DISOR
DISORDER
DER
Generalized Anxiety
Disorder (GAD)
Panic Disorder
Agoraphobia
Specific Phobia
ANX
ANXIETY,
IETY, TRAUM
TRAUMAA- AN
AND
D SSTRES
TRES
TRESSOR
SOR
SOR-RELA
-RELA
-RELATED
TED
TED,, AND O
OBSSES
BSSES
BSSESSIV
SIV
SIVE-COM
E-COM
E-COMPUL
PUL
PULSIVE
SIVE AND RELA
RELATED
TED DIS
DISORDE
ORDE
ORDERS
RS
CRITE
CRITERIA
RIA
STATIS
STATISTICS
TICS
CAUS
CAUSES
ES
-some people inherit a tendency
A. Excessive worry, occurring more days than not Prevalence in the
population for a one-year
to be tense (generalized
for at least 6 months
biological vulnerability), and they
B. The individual finds it difficult to control the period: 3.1%
Prevalence for adolescents
develop a sense early on that
worry
important events in their lives
C. The anxiety and worry are associated with at for a one-year period: 1.1%
Gender: two thirds are
are
uncontrollable
and
least three or more of the following symptoms:
potentially
dangerous
-restlessness, being easily fatigued, irritability, female
Onset: early adulthood
(generalized
psychological
muscle tension, sleep disturbance
Median Age of Onset: 31
vulnerability)
Course: chronic
-this sets off intense worry with
Prevalence rates for older
resulting physical changes (less
adults: 10%
responsiveness—autonomic
restrictors, chronic muscle
tension), leading to GAD
For Panic Attack
Prevalence in the
-agoraphobia often develops
An abrupt surge of intense fear or intense population for a one-year
after a person has unexpected
discomfort that reaches a peak within minutes, period: 2.7%
panic attacks
and during which time four or more of the Prevalence in the
-David Clark emphasizes the
following symptom occur: palpitations, sweating, population at some point in specific psychological
trembling, sensations of shortness of breath, their lives: 4.7%
vulnerability of people with this
feeling of choking, chest pains, nausea, Onset: early adulthood
disorder to interpret normal
lightheaded, chills, paresthesias, derealization, Median Age of Onset:
physical sensations in a
depersonalization, fear of losing control or dying between 20 to 24
catastrophic way
A. marked fear or anxiety about two or more of Gender: two thirds are
the
following
five
situations:
public female
transportation, open spaces, enclosed places, Gender in Agoraphobia:
standing in line or being in a crowd, being outside 75% are female
the home alone
B. the individual fears or avoids these situations
E. the fear or anxiety is out of proportion
F. the fear, anxiety or avoidance is persistent,
typically lasting for 6 months
direct experience
A. marked fear or anxiety about a specific object Prevalence in the
population for a one-year
-experiencing false alarms in a
or situation
specific situation
B. The phobic object or situation almost always period: 8.7%
Prevalence for adolescents
-observing someone else
provokes immediate fear or anxiety
experience severe fear
C. The phobic object or situation is actively for a one-year period:
avoided or endured with intense fear
15.8%
(vicarious experience)
Median Age of Onset: 7
TREATM
TREATMEN
EN
ENTT
Medication: Benzodiazepine
(has negative effects, should be
prescribed for no more than a
week or two), Paroxetine (Paxil),
Venlafaxine (Effexor)
Psychological Intervention: CBT
Medications: Benzodiazepine
(Xanax, hard to stop taking),
SSRIs (Prozac and Paxil), SNRIs
(Venlafaxine)
Psychological Intervention:
exposure-based treatments,
anxiety-reducing coping
mechanisms, Panic Control
Treatment (PCT)
Psychological Intervention::
structured and consistent
exposure-based exercises
Social Anxiety Disorder
(Social Phobia)
Posttraumatic Stress
Disorder (PTSD)
D. The fear or anxiety is out of proportion to the
actual danger
E. The fear, anxiety, or avoidance is persistent,
typically lasting for 6 months or more
A. Marked fear or anxiety about one or more
social situations in which the person is exposed to
possible scrutiny by others
B. The individual fears that he or she will act in a
way, or show anxiety symptoms, that will be
negatively evaluated
C. The social situations almost always provoke
fear or anxiety
D. The social situations are avoided or endured
with intense fear or anxiety
D. The fear or anxiety is out of proportion to the
actual threat posed by the social situation
E. The fear, anxiety, or avoidance is persistent,
typically lasting for 6 months or more
A. Exposure to actual or threatened death,
serious injury, or sexual violence in one or more
of the following ways: directly, witnessing,
learning that the event occurred to a close
relative or friend, experiencing repeated or
extreme exposure to aversive details of the event
B. Presence of one or more of the following
intrusion symptoms: recurrent, involuntary
distressing memories of the event, recurrent
distressing dreams, dissociative reactions,
intense or prolonged psychological distress,
marked physiological reactions to internal or
external cues
C. Persistent avoidance of stimuli associated with
the event: avoidance of or efforts to avoid
distressing memories, external reminders,
inability to recall an important aspect of the
trauma, marked diminished interest in significant
activities, feeling of detachment from others,
restricted range of affect, sense of foreshortened
future
Course: chronic
-being told about danger
(information transmission)
Prevalence in the
population for a one-year
period: 6.8%
Prevalence for adolescents
for a one-year period: 8.2%
Prevalence in the
population at some point in
their lives: 12.1%
Onset: begins during
adolescents
Median Age of Onset: 13
Gender: 50:50
Prevalent among: people
who are young,
undereducated, single, and
of low socioeconomic class
Prevalence in the
population for a one-year
period: 3.5%
Prevalence for adolescents
for a one-year period: 3.9%
Prevalence in the
population at some point in
their lives: 6.8%
Course: chronic
-someone could inherit a
generalized biological
vulnerability to develop anxiety,
a biological tendency to be
socially inhibited, or both
-when under stress, someone
might have an unexpected panic
attack that would become
associated to social cues
-someone might experience a
real social trauma resulting in a
true alarm
Psychological Intervention:
cognitive therapy program that
emphasizes real-life experiences
to disprove automatic
perceptions of danger
-interpersonal psychotherapy
(IPT)
Medication: SSRIs (Prozac), Ccycloserine (makes extinction
work faster)
Combined: DCS + CBT
-precipitating event: someone
personally experiences a trauma
and develops a disorder
-a family history of anxiety
suggests a generalized biological
vulnerability for PTSD
-support from loved ones
reduces cortisol secretion and
hypothalamic-pituitaryadrenocortical (HPA) axis
activity
Psychological Intervention:: face
original trauma, process the
intense emotions, and develop
effective coping procedures in
order
to
overcome
the
debilitating effects of the
disorder
-catharsis
-cognitive therapy
Medication: SSRIs (Prozac and
Paxil)
Obsessive-Compulsive
Disorder
Body Dysmorphic
Disorder
DISOR
DISORDER
DER
Somatic Symptom
Disorder
D. Negative alterations in cognitions and mood
associated with the event: inability to remember
an important aspect of the event due to
dissociative amnesia, persistent and exaggerated
negative beliefs, persistent distorted cognitions
about the cause or consequence of the event,
persistent negative emotional state, persistent
inability to experience positive emotions
E. Duration of the disturbance is more than one
month
A. Presence of obsessions, compulsions, or both
B. The obsessions or compulsion are timeconsuming, or cause clinically significant distress
or impairment in social, occupational, or other
important areas of functioning
Lifetime prevalence: 1.6% -someone must develop anxiety
2.3%
focused on the possibility of
Prevalence in the
having additional
intrusive
population for a one-year
thoughts
period: 1%
Thought-Action Fusion – when
Gender: 1:1
clients with OCD equate
Age of Onset: childhood
thoughts with the specific
through the 30s
actions or activity represented
by the thoughts
Median Age of Onset: 19
Course: chronic
A. Preoccupation with one or more defects or Prevalence: hard to
-defense
mechanism
of
flaws in physical appearance that are not estimate because by its
displacement—that
is,
an
very nature, it tends to be
observable or appear slight to others
underlying unconscious conflict
B. At some point during the course of the kept secret
would be too anxiety provoking
disorder, the individual has performed repetitive -far more common
to admit into consciousness, so
the person displaces it onto a
behaviors or mental acts in response to Course: chronic
body part
Gender: 1:1
appearance concerns
Age of Onset: early
adolescent through the 20s
Peak Age of Onset: 16-17
SOMA
SOMATIC
TIC SYM
SYMPTOM
PTOM AND REL
RELATED
ATED DISO
DISORDERS
RDERS AN
AND
D DIS
DISSOCI
SOCI
SOCIATIV
ATIV
ATIVE
E DISO
DISORDE
RDE
RDERS
RS
CRITE
CRITERIA
RIA
STATIS
STATISTICS
TICS
CAUS
CAUSES
ES
-psychological or behavioral
A. One or more somatic symptoms that are Age of Onset: Adolescence
factors are compounding the
distressing and/or result in significant disruption Course: chronic
and
impairment
Prevalence among: women, severity
of daily life
with
physical
B. Excessive thoughts, feelings, and behaviors unmarried, and from lower associated
symptoms
related
to
the
somatic
symptoms: socioeconomic groups
-these disorders are basically
disproportionate and persistent thought about Gender: women
the seriousness of the symptoms, high level of
disorders of cognition or
health-related anxiety, excessive time and energy
devoted to these symptoms or health concerns
Psychological Intervention
Exposure and Ritual Prevention –
the rituals are actively prevented
and the patient is systematically
and gradually exposed the
feared thoughts or situations
Psychosurgery – surgical lesion
to the cingulate bundle
Medication: SSRIs, clomipramine
-psychological treatment is
similar to those of OCD but are
less successful
TREATM
TREATMEN
EN
ENTT
Psychological
Intervention:
explanatory therapy, CBT
Medication:
antidepressants,
paroxetine (Paxil)
Illness Anxiety Disorder
Conversion Disorder
(Functional
Neurological Symptom
Disorder)
C. Although any one symptom may not be
continuously present, the state of being
symptomatic is persistent (typically more than 6
months)
A. Preoccupation with fears of having or acquiring
a serious illness
B. Somatic symptoms are not present or, if
present, are only mild in intensity
C. There is a high level of anxiety about health,
and the individual is easily alarmed about
personal health status
D. The individual performs excessive healthrelated behaviors or exhibits maladaptive
avoidance
E. Illness preoccupation has been present for at
least 6 months, but the specific illness that is
feared may change over that period of time
A. One or more symptoms of altered voluntary
motor or sensory function
B. Clinical findings provide evidence of
incompatibility between the symptom and
recognized neurological or medical conditions
Prevalence from DSM IV: 15%
Prevalence of both Somatic
Symptom and Illness Anxiety
Disorders: 16.6%
Age of Onset: adolescence
Prevalence
in
the
neurological setting: 30%
Gender: women
Age of Onset: adolescence
perception
with
strong
emotional contributions
-using a stroop test, participants
with these disorders show
enhanced perceptual sensitivity
to illness cues
-individuals with these disorders
may have learned from family
members to focus their anxiety
on specific physical conditions
and illnesses
3 factors may contribute to this
etiological process:
1. These disorders seem to
develop in the context of a
stressful life event
2. People who develop these
disorders tend to have a
disproportionate incidence of
disease in their family when they
were children
3. An important social and
interpersonal influence may be
involved
Freud described 4 basic
processes in the development of
conversion disorder:
1. The individual experiences a
traumatic event
2. Because the conflict and the
resulting
anxiety
are
unacceptable,
the
person
represses the conflict, making it
unconscious
3. The anxiety continues to
increase and threaten to emerge
into consciousness, and the
Psychological Intervention:
-identify and attend to the
traumatic or stressful life event,
reduce any reinforcing or
supportive consequences of the
conversion
symptoms
(secondary gain),
-hypnosis, CBT
person converts it into physical
symptoms
4. The individual receives greatly
increased
attention
and
sympathy from loved ones and
may also be allowed to avoid a
difficult situation or task
-individuals with conversion
disorder have experienced a
traumatic event that must be
escaped at all cost
DepersonalizationDerealization Disorder
Dissociative Amnesia
Dissociative Identity
Disorder
DISOR
DISORDER
DER
Major Depressive
Episode
A. The presence of persistent or recurrent
experiences of depersonalization, derealization,
or both
B. During the depersonalization or derealization
experience, reality testing remains intact
Prevalence among the
population: 0.8% to 2.8%
Gender: 1:1
Mean Age of Onset: 16
Course: chronic
A.
An inability
to
recall
important Prevalence: 1.8% to 7.3%
autobiographical information, usually of a Onset: adulthood
traumatic or stressful nature, that is inconsistent Course: chronic
with ordinary forgetting
A. Disruption of identity characterized by two or
more distinct personality states. The disruption of
marked discontinuity in sense of self and sense of
agency, accompanied by related alteration in
affect, behavior, consciousness, memory,
perception, cognition
B. Recurrent gaps in the recall of everyday events,
important personal information, and/or
traumatic events that are inconsistent with
ordinary forgetting
Average number of alter
personalities: 15
Gender: Female 9:1 Male
Age of Onset: 4
Course: chronic
Prevalence in the
population for a one-year
period: 1.5%
MOOD DIS
DISORDE
ORDE
ORDERS
RS
CRITE
CRITERIA
RIA
STATIS
STATISTICS
TICS
A. Five or more of the following symptoms have Duration if Untreated: 4 to 9
been present during the same 2-week period and months
represent a change from previous functioning: at
least one of the symptoms is either depressed
mood or loss of interest or pleasure:
-forgetting is selective for Psychological
Intervention:
traumatic events or memories involves helping the patient reexperience the traumatic events
rather than generalized
in a controlled therapeutic
manner to develop better coping
skills
-childhood trauma
Psychological
Intervention:
-lack of social support during or therapy is long term, particularly
after the abuse also seems with this disorder is the sense of
trust between therapist and
implicated
-can be attributed to a chaotic, patient
nonsupportive
environment
family
CAUS
CAUSES
ES
Central
Indicator:
physical
changes
along
with
the
behavioral and emotional shut
down
TREATM
TREATMEN
EN
ENTT
Medication:
Selective Serotonin Reuptake
Inhibitors (SSRIs): fluoxetine
(Prozac)
Major Depressive
Disorder
Persistent Depressive
Disorder (Dysthymia)
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
3. significant weight loss when not dieting or
weight gain, or decrease or increase in appetite
4. insomnia or hypersomnia
5. psychomotor agitation or retardation
6. fatigue or loss of energy
7. feelings of worthlessness or excessive or
inappropriate guilt
8. diminished ability to think or concentrate, or
indecisiveness
9. recurrent thoughts of death, recurrent suicidal
ideation without a specific plan, or a suicide
attempt
A. At least one major depressive episode
Course: chronic
Median Lifetime Number of
Major Depressive Episode: 4
to 7
Recurrent: if two or more
major depressive episodes
occurred
and
were
separated by at least 2
months
Mean Age of Onset: 30
Prevalence among Children
Ages 2 to 5: 1.5%
Gender among Adolescents:
more female
A. Depressed mood for most of the day, more Mean Age of Onset: 21
Prevalence among Children:
days than not, for at least 2 years
B. Presence, while depressed, of two or more of 0.07%
the following: poor appetite or overeating, Prevalence among Adults:
insomnia or hypersomnia, low energy or fatigue, 3%-6%
low self-esteem, poor concentration, feelings of Mean Duration: 5 years
hopelessness
C. During the 2-year period of the disturbance,
the person has never been without the symptoms
in criteria A and B for more than 2 months at a
time
Mixed Reuptake Inhibitors:
venlafaxine (Effexor)
Tricyclic
Antidepressants:
imipramine
(Tofranil),
amitriptyline (Elavil)
Monoamine Oxidase (MAO)
Inhibitors.
Medication for Bipolar: Lithium
Carbonate
Psychological Intervention: CBT,
Interpersonal Psychotherapy
Psychological Intervention for
Seasonal Affective Disorder: light
therapy
ETC: electroconvulsive therapy
(ECT)
-the causes of mood disorders lie
in a complex interaction of
biological, psychological, and
social factors
-from a biological perspective,
researchers are particularly
interested
in
the
stress
hypothesis and the role of
neurohormones
-psychological
theories
of
depression focus on learned
helplessness and the depressive
cognitive schemas, as well as
interpersonal disruptions
-60% to 80% of the causes of
depression can be attributed to
environmental factors
-low levels of serotonin in the
causes of mood disorders but
only in relation to other
neurotransmitters
-cortisol level is elevated in
depressed patients
D. Criteria for major depressive disorder may be
continuously present for 2 years
Manic Episode
Premenstrual
Dysphoric Disorder
(PMDD)
Disruptive Mood
Dysregulation Disorder
A. A distinct period of abnormally persistent Duration: 1 week
elevated, expansive, or irritable mood and Duration if Untreated: 3 to 4
abnormally persistently increased goal-directed months
activity or energy, lasting at least 1 week and
present most of the day, nearly everyday
B. During the period of mood disturbance and
increased energy or activity, three or more of the
following symptoms are present to a significant
degree:
1. inflated self-esteem or grandiosity
2. decreased need for sleep
3. more talkative than usual or pressure to keep
talking
4. flight of ideas
5. distractibility
6. increase in goal-directed activity
7. excessive involvement in activities that have a
high potential for painful consequences
A. In the majority of menstrual cycles, at least 5
symptoms must be present in the final week
before the onset of menses, start to improve
within a few days after the onset, and become
minimal in the week postmenses
B. marked affective ability, marked irritability,
marked depressed mood, marked anxiety
C. decreased interest in usual activities,
subjective difficulty in concentration, lethargy,
marked change in appetite, hypersomnia or
insomnia, sense of being overwhelmed, physical
symptoms
A. Severe recurrent temper outburst manifested
verbally and/or behaviorally that are grossly out
of proportion in intensity or duration to the
situation or provocation
Dexamethasone
Suppression
Test (DST) – suppresses cortisol
secretion
-heightened levels of stress
hormones can cause shrinkage
of the hippocampus
Bipolar II Disorder
Bipolar I Disorder
Cyclothymic Disorder
DISOR
DISORDER
DER
Bulimia Nervosa
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 is
persistently irritable or angry most of the day,
nearly every day, and is observable by others
E. Must be present for 12 or more months
A. At least one hypomanic episode and at least
one major depressive episode
B. There has never been a manic episode
-At least one manic episode
-May or may not have history of major depressive
disorder
A. For at least 2 years there have been numerous
periods with hypomanic symptoms that do not
meet criteria for a hypomanic episode and
numerous periods with depressive symptoms
that do not meet criteria for a major depressive
episode
B.
During the above 2-year period, the
hypomanic and depressive periods have been
present for at least half the time and the
individual has not been without the symptoms or
more than 2 months
CRITE
CRITERIA
RIA
A. Recurrent episodes of binge eating:
1. Eating, in a discrete period of time, an amount
of food that is definitely larger than most people
would eat during a similar period of time and
under similar circumstances
2. A sense of lack of control over eating during the
episode
B. Recurrent inappropriate compensatory
behavior in order to prevent weight gain
C. The binge eating and inappropriate
compensatory behaviors both occur, on average,
at least once a week
Lifetime Prevalence: 1%
Prevalence in the population
for a one-year period: 0.8%
Gender: equal
EATIN
EATING
G DIS
DISORDE
ORDE
ORDERS
RS
STATIS
STATISTICS
TICS
Gender: more female
Lifetime prevalence for
females: 2 to 3 times greater
Lifetime prevalence: 1.0%
Prevalence in the population
for a one-year period: 0.3%
Median age of onset: 18 to
21 years old
Course: chronic if untreated
CAUS
CAUSES
ES
Causal factors include possible
biological
and
genetic
vulnerabilities (the disorders
tend to run in families),
psychological factors (low selfesteem), social anxiety (fear of
rejection), and distorted body
image (relatively normal-weight
individuals view themselves as
fat and ugly)
TREATM
TREATMEN
EN
ENTT
Medication: drug treatment
such as antidepressants
Psychological
Intervention:
short-term cognitive-behavioral
therapy to address behavior and
attitudes on eating and body
shape
Interpersonal psychotherapy to
improve
interpersonal
functioning
Anorexia Nervosa
Binge-Eating Disorder
DISOR
DISORDER
DER
Insomnia Disorder
D. Self-evaluation is unduly influenced by body
shape and weight
A. Restriction of energy intake relative to
requirements, leading to a significantly low body
weight in the context of age, sex, developmental
trajectory, and physical health.
B. Intense fear of gaining weight or of becoming
fat, or persistent behavior that interferes with
weight gain, even though at a significantly low
weight
C. Disturbance in the way in which one’s body
weight or shape is experienced, undue influence
A. Recurrent episodes of binge eating:
1. Eating, in a discrete period of time, an amount
of food that is definitely larger than most people
would eat during a similar period of time and
under similar circumstances
2. 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:
1. Eating much more rapidly than normal
2. Eating until feeling uncomfortably full
3. Eating large amounts of food when not feelings
physically hungry
4. Eating alone because of feeling embarrassed
by how much one is eating
5.Feeling disgusted with oneself, depressed, or
very guilty afterward
C. Marked distress regarding binge eating is
present
Lifetime prevalence: 0.6%
Median age of onset: 18 to
21 years old
Course: chronic
Hospitalization (at 70% below
norms weight)
Psychological
Intervention:
outpatient treatment to restore
weight and correct dysfunctional
attitude on eating and body
shape
Lifetime prevalence: 2.8%
Prevalence in the population
for a one-year period: 1.2%
Median age of onset: 18 to
21 years old
Medication: drug treatments
that reduce feelings of hunger
Psychological
Intervention:
Short-term CBT to address
behavior and attitudes on eating
and body shape
IPT to improve interpersonal
functioning
Self-help approaches
SLEE
SLEEP-WA
P-WA
P-WAKE
KE DI
DISORD
SORD
SORDERS
ERS
CRITE
CRITERIA
RIA
STATIS
STATISTICS
TICS
A. A predominant complaint of dissatisfaction Gender: women report
with sleep quantity or quality associated with one insomnia twice as often as
or more of the following: difficulty initiating or men
maintaining sleep, and early-morning awakening
with inability to return to sleep
B. The sleep disturbance causes clinically
significant distress to functioning
CAUS
CAUSES
ES
-people may be biologically
vulnerable to disturbed sleep.
Biological vulnerability may, in
turn, interact with sleep stress.
-causes include pain, insufficient
exercise,
drug
use,
environmental
influences,
TREATM
TREATMEN
EN
ENTT
Medication: benzodiazepines
Psychological
Intervention:
anxiety reduction, improved
sleep hygiene
Hypersomnolence
Disorder
Narcolepsy
Obstructive Sleep
Apnea Hypopnea
C. The sleep difficulty is occurs at least 3 nights
per week
D. The sleep difficulty is present for at least 3
months
E. The sleep difficulty occurs despite adequate
opportunity for sleep
A. Self-reported excessive sleepiness despite a
main sleep period lasting at least 7 hours, with at
least one of the following:
1. recurrent periods of sleep or lapses into sleep
within the same day
2. a prolonged main sleep episode of more than
9 hours per day that is non-restorative
3. difficulty being fully awake after abrupt
awakening
B. The hypersomnolence occurs at least three
times per week for at least 3 months
A. Recurrent periods of irrepressible need to Prevalence: 0.03% to 0.16%
sleep, lapsing into sleep, or napping occurring Gender: equal
within the same day. These must have been
occurring at least three times per week over the
past 3 months
B. The presence of at least one of the following:
1. Episodes of cataplexy defined as either (a) or
(b), occurring at least few times per month: (a) an
individuals with long standing disease,
precipitated by laughter or joking
(b) in children or in individuals within 6 months of
onset, spontaneous grimaces or jaw-opening
episodes
C. Hypocretin deficiency
D. Nocturnal sleep polysomnography showing
REM sleep latency less than or equal to 15
minutes
A. Either (1) or (2):
1. Evidence by polysomnography of at least 5
obstructive apneas or hypopneas per hour of
sleep and either of the following sleep symptoms:
a. nocturnal breathing disturbances, b. daytime
sleepiness
anxiety, respiratory problems,
and biological vulnerability
Causes may involve genetic link Medication: stimulant drugs
and/or excess serotonin
Causes are likely to be genetic
Medication: stimulant drugs
Causes may include narrow or Treatment using continuous
obstructed airway, obesity, and positive air pressure (CPAP)
machines is the gold standard,
increasing age
wright loss is also often
prescribed
Central Sleep Apnea
Sleep-Related
Hypoventilation
Circadian Rhythm
Sleep-Wake Disorders
Non-Rapid Eye
Movement Sleep
Arousal Disorders
Nightmare Disorder
Rapid Eye Movement
Sleep Behavior
Disorder
2. Evidence by polysomnography of 15 or more
obstructive apneas and/or hypopneas per hour of
sleep regardless of accompanying symptoms
A. Evidence by polysomnography of five or more
central apneas per hour of sleep
A. Polysomnography demonstrates episodes of
decreased respiration associated with elevated
CO2 levels
A. A persistent or recurrent pattern of sleep
disruption that is primarily due to an alteration of
the circadian system or to a misalignment
between the endogenous circadian rhythm and
the sleep-wake schedule required by an
individual’s physical environment or social or
professional schedule
B. The sleep disruption least to excessive
sleepiness or insomnia, or both
A. Recurrent episodes of incomplete awakening
from sleep usually occurring during the first third
of the major sleep episode accompanied by
either one of the following:
1. Sleepwalking (Somnambulism)
2. Sleep terrors
B. No or little dream imagery is recalled
C. Amnesia for the episodes is present
A. Repeated occurrences of extended, extremely
dysphoric, and well-remembered dreams that
usually involve efforts to avoid threats of survival,
security, or physical integrity and that generally
occur during the second half of the major sleep
episode
B. On awakening from the dysphoric dreams, the
person rapidly becomes disoriented and alert
A. Repeated episodes of arousal during sleep
associated with vocalization and/or complex
motor behaviors
B. These behaviors arise during REM sleep and
therefore usually occur greater than 90 minutes
after sleep onset
Caused
by
inability
to Treatment includes phase delays
synchronize sleep patterns with to adjust bedtime and bright
current pattern of day and night light to readjust biological clock
due to jet lag, shift work, delayed
sleep, or advanced sleep
Somnambulism: occurs at
least once during non-REM
sleep In 15% to 30% of
children under age 15
Sleep
Terrors:
more
common in boys than girls
Causes may include extreme
fatigue,
sleep
deprivation,
sedative or hypnotic drugs, and
stress. May have an genetic link
Causes are unknown but they
tend to decrease with age
DISOR
DISORDER
DER
Male Hypoactive
Sexual Desire Disorder
Female Sexual
Interest/Arousal
Disorder
C. Upon awakening from these episodes, the
individual is completely awake, alert, and not
confused or disoriented
D. Either of the following:
1.
REM
sleep
without
atonia
on
polysomnographic recording
2. A history suggestive of REM sleep behavior
disorder and an established synucleinopathy
diagnosis
SEXU
SEXUAL
AL DY
DYSFU
SFU
SFUNCTION
NCTION
NCTIONS,
S, PARA
PARAPHILI
PHILI
PHILIC
C DIS
DISORDE
ORDE
ORDERS,
RS, AND G
GEND
END
ENDER
ER DYSPH
DYSPHORIA
ORIA
CRITE
CRITERIA
RIA
STATIS
STATISTICS
TICS
CAUS
CAUSES
ES
Contributions:
A. Persistently or recurrently deficient Prevalence: increases with Psychological
distraction, underestimates of
sexual/erotic thoughts or fantasies and desire for age
sexual activity. The judgment of deficiency is Prevalence: 5%
arousal,
negative
thought
made by the clinician, taking into account factors
process
that affect sexual functioning, such as age and
Psychological
and
Physical
general and socio-cultural contexts of the
Interaction: a combination of
person’s life
influence is almost always
B. The symptoms in criterion A have persisted for
present,
specific biological
a minimum duration of approximately 6 months
predisposition and psychological
A. Lack of, or significantly reduced, sexual Prevalence: 22%
factors may produce a particular
interest/arousal, as manifested by at least three Overall Prevalence: 43%
Prevalence: decreases with disorder
of the following:
Sociocultural
Contribution:
age
1. absent/reduced interest in sexual activity
erotophobia,
caused
by
2. absent/reduced sexual/erotic thoughts or
formative experiences of sexual
fantasies
cues as alarming, negative
3. No/reduced initiation of sexual activity, and
typically unreceptive to a partner’s attempts to
experiences, deterioration of
initiate
relationship
4. Absent/reduced sexual excitement or pleasure
Biological
Contributions:
during sexual activity in almost all or all sexual
neurological or other nervous
encounters
system
problems,
vascular
5. Absent/reduced sexual interest/arousal in
disease,
chronic
illness,
response to any internal or external sexual/erotic
prescription medication, drugs
cues
abuse including alcohol
6. Absent/reduced genital or nongenital
sensations during sexual activity
B. The symptoms in criterion A have persisted for
a minimum duration of approximately 6 months
TREATM
TREATMEN
EN
ENTT
Psychosocial:
therapeutic
program
to
facilitate
communication, improve sexual
education,
and
eliminate
anxiety.
Both
partners
participate fully
Medical: almost all interventions
focus on male erectile disorder,
including
drugs.
Medical
treatment is combined with
sexual education and therapy to
achieve maximum benefit
Female Orgasmic
Disorder
Premature Ejaculation
Genito-Pelvic
Pain/Penetration
Disorder
Frotteuristic Disorder
Fetishistic Disorder
A. Presence of either of the following symptoms
and experienced on almost all or all occasions of
sexual activity:
1. Marked delay in. marked infrequency of, or
absence of orgasm
2. Markedly reduced intensity of orgasmic
sensations
B. The symptoms in criterion A have persisted for
a minimum duration of approximately 6 months
A. A persistent or recurrent pattern of ejaculation
occurring during partnered sexual activity within
approximately 1 minute following vaginal
penetration
B. The symptom in criterion must have been
present for at least 6 months and must be
experienced on almost all or all occasions of
sexual activity
A. Persistent or recurrent difficulties with one or
more of the following:
1. Vaginal penetration during intercourse
2. Marked vulvovaginal or pelvic pain during
vaginal intercourse or penetration attempts
3. Marked fear or anxiety about vulvovaginal or
pelvic pain in anticipation of, during, or as a result
of vaginal penetration
4. Marked tensing or tightening of the pelvic floor
muscles during attempted vaginal penetration
B. The symptom in criterion must have been
present for at least 6 months and must be
experienced on almost all or all occasions of
sexual activity
A. Over a period of at least 6 months, recurrent
and intense sexual arousal from touching or
rubbing against a non-consenting person, as
manifested by fantasies, urges, or behaviors
B. The person has acted on these sexual urges
with a non-consenting person, or the sexual urges
or fantasies cause clinically significant distress or
impairment in functioning
A. Over a period of at least 6 months, recurrent
and intense sexual arousal from the use of
Most common complaint
among women who seek
therapy for sexual problems
Most common male sexual
dysfunction
Estimated Prevalence: 6% of
women
Preexisting deficiencies:
-in levels of arousal with
consensual adults
-in consensual adult social skills
Treatment received from adults
during childhood
Early sexual fantasies reinforced
by masturbation
Covert Sensitization – repeated
mental reviewing or aversive
consequences to establish
negative
association
with
behavior
Relapse Prevention – therapeutic
preparation for coping with
future situations
Orgasmic Reconditioning –
pairing appropriate stimuli with
Voyeuristic Disorder
Exhibitionistic Disorder
Transvestic Disorder
Sexual Sadism Disorder
nonliving objects or a highly specific focus on the
nongenital body parts, as manifested
by
fantasies, urges, or behaviors
B. The fantasies, sexual urges, or behaviors cause
clinically significant distress or impairment in
functioning
C. The fetish objects are not limited to articles of
clothing used in cross-dressing or devices
specifically designed for the purpose of tactile
genital stimulation
A. Over a period of 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
B. The person has acted on these sexual urges
with a non-consenting person, or the sexual urges
or fantasies cause clinically significant distress or
impairment in functioning
C. The individual experiencing the arousal and/or
acting on the urges are at least 18 years of age
A. Over a period of at least 6 months, recurrent
and intense sexual arousal from the exposure of
one’s genitals to an unsuspecting person, as
manifested by fantasies, urges, or behaviors
B. The person has acted on these sexual urges
with a non-consenting person, or the sexual urges
or fantasies cause clinically significant distress or
impairment in functioning
A. Over a period of at least 6 months, recurrent
and intense sexual arousal from cross-dressing,
as manifested by fantasies, urges, or behaviors
B. The fantasies, sexual urges, or behaviors cause
clinically significant distress or impairment in
functioning
A. Over a period of at least 6 months, recurrent
and intense sexual arousal from the psychological
or physical suffering of another person, as
manifested by fantasies, urges, or behaviors
B. The person has acted on these sexual urges
with a non-consenting person, or the sexual urges
Extremely strong sex drive masturbation to create positive
combined with uncontrollable arousal patterns
Medication: drugs that reduce
thought process
testosterone to suppress sexual
desire; fantasies and arousal
return when drugs are stopped
Survey from Sweden:
7.7% reported at least one
incident of being sexually
aroused by spying on others
having sex
Survey from Sweden:
31% reported at least one
incident of being sexually
aroused by exposing their
genitals to a stranger
Survey from Sweden:
2.8% of men and 0.4% of
women reported at least
one episode of transvestic
disorder
Sexual Masochism
Disorder
Pedophilic Disorder
Gender Dysphoria
or fantasies cause clinically significant distress or
impairment in functioning
A. Over a period of at least 6 months, 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
B. The fantasies, sexual urges, or behaviors cause
clinically significant distress or impairment in
functioning
A. Over a period of at least 6 months, recurrent, Gender: approximately 90%
intense sexually arousing fantasies, sexual urges, of abusers are male, and
or behaviors involving sexual activity with a 10% are female
prepubescent child or children (generally age 13
years or younger)
B. The person has acted on these sexual urges or
the sexual urges or fantasies caused marked
distress or interpersonal difficulty
C. The individual is at least 16 years and at least 5
years older than the child or children in criterion
A
In Chil
Children
dren
A. A marked incongruence between one’s
experienced/expressed gender and assigned
gender, of at least 6 months’ duration, as
manifested by at least six of the following:
1. A strong desire to be of the other gender or an
insistence that one is the other gender
2. In boys (assigned gender), a strong preference
for cross-dressing or simulation female attire or
in girls (assigned gender), a strong preference for
wearing only typical masculine clothing
3. A strong preference for cross-gender roles in
make-believe play or fantasy play.
4. A strong preference for the toys, games, or
activities stereotypically used or engaged in by
the other gender
5. In boys, a strong rejection of typically
masculine toys, games, and activities, and a
strong evidence of rough-and-tumble play or in
Biological Influences – not yet
confirmed, although likely to
involve prenatal exposure to
hormones. Hormonal variations
may be natural or result from
medication
Psychological
Influences
–
gender
identity
develops
between 1 ½ and 3 years of age.
“Masculine” behaviors in girls
and “feminine” behaviors in boys
evoke different responses in
different families
Sex Reassignment Surgery –
removal of breasts or penis;
genital reconstruction
-requires rigorous psychological
and financial and social stability
Psychosocial intervention to
change identity – usually
unsuccessful
except
as
temporary relief until surgery
DISOR
DISORDER
DER
Alcohol Use Disorder /
Sedative-, Hypnotic-,
or Anxiolytic-Related
Disorders / Stimulant
Use Disorder /
Tobacco Use Disorder
/ Opiod Use Disorder /
Cannabis Use Disorder
/ Hallucinogen Use
Disorder / Inhalant Use
Disorder /
girls, a strong rejection in of typically feminine
toys, games, and activities
6. A strong dislike for one’s sexual anatomy
7. A strong desire for the primary and/or
secondary sex characteristics that match one’s
experienced gender
In Adol
Adolesce
esce
escents
nts and Adult
Adults:
s:
A. A marked incongruence between one’s
experienced/expressed gender and assigned
gender, of at least 6 months’ duration, as
manifested by at least two of the following:
1. A marked incongruence between one’s
experienced/expressed gender and primary
and/or secondary sex characteristics
2. A strong desire to be rid of one’s primary
and/or secondary sex characteristics
3. A strong desire for the primary and/or
secondary sex characteristics of the other gender
4. A strong desire to be of the other gender
5. A strong desire to be treated as the other
gender
6. A strong conviction that one has the typical
feelings and reactions of the other gender
SUBS
SUBSTANC
TANC
TANCE-REL
E-REL
E-RELATE
ATE
ATED,
D, AD
ADDICTI
DICTI
DICTIVE,
VE, AND IM
IMPUL
PUL
PULSE-C
SE-C
SE-CONTR
ONTR
ONTROL
OL DI
DISORDERS
SORDERS
CRITE
CRITERIA
RIA
STATIS
STATISTICS
TICS
CAUS
CAUSES
ES
Psychological Influences:
A. A problematic pattern of substance (alcohol,
Not to use:
sedative, hypnotic, anxiolytic, amphetamine-type
substance, cocaine, other stimulant, tobacco,
-fear of effects of drug use,
opiod, cannabis, hallucinogen, and hydrocarbondecision not to use drugs, feeling
based inhalant substance) use leading to clinically
of confidence and self-esteem
significant impairment or distress, as manifested
without drug use
by at least two of the following, occurring within
To use:
a 12-month period:
-drug
use
for
pleasure,
1. Substance is often taken in larger amount or
association with “feeling good,”
over a longer period than was intended
drug use to avoid pain and
2. There is a persistent desire or unsuccessful
escape
unpleasantness
by
efforts to cut down or control substance use
“numbing out,” feeling of being
3. A great deal of time is spent in activities
in
control,
positive
necessary to obtain substance, use substance, or
expectation/urges about what
recover from its effects
TREATM
TREATMEN
EN
ENTT
Psychosocial Treatments:
-Aversion Therapy to create
negative associations with drug
use
-Contingency Management to
change behaviors by rewarding
chosen behaviors
-Alcoholic Anonymous and its
variations
-Inpatient hospital treatment
-Controlled use
-Community reinforcement
-Relapse prevention
Biological Treatments
Caffeine Intoxication
Gambling Disorder
4. Craving, or a strong desire or urge to use
substance
5. Recurrent _______ use resulting in a failure to
fulfill major role obligations at work, school, or
home
6. Continued substance use despite having
persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects of
substance
7. Important social, occupational, or recreational
activities are given up or reduced because of
substance use
8. Recurrent alcohol use in situations in which it
is physically hazardous
9. Substance use is continued despite knowledge
of having persistent or recurrent physical or
psychological problem that is likely to have been
caused or exacerbated by substance
10. Tolerance, as defined by either or both of the
following: (a) a need for markedly increased
amounts of substance to achieve intoxication or
desired effect (b) a markedly diminished effect
with continued use of the same amount of
alcohol
11. Withdrawal, as manifested by either of the
following: (a) the characteristic withdrawal
symptoms for substance (b) substance is taken to
relieve or avoid withdrawal symptoms
A. Recent consumption of caffeine (typically a
high dose well in excess of 250 mg)
B. Five or more of the following signs or
symptoms developing during, or shortly after,
caffeine use:
Restlessness,
nervousness,
excitement,
insomnia, flushed face, diuresis, gastrointestinal
disturbance, muscle twitching, rambling flow of
thought and speech, tachycardia or cardiac
arrhythmia,
periods
of
inexhaustibility,
psychomotor agitation
A. Persistent and recurrent problematic gambling Lifetime Prevalence: 1.9% of
behavior leading to clinically significant adult Americans
drug use will be like, avoidance
of withdrawal symptoms, and
presence of other psychological
disorders
-Agonist Substitution – replacing
one drug with a similar one
-Antagonist
Substitution
–
blocking one drug’s effect with
another drug
-Aversive Treatments – making
Social Influences:
taking drug very unpleasant
-exposure to drugs—through
-Drugs to help recovering person
media, peers, parents, or lack of
deal with withdrawal symptoms
parental monitoring—versus no
exposure to drugs
-social expectations and cultural
expectations for use
-family/culture/society
and
peers
supportive
versus
unsupportive of drug use
Biological Influences:
-inherited genetic vulnerability
affects: body’s sensitivity to
drug, body’s ability to metabolize
drug
-drugs activate natural reward
center (pleasure pathway) in
brain
-neuroplasticity increases drugseeking and relapse
impairment or distress as indicated by the
individual exhibiting 4 or more of the following in
a 12-month period:
1. Needs to gamble with increasing amounts of
money in order to achieve the desired excitement
2. Is restless or irritable when attempting to cut
down or stop gambling
3. Has made repeated unsuccessful efforts to
control, cut back, or stop gambling
4. Is often preoccupied with gambling
5. Often gambles when feeling distressed
6. After losing money gambling, often returns
another day to get even
7. Lies to conceal the extent of involvement with
gambling
8. Has jeopardized or lost a significant
relationship, job, or educational or career
opportunity because of gambling
9. Relies on others to provide money to relieve
desperate financial situations caused by gambling
DISOR
DISORDER
DER
Cluster A: Paranoid
Personality Disorder
CRITE
CRITERIA
RIA
A. A pervasive distrust and suspiciousness of
others such that their motives are interpreted as
malevolent, beginning by early adulthood and
present in variety of contexts, as indicated by 4 or
more of the following:
1. Suspects, without sufficient basis, that others
are exploiting, harming, or deceiving him or her
2. Is preoccupied with unjustified doubts about
the loyalty or trustworthiness of friends or
associates
3. Is reluctant to confide in others because of
unwarranted fear that the information will be
used maliciously against him or her
4. Reads hidden demeaning or threatening
meanings into benign remarks or events
5. Persistently bears grudges
6. Perceives attacks on his or her character or
reputation that are not apparent to others and is
quick to react angrily or to counterattack
PERSON
PERSONALI
ALI
ALITY
TY DI
DISORD
SORD
SORDERS
ERS
STATIS
STATISTICS
TICS
Prevalence in the Clinical
Population: 6.3% to 9.6%
Prevalence in the General
Population: 1.5% to 1.8%
Gender:
approximately
equal among men and
women
CAUS
CAUSES
ES
Psychological Influences:
-thoughts that people are
malicious,
deceptive,
and
threatening
-behavior based on mistaken
assumptions about others
Biological Influences:
-possible but unclear link with
schizophrenia
Social/Cultural Influences:
-“outsiders” may be susceptible
because of unique experiences
-parents’ early teaching may
influence
TREATM
TREATMEN
EN
ENTT
-difficult because of client’s
mistrust and suspicion
-cognitive work to change
thoughts
-low success rate
Cluster A: Schizoid
Personality Disorder
Cluster A: Schizotypal
Personality Disorder
7. Has recurrent suspicions, without justification,
regarding fidelity of spouse or sexual partner
A. A pervasive pattern of detachment from social
relationships and a restricted range or expression
of emotions in interpersonal settings, beginning
by early adulthood and present in a variety of
contexts, as indicated by 4 or more of the
following:
1. Neither desires nor enjoys close relationships,
including being part of a family
2. Almost always chooses solitary activities
3. Has little, if any, interest in having sexual
experiences with another person
4. Takes pleasure in few, if any, activities
5. Lacks close friends or confidants other than
first-degree relatives
6. Appears indifferent to the praise or criticism of
others
7. Shows emotional coldness, detachment, or
flattened affectivity
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 5 or more of the following:
1. Ideas of reference (excluding delusions of
reference)
2. Odd beliefs or magical thinking that influences
behavior and is inconsistent with subcultural
norms
3. Unusual perceptual experiences, including
bodily illusions
4. Odd thinking and speech
5. Suspiciousness or paranoid ideation
6. Inappropriate or constricted affect
7. Behavior or appearance that is odd, eccentric,
or peculiar
8. Lack of close friends or confidants other than
first degree relatives
Prevalence in the Clinical
Population: 1.4% to 1.9%
Prevalence in the General
Population: 0.9% to 1.2%
Gender:
slightly
more
common among men
Psychological Influences:
-very limited range of influences
-apparently
cold
and
unconnected
-unaffected by praise or criticism
Biological Influences:
-may be associated with lower
density of dopamine receptors
Social/Cultural Influences:
-preference for social isolation
-lack of social skills
-lack of interest in close
relationships, including romantic
or sexual
-learning value of social
relationships
-social skills training with role
playing
Prevalence in the Clinical
Population: 6.4% to 5.7%
Prevalence in the General
Population: 0.7% to 1.1%
Gender:
slightly
more
common among men
Course: chronic, some go on
to develop schizophrenia
Psychological Influences:
-unusual beliefs, behaviors, or
dress
-suspiciousness
-believing insignificant events
are personally relevant
-expressing little emotion
-symptoms of major depressive
disorder
Biological Influences:
-genetic
vulnerability
for
schizophrenia but without the
biological or environmental
stresses present in that disorder
Social/Cultural Influences:
-presence for social isolation
-excessive social anxiety
-lack of social skills
-teaching social skills to reduce
isolation an and suspicion
-medication (haloperidol) to
reduce ideas of reference, odd
communication, and isolation
-low success rate
Cluster B: Antisocial
Personality Disorder
Cluster B: Conduct
Disorder
9. Excessive social anxiety that does not diminish
with familiarity and tends to be associated with
paranoid psychotic fears rather than negative
judgments about self
A. A pervasive pattern of disregard for and
violation of the rights of others, occurring since
age 15 years, as indicated by 3 or more of the
following:
1. Failure to conform to social norms with respect
to lawful behaviors, as indicated by repeatedly
performing acts that are grounds for arrest
2. Deceitfulness, as indicated by repeated lying,
use of aliases, or conning others for personal
profit or pleasure
3. Impulsivity or failure to plan ahead
4. Irritability and aggressiveness, as indicated by
repeated physical fights or assaults
5. Reckless disregard for safety of self or others
6. Consistent irresponsibility, as indicated by
repeated failure to sustain consistent work
behavior or honor financial obligations
7. Lack of remorse, as indicated by being
indifferent to or rationalizing having hurt,
mistreated, or stolen from another
B. The individual is at least age 18 years
C. There is evidence of conduct disorder with
onset before age 15 yea rs
A. A repetitive and persistent pattern of behavior
in which the basic rights of others or major ageappropriate societal norms or rules are violated,
as manifested by the presence of at least three of
the following 15 criteria in the past 12 months
from any categories below, with at least one
criterion present in the past 6 months:
Aggression to People and Animals
1. Often bullies, threatens, or intimidates others
2. Often initiates physical fights
3. Has used weapon that can cause serious
physical harm to others
4. Has been physically cruel to people
5. Has been physically cruel to animals
Prevalence in the Clinical
Population: 3.9% to 5.9%
Prevalence in the General
Population: 1.0% to 1.8
Gender:
much
more
common in men
Course: dissipates after age
40
Psychological Influences:
-difficulty learning to avoid
punishment
-indifferent to concern of others
Biological Influences:
-genetic vulnerability combined
with environmental influences
-abnormally low cortical arousal
-high fear threshold
Social/Cultural Influences:
-criminality
-stress/exposure to trauma
-inconsistent parental discipline
-socioeconomic disadvantage
-seldom
successful
(incarceration instead)
-parent training if problems are
caught early
-prevention through preschool
programs
Cluster B: Borderline
Personality Disorder
6. Has stolen while confronting a victim
7. Has forced someone into sexual activity
Destruction of Property
8. Has deliberately engaged in fire setting with
the intention of causing serious damage
9. Has deliberately destroyed others’ property
Deceitfulness or Theft
10. Has broken into someone else’s house,
building, or car
11. Often lies to obtain goods or favors or to avoid
obligations
12. Has stolen items of nontrivial value without
confronting a victim
Serious Violation of Rules
13. Often stays out at night despite parental
prohibitions, beginning before age of 13 years
14. Has run away from home overnight at least
twice while living in the parental or parental
surrogate home, or once without returning for a
lengthy period
15. Is often truant from school, beginning before
age of 13 years
A pervasive pattern of instability of interpersonal
relationships, self-image, and affects, and marked
impulsivity, beginning by early adulthood and
present in a variety of contexts, as indicated by 5
or more of the following:
1. Frantic efforts to avoid real or imagined
abandonment
2. A pattern of unstable and intense interpersonal
relationships characterized by alternating
between extremes of idealization and
devaluation
3. Identity disturbance: markedly and persistently
unstable self-image or sense of self
4. Impulsivity in at least two areas that are
potentially self-damaging
5. Recurrent suicidal behavior, gestures, or
threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity
of mood
Prevalence in the Clinical
Population: 28.5%
Prevalence in the General
Population: 1.4% to 1.6%
Gender:
approximately
equal among men and
women
Course: symptoms gradually
improve
if
individuals
survive into their 30s
Psychological Influences:
-suicidal
-erratic moods
-impulsivity
Biological Influences:
-familial link to mood disorders
-possibly inherited tendencies
(impulsivity or volatility)
Social/Cultural Influences:
-early
trauma,
especially
sexual/physical abuse
-rapid
cultural
changes
(immigration)
may
trigger
symptoms
Psychological Intervention:
-Dialectical Behavior Therapy
(DBT)
Medication:
-tricyclic antidepressants
-minor tranquilizers
-lithium
Cluster B: Histrionic
Personality Disorder
Cluster B: Narcissistic
Personality Disorder
7. Chronic feeling of emptiness
8. Inappropriate, intense anger or difficulty
controlling anger
9. Transient, stress-related paranoid ideation or
severe dissociative symptoms
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
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
8. Considers relationships to be more intimate
than they actually are
A pervasive pattern of grandiosity, need for
admiration, and lack of empathy, beginning by
early adulthood and present in a variety of
contexts, as indicated by 5 or more of the
following:
1. Has a grandiose sense of self-importance
2. Is preoccupied with fantasies of unlimited
success, power, brilliance, beauty, or ideal love
3. Believes that he or she is “special” and unique
and can only be understood by, or should
associate with, other special or high-status
people
4. Requests excessive admiration
5. Has a sense of entitlement
6. Is interpersonally exploitative
Prevalence in the Clinical
Population: 8.0% to 9.7%
Prevalence in the General
Population: 1.2% to 1.3%
Gender:
slightly
more
common among women
Course: chronic
Psychological Influences:
-little evidence of success
-rewards and fines
-vain and self-centered
-focus on interpersonal relations
-easily upset if ignored
-vague and hyperbolic
-impulsive; difficulty delaying
gratification
Biological Influences:
-possible link to antisocial
disorder (women histrionic/men
antisocial)
Social/Cultural Influences:
-overly
dramatic
behavior
attracts attention
-seductive
-approval-seeking
Prevalence in the Clinical
Population: 5.1% to 10.1%
Prevalence in the General
Population: 0.1% to 0.8%
Gender:
slightly
more
common among men
Course: may improve over
time
-narcissistic personality disorder
arises largely from a profound
failure by the parents of
modeling empathy early in a
child’s development
-therapy focuses on the patient’s
grandiosity,
their
hypersensitivity to evaluation,
and their lack of empathy
towards others
-cognitive therapy to replace
their fantasies with a focus on
day-to-day
pleasurable
experiences that are truly
attainable
Cluster C: Avoidant
Personality Disorder
Cluster C: Dependent
Personality Disorder
7. Lacks empathy: is unwilling to recognize or
identify with feelings and needs of others
8. Is often envious of others or believes that
others are envious of him or her
9. Shows arrogant, haughty behaviors or
attitudes
A pervasive pattern of social inhibition, feelings of
inadequacy, and hypersensitivity to negative
evaluation, beginning by early adulthood and
present in a variety of contexts, as indicated by 4
or more of the following:
1. Avoids occupational activities that involves
significant interpersonal contact because of fears
of criticism, disapproval, or rejection
2. Is unwilling to get involved with people unless
certain of being liked
3. Shows restraint within intimate relationships
because of the fear of being shamed or ridiculed
4. Is preoccupied with being criticized or rejected
in social situations
5. Is inhibited in new interpersonal situations
because of feelings of inadequacy
6. Views self as socially inept, personally
unappealing, or inferior to others
7. Is unusually reluctant to take personal risks or
to engage in any new activities because they may
prove embarassing
A pervasive and excessive need to be taken care
of that leads to submissive and clinging behavior
and fears of separation, beginning by early
adulthood and present in a variety of contexts, as
indicated by 5 or more of the following:
1. Has difficulty making everyday decisions
without an excessive amount of advice and
reassurance from others
2. Needs others to assume responsibility for most
major areas of his or her life
3. Has a difficulty expressing disagreement with
others because of fear of loss of support or
approval
Prevalence in the Clinical
Population: 21.5% to 24.6%
Prevalence in the General
Population: 1.4% to 2.5%
Gender:
slightly
more
common among women
Psychological Influences:
-low self-esteem
-fear of rejection, criticism leads
to fear of attention
-extreme sensitivity
-resembles social phobia
Biological Influences:
-innate characteristics may
cause rejection
Social/Cultural Influences:
-insufficient parental affection
Psychological Intervention:
-behavioral intervention
techniques sometimes
successful:
-systematic desensitization
-behavioral rehearsal
-improvements usually modest
Prevalence in the Clinical
Population: 13.0% to 15.0%
Prevalence in the General
Population: 0.9% to 1.0%
Gender:
much
more
common among women
Psychological Influences:
-early “loss” of caretaker leads to
fear of abandonment
-timidity and passivity
Biological Influences:
-each of us born dependent for
protection, food, and nurturance
Social/Cultural Influences:
-agreement for the sake of
avoiding conflict
-similar to avoidant: inadequacy,
sensitivity to criticism, and need
of assurance BUT for the same
-very little research
-appear as ideal clients
-submissiveness
negates
independence
Cluster C: ObsessiveCompulsive Personality
Disorder
4. Has difficulty initiating projects or doing things
on his or her own
5. Goes to excessive lengths to obtain nurturance
and support from others, to the point of
volunteering to do things that are unpleasant
6. Feels uncomfortable or helpless when alone
because of exaggerated fears of being unable to
care of himself or herself
7. Urgently seeks another relationship as a source
of care and support when a close relationship
ends
8. Is unrealistically preoccupied with fears of
being left to take care of himself or herself
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
3. Is excessively devoted to work and productivity
to the exclusion of leisure activities and
friendships
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
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
shared
reasons,
avoidants
withdraw, dependents cling
Prevalence in the Clinical
Population: 6.1% to 10.5%
Prevalence in the General
Population: 1.9% to 2.1%
Gender:
slightly
more
common among men
Psychological Influences:
-generally rigid
-dependent on routines
-procrastinating
Biological Influences:
-distant relation to OCD
-probable weak genetic rule:
predisposition to structure
combined
with
parental
reinforcement
Social/Cultural Influences:
-very work-oriented
-poor interpersonal relationships
-little information
-attacks anxiety behind need
-relaxation
or
distraction
techniques redirect compulsion
to order
DISOR
DISORDER
DER
Schizophrenia
Catatonia Associated
with Another Mental
Disorder (Catatonia
Specifier)
SCHIZO
SCHIZOPHRENIA
PHRENIA SPEC
SPECTRUM
TRUM AND O
OTHER
THER PSYC
PSYCHO
HO
HOTIC
TIC DIS
DISORD
ORD
ORDERS
ERS
CRITE
CRITERIA
RIA
STATIS
STATISTICS
TICS
CAUS
CAUSES
ES
A. Two (or more) of the following, each present Lifetime Prevalence: 0.2% to Trigger:
for a significant portion of time during a 1-month 1.5%
-stressful, traumatic life event
period (or less if successfully treated). At least Course: generally chronic
-high expressed emotion
Gender: equal
one of these must be (1), (2), or (3):
-sometimes no obvious trigger
Onset with Men: likelihood Biological Influences:
1. Delusions
of onset diminishes with -inherited tendency (multiple
2. Hallucinations
age, but it can still occur
3. Disorganized speech
genes) to develop disease
after the age of 75
4. Grossly disorganized or catatonic behavior
-prenatal/birth complications—
Onset with Women: lower
5. Negative symptoms
viral
infection
during
B. For a significant portion of time since the onset than for men until age 36,
pregnancy/birth injury affects
of the disturbance, level of functioning in one or when the relative risk for
more major areas, such as work, interpersonal onset switches, with more child’s brain cells
relations, or self-care, is markedly below the level than women than men -brain chemistry (abnormalities
in the dopamine and glutamate
being affected later in life
achieved prior to the onset
systems)
C. Continuous signs of the disturbance persist for
-brain
structure
(enlarged
at least 6 months. This 6-month period must
ventricles)
include at least 1 month of symptoms that meet
Behavioral Influences:
criterion A and may include periods of prodromal
or residual symptoms. During these prodromal or
Positive Symptoms:
residual periods, the signs of the disturbance may
-active
manifestations
of
be manifested by only negative symptoms or by
abnormal behaviors (delusions,
two or more symptoms listed in criterion A
hallucinations,
disorganized
present in an attenuated form
speech, odd body movements,
A. The clinical picture is dominated by three or
or catatonia)
more of the following symptoms:
Negative Symptoms:
1. Stupor (i.e., no psychomotor activity; not
-flat affect (lack of emotional
actively relating to environment)
expression)
2. Cataplexy (i.e., passive induction of a posture
-avolition (lack of initiative,
held against gravity
apathy)
3. Waxy Flexibility (i.e., slight, even resistance to
-alogia (relative absence in
positioning by examiner
amount or content of speech)
4. Mutism
Social Influences:
5. Negativism (i.e., opposition or no response to
instructions or external stimuli)
-environmental (early family
6. Posturing (i.e., spontaneous and active
experiences) can trigger onset
maintenance of a posture against gravity)
7. Mannerism (i.e., odd, circumstantial caricature
of normal behavior)
TREATM
TREATMEN
EN
ENTT
Integrative Treatment Approach:
Collaborative
Psychopharmacology – using
antipsychotic medications to
treat to the main symptoms of
the disorder, as well as using
other medications for secondary
symptoms
Assertive Community Treatment
– providing support in the
community, with emphasis on
small caseloads for care
providers, services in the
community setting rather than a
clinic, and 24-hour coverage
Family
Psychoeducation
–
assisting
family
members,
including educating them about
the
disorder
and
its
management, helping them
reduce stress and tension in the
home, and providing social
support
Supportive
Employment
–
providing sufficient support
before and during employment
so that the person can find and
keep a meaningful job
Illness
Management
and
Recovery – helping the individual
become an active participant in
treatment, including providing
education about the disorder,
teaching effective use of
medication
strategies
for
collaborating with clinicians, and
coping with symptoms when
they reoccur
Schizophreniform
Disorder
Schizoaffective
Disorder
Delusional Disorder
8. Stereotypy (i.e., repetitive abnormally
frequent, non-goal-directed movements)
9. Agitation, not influenced by external stimuli
10. Grimacing
11. Echolalia
12. Echopraxia
A. Two (or more) of the following, each present
for a significant portion of time during a 1-month
period (or less if successfully treated). At least
one of these must be (1), (2), or (3):
1.Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized
5. Negative symptoms
B. An episode of the disorder lasts at least 1
month but less than 6 months. When the
diagnosis must be made without waiting for
recovery, it should be q ualified as “provisional”
A. An uninterrupted period of illness during which
there is a major mood episode (major depressive
or manic) concurrent with criterion A of
schizophrenia
Note: The major depressive episodes must
include Criterion A1: Depressed Mood
B. Delusions or hallucinations for 2 or more weeks
in the absence of a major mood episode during
the lifetime duration of the illness
C. Symptoms that meet criteria for a major mood
episode are present for the majority of the total
durance of the active and residual portions of the
illness
A. The presence of one (or more) delusions with
a duration of 1 month or longer
B. Criterion A for schizophrenia has never been
met
C. Apart from the impact of the delusion(s) or its
ramifications, functioning is not markedly
impaired, and behavior is not obviously bizarre or
odd
-culture
influences Integrated
Dual-Disorder
interpretation
of Treatment – treating coexisting
substance use
disease/symptoms
Emotional
and
Cognitive
Influences:
-interaction styles that are high
in criticism, hostility, and
emotional over-involvement can
trigger a relapse
Substance/MedicationInduced Psychotic
Disorder
Psychotic Disorder
Associated with
another Medical
Condition
Brief Psychotic
Disorder
D. If manic or depressive episodes have occurred,
these have been brief relative to the duration of
the delusional periods
A. Presence of one or both of the following
symptoms: delusion, hallucinations
B. There is evidence from the history, physical
examination, or laboratory findings of both (1)
and (2):
1. The symptoms in Criterion A developed during,
or soon after substance intoxication or
withdrawal or after exposure to a medication
2. The involved substance/medication is capable
of producing the symptoms in Criterion A
A. Prominent hallucinations or delusions
B. There is evidence from the history, physical
examination, or laboratory findings that the
disturbances in the direct pathophysiological
consequence of another medical condition
A. Presence of one (or more) of the following
symptoms. At least one of these must be (1), (2),
or (3):
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
B. Duration of an episode of the disturbance is at
least 1 day but less than 1 months, with eventual
full return to premorbid level of functioning