in trigger
eating disorders, then such disorders would be
expected to occur where these pressures are
particularly severe
(e.g ballet dancers; under extraordinary pressures
to be thin)
Family influences typical family of someone
with anorexia is successful, hard driving, concerned
about external appearances and eager to
maintain harmony.
B. Biological dimensions
Genetic component
Eating disorders runs in families
Hypothalamus and Major neurotransmitter;
norepinephrine, dopamine and serotonin. That
passes through it to determine whether something
is malfunctioning when eating disorders occur.
Low levels of serotonergic activity
- the system most often associated with eating
disorders.
-associated with impulsivity generally and binge
eating disorders
Association between ovarian hormones and
dysregulated or impulsive eating in women prone
to binge episodes.
C. Psychological Dimensions
Young women with eating disorder diminished
a sense of personal control and confidence in
their own abilities and talents.
More perfectionist attitude which may reflect
attempts to exert control over important events
in their lives.
Preoccupied with how they appear to others
Perceived themselves as frauds, conseidring false
any impressions they make of being adequate,
se- lf sufficient or worthwhile.
Feel like impostors in their social group and
experienced heightened levels of social anxiety.
Women with bulimia judged that their bodies
were larger after they ate acandy bar and soft
drinks
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TREATMENT OF EATING DISORDER
A. Drug treatments
 Not been found effective in the treatment of
anorexia nervosa
 May be useful for people with bulimia,
particularly duringthe bingeing and purging
cycle. (same antidepressant medications for
anxiety and mood disorders)
 Prozac
B. Psychological treatments
BN:
Short term cognitive behavioral therapy (CBT) to
address behavior and attitudes on eating and body
shape
Interpersonal psychotherapy (IPT) to improve
interpersonal functioning
Tends to be chronic if left untreated
AN:
Outpatient treatment to restore weight and correct
dysfunctional attitudes on eating and body shape.
Family therapy
Tends to be chronic if left untreated moreresistant
to treatment than bulimia
BE:
Short term CBT to address behavior and attitudes
on eating and body shape.
IPT to improve interpersonal functioning
Self-help approaches
Prevent Eating Disorders: Healthy Weight
OBESITY
- not formally considered aseating disorder in DSM
- increases risk of cardiovascular disease, diabetes,
hypertension, stroke and other physical problems. Night
eating syndrome
Consume a third or more of their daily intake after
their evening meal and get out of bed at least once
during the night to have a high calories snack.
In the morning, they are not hungry and do not
usually eat breakfast.
CAUSE
Psychological Influences
Affects impulse control, attitudes and
motivation towards eating and responsiveness
to the consequences of aeting
Social Influences
Advancing technology promotes sedentary
lifestyle and consumption of high fat foods.
Biological Influences
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-
3.
cells tendency toward fat storage and
activity levels.
TREATMENT
1. Self- directedweight loss programs
2. Commercial self-help programs, such
as weight watchers
4.
Professionally directed behavior modification
programs which are the most effective
treatment.
Surgery as a last resort.
Sleep-Wake Disorders: Major
Dyssomnias
DYSSOMNIAS problems in the amount, thing or
quality of sleep; involve in difficulties in getting
enoug
sleep, problems with sleeping when you want to
and
complaints about the quality of sleep.
Insomnia Disorder difficulty falling asleep at
bedtime, problems staying asleep throughout the
night, or sleep that does not result in the person
feeling rested even after amounts of sleep
Hypersomnolence Disorders excessive sleepiness
that is displayed as either sleeping longer than is
typical or frequent falling asleep during the day.
Narcolepsy episodes of irresistible attacks of
refreshing sleep occurring daily, accompanied by
BREATHING RELATED SLEEPING DISORDERS
a variety of breathing disorders occur during
sleep and that lead to excessive sleepiness or
insomnia
Obstructive Sleep Apnea Hypopnea Syndrome
occurs when Airflow stops despite continued activity
by the respiratory system.
Central Sleep Apnea complete cessation of
respiratory activity for brief periods and is often
associated with certain central nervous system
disorders (cerebral vascular diseases, head trauma
and degenerative disorders)
Sleep related Hypoventilation a decrease in airflow
without a complete pause in breathing
Delayed sleep phase type sleep is delayed or
there is a later than normal bedtime
Irregular sleep wake type people who
experience highly varied sleep cycles
Non- 24 hour sleep- wake type sleeping on a 2526
hour cycle with later and later bedtime ultimately
going throughout the day.
PARASOMNIAS- abnormal behavior or
physiological events that occur during sleep.
Disorder of Arousal motor movements and
behaviors that occur during NREM sleep including
incomplete awakening (confusional arousals) sleep
waking, or sleep terrors (abrupt awakeningfrom
sleep that begins with a panicky scream)
Nightmare Disorder frequently being awakened by
extended and extremely frightening dreams that
causes significant distress and impaired functioning.
Rapid Eye Movement Sleep Behavior Disorder
episodes ofarousal during REM sleep that result in
behaviors that can cause harm to the individual and
others.
Restless Legs Syndrome irresistible urges to move
the legs as a result of unpleasant sensations
in the limbs) (otherwise referred to as WillisEkbom- Disease)
CIRCADIAN RHYTHM SLEEP DISORDER
disturbed sleep (either insomnia or excessive
Polysomnigraphic evaluation patient spend one or
more nights sleeping in a sleep laboratory and
being monitored on a number of measures
including:
current patternof day and night.
Jet Lag Type caused by rapidly crossing multiple
time zones
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Shift Work Type associated with work problems
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

respiration and oxygen desaturation (a measure
of airflow)
leg movements
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
brain wave activity (by EEG)

eye movements (by electrooculagram)

muscle movements (by electromyogram)

heart activity (by electrocardiogram)
Actigraph records the number of arm movements
and the data can be downloaded into a computer to
determine the length and quality of sleep.
Sleep efficiency the percentage of time actually spent
asleep.
100%: you fall asleep as soon as your head hits
the pillow and do not wake up during the ngi ht.
50%: half of your time in bed is spent trying
to sleep- you are half the time awake.
INSOMIA DISORDER:
most common sleep wake disorder
micro sleeps
Fatal Insomnia: total lack of sleep eventually
leads to death
night
(difficulty iniating sleep), if they wake up
Sleep Stres-sincludes a number of events that
can negatively affect sleep
Rebound Insomnia- sleep problems reappear
sometimes wors-t may occur when the
medication is withdrawn.
HYPERSOMNOLENCE DISORDER
people who sleep all night find
themselves falling asleep several times
the next day.
excessive sleepiness
NARCOLEPSY
experience cataplexy, a sudden loss of
musecl tone.
Cataplexy
- person is awake and can range from
slight weakness in the facial muscles to
complete physical collage
- preceded by strong emotion such as anger
or happiness.
-
Two characteristics:
1.Sleep Paralysis brief period after awakening
sleep reasonable number of hours but still not
rested the next day (NONRESTORATIVE
SLEEP)
Primary Insomnia- sleep problems were not related to
other medical or psychiatric problems.
CAUSE

Problems with the biological clock and its
control of temperature.

Delayed temperature
rhythm: 1.



2. Drowsy until later at night
People with Insomnia seemsto have higher
body temperature than good sleepers
Drug use
Environmental influences: light, noise
and temperature
Sleep apnea- a disorder that involves obstructed
nighttime breathing

Periodic limb movement disorde-rexcessive leg
movements
Family history of insomnia, narcolepsy or
obstructed breathing. (Predispotioning
Conditions)
Light sleeper- easily aroused at night
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2.
frightening to those who go through.
Hyponagogic hallucinations vivid and often
terrifying experiences that begin at the start of
sleep and are said to be unbelievably
realistic because they include not only visual
aspects but also sensation of body
movements.
Isolated sleep paralysis sleep paralysis commonly
occurs with anxiety disorders.
BREATH-RELATED SLEEP DISORDERS
People whose breathing is interrupted during their
sleepoften experience numerous brief arousals
throughout the nights and do not feel rested
even after 8 or 9 hours.
Hypoventilation breathing is constricted a great
deal and may be labored
Signs:
o loud snoring
o heavy sweating during the night
o morning headaches
o sleep attacks
-
Three types of Apnea
1. OBSTRUCTURE SLEEP APNEA HYPOPNEA
SYNDROME
 airflows stop continued activity by the
respiratory system
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



snoring at night
obesity
used of MDMA (ecstasy)
young and healthy adults (mostly male)
-
Longer use may cause
dependence and rebound
insomnia.
CIRCADIAN RHYTHM SLEEPDISORDERS
-
–
–
Disturbed sleep (either insomnia or excessive
inability to synchronize its sleep patterns with the
current patterns of day and night.
Suprachiasmatic nucleus
Our biological clock (hypothalamus)
connected to it is a pathway that comes from
our eyes
Types of Circadian Rhythm
1. Jet lag type caused by rapidly
crossing multiple time-zones
2. Shift work type sleep associated with
work schedules
3. Delayed sleep phase type sleep is delayed
or there is a later than normal bedtime
4. Advanced sleep phase typeearly to
bed early to rise
5. Irregular sleep wake type people
who experience highly varied sleep
cycles
6. Non- 24 hour sleep- wake type sleeping on
a 25-26 hour cycle with later and later
bedtime ultimately going throughout the
day.
TREATMENT OF SLEEP DISORDER
1. Medical Treatment
Insomnia:
 Benzodiazepine- can cause excessive sleep
 Medications:
o triazolam (halcion)
o zaleplon (sonata)
o zolpidem (ambien)
 Long acting drug:flurazepam(dalmane)
 Short acting drug:
Cause only brief drowsiness
Drawbacks:
Benzodiazepines can cause excessive sleepiness
People can easily become dependent on
them and rather easily misuse them
Meant for short-term treatment and are
not recommended for use longer than 4
weeks.
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Increase the likelihood of sleepwalking related
problems
Not intended for long term chronic problems.
Hypersomnolence or Narcolepsy
Methylphenidate
Modafinil
Cataplexy
Antidepressant medication, suppress REM
(dream) sleep
Breathing- related sleeping disorder
Recommending weight loss
Obstructive Sleep apnea
Mechanical device called CPAP or Continuous
Positive Air Pressure Machine
2. Environmental Treatments
General principles in treating Circadian rhythm
disorder
Phase Delays (moving bedtime later) Phase
advances(moving bedtime earlier)
Light Therapy(using bright light to trick the brain into
readjusting the biological clock)
3. Psychological Treatment
4. Relaxation treatmentr:educe physical tension that
seems to prevent some people from falling asleep
at night.
5. Cognitive Treatmen:tFocus on worries about
sleep.
a) Guided Imagery Relaxation
Uses medication or imagery to help with
relaxation at bedtime or after a night
waking
b) Graduated Extinction
6. Instruct the parents of the child who has tantrums to
check the progressively longer period until the child
falls asleep on his or her own.
Paradoxial Intention
7. Instructing individuals in the opposite behavior
from the desired outcome.
Progressive Relaxation
8. Relaxing muscles of the body in an effort to
introduce drowsiness
Sleep Hygiene changes in lifestyle can be relatively simple
to follow and can help avoid problems such as insomnia for
some people.
-
PARASOMNIAS
Not problems with sleep itself but abnormal events
that occur during sleep or during that twilight
time between sleeping and waking.
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Nightmare
- occur during REM or dream sleep
- disturbing dreams that awaken the sleeper
Disorder of Arousal
- Includes a number of motor movements
and behavior during NREM sleep such
as sleepwalking, sleep terrors and
incomplete awakening.
Sleep terrors
- The child is extremely upset often sweating
and frequently has a rapid heartbeat.
Sleep walking(Somnambulism)
- Occurs during NREM sleep
- People walk in their sleep, they probably
not acting out a dream.
- Occurs during the first few hours while a
person is in deep stages of sleep.
RELATED DISORDER:
1. Nocturnal Eating Syndrome- Individuals rise
fromtheir beds and eats while they are still
sleeping.
2. Night Eating Syndrome
3. Sexsomnia- Acting out a sexual behavior such as
masturbation and sexual intercourse with no memory
of the event.
Sexual DysFunction
difficulty to function adequately while having sex
Two disorder (sex specific)
2.
Heterosexual BehaviorS:ex with opposite sex
Homosexual Behavio:rSex with same sex
3.
Gender Difference
Men and women tend toward
amonogamous (one Partner) pattern of
relationship, gender differences in sexual
behavior do exist and some of them are
quite dramatic.
Reflected in the incidence of casual sex,
attitudes toward casual premarital sex
and pornography use, with men
expressingmore permissive attitudes and
behaviors than women.
Four themes of gender differences in
human sexuality:
1. Men show more sexual desire and
arousal than women.
Women emphasize committed
relationships as a context for sex
more than me
-concept, unlike
independence and aggression
4.
in that they are more easily shaped
by cultural, social and situational
factors.
1. Premature (early) ejaculation- males
2. Genito-pelvic pain/penetration disorderfemales
SD can be:
 Lifelong present during entire sexual history



Acquired interrupts normal sexual pattern
Generalized present in every encounter
Situational present only with a
certain partners or at certain times
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Four Phases of sexual response cycle
1. Desire Phase refers to sexual interest/desire
associated with arousing fantasies or thoughts
2. Excitement Phase experience of pleasure
and increase blood flow to the genitalia
3. Orgasm phase sexual pleasurepeaks in
ways occurringa general muscle tension
4. Resolutionphase relaxation and sense of well being followed an orgasm
Types of Sexual Dysfunction
Male Hypoactive Sexual Desire Disorder
A. Persistently or recurrently deficient (or absent)
sexual/erotic thoughts or fantasies and desire for
sexual activity. The judgment of deficiency is
made by the clinician, taking into account factors
that affect sexual functioning, such as age and
general and
.
Female Sexual Interest/Arousal Disorder
A. Lack of, or significantly reduced, sexual
interest/arousal, as manifested by at least three of
the following:
1. Absent/reduced interest in sexual activity.
2. Absent/reduced sexual/erotic thoughts
or fantasies.
3. No/reduced initiation of sexual activity, and
4.
5.
6.
initiate.
Absent/reduced sexual excitement/pleasure
during sexual activity in almost all or all
(approximately 75%-100%) sexual
encounters (in identified situational
contexts or, if generalized, in all contexts).
Absent/reduced sexual interest/arousal in
response to any internal or external
sexual/ erotic cues (e.g., written, verbal,
visual).
Absent/reduced genital or nongenital
sensations during sexual activity ni almost all
or all (approximately 75%-100%) sexual
encounters (in identified situational contexts
Erectile Disorder
A. At least one of the three following symptoms
must be experienced on almost all or all
(approximaetly 75%-100%) occasions of sexual
activity (in identified situational contexts or, if
generalized, in all contexts):
1. Marked difficulty in obtaining an
erection during sexual activity.
2. Marked difficulty in maintaining an
erection until the completion of
sexual activity.
3. Marked decrease in erectile rigidity.

Female sexual interest/arousal disorder
recurring inability to maintain adequate
lubrication
Female Orgasmic Disorder
A. Presence of either of the following symptoms
and experienced on almost all orall
(approximately
75%-100%) occasions of sexual activity (in identified
situational contexts or, if generalized, in all
contexts):
1. Marked delay in, marked infrequency of,
or absence of orgasm.
2. Markedly reduced intensity of orgasmic
sensations.
Premature(Early) Ejaculation
A. A persistent or recurrent pattern of ejaculation
occurring during partnered sexual activity within
approximately 1 minute following vaginal
penetration and before the individual wishes it.
(approximately 75%-100%) occasions of sexual
activity (in identified situational contexts or, if
generalized, in all contexts).
Delayed Ejaculation
A. Either of the following symptoms must be
experienced on almost all or all occasions
(Approximately 75%-100%) of partnered sexual
activity (in identified situational contexts or, if
generalized, in all contexts), and without the
individual desiring delay:
1. Marked delay in ejaculation.


Sexual Pain Disorder
Genito-Pelvic pain/Penetration Disorde-r
marked pain, anxiety, and tension
associated with intercourse for which there
is no medical cause
Vaginismus muscle spasm in the front of
the vagina that prevent the intercourse
pelvic muscles in the outer third of the
vagina undergo involuntary spasms when
intercourse is attempted
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.
untielventually penis is briefly inserted in the
vagina without thrusting.
Assessing Sexual Behavior
1. Interview- supported by numerous questionnaire
because patients may provide more
information on paper than in verbal interview
2. Thorough medical evaluatio-nto rule out
variety of medical conditions that can contribute
to sexual problems
3. Psychophysiological assessm-ent ot
directly measure the physiological aspects
of sexual arousal.
Vaginal photoplethysmograp-hsmaller than a
tampon, inserted by the woman inot her vagina.
Causes:
Biological predisposition and psychological factors
a. Neurological and other NS problems
b. Vascular Disease
c. Chronic illness
d. Prescription medication
e. Drug abuse, and alcohol
f. Distraction
g. Underestimates arousal
h. Negative thoughtprocesses
i.
Erotophobia sexuality can be negative
and somewhat threatening and the responses
they develop reflect this belief
j.
Negative experiences, such as rape
k. Deterioration of relationship
Treatment:
1. Education- ignorance of the most basic
aspectsfo the sexual response cycle and
intercourse often leads to long lasting
dysfunction
2. Psychosocial treatments: SEX
THERAPY providing a brief, and
reasonably successful therapeutic program
for sexual dysfunction.
Conducted over a 2-weeks period
Primary goalis to eliminate psychologically
based performance
3. Sensate and nondemand pleasurin-cgouples
are instructed to refrain from intercourse or
genital caressing and simply explore and
enjoy each
4.
massaging or simliar kinds of behavior.
Squeeze techniqu-epenis is stimulating usually
by the partner, to nearly full erection. Partners
firmly squeeze the penis near the top where
the head of penis joins the shaft, which quickly
reduces arousal. Steps are repeated
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5.
6.
Explicit training in masturbatory procedu-re
Lifelong female orgasmic disorder
To treat vaginismus and pain related to
penetration in genital pelvic pain/ penetration
disorder, the womanand eventually the partner
gradually insert increasingly larger dilators at the
carried out in the context of genital and nongenital
pleasuring so as to retain arouasl.
7. MEDICAL:
b. Viagra, Levitra and Cialis
c. Four most popular procedures:
A. Oral medication,
B. Injection of vasoactive substances directly
into the penis,
C. surgery and
D. Vacuum device therapy
8. Testosteron-etreat erect dysfunction
9. Papaverine or prostgalandin- vasodilating
drugs that inject directly into the penis when
they want to have sexual intercourse.
10. Medical Urethral System for Erection
(MUSE)a soft capsule that contains papaverine
inserted directly into the urethra, somewhat
painful, is less effective than injections and
remain awkward and artificial enough to
preclude wide acceptance
11. Penile Prothese-simplants, good enough
to approximate normal sexual
functioning.
12. Vacuum Device Therap-ycreating a vacuum in
a cylinder and placed over the penisit draws
blood into the penos, which is then trapped by a
specially designed ring placed around the base of
the penis.
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Paraphilic Disorder
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sexual arousal occurs almost exclusively in the
context of inappropriate objects or individuals
-
-
-
-
Types of Paraphilic Disorder
1) Fetishistic Disorder
sexual attraction tononliving objects (1) an
inanimate object or (2) a source of specific
tactile stimulation such as rubber, particularly
clothing made out of rubber.
Over a period ofat least 6 months,recurrent
and intense sexual arousal from either the use
of nonliving objects or a highly specific focus
on nongenital body part(s), as manifested by
fantasies, urges, or behaviors.
2) Voyeuristic Disorder
sexual arousal achieved by viewing unsuspecting
person undressing or naked
at least 6 months, recurrent and intense
sexual arousal from observing an
unsuspecting person who is naked, in the
process of disrobing, or engaging in sexual
activity, as manifested by fantasies, urges, or
behaviors.
The individual has acted on these sexual
urges with a nonconsenting person, or the
sxeual urges or fantasies cause clinically
significant distress or impairment in social,
occupational, or other
important areas of functioning.
3) Exhibitionistic Disorder
-
-
to unsuspecting strangers
Over a period ofat least 6 months, recurrent
and intense sexual arousal from the exposure
of
manifested by fantasies, urges, or behaviors.
4) Transvestic Disorder
sexual arousal fromCrossdressing
A. Over a period of at least 6
months,recurrent and intense sexual arousal
from crossdressing, a manifested by fantasies,
urges, or behaviors.
Autogynephilia arousal by thought/ images of self
as a FEMALE
5) Frotteuristic Disorder
grope in public places
at least 6months, recurrent and intense
sexual arousal from touching or rubbing
against a nonconsenting person, as
manifested by
fantasies, urges, or behaviors.
-
-
-
-
6) Sexual Sadism Disorder
sexual arousal associated with inflicting pain
or humiliation
at least 6 months, recurrent and intense
sexual arousal from the physical or
psychological suffering of another person,
as manifested by fantasies, urges, or
behaviors.
7) Sexual Masochism Disorder
sexual arousal associated with experiencing pain
or humiliation
at least 6months, recurrent and intense
sexual arousal from the act of being
humiliated, beaten, bound, or otherwise made
to suffer, as manifested by fantasies, urges,
or behaviors.
8) Pedophilic Disorder
strong sexual attraction to children
at least 6 months, recurrent, intense
sexually arousing fantasies, sexual urges, or
behaviors involving sexual activity with a
prepubescent child or children (generally
age 13 years or younger).
The individual has acted on these sexual
urges, or the sexual urges or fantasiescause
marked distress or interpersonal difficulty.
The individual is at least age 16 years and
a
least 5 years older than the child or
children in Criterion A.
9) Incest sexual attraction to family
members
Causes:
a. Preexisting deficiencies
b. Treatment received from adults
during childhood
c. Early sexual fantasies reinforced by
masturbation
d. Extremely strong sex drive combined
with uncontrollable thought processes
Treatment:
1. Covert sensitization repeated mental
reviewing of aversive consequences to
establish negative associations with behaviors
2. Relapse intervention therapeutic
preparation for coping with future
situation
3. Orgasmic reconditioning pairing
appropriate stimuli with masturbation
to create positive arousal patterns
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4.
Medical drug that reduce testosterone to
suppress sexual desire; fantasies and
arousal return when drugs are stopped
Gender Dysphoria
–
incongruences and psychological distress and
dissatisfaction with the gender one has assigned at
birth (boy or girl)
Gender Dysphoria in Children(2 or 4 of age)
-
1.
2.
3.
4.
5.
6.
7.
8.
experienced/expressed gender and
assigned gender, of
, as
manifestedby at least sixof the following: (A
Strong.)
To be of the other gender or an insistence
that one is the other gender
In boys (assigned gender), a strong preference
fo cross-dressing or simulating female attire:
or in girls (assigned gender), a strong
preference for wearing only typical masculine
clothing and a strong resistance to the
wearing of typical feminine clothing.
preference for cross-gender roles in makebelieve play or fantasy play.
preference for the toys, games, or
activities stereotypically used or engagedin
by the other gender.
preference for playmates of the other gender.
In boys (assigned gender), a strong rejection
of typically masculine toys, games, and
activities and a strong avoidance of r oughand-tumble play; or in girls (assigned
gender), a strong rejection of typically
feminine toys, games, and activities.
desire for the primary and/or secondary sex
gender.
Gender Dysphoria in Adolescents and Adults
experienced/expressed gender and assigned
gender, of at
manifestedby at
least twoof the following:
as
1.
experienced/expressed gender and primary
and/or secondary sex characteristics (or in
young adolescents, the anticipated secondary
sex characteristics).
2.
secondary sex characteristics because of a
3.
4.
5.
experienced/expressed gender (roin young
adolescents, a desire to prevent the
development of the anticipated secondary sex
characteristics).
A strong desire for the primary and/or
secondary sex characteristics of the other
gender.
A strong desire to be of the other gender
(or some alte
assigned gender).
A strong desire to be treated as the other
gender
assigned gender).
6. A strong conviction that one has the
Transman / transwoman- if the natal sex is female/male
but the experiencedgender is strongly male/female.
Posttrasition-if the individual made the transition to
full time living in their experienced gender and they are
preparing for, or have undergo sexual reassignment.
Intersexuality or hermaphroditism born with
ambiguous genitalia associated with documented
hormonal or other physical abnormalities.
Autogynephilia distinct subset of transwoman with
different pattern of development.
Causes:

Hormonal variation
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
Gender nonconformity boys who behave
in feminine ways and girls who behave on
masculine ways
Treatment:

Sex reassignment surgery alter
anatomy physically to be conssi tent
with gender identity




removal of breasts or penis
genital reconstruction
Psychosocial intervention to change gender
identity
Gynecomastia(the growth of breast)
Elimination Disorder
antidepressant
medication that has been taken continuous for at least 1 month.
Enuresis
Symptoms usually
within
2-4 daysurinate
when begin
children
repeatedly
No symptom present prior to reduction
in inappropriate places
of antidepressant(SSRI or SNRI)
Involuntary in nature/ perceived by
Flashes of light, electric shock sense,
the child as unavoidable
nausea, hyper responses to noise/tight,
At least 2 times per week for 3
anxiety, feelings of dread, ringing in the
consecutive months
ears, inability to sleep
Subtypes:
Nocturnal only (night)
Diurnal only (day)
Nocturnal and Diurnal (both)
Encopresis
–
repeatedly defecate in inappropriate
places
At least once a month for 3 months
Subtypes:
With constipation and overflow
incontinence
Without constipation and overflow
ADVERSEincontinence
EFFECTS OF MEDICATION
TardiveDyskinesia
-
Result in involuntary, repetitive body
movement; NEUROLOGICAL
Often in the lips, jaw, tongue can also
affect the arms, legs, fingers and toes
Purely medication is the main cause
Tardive Dystonia
A movement disorder characterized by
involuntary muscle contractions; MUSCULAR
Mostly inherited or acquired is the main cause
Tardive Akithisia
Subjective sense of inner restlessness
leading to inability to sit still and a
compulsion to move
Antidepressant Discontinuation Syndrome
Is a set of symptoms that may occur
abruptly stopping or great reduction of an
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Disruptive, Impulse Control and Conduct
Disorder
-
Problems in the sel-fcontrol and behaviors
Oppositional Defiant Disorder frequent and
persistent pattern of:
Angry/Irritable mood (often loses temper,
often touchy or easilyannoyed, often
angry & resentful)
Argumentative/ defiant behavior (often
argues w/ authority)
Vindictiveness (has been spiteful/
vindictive at least twice within the past
6 months)
At least 4 symptoms in any of the categories
At least 6 months (age 5 belowmost days, age
5
above at least 1 per week)
Intermittent Explosive Disorder
Recurrent behavioral outbursts/ impulsive
aggressive outburst typically last for
less than 30 mins. Occurred in
response to minor provocation by a
close intimate or associate
At least 6 years of age
Verbal aggression/ physical aggression
twice weekly for 3 months or behavioral
outbursts (destruction of property/ physical
assault in 12 months
Conduct Disorder
Repetitive and persistent pattern of
violating the basic rights of othesr,
societal norms or rules
For age 18 years below
At least 3 symptoms form 15 criteria
Occurring in the past for 12 months
At least 1 criterion for 6 months
Categories:
Aggressive to people/ animals
Destruction of property Deceitfulness/
theft
Seriousviolation of rules
Antisocial Personality Disorder
Pyromania
–
multiple episodes of deliberate
and purposive fire setting
–
often in male
Kleptomania
–
recurrent failure to resist impulses to
steal items even though the items are not
needed for personaluse or for their
monetary
value.
–
Often in female
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Substance-Related and Addictive
Disorder
SUBSTANCE-RELATED
Substance UseDisorder cluster of cognitive,
behavioral, and physiological symptoms indicating
that the person continues to pathologically use the
substance despite substanc-erelated symptoms
Substance-Induced Disorder the development of a
reversible substance spceific syndrome due to the
recent ingestion of a substance
Clinically significant changes involve
disturbances of perception, wakefulness,
attention, thinking, judgment, psychomotor
behavior and interpersonal behavior
Different substances;
1. Alcohol
2. Caffeine
3. Cannabis
4. Hallucinugen
5. Inhalant
6. Opiod
7. Sedative/ hypnotic/ anxiolytic
8. Stimulant
9. Tobacco
NON-SUBSTANCE RELATED
Gambling Disorder-4 or more symptoms occurring
anytime at 12 months
Persistent & recurrent problematic
gambling behavior leading to/ clinically
significant impairment
Distress
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-
-
Involves risking of something value in
the hopes of obtaining something of
great value
Often in male
Substance Abuse harmful or hazardous use of
psychoactive substances that are no legal usage
Substance Dependence persist to use despite problems
related to compulsive and repetitive use that may result in
tolerance and withdrawal symptoms
Substance Intoxication developing irreversible substanc-especific syndrome due to recent ingestion of substance
Addiction havingmore symptoms, tolerance, withdrawal by using more than intended by trying unsuccessfully
to stop by having physical and psychological problems made worse
Tolerance indicated by larger doses of the substance being needed to produce the desired effencdt abecoming
less effect if using amount
Withdrawal the negative physical and psychological effects that develops when a perssotnop taking/ reduces the
amount
BIOLOGICAL FACTORS
DOPAMINE pro
(euphoria
Personality Disorders
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An enduring pattern of inner experience and behavior that deviates markedly from the expectations of
-
the individual's culture 9pervasive and flexible) has onset in adolescenceea/rly adulthood, stable over
time and leads to distress or impairment
Cluster A Odd or Eccentric Disorders
1. Paranoid personality disorder
A pervasive distrust and suspiciousness of
others such that their motives are
interpretedas malevolent.
Are excessively mistrustful and suspicious
of others, without any justification.
Begins early adulthood (4 or more criteria)
TREATMENT
•
suspicion
• Cognitive work to change thoughts
• Low success rate
2. Schizoid personality disorder
A pervasive pattern of detachment from social
relationships and a restricted range of
expression of emotions in interpersonal
settings.
Begins early adulthood (4 or more criteria)
*MALE
TREATMENT
relationships
ills training with role
playing
3. Schizotypal personality disorder
A pervasive pattern of social and interpersonal
deficits marked by acute discomfort with
reduced capacity for close relationships, as
well as by cognitive or perceptual distortions
and eccentricities of behavior.
People with schizotypal personality disorder
are typically socially isolated, like those with
schizoid personality disorder.
They also behave in ways that would
seem unusual to many of us, and they
tend tobe suspicious and to have odd
beliefs.
Begins early adulthood (5 or more criteria)
*MALE
TREATMENT
Treatment
• Teaching social skills to reduce
isolation and suspicion
• Medication (haloperidol) to reduce ideas
of reference, odd communication, and
Cluster B Dramatic, Emotional, or Erratic
Disorders
1. Antisocial personality disorder
A pervasive pattern of disregard for and
violation of the rights of others.
They perform actions most of us would find
unacceptable, such as stealing from friends
and family.
Begins age 15 evidence of Conduct Disorder
(3 or more criteria)
Callous and unemotional traits
*MALES
TREATMENT
• Seldom successful (ni carceration instead)
• Parent training if problems are caught
early
• Prevention through preschool programs
2. Borderline personality disorder
A pervasive pattern of instability of interpersonal
relationships, sel-fimage, affects, and control
over impulses.
Their moods and relationships are unstable,
and usually they have a poor se-lfimage.
These people often feel empty and are at
great risk of dying by their own hands.
Begins early childhood (5 or more criteria)
*75% in
FEMALES
TREATMENT
• Dialectical behaviortherapy
(DBT) Medication:
tricyclic antidepressants
minor tranquilizers
lithium
3. Histrionic personality disorder
A pervasive pattern of excessive emotion
and attention seeking.
Begins early childhood (5 or more criteria)
*more frequently in
FEMALES TREATMENT
• Little evidence of success
• Rewards and fines
• Focus on interpersonal relations
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4. Narcissistic personality disorder
A pervasive pattern of grandiosity (in fantasy
or behavior), need for admiration, and lack
of empathy.
people who think highly of themselves
perhaps exaggerating their real abilities.
They consider themselves somehow different
from others and deserving of special
treatment.
In Greek mythology,Narcissuswas a youth
who spurned thelove of Echo, so
enamoredwas he of his own beauty. He spent
his days admiring his own image reflected in
a pool of water.
Begins early adulthood (5 or more symptoms)
TREATMENT
• Cognitive therapy focus on the da-ytoday pleasurable experiences that are
attainable
• Teaching coachingstrategies to use
-
-
-
3. Obsessiv-ecompulsive personality
A pervasive pattern of preoccupation with
orderliness, perfectionism, and mental and
interpersonal
control, disorder
at the
expense
Cluster C Anxious
or Fearful
Disorders
of flexibility,
openness,
and
efficiency.
1. Avoidant personality disorder
People
haveobsessive-compulsive
A who
pervasive
pattern of social inhibition,
personality
disorder
are characterized
by
feelings of inadequacy,
and hypersensitivity
to
a
negative evaluation.
Their extremely low sel-festeem, coupledwith
Begins
earlyofadulthood
or more
symptoms)
a fear
rejection,(4causes
them
to be
*twicelimited
often in
intheir
MALE
friendships and dependent on
*control
freaks
those
they feel comfortable with.
TREATMENT
Begins early adulthood (4 or more symptoms)
•TREATMENT
Little information
• Therapy
• Behavioral intervention
attack fears behind
needsometimes
techniques
relaxation or distraction
successfultechniques redirect
compulsion
order
– to systematic
desensitiztaion
Acute Stress Disorder
Same w/ PTSD but in shorter duration
Lasting in 3 days up to 1 month after
the exposure
At least 8 months
–
behavioral rehearsal
• Improvements usually modest
2. Dependent personality disorder
A pervasive and excessive need to be taken
5 Personality Traits
care of, which leads to submissive and
I.
Negative Affectvi ity
clinging behavior and fears of separation.
Anxiousness
People with dependent personality disorder,
Emotional lability
however, rely on others to make ordinary
Hostility
decisions as well as important ones, which
Perseveration
results in an unreasonable fear of
Restricted (lack of) affectivity
abandonment
Separation insecurity
Begins early adulthood 95 or more symptoms)
Submissiveness
- *FEMALES
II.
Detachment
TREATMENT
Anhedonia
• Very little research
Depressivity
• Appear as ideal clients
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III.
IV.
V.
-
Intimacy avoidance
Suspiciousness
Withdrawal
Antagonism
Attention seeking
Callousness
Deceitfulness
Grandiosity
Manipulativeness
Disinhibition
distractibility
Impulsivity
Irresponsibility
Rigid perfection
Risk-taking
Psychoticism
Eccentricity
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Perceptual dysregulation
Unusual beliefs and experience
-
Schizophrenia Spectrum and Other
Psychotic Disorders
-
Abnormalities in 1 or more of the following domain
POSITIVE SYMPTOMS comprise excesses and
distortions
1. Delusions fixed belief that are not amenable
to change in spite of conflicting evidence
2. Hallucinations perception like experiences
that occur without an external stimulus
3. Disorganized thinking/ speech problems
in organizing ideas and in speaking so that
the
listener can understand.
GROSSLY DISORGANIZED. ABNORMAL MOTOR
BEHAVIOR
Catatonia severe motor abnormalities marked
by decrease reactivity to the environment
o negativism (resistance to instructions)
to maintain a rigid/ bizarre posture
o mutism/ stupor (complete lack of verbal
and motor responses
o catatonic excitement (purposeless and execssive
motor activity without obvious cause)
NEGATIVE SYMPTOMS behavioral deficits
-
-
Avolition lack of motivation and seeming
absence of interest/ inability to persist in
routine activities
Asociality severe impairment in
social relationships
-
Anhedonia loss of interest/ decrease in
experiencing of pleasure either consummatory
or anticipatory
-
Blunted Affect lack of outward expression
of emotion, face motionless, eyes lifeless
Alogia significant reduction in the amount
of speech
-
Delusional Disorder presence of 1 month or for
longer
(Specifiers: Erotomatic, Grandiose, Jealous,
Persecutory, Somatic and Mixed)
Brief Psychotic Disorder disturbance that involves
sudden onset from non-psychotic state to clearly
psychotic state within 2 weeks
at least 1 positive symptoms or more negative
symptoms
duration of episode is at least 1 day but less than
1 month
Schizophreniform Disorder same with
schizophrenia but differ in duration
total duration is at least 1 month but less than 6
months
duration of episodes is more than 1 day but remits
by 1 month
2 conditions to diagnose1) when episode of illness
2)
when symptomatic for lessthan 6 months duration
required for schizophrenia but not yet recovered.
Schizophrenia involve range of cognitive,
behavioral and emotional dysfunctions but no single
symptoms is pathogenic of the disorder
2 or more symptoms with at least 1
positive symptoms
at least 6 months (slightly high in MALES)
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Schizoaffective Disorder delusions/
hallucinations at least 2 weeks without Major
episodes
uninterrupted period of illness which the
individual continues to display active/ residual
symptoms of psychotic illness.
inclusion of major mood episode (Major
Depression with Manic) concurrent with
schizophrenia (Criteria A) Criteria has not been mte
Prodromal Phase
Early symptoms gradually appear to the person
Lasts for weeks/ months
Active Phase
Acute phase, wherein patient is psychotic
Residual Phase
active phase symptoms subsides then returning of symptoms similar to prodomal phase
12 Psychomotor Features
1. Stupor
2. Catalepsy
3. Waxy flexibility
4. Mutism
5. Negativism
6. Posturing
7. Mannerism
8. Streatype
9. Agitation
10. Grimacing
11. Echolalia
12. Echopraxia
PHASES OF SCHIZOPHRENIA
Biological factors
↑dopamine (psychosis) hallucination/delusions
↓dopamine antipsychotic (Neuroleptics)
*dopamine theory positive symptoms result
decrease volume of prefrontal cortex
- age 15-25 YEARS: schizophrenia for men are high
- age 40 YEARS: schizophrenia for women are high
Sociocultural Factors
Downward drift hypothesis fail to rise out
of a low socioeconomic because of illness
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SUBTEST OF SCHIZOPHRENIA
1.
2.
3.
4.
Paranoid Extreme suspicion/ persecution
Schizoaffective schizophrenia +
major mood disorder
Catatonic psychomotor
activities disturbances
Disorganized disordered thought,
feelings, emotions
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Neurodevelopmental Disorder
-
Characterize by developmental deficits
COMMUNICATION DISORDERS
that
produce impairment of personal, social, academic
Language Disorde-rdifficulties in the acquisition
or occupational functioning
and use of language dueto deficit in the
comprehension or production of vocabulary,
INTELLECTUAL DISABILITIES
sentence structure and discourse (spoken, written
or sign language)
Intellectual Disability (Intellectual Developmental
- Expressive Ability production of vocal,
Disorder) characterized by deficits in general
gestural and/or verbal signs
mental abilities (reasoning, problem-solving,
Receptive Ability process of receiving and
planning, abstract, thinking, judgment, academic
comprehending language messages
learning and learning from experience) *Males
Global Developmental Delay reserved for under
age 5 that cannot be reliably assesses/unable to
undergo. an individual fail to meet expected
developmental milestones in several areas of
intellectual functioning
Types and Levels of Intellectual Disabilities
1. Mild IQ (50-70) capable of functioning but
slight delay on learning to communicate
2. Moderate IQ (35-49) capable for simple
and basic activities but noticeable delays in
learning
3. Severe IQ (20-34) capable of being taught in
daily routine activities but requiressupervision/
directions with noticeable motor movement
4. Profound IQ (20 below) slower and delayed in
all aspects, incapable of performing activities
Speech Sound Disorder difficult in speech
sound production that interferes w/ speech
intelligibility or prevents verbal communication of
messages
Childhood-Onset Fluency Disorder (Stuttering)
disturbance in the normal fluency and time pattern
of speech that is inappropriate in individuals age.
1 or
more criteria
Social (pragmatic) Communication Disorder
primarily difficulty w/ pragmatic or social use of
language and communication manifested by
deficits in understanding and following social rules
(verbal or nonverbal)
Autism Spectrum Disorder characterized by
persistent deficits in social communication and
interaction across multiple context that requires
presence of restricted, repteitive patterns of behavior,
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Attention- Deficit Hyperactivity Disorder
Developmental Coordination Disorder
persistent pattern of inattention/ hyperactivity,
characterized by deficits in the acquisition and
impulsivity that interferes w/ functioning or
execution of coordinated motor skills manifested
development 6 or more symptoms for at least
by clumsiness and slowness/ inaccuracy of
6 months Age 17 above = 5 or more
performance that interfere daily activities
symptoms
Inattention wandering
off tasks,
Stereotypic
Movement Disorderrepetitive
lacking persistence/
focus,
seemingly driven and apparently purposeless motor
dsiorganized
behaviors (hand flapping, body rocking, head
Hyperactivity excessive
activityhitting)
when interfering social,
banging,motor
self-biting,
it is inappropriateacademic
(fidgeting,and
tapping,
other activities
talkativeness)
Specific Learning Disorder abnormalities at a
TIC DISORDERS
cognitive level associated w/ behavioral signs of
- Rapid/ sudden/ recurrent nonrhythmic
disorder characterized by persistent and impairing
motor movement or vocalization
difficulties w/ learning foundation/ key stones
academic skills (reading, writing or math) at least 1
multiple motor and vocal tics
month or more symptoms for 6months
that may wax and wane in frequency present both
Dyslexia difficulty in reading
at the same time more than 1 yr. since first tic
MOTOR DISORDERS
onset
onset before 18 of age
Provisional Tic Disorder never met the criteria for
disorder
Persistent (chronic) Motor or Vocal Tic
Disorder single or multiple motor and vocal tics
that may and wane but not both motor and vocal
occurs. more than 1 year since first tic onset
onset before 18 of age
Specifiers: w/ Motor Tics only & w/ Vocal
Tics only
*TIC DISORDERS ARE COMMONLY IN MALES
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Neurocognitive Disorder
-
Cognitive function deficits that are
acquired rather than
developmental
Delirium
out of track
- Clouded state of consciousness/ state of
mental confusion
- Disturbance of attention and awareness
accompanied by changed in baseline cognition
tha cannot be better explained by preexisting or
evolving NCD

Questions must be repeated due
to attention wanders
COGNITIVE DOMAIN

Easily
distracted by irrelevant stimuli
I.
Complex
Attention

Manifested by reduced orientation
to environment and self
Cause by medical conditions
Common in children and older adults
II.
Executive Function
Major Neurocognitive Disorder significant
cognitive decline from a previous level of
performance in 1 or more cognitive domain
- Tasks may only be completed with assistance
or may be abandoned altogether
- Low score for at least 2 different cognitive test
-
Mild Neurocognitive Disorder modest cognitive
declinefrom a previous level of performance in
one or more cognitive domains
- May view as normal for the elderly
- Require a low score on only 1 cognitive test
- Not all people develop to dementia, only 1%
per year
* common in children and older adults
-
Sustained attention
Divided attention
Selective attention
Processing speed
III.
Planning
Decision making
Working memory
Responding to feedback/ error correction
Overriding habits/ inhibition
Mental flexibility
Learning and Memory
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Immediate memory
Recent memory (free call, recall, recognition)
Very long term (semantic,
autobiographical, implicit)
IV.
Language
Expressive language (naming, word
finding, fluency, grammar
Receptive language (comprehension)
V.
Perceptual Motor
Abilities subsumed under visual
perception, visuo-construct
VI.
Social Cognition
Recognition of emotions
Theory of mind
-
Physical Disorders and Health
Psychology
PSYCHOLOGICAL AND SOCIAL FACTORS THAT
INFLUENCE HEALTH
Psychological, Behavioral, and Social Facto-rsAre
major contributors to medical illness and disease
Examples: Genital herpes, AIDS, cancer,
cardiovascular diseases
1.
2.
3.
(PHYSICAL DISORDERS)known physical causes
and mostly observable physical pathology.
(PHSYCHOSOMATIC MEDICINE) study of
how a psychological and social factor affects
physical
disorders used to be distinct and somewhat
separate from the remainder of psychopathology.
(PSYCHOPHYSIOLOGICAL DISORDER)used to
communicate a similar idea.
Psychosocial factors directly affect physical health
Psychological and Social Factors that Influence Health
(continued)
DSM-IV-TR and Physical Disorders
Coded on Axis III
Recognize that psychological factors affect
medical conditions
-
Psychological Approaches to Health and Disease
-
Behavioral medicine Study of factors
affecting medical illness
Health psychology Promotion of health
HOW DO PSYCHOLOGICAL AND SOCIAL
FACTORS INFLUENCE MEDICAL ILLNESS?
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Two Primary Paths
1. Psychological factors can influence basic
biological processes that lead to illness and
disease.
2. Long-standing behavior patterns may put
people at risk to develop certain physical
disorders.
–
AIDS is an Example of Both Forms
of Influence
–
Leading Causes of Death in the U.S.
o 50% are linked to lifestyle and
behavior patterns
OVERVIEW OF STRESS AND THE STRESS
RESPONSE
Nature of Stress
o Stress Physiological response of
an individual
o Stressor Event that evokes stress response
o Stress responses vary from person to person
o Stress Physiology
The Stress Response and the General Adaptation
Syndrome(Sustained Stress)
1.
Phase 1 Alarm response to immediate
danger or threat (sympathetic arousal)
Phase 2 Resistance (mobilized coping
and action mechanisms to stress)
Phase 3 Exhaustion (chronic stress,
permanent damage)
2.
3.
PHYSIOLOGY OF STRESS
The Biology of Stress
–
Activates the sympathetic branch of the ANS
–
Neuromodulators and neuropeptides act
like neurotransmitters
–
Activates the HPA axis,producing cortisol
–
The relation between the hippocampus
and HPA activation
The Function of the Hippocampus in HPAStress Response Cycle
–
–
–
–
–
Part of the limbic system
Highly responsive to cortisol
Hippocampus helps to turn off the HPA cycle
Chronic stress maydamage cells in
the hippocampus
Damage to hippocampal cells interferes
with stopping the HPA loop
Primate Research: High and Low Social Status
High cortisol is associated with lowsocial
status
Low social status Fewer lymphocytes
and immune suppression
Dominant males benefit from
predictability and controllability
–
–
–
Vulnerabilities in Mental Illness Contribute to
Physical Illness
Stress
Perceived uncontrollability, low social
support, negative affect
–
–
Interpretation of Physiological Response and Situation
Seems critical in the stress response
The role of self-efficacy
–
–
STRESS AND THE IMMUNE SYSTEM
Immune system- protects the body from foreign
materials that may enter it, includingcold viruses.


Depression lowers immune
system functioning (older adults)
Optimism & positive affect
Stronger immune system
How Immune System work?
1. Eliminates foreign materials called
ANTIGENS (bacteria, viruses or
parasites)
2. Divisions of the Immune System
a. Humoral branch
i. Blood and other bodily fluids
b. Cellular branch
i. Protects against viral and parasitic
infections
Function of the Immune System
 Identify and eliminate antigens from
the body
 Leukocytes(White Blood Cells) are
the primary agents
LEUKOCYTES: Subtypes and Functions
a.
i.
Macrophages
First line of defense, destroy antigens,
signal lymphocytes
PSYCHOLOGICAL AND SOCIAL FACTORS:
THEIR RELATION TO STRESS PHYSIOLOGY
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LYMPHOCYTES
a. B cells(humoral branch) releasing
molecules that seek antigens in blood and
other bodily fluids with purpose of
neutralizing them
b. B cells produce highly specific molecule
called IMMUGNOGLOBIN act
asantibodies, combine with the antigens
to neutralize.
c. Memory B cellsare created so that the
next time that the antigen is encountered,
the immune system response will be even
faster.
d. Functional role of B and T cells and
associated memory cells
e. T cells(cellular branch
antibodies.
f.
Killer T cellsdirectly destroy viruses
and cancer cells.
g. Memory T cellsare created to speed
future responses to the same antigen.
h. T4 cells(Helper T cells) enhance the
immune system response by signaling B
cells to produce antibodies and telling other
T cells to destroy the antigen.
i.
Autoimmune diseasesuch
asRheumatoid arthritis, over reactive
and may attack the
ens.
j.
Psychoneuroimmunologyor PNI object
of study is psychological influences on
the neurological responding implicated
in our immune response.


Higher stress and low social support
speed disease progression
Reduce stress, improve immune
system functioning
Psychosocial Effects on Physical Disorders
ACQUIRED IMMUNODEFICIENCY VIRUS
(AIDS)
Nature of AIDS
o
o

o
o
Course from HIV to full blown AIDS is variable
Median time from initial infection to fullblown AIDS?
7.3 to 10 years or more
Stress of getting an AIDS diagnosis can
be devastating
AIDS-related complex (ARC)after
several months to several years with no
symptoms, patients may develop minor
health problems such as weight loss, fever
and night sweats.
Role of Stress Reduction Programs
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The Development and Couresof AIDS
 Influenced by psychological, behavioral,
and social factors
CANCER: PSYCHOLOGICAL AND SOCIAL
INFLUENCES
Oncology- Study of cancer
Psychoncology- Study of psychological factors and
their relation to cancer
Psychological and Behavioral Contbrui tions to Cancer
 Perceived lack of control
 Inadequate or inappropriate coping
responses (e.g., denial)
 Overwhelming stressful life events
 Life-style risk behaviors
 Psychological factors also are involved
in chemotherapy
Cancer is influenced by Psychological, Behavioral,
and Social Factors
CARDIOVASCULAR PROBLEMS:
HYPERTENSION
Cardiovascular System
 Heart, blood vessels and complex
control mechanisms for regulating
function
Hypertension High Blood Pressure






Major risk factor for stroke, heart disease,
and kidney disease
Blood pressure increases when the blood
vessels leading to organs and peripheral areas
constrict (become narrower) forcing increasing
amounts of blood to muscles in central parts
of the body.
Causes wearand tear of the blood vessels
Essential hypertensionis the most
common form
Sytolic Blood Pressur-epressure when the
heart is pumping blood.
Diastolic Blood Pressur-epressure
between beats when the heart is at rest.

Contributing Factorsand Associated Features
 Affects 20% of all adults (between ages of 25
and 74)
 African Americans are most at risk
 Affected by salt, fluid volume,
sympathetic arousal, and stress
 Psychological contributors include anger
and hostility
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Influenced by Psychologi cal , Behavioral, and
Social Factors
Pain: Some Clinical Distinctions
Subjective vs. overt
behavioral manifestations of
pain
CARDIOVASCULAR DISEASES: CORONARY
HEART DISEASE (CHD)
Coronary Heart Disease (CHD-) Blockage of
the arteries supplying blood to the heart
muscle ( MYOCARDIUM)
Angina pectoris:Chest pain from partial obstruction of
the arteries
Atherosclerosis:Accumulation of artery plaque (i.e., fatty
substances)
Ischemia:Deficiency of blood supply because of too
much plaque
Myocardial infarction: Heart attack involving death of
heart tissue
Psychological and Social Factors in Chronic Pain

Perceived control over pain and
its consequences

Negative emotion, poor coping skills

Low social support, compensation

Social reinforcement for pain behaviors
MECHANISMS OF PAIN EXPERIENCE AND
PAIN CONTROL
Gate Control Theory: nerve impulses from
painful stimuli make their way to the spinal
column and from the brain.
Dorsal Horns of the Spinal Colum:nacts as a gate
and may open and transmit sensations of pain if the
stimulation is sufficiently intense.
Psychological and Behavioral Risk Facrtsofor CHD
 Stress, anxiety, anger,
 Poor coping skills
 Low social support
 Lifestyle factors (e.g., smoking, diet,
exercise)
Classic Type A Behavior Pattern
 Anger and negative affect
 Impatience, accelerated speech and
motor activity
Classic Type B BehaviorPattern
 Relaxed, less concerned about deadlines
and seldom feels the pressure or
excitement of challenges or overriding
ambition.
CHD Is Influenced by Psychological,
Behavioral, and Social Factors
CHRONIC PAIN
Two Kinds of Clinical Pain


Acute pain- follows an injury and
disappears once the injury heals or effectively
treated, often within a month.
chronic pain- may begin with an acute
episode but does not decrease over time, even
when the injury has healed or effective
treatments have been administered

to it
-
Small Fibers: A-Delta and C fibers
Large Fibers: A-Beta fibers
THE ROLE OF ENDOGENOUS (Natural) OPIODS
-
-
-
the neurochemical means by which the
brain inhibits pain is an important
discovery
drugs such as heroin and morphine
are manufactured from opioid
substances.
Exist within the body
Endorphins (shut down pain even in the
presence of marked tissue damage orni jury.)
and encephalin.
CHRONIC FATIGUE SYNDROME:
PSYCHOLOGICAL, BEHAVIORAL, AND SOCIAL
INFLUENCES
Nature of Chronic Fatigue (CF)




Lack of nerve strength, marked fatigue, pain, low grade fever
Most common in females
Incidence increasing in Westerncountries
Unrelated to viral infection, immune
problems, depression
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Speculation About Causes
 High-achievement oriented lifestyle
 Fast paced lifestyle combines with stress
and illness
 Psychological misinterpretation of consequences
of illness
SUMMARY OF PHYSICAL DISORDERS
AND HEALTH PSYCHOLOGY
Psychological Factors Play a Major Role in Physical
Disorders
o
Treatment
 Medications are ineffective
 Cognitive-behavioral interventions
appear promising
PSYCHOSOCIAL TREATMENT OF PHYSICAL
DISORDERS
Biofeedback: An Overview

Patient learns to control bodily
responses

Used with chronic headache
and hypertension
Relaxation andMeditation

Progressive muscle relaxation

Transcendental meditation (TM)
Behavioral medicine and
health psychology
Psychological and Social Factors: Their Role
in Illness and Disease
o
o
Stress, immune function, and disease
Such influences interact with
other psychosocial factors
Risk for Physical Illness
o Related to long-standing patterns
of behavior & life-style factors
Psychosocial Treatments
o Aim to prevent and/or treat
physical disorders
o Comprehensive individual or community
programs are best
Comprehensive Stress Reduction and Pain
Management Programs


Own stress- management program
More effective and durable
than individual interventions
alone
Modifying Behaviors to PromoetHealth
Life-Style Practices Core of Many Health Problems

Behavioral risk factors are also
influenced by psychosocial factors

Prevention and intervention
programs target behavioral risks
Types of Life-Style Behaviors

Injury and injury prevention:Repeated
warnings are not enough



AIDS: Highly preventable by
changing behaviors
Smoking in China: Children
intervene in smoking. They wrote
letters to their father asking them to
quit smoking and they submitted
monthly reports on their fathers
smoking habits to the school.
Stanford three community
stud:yDiet, exercise, promotion of
health and wellness
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