Abnormal

Psychology
Review
Day Two

Raissa N. Matunog, RPm

st data on the mental health scenario in the Philipp
a study sponsored by the World Health Organisatio
 Classification System of
DSM-IV-TR (Review)
Axis I - all categories of clinical syndromes except personalit
disorders and intellectual disorders (mental retardation)

Axis II - Personality disorders and intellectual disorders

Axis III - General medical conditions

Axis IV - Psychosocial stressors (recent stressors, social

esources, sociocultural background) and environmental
problems

Axis V - Global level of current functioning (overall clinical

ating of degree of impairment)
Schizophrenia & Other
Psychotic Disorders
 Symptoms
ur Domains

isorganized behaviour

chaotic functioning, bizarre behaviour, odd motor

movements or posturing

isturbances in thought & speech

delusions, disorganized thinking and/or bizarre

communication characterised by nonsensical words &
phrases

erceptual disturbances

hallucinations - projection of internal sensory

experiences onto the outside world (all sensory
modalities)

motional disturbances

very socially isolated and withdrawn, marked decreases

in motivated, goal-directed behavior, disturbance in
sense of self, poor self/other differentiation

flat or inappropriate affect

 Symptoms
wo types

Positive

• delusions, hallucinations,
speech and thought
incoherence

• errors of commission

Negative

• flat affect, avolition/apathy,

social withdrawal, anhedonia

• errors of omission
 Diagnostic Criteria
wo or more of the ff five symptoms must be present in a significant way
t least 1 month during a period of 6 months:

delusions

hallucinations

markedly disorganized or catatonic symptoms

negative symptoms

Patient must have symptoms continuously for at least 6 months, with at

east 1 month of acute symptoms as noted above

symptoms are present for at least 1 month but less than 6 months,
iagnosis of schizophreniform disorder is made
Phases of Schizophrenia
odromal phase - early signs of
eterioration, which may last for years.
ypical elements are:

decreased interest in social activities

difficulty meeting requirements of daily

living

some strange behaviour

cute phase - full-blown psychotic

allucinations and/or delusions develop)

very difficult to understand or communicate

with the person

esidual phase - behaviour returns to

odromal level, but patient still shows
ficulty meeting demands of social roles
 Subcategories
ranoid - characterized by delusions and hallucinations, with themes of persecution and/or grandiosity, of
gross disorganisation of speech and behaviour and no prominent negative symptoms

sorganized - (formerly hebephrenic) severe disorganization of behaviour and marked incoherence of tho
d speech; inappropriate or flat affect; odd mannerisms; sometimes poor self-care

ex: patient might use word salad (bizarre stream of words) or neologisms (made-up words)

tatonic - at least 2 of the following:

stupor or motoric immobility

excitement

marked negativism

strange, stereotyped movements, mannerisms, gestures

echolalia (automatic repetition of voices) or echopraxia (automatic repetition of another person’s moveme

differentiated - does not meet criteria for any of the other three types but does meet criteria for
hizophrenia
Other Psychotic Disorders
chizophreniform disorder - meets criteria for less than 6 months but more than 1 mon

rief psychotic disorder - 1 or more of the following symptoms for at least 1 day but les
an 1 month with eventual full return to premorbid functioning: delusions, hallucinations,
sorganised speech or behavior

hared psychotic disorder - (folie a deux) two people in a close relationship who shar
e same delusion

chizoaffective disorder - meets criteria for both schizophrenia and a mood disorder. H
elusions or hallucinations for at least 2 weeks in the absence of significant mood
ymptoms. Can be either bipolar type or depressive type.

ubstance-induced psychotic disorder

elusional disorder - for at least 1 month, clear non bizarre delusions. No indication of
ain schizophrenia symptoms. Behaviour outside delusional beliefs is not grossly impair
x: erotomania - delusional belief that a person of higher status is in love with you)
 Possible Etiologies
ological

Genetic factors - degree of risk correlates

with degree of shared genes, but
concordance rates for identical twins (50%)
leave room for environmental & other
factors

Structural brain abnormalities - reduction

in gray matter; low metabolic rates in
prefrontal cortex and larger cerebral
ventricles; all imply loss of brain cells

Dopamine hypothesis - positive

symptoms related to excess dopamine
activity in the brain

Pregnancy complications - possible

maternal influenza during gestation
 Possible Etiologies
ychological

Adverse family environment leads to

ncreased stress and higher relapse rates

high ‘expressed’ emotion - negative criticism

by hostile, over involved family members

Communication deviance

double-bind message - inconsistent,

contradictory messages

Behavioral theories stress that schizophrenics

have not learned appropriate social skills and
acceptable social responses

Cognitive theories focus on patient’s

delusional beliefs as ways of understanding
peculiar perceptions that are biologically caused
 DSM 5 Changes
Bizarre delusions and ‘conversation-like’ auditory
hallucinations are eliminated

At least 1 positive symptom is needed to diagnose

Schizophrenia subtypes are eliminated

Schizoaffective disorder - mood disorder needs to

be diagnosed after schizophrenia symptoms are
verified
Depressive & Bipolar
Disorders
Types
• Unipolar disorders

• Major depression

• Main symptoms - for more than 2 weeks, 5 or more

symptoms

• depressed mood, crying, sleep problems, weight

loss/gain, psychomotor agitation/retardation, suicidal
ideation, poor concentration, low self-esteem and
feelings of worthlessness/guilt, fatigue

• Several subtypes - melancholic, catatonic or psychotic

features; postpartum onset; seasonal pattern (SAD)

• Dysthymic disorder - similar symptoms at much milder

for 2 years

• Double depression - major depressive episode + dysthy

disorder
 Types
ipolar disorders

Bipolar I (manic episode) - elevated mood;

inflated, grandiose self-image; more talkative; little
sleep; flight of ideas; pressured speech; high risk-
taking. Patient meets criteria for mania and also
major depression. Episodes of m & d may alternate
in more or less rapid cycles or be mixed.

Bipolar II (hypomanic episode) - same but much

milder, no history of manic episode. Alternating
periods of major depressive episodes and
hypomanic episodes (similar to manic but shorter,
less severe and impairing)

Cyclothymic disorder - alternation of depressive

symptoms (in the dysthymic range) and hypomanic
episodes for at least 2 years
 Possible Etiologies
Biological

Genetic predisposition -
stonger for bipolar disorders

Neurotransmitter
dysregulation

• depression results from

decreased levels of
norepinephrine

• depression results from

decreased levels of
 Possible Etiologies
Behavioral
Reduction in
Social
ife stress positive Depressio
withdrawal reinforcement

Learned Helplessness Theory (Seligman) - states

that one gives up after learning that one’s efforts a
futile in avoiding pain and frustration

Perceived Generalize
ncontrollable
bad events lack of helpless
control behavior
Possible Etiologies
• Cognitive Triad (Beck) - negati
view of self, others & the future

• Schemas are rigid, negative,

dysfunctional

• show indications of
overgeneralization, excessive
of responsibility, all-or-nothing
thinking

• negative automatic thoughts a

cognitive distortions promote a
maintain depression
 ltering.
e take the negative details and magnify them while filtering out all positive aspects of a
tion. For instance, a person may pick out a single, unpleasant detail and dwell on it exclusively
their vision of reality becomes darkened or distorted.
olarized Thinking (or “Black and White” Thinking).
polarized thinking, things are either “black-or-white.” We have to be perfect or we’re a failure
e is no middle ground. You place people or situations in “either/or” categories, with no shades o
or allowing for the complexity of most people and situations. If your performance falls short of
ect, you see yourself as a total failure.
vergeneralization.
this cognitive distortion, we come to a general conclusion based on a single incident or a
e piece of evidence. If something bad happens only once, we expect it to happen over and ove
n. A person may see a single, unpleasant event as part of a never-ending pattern of defeat.
umping to Conclusions.
ithout individuals saying so, we know what they are feeling and why they act the way the
n particular, we are able to determine how people are feeling toward us. For example, a person
conclude that someone is reacting negatively toward them but doesn’t actually bother to find ou
are correct. Another example is a person may anticipate that things will turn out badly, and will
inced that their prediction is already an established fact.
 atastrophizing.
e expect disaster to strike, no matter what. This is also referred to as “magnifying or minimiz
hear about a problem and use what if questions (e.g., “What if tragedy strikes?” “What if it happe
e?”). For example, a person might exaggerate the importance of insignificant events (such as th
ake, or someone else’s achievement). Or they may inappropriately shrink the magnitude of
ficant events until they appear tiny (for example, a person’s own desirable qualities or someone
s imperfections).
ersonalization.
ersonalization is a distortion where a person believes that everything others do or say is som
of direct, personal reaction to the person. We also compare ourselves to others trying to
rmine who is smarter, better looking, etc. A person engaging in personalization may also see
mselves as the cause of some unhealthy external event that they were not responsible for. For
mple, “We were late to the dinner party and caused the hostess to overcook the meal. If I had on
hed my husband to leave on time, this wouldn’t have happened.”
ontrol Fallacies.
we feel externally controlled, we see ourselves as helpless a victim of fate. For example, “I ca
it if the quality of the work is poor, my boss demanded I work overtime on it.” The fallacy of inte
rol has us assuming responsibility for the pain and happiness of everyone around us. For exam
y aren’t you happy? Is it because of something I did?”
allacy of Fairness.
e feel resentful because we think we know what is fair, but other people won’t agree with us
parents tell us when we’re growing up and something doesn’t go our way, “Life isn’t always fair.”
ple who go through life applying a measuring ruler against every situation judging its “fairness” w
n feel badly and negative because of it. Because life isn’t “fair” — things will not always work out
favor, even when you think they should.
aming.
e hold other people responsible for our pain, or take the other track and blame ourselves for
y problem. For example, “Stop making me feel bad about myself!” Nobody can “make” us feel an
cular way — only we have control over our own emotions and emotional reactions.
Shoulds.
e have a list of ironclad rules about how others and we should behave. People who break the
make us angry, and we feel guilty when we violate these rules. A person may often believe they
rying to motivate themselves with shoulds and shouldn’ts, as if they have to be punished before
do anything. For example, “I really should exercise. I shouldn’t be so lazy.” Musts and oughts are
offenders. The emotional consequence is guilt. When a person directs should statements toward
rs, they often feel anger, frustration and resentment.
Emotional Reasoning.
e believe that what we feel must be true automatically. If we feel stupid and boring, then we m
upid and boring. You assume that your unhealthy emotions reflect he way things really are — “I
erefore it must be true.”
Fallacy of Change.
e expect that other people will change to suit us if we just pressure or cajole them enough. W
d to change people because our hopes for happiness seem to depend entirely on them.
Global Labeling.
e generalize one or two qualities into a negative global judgment. These are extreme forms
eralizing, and are also referred to as “labeling” and “mislabeling.” Instead of describing an error in
ext of a specific situation, a person will attach an unhealthy label to themselves. For example, the
say, “I’m a loser” in a situation where they failed at a specific task. When someone else’s behav
a person the wrong way, they may attach an unhealthy label to him, such as “He’s a real jerk.”
abeling involves describing an event with language that is highly colored and emotionally loaded.
mple, instead of saying someone drops her children off at daycare every day, a person who is
abeling might say that “she abandons her children to strangers.”
Always Being Right.
e are continually on trial to prove that our opinions and actions are correct. Being wrong is
nkable and we will go to any length to demonstrate our rightness. For example, “I don’t care how
y arguing with me makes you feel, I’m going to win this argument no matter what because I’m rig
g right often is more important than the feelings of others around a person who engages in this
itive distortion, even loved ones.
Heaven’s Reward Fallacy.
e expect our sacrifice and self-denial to pay off, as if someone is keeping score. We feel bitte
n the reward doesn’t come.
 Suicide
up to 70% of all suicides result from a mood
disorder

Warning signs - social withdrawal, decline in

chool functioning, loss of appetite, sleep
problems. More apt to occur when
depression has lifted somewhat.

stressful life events also contribute to

serious illness. Important losses lead to
sense of hopelessness and negative
expectations, depression.

suicide does not necessarily occur

Three Types (Durkheim

Egoistic - people who are alienated and are

unconcerned with social norms

Anomic - people who feel let down by society

and/or have experienced major change

Altruistic - believe it will benefit society

 DSM 5 Changes
ipolar disorder - emphasis on changes in activity and energy as well as mood

“With mixed features” instead of mania + major depressive episode

added anxious distress specifier

epressive disorders

disruptive mood dysregulation - for children up to age 18 years who display

persistent irritability and frequent episodes of extreme behavioral dyscontrol

premenstrual dysphoric disorder

dysthymia & chronic major depressive disorder is now persistent depressive

disorder

bereavement is now recognised as a severe psychosocial stressor that can

precipitate an episode of MDD
Substance-Use
Disorders
 Types
ubstance use disorders

Substance dependence - involves 3 or more of the ff:

• physiological dependence, indicated by tolerance or withdrawal

• strong focus on obtaining the substance

• impaired functioning due to use of substance

• inability to curtail or control use of substance

Substance abuse - maladaptive pattern due to substance use as seen by 1 or more of the ff:

• continued use despite interpersonal difficulties, legal problems or physically hazardous situatio

• continued use despite interference with major responsibilities

Types of substance used - depressants, stimulants, narcotics, hallucinogens

Substance-induced disorders - psychosis, sleep disorder

 Possible Etiologies

gical • Stressful emotions

ereditary influences • Behavioral undercontrol (associat

rebelliousness, novelty-seeking, r
opamine reward/stress pathways and impulsivity)

• Coping with life transitions

 Possible Etiologies
Social

Parental and peer models

Social pressures

Childhood stressors

Sociocultural

Norms and values

Media influences

Societal stressors
 DSM 5 changes
ddition of gambling disorder - some behaviours, like gambling, activate the
rain reward system with effects similar to those of drugs of abuse

No more separation of abuse and dependence

Criteria instead are provided for intoxication, withdrawal,

ubstance/medication-induced disorders and unspecified substance-induce
isorders

recurrent legal problems deleted

new criterion - craving or a strong desire or urge to use a substance

severity has been added - 2-3 criteria (mild), 4-5 criteria (moderate), 6 or
more criteria (severe)
Personality Psychopatholog
chronic patterns of maladaptive, pervasive, stable
and distressing behavior and inner experience

clustered into three main categories

• A: Odd/Eccentric

• B: Dramatic/Erratic

• C: Anxious/Fearful
 Name Symptoms

excessively mistrustful and suspicious of

other people without any justification. Tends
Paranoid to not confide in others, expects others to do
them harm.

pattern of detachment from social

relationships, limited range of emotions in
Schizoid interpersonal situations. Seem aloof, cold
and indifferent to others

typically socially isolated, behave in ways

that would seem unusual to rest of us. Tend
Schizotypal to be suspicious and have odd beliefs about
the world. Tend to have ideas of reference.
 Name Symptoms

history of failing to comply with social norms

perform actions most of us would find
Antisocial unacceptable. tend to be irresponsible,
impulsive and deceitful.

lack stability in moods and in relationships

with others. usually have poor self-esteem.
Borderline individuals often feel empty and are at great
risk of suicide.

tend to be overly dramatic and often appear

Histrionic to be acting

think highly of themselves - beyond their rea

abilities. consider themselves somehow
Narcissistic different from others and deserving of specia
treatment
 Name Symptoms

extremely sensitive to the opinions of others

and therefore avoid social relationships.
Avoidant extremely low self-esteem + fear of rejection
= reject the attention of others

rely on others to the extent of letting them

make everyday decisions and major ones.
Dependent results in unreasonable fear of being
abandoned.

characterized by a fixation on things being

done the “right way”. preoccupation with
Obsessive-Compulsive details prevents them from completing much
of anything.
 Possible Etiologies
Psychodynamic

Freud - unresolved Oedipal conflicts (antisocial PD)

Kohut - (narcissistic) lack of parental empathy and

support sets stage for pathological narcissism

Kernberg - (borderline) patients cannot synthesize

contradictory (positive and negative) elements of
themselves and others into complete, stable wholes

Mahler - (borderline) disrupted separation-individuation

process
earning

childhood experiences shape pattern of maladaptive habits that constitute

personality disorders

(dependent) children are regularly discouraged from speaking their minds

(ocpd) excessive parental discipline

(histrionic) social reinforcers, like parental attention, are connected to child’s

appearance and willingness to perform for others, especially when reinforcers ar
dispensed inconsistently; may have parents who are dramatic, emotional and
attention-seeking

social cognitive - role of reinforcement

• (antisocial) early learning experiences lacked consistency and predictability, as

adults do not place much value on what other people expect

• (antisocial) often have difficulty ‘reading’ emotions in other people’s faces and
have hostile cognitive biases
 Possible Etiologies
Family - disturbances in family relationships

(borderline) tend to have early memories that paint

significant others as malevolent or evil

(borderline) childhood physical or sexual abuse/neglect

(dependent) parental overprotection and authoritarianis

resulting to extreme fears of abandonment and clingy
behaviours

(ocpd) may emerge within a strongly moralistic and rigid

family environment
Biological

(antisocial, narcissistic, paranoid, borderline) genetic factors

(antisocial) lack of anxiety in response to threatening

situations; lack of emotion responsiveness in general

(antisocial) exaggerated cravings for stimulation; possibly

require higher-than-normal threshold of stimulation to mainta
an optimum state of arousal

(borderline and antisocial) dysfunctions in parts of brain

involved in regulating emotions and restraining impulsive
behaviours; prefrontal cortex and deeper brain structures in
the limbic system
DSM 5 Personality Disorder
Types
Name Symptoms Gender Differenc

Schizotypal
peculiar thoughts and behaviors, poor
interpersonal relationships higher in males

Borderline
intense fluctuations in mood, self-image, and
interpersonal relationships higher in females

Avoidant
fear of rejection and humiliation, reluctance
to enter into social relationships none
exaggerated sense of self-importance,
Narcissistic exploitativeness, relationships largely higher in males
superficial

essive Compulsive
perfectionism, interpersonally controlling,
devotion to details, and rigidity higher in males
Neurodevelopmental
Disorders
 Conduct disorder and
Oppositional defiant disorde
• Characteristics

• CD - person violates rights of others and

societal norms for appropriate, rule-bound
behaviour

• ODD - negative, irritable, uncooperative,

argumentative; less severe than conduct
disorder

• Contributing factors

• difficult temperament, parental violence, poo

parental supervision and uninvolvement,
serotonin imbalances, lower physiological
arousal to punishment, increased testosteron
levels, genetic predisposition
Separation Anxiety Disorde
Excessive fear and distress
on separation from
caregivers

Causes - parental behaviors

that encourage fear;
childhood traumas;
behavioural inhibition (an
innate inhibited and fearful
temperament)
Elimination disorders
• disturbances in bladder and
bowel control

• Enuresis - unintended urination

least twice per week for more
than 3 months in a child over fiv

• Encopresis - unintended
defecation at least once per
month for 3 months in a child ov
four
otor skills disorder (developmental coordination disorder) - development
elays or difficulties especially with motor skills

ommunication disorders - deficits in verbal communication (eg. stuttering

Expressive language disorder - difficulty learning or retrieving words

earning disorders - performance in reading, math or writing is below that

xpected for age, grade or IQ
 Tic Disorders
nvoluntary, repetitive movements or
ocalizations, occasionally persists into
dulthood

Stress can increase frequency & intensity of tics

ourette’s disorder - multiple motor tics and one

r more vocal tics

can include involuntary coprolalia or motor

movements involving self-harm

Comorbid conditions include poor anger control,

dhd, ocd, impulsive behaviour and poor social
kills
Attention-deficit hyperactivity
disorder
characterized by attentional
problems and/or impulsive,
hyperactive behaviours that are
atypical fo the child’s age and
developmental level

significantly interfere with social,

academic or occupational activities

poor regulation of attentional

processes = distractibility and
ntense focus on irrelevant
environmental stimuli

Inattention
Poor attention to detail
Difficulty sustaining attention
Does not seem to listen
Poor follow-through
Difficulty organizing tasks
Avoids sustained mental effort
Loses objects
Easily distracted
Forgetful
Hyperactivity &
Impulsivity
Fidgets
Restless
Moves excessively
Excessively loud
Talks excessively
Blurts out answers
Difficulty waiting for turn
Interrupts or intrudes on others
Impatient
 Etiology
Biological

ADHD is highly heritable (80% of factors explainable by

genetic factors)

Brain structure abnormalities and neurotransmitter

dysregulation (dopamine and associated
neurotransmitters)

Prematurity, oxygen deprivation during birth, very low

birth weight, lead and PCB exposure, viral infections,
meningitis, encephalitis and maternal smoking/drug use
during pregnancy
 Etiology

Psychological, Social and Sociocultural

• sociocultural and social adversity

• problems at home and with the child with ADHD

• negative interactions with ADHD child and

associated interpersonal conflict
Autism Spectrum Disorders
• characterized by significant impairment in
social communication skills and the display
of stereotyped interests and behaviours

• can range from mild to severe

• often not diagnosed until age 3 or later

• infants may have difficulty attending to

human motion or demonstrating interest in
human faces

• symptoms can sometimes appear after a

period of apparently normal social and
 Symptoms
eficits in social communication and social interaction

atypical social-emotional reciprocity

atypical nonverbal communication

difficulties developing and maintaining relationships

epetitive behavior or restricted interests or activities involving at least 2 of the f

repetitive speech, movement or use of objects

intense focus on rituals or routines and strong resistance to change

intense fixations or restricted interests

atypical sensory reactivity

 Autistic Savants

display ‘splinter skills’

• they do well on isolated tasks but perform poorly

on verbal tasks and tasks that require language
skills and symbolic thinking
 Etiology
ological

neurological findings

• unique patterns of metabolic brain activity

• poor connectivity involving amygdala and other brain regions associated with autistic
symptoms

• correlations between biochemicals in amygdala and severity of symptoms

• abnormally high levels of serotonin in males with ASD and those with high functioning autis

• decreasing size of occipital cortex, region responsible for visual processing

ssibly accelerated head growth (biomarker for ASD)

netic mutations in familial autism

ildren with autism seem to have an innate vulnerability later triggered by environmental factor
 Etiology
Psychological

• autism affects the way the child interacts with the

world, which also affects the way the world interac
with the child

• possibly lack a ‘theory of mind’ - they seem unable

to understand that others think and have beliefs

• isolation due to problems with communication and

establishing social relationships
 Intellectual Disability
involves lifelong
cognitive deficits
characterized by
significant limitations in
intellectual functioning
and adaptive
behaviours

usually have coexisting

disorders
 Intellectual Disability
defined as involving:

significantly subaverage general intellectual functioning

(usually interpreted as a score of 70 or less on an
individually administered IQ test)

deficiencies in adaptive behavior that are lower than

would be expected based on age or cultural background

• skills required for communication, self care, social

interactions, health and safety, work and leisure
activities
 Adaptive characteristics
associated with ID
Level Approximate IQ Range Characteristics

daily living and social interactions mildly affecte

Mild 50-70 difficulties involve conceptual and academic und

may need assistance with job skills or indepen
may marry and raise children

may have functional self-care skills and ab

oderate 35-49 communicate basic needs; may read a few ba
lifelong support and supervision requir

Severe 20-34 may recognise familiar people, limited communi

lifelong support required

ofound Below 20 similar to severe intellectual disability

 Etiology
mild ID is idiopathic (having no known cause)

more pronounced ID is often related to genetic factors, brain abnormalities or

rain injury

genetic factors - chromosomal abnormalities (ex: Down syndrome), condition

resulting from inheritance of a single gene (ex: fragile x syndrome)

nongenetic factors - usually preventable environmental influences during

prenatal, perinatal or postnatal period

• prenatal - severe malnutrition, alcohol or illicit drugs

• perinatal - severe prematurity, birth trauma, lack of oxygen

• infancy/childhood - untreated PKU, nutritional deficiencies, iodine deficienc

head injury, brain infection
Psychological factors

• socioeconomically disadvantaged background

• crowded living conditions, lack of adequate healt

care, poor nutrition, inadequate educational
opportunities

• possibly being raised by parents with mild ID

Delirium, Dementia,
Amnesia and Other
Cognitive Disorders
 Types
Delirium - disturbance in conscious experience, with
ttentional/perceptual and memory deficits caused by a medical or
hysiological condition

Dementia

Alzheimer’s type - memory impairment, cognitive impairment (agnosi

apraxia or aphasia) not due to other factors

Vascular dementia - progressive dementia like Alzheimer’s, but begin

abruptly often due to stroke; cognitive dysfunctions may be more
localised rather than pervasive

Amnestic Disorders - disorders of an organic nature involving loss of

memory; may be transient or chronic; caused by drug use or medicatio
 DSM 5 changes

Delirium criteria is updated

Dementia and amnestic disorders now under majo

neurocognitive disorder

There is now also a category for mild MCD

Neurocognitive Disorders
Mild Neurocognitive Disorder - minor decline in
performance in one or more cognitive areas;
compensatory strategies may be required to maintain
ndependence

Major Neurocognitive Disorder - Significant decline in

performance in one or more cognitive area; severity of
deficit interferes with independence

Delirium - sudden changes in cognition, including

diminished awareness and impaired attention and focus
can occur independent of -above disorders-
Trauma and Stress
Related Disorders
 cute Stress Disorder (ASD) & Pos
Traumatic Stress Disorder (PTSD)
nvolve exposure to a traumatic event, resulting
n intrusive memories of the occurrence,
ttempts to forget or repress the memories,
motional withdrawal and increased arousal

SD - anxiety and dissociative symptoms that

ccur within one month after exposure to
aumatic stressor

TSD - anxiety, dissociative, evasion of stimuli

ssociated with trauma, alterations of cognitions
nd mood, heightened autonomic arousal or
eactivity involving symptoms (such as
ritability, aggressive, reckless or self-
estructive behavior) that last for more than 1
month and that occur as a result of exposure to
xtreme trauma
 Etiology
iological • Social

sensitized autonomic system • history of childhood neglect or ab

hypothalamic - pituitary - adrenal • lack of social support

axis dysfunction (stress reactions)
• social isolation
hippocampus atrophy
• Sociocultural
sensitized neural circuits
• low socioeconomic status
sychological
• gender differences
pre-existing anxiety or depression
• women more than men
dysfunctional cognitions
• immigration/refugee status
interpretation of trauma
Anxiety and Obsessive-
Compulsive Related
Disorders
Anxiety
• a fundamental human emotion th
produces bodily reactions that
prepare us for fight or flight

• anxiety is anticipatory - the dread

event has not yet occurred

• a state of unpleasant apprehensio

and tension in which a person fea
some type of future negative
experience
Types of Anxiety
Disorders
Phobias
• characterized by disruptive and intense, irrational fea
of specific objects or situations.

• fears are disproportionate to actual danger caused b

object/event

• Specific phobias - excessive, irrational fear cause

by particular object/event (animals, blood, injection
heights, etc)

• Social phobia - constant, irrational fear of specific

general situations that involve other people, fear of
social performance & being judged by others.

• sufferer avoids social situations that could be

embarrassing, result in a negative evaluation, or
show that he/she is anxious

• performance only subset

 Panic Disorder
characterized by intermittent
anxiety and by a sudden attack of
symptoms called panic attacks

people with this disorder fear

osing control, going crazy, or
dying and experience
depersonalisation and
derealisation.

can occur with or without

agoraphobia
Panic Disorder
• Panic attacks - episodes of intense fear
and 4 more symptoms (heart palpitations
nausea, chest pain, dizziness, sweating,
trembling, choking sensations, difficulty
breathing, terror, intense apprehension)

• attacks tend to be brief but are recurre

and unexpected

• Depersonalization - state of feeling

estranged from the body

• Derealization - state of feeling as if the

world or surroundings are not real
Generalized Anxiety Disorde
(GAD)
• sufferer experience chronic, uncontrollable and
pervasive low-level anxiety and worry

• symptoms include

• difficulty concentrating and sleeping

• irritability

• muscle tension

• pounding heart

• sweating

• restlessness

• upset stomach
 Obsessive-Compulsive
Disorder (OCD)
ufferer is compelled to repeat acts
compulsions) and/or is flooded with
uncontrollable and persistent thoughts
obsessions), which can cause distress
and interfere with daily functioning

Obsessions - uncontrollable, intrusive,

and repetitive thoughts, images and
impulses that cause anxiety

Compulsions - repetitive behavior or

mental act that is performed to
counteract the distress of the obsessive
thoughts (eg. hand washing or counting)
OCD (DSM 5 changes)
has its own chapter

new disorders within this chapter (hoarding,

excoriation [skin-picking], substance/medication
induced ocd, ocd and related disorder due to
another medical condition, trichotillomania, body
dysmorphic disorder)

individuals can be classified good/fair insight, poor

insight and ‘absent insight/delusional ocd beliefs’
Body Dysmorphic Disorde

• Preoccupation with imagined

defects in appearance or
excessive concern with slight
defects if they exist
 Etiology
Biological

• neurotransmitter dysregulation - deficiency of

GABA in generalized anxiety disorder

• increased physiological sensitivity - some people

are more reactive and easily aroused

• genetic factors
 Etiology
Behavioral

• learned alarms - mild physical cues become link

with panic attacks

• classical conditioning creates fear of non-

dangerous objects and operant conditioning
maintains avoidance of feared stimuli

• modeling - observational learning

Etiology
• Cognitive

• misinterpretations - overestimate
probability of negative event,
underestimate own ability to cope

• sense of unpredictability and lack

safety/control

• magical thinking - thinking that

worrying or performing compulsio
may superstitiously prevent feared
event
Dissociative Disorders
Dissociative Disorders

• Aspects of one’s identity,

consciousness or memory
become split off from one
another. These disorders
usually follow heightened
stress or trauma
Dissociative Identity Disorde
(DID)
ormerly known as multiple personality disorder

eparate personalities coexisting in the same person

iven personality may or may not be aware of the existence of alters (other
ersonalities)

alters may have different names, different ways of speaking and relating to
others, and even may have different physiological reactions
 Dissociative Fugue

person loses all memory of

his/her identity, moves to a
new place, and assumes a
new identity

can last for days or years,

usually occurs during
adulthood
 Dissociative Amnesia
oss of memory for significant personal facts, usually
related to a traumatic experience

• localized amnesia - failure to recall events about th

first few hours or days after a traumatic experience

• selective amnesia - failure to recall some of these

events

• generalized amnesia - failure to recall anything abo

one’s prior life
 Depersonalization Disorder

feelings of detachment, as though one is an outside

observer of one’s self or mental processes
 SOMATIC
DISORDERS
 Types
Conversion disorder - symptoms or deficits in sensory and motor
unction, often suggestive of a neurological condition but without
physical basis (eg hand paralysis)

Somatization disorder - history of bodily complaints with no appare

physical basis

Pain disorder - history of complaints about pain, not fully explained

physical cause

Hypochondriasis - chronic worry that one has a physical illness

without physical evidence

in DSM IV TR) Body dysmorphic disorder - excessive

preoccupation with a part of one’s body that one believes is defectiv
 DSM 5 Changes
Complex somatic symptom disorders (CSSD) - extreme distress over
omatic symptoms that are accompanied by high levels of health relate
nxiety (6 months or more)

… with somatisation features

… with pain features

lness anxiety disorder - formerly hypochondriasis

unctional neurological symptom disorder - formerly conversion disorde

actitious disorder and Factitious disorder imposed on another

note: not malingering

Eating Disorders
Anorexia nervosa
• refusal to maintain a body weight
above the minimum normal weigh
for one’s age and height

• an intense fear of becoming obes

that does not diminish with weight
loss

• body image distortion

• undue self-evaluation based on

weight or body shape
 Two Subtypes

Restricting type - accomplishes weight loss

through dieting or exercising

Binge-eating/purging type - accomplishes weigh

loss through use of self-induced vomiting, laxatives
or diuretics, often after binge eating
 Bulimia nervosa
current episodes of binge eating (rapid consumption
large quantities of food) at least once a week for
ree months, during which the person loses control
ver eating

ubtypes

Purging type - individual regularly vomits or uses

laxatives, diuretics or enemas

Nonpurging type - excessive exercise or fasting is

used in an attempt to compensate for binges

ersistent focus on body image and weight

ay have insight and may be frustrated by that

nowledge; disgust and shame are felt, usually binges
ccur in private,
 Sexual Dysfunction
and Gender Dysphoria
Sexual Interest Disorders
problems during the
appetitive phase/desire
phase

Hypoactive sexual desire

disorder - absent or low
sexual interest/desire

Sexual aversion disorder

- avoidance of/aversion
o sexual intercourse
Sexual Arousal Disorders
• problems of sexual pleasure or
physiological changes involving sexua
excitement

• Erectile disorder (ED) - inability to

attain/maintain an erection sufficient fo
sexual intercourse and/or psychologic
arousal during sexual activity

• Female sexual arousal disorder -

inability to attain/maintain physiologica
response and/or psychological arousa
during sexual activity
 Orgasmic Disorders
problems with the orgasm
phase

Female/male orgasmic disorder

persistent delay or inability to
achieve orgasm after reaching
excitement phase

Early (premature) ejaculation -

ejaculation with minimal sexual
stimulation before, during or
shortly after penetration
 Genital-Pelvic
Pain/Penetration Disorders

Dyspareunia - genital pain in a man or woman not

primarily due to lack of lubrication in the vagina or
vaginismus

Vaginismus - involuntary spasm of the outer third o

the vaginal wall that prevents or interferes with
sexual intercourse
 Etiology
Biology - physical and medical conditions; hormonal
deficiencies; ans reactivity to anxiety

Psychological - situational or coital anxiety/guilt;

performance anxiety; negative attitudes towards sex; fear
pregnancy, HIV infection or venereal disease

Social - relational problems with partner; negative parenta

attitudes towards sex in childhood; rape or sexual
molestation/abuse; strict religious & moralistic upbringing

Sociocultural - cultural scripts; gender roles; age-related

changes
Gender Dysphoria

• characterized by a marked
incongruence between one’s
experienced/expressed gende
and assigned gender as male
female

• gender dysphoria is not equal

sexual orientation