Mental Health Disorders

Therapeutic Interventions

Objective: Understanding Mental Health Disorders

I. MENTAL HEALTH DISORDERS

I. I. MENTAL HEALTH & MENTAL ILLNESS

Mental health and mental illness are difficult to define precisely. People who can

carry out their roles in society and whose behavior is appropriate and adaptive are

viewed as healthy. Conversely, those who fail to fulfill roles and carry out

responsibilities or whose behavior is inappropriate are viewed as ill. The culture of

any society strongly influences its values and beliefs, and this in turn affects how

the society defines health and illness. What one society may view as acceptable

and appropriate, another society may see as maladaptive and in appropriate.

I. II. MENTAL HEALTH

The World Health Organization defines health as a state of complete physical,

mental, and social wellness, not merely the absence of disease or infirmity. This

definition emphasizes health as a positive state of well-being. No single universal

definition of mental health exists. Generally, a person’s behavior can provide

clues to his or her mental health. Because each person can have a different view or

interpretation of behavior, the determination of mental health may be difficult. In

most cases, mental health is a state of emotional, psychological, and social

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wellness evidences by satisfying interpersonal relationships, effective behavior and

coping, positive self-concept, and emotional stability.

Mental Health has many components and a wide variety of factors influence it.

These factors interact; thus, a person’s mental health is a dynamic, or ever-

changing, state. Factors influencing a person’s mental health can be categorized as

individual, interpersonal, and social/cultural.

Individual, or personal, factors include a person’s biologic makeup, autonomy and

independence, self-esteem, capacity for growth, vitality, ability to find meaning in

life, emotional resilience or hardiness, sense of belonging. Reality orientation, and

coping or stress management abilities.

Interpersonal, or relationship, factors include effective communication, ability to

help others, intimacy, and a balance of separateness and connectedness.

Social/cultural, or environmental, factors include a sense of community, access to

adequate resources, intolerance of violence, support of diversity among people,

mastery of the environment, and a positive, yet realistic, view of one’s world.

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I. III MENTAL ILLNESS

Mental illness refers to a wide range of mental health conditions — disorders that

affect your mood, thinking and behavior. It is a behavioral or mental pattern that

causes significant distress or impairment of personal functioning. Examples of

mental illness include depression, anxiety disorders, schizophrenia, eating

disorders and addictive behaviors.

Many people have mental health concerns from time to time. But a mental health

concern becomes a mental illness when ongoing signs and symptoms cause

frequent stress and affect your ability to function.

A mental illness can make you miserable and can cause problems in your daily life,

such as at school or work or in relationships. The causes of mental disorders are

often unclear. Theories may incorporate findings from a range of fields. Mental

disorders are usually defined by a combination of how a person behaves, feels,

perceives, or thinks. This may be associated with particular regions or functions of

the brain, often in a social context. A mental disorder is one aspect of mental

health. Cultural and religious beliefs, as well as social norms, should be considered

when making a diagnosis.

(Psychiatric Mental Health Nursing of Sheila L. Videback )

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Objective: To explain the structure of the major layers of the brain

I. IV. STRUCTURE AND FUNCTION OF THE

BRAIN

I. IV. I. DEVELOPMENT OF THE HUMAN BRAIN

The mental processes and behaviors studied by psychology are directly controlled

by the brain, one of the most complex systems in nature. The human brain is one of

the most complex systems on earth. Every component of the brain must work

together in order to keep its body functioning. The brain and the spinal cord make

up the central nervous system, which alongside the peripheral nervous system is

responsible for regulating all bodily functions.

Psychology seeks to explain the mental processes and behavior of individuals by

studying the interaction between mental processes and behavior on a systemic

level. Therefore, the field of psychology is tightly intertwined with the study of the

brain.

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I. IV. II. THE STRUCTURE OF THE BRAIN

The developing brain goes through many stages. In

the embryos of vertebrates, the predecessor to the brain

and spinal cord is the neural tube. As the fetus

develops, the grooves and folds in the neural tube

deepen, giving rise to different layers of the brain.

The human brain is split up into three major layers: the hindbrain, the

midbrain, and the forebrain. The central

nervous system:
I. IV. II. a. HINDBRAIN 1. Brain
2. Brain stem
3. Spinal cord
The hindbrain is the well-protected central core of the

brain. It includes the cerebellum,

reticular formation, and brain

stem, which are responsible for

some of the most basic autonomic

functions of life, such as

breathing and movement. The

brain stem contains the pons and

medulla oblongata. Evolutionarily speaking, the hindbrain contains the oldest parts

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of the brain, which all vertebrates possess, though they may look different from

species to species.

I. IV. II. b. MIDBRAIN

The midbrain makes up part of the brain stem. It is located between the hindbrain

and forebrain. All sensory and motor information that travels between the forebrain

and the spinal cord passes through the midbrain, making it a relay station for the

central nervous system.

I. IV. II. c. FOREBRAIN

The forebrain is the most anterior division of the developing vertebrate brain,

containing the most complex networks in the central nervous system. The forebrain

has two major divisions: the diencephalon and the telencephalon. The diencephalon

is lower, containing the thalamus and hypothalamus; the telencephalon is on top of

the diencephalon and contains the cerebrum, the home of the highest-level cognitive

processing in the brain. It is the large and complicated forebrain that distinguishes

the human brain from other vertebrate brains.

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Objective: Outline the location and functions of the lower-level

structures of the brain.

I. IV. III. LOWER-LEVEL STRUCTURES

The brain’s lower-level structures consist of the brain stem and spinal cord, along

with the cerebellum. With the exception of the spinal cord, these structures are

largely located within the hindbrain, diencephalon (or interbrain), and midbrain.

These lower dorsal structures are the oldest parts of the brain, having existed for

much of its evolutionary history. As such they are geared more toward basic bodily

processes necessary to survival. It is the more recent layers of the brain (the

forebrain) which are responsible for the higher-level cognitive functioning

(language, reasoning) not strictly necessary to keep a body alive.

I. IV. III. I. THE HINDBRAIN

The hindbrain, which includes the medulla oblongata, the pons, and the

cerebellum, is responsible some of the oldest and most primitive body functions.

Each of these structures is described below.

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I. IV. III. I. a. MEDULLA OBLONGATA

The medulla oblongata sits at the transition zone between the brain and the spinal

cord. It is the first region that formally belongs to the brain. It is the control center

for respiratory, cardiovascular, and digestive functions.

I. IV. III. I. b. PONS

The pons connects the medulla oblongata with the midbrain region, and also relays

signals from the forebrain to the cerebellum. It houses the control centers for

respiration and inhibitory functions. The cerebellum is attached to the dorsal side

of the pons.

I. IV. III. I. c. CEREBELLUM

The cerebellum is a separate region of the brain located behind the medulla

oblongata and pons. It is attached to the rest of the brain by three stalks, and

coordinates skeletal muscles to produce smooth, graceful motions. The cerebellum

receives information from our eyes, ears, muscles, and joints about the body’s

current positioning. After processing this information, the cerebellum sends motor

impulses from the brain stem to the skeletal muscles so that they can move. The

main function of the cerebellum is this muscle coordination.

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I. IV. III. II. THE MIDBRAIN

The midbrain is located between the hindbrain

and forebrain, but it is actually part of the brain

stem. It displays the same basic functional

composition found in the spinal cord and the

hindbrain. Ventral areas control motor function

and convey motor information from the cerebral

cortex. Dorsal regions of the midbrain are

involved in sensory information circuits. The

Substantia Nigra, a part of the brain that plays
a role in reward, addiction, and movement is
Human and shark brains: The shark brain
diverged on the evolutionary tree from the
human brain, but both still have the “old”
structures of the hindbrain and midbrain
dedicated to autonomic bodily processes.

located in the midbrain. In Parkinson’s disease, which is characterized by a deficit

of dopamine, death of the Substantia Nigra is evident.

I. IV. III. II. I. DIENCEPHALON

The diencephalon is the region of the embryonic vertebrate neural tube that gives

rise to posterior forebrain structures. In adults, the diencephalon appears at the

upper end of the brain stem, situated between the cerebrum and the brain stem. It is

home to the limbic system, which is considered the seat of emotion in the human

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brain. The diencephalon is made up of four distinct components: the thalamus, the

Subthalamus, the hypothalamus, and the Epithalamus.

I. IV. III. II. I. a. THALAMUS

The thalamus is part of the limbic system. It consists of two lobes of grey matter

along the bottom of the cerebral cortex. Because nearly all sensory information

passes through the thalamus it is considered the sensory “way station” of the brain,

passing information on to the cerebral cortex. Lesions of, or stimulation to, the

thalamus are associated with changes in emotional reactivity. However, the

importance of this structure on the regulation of emotional behavior is not due to

the activity of the thalamus itself, but to the connections between the thalamus and

other limbic-system structures.

I. IV. III. II. I. b. HYPOTHALAMUS

The hypothalamus is a small part of the brain

located just below the thalamus. Lesions of the

hypothalamus interfere with motivated behaviors

like sexuality, combativeness, and hunger. The

hypothalamus also plays a role in emotion: parts of

Hypothalamus: An image of the the hypothalamus seem to be involved in pleasure

brain showing the location of the
hypothalamus. and rage, while the central part is linked to
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aversion, displeasure, and a tendency towards uncontrollable and loud laughing.

When external stimuli are presented, the hypothalamus sends signals to other

limbic areas to trigger feeling states in response to the stimuli.

I. IV. III. II. I. c. SPINAL CORD

The spinal cord is a tail-like structure embedded in the vertebral canal of the spine.

The adult spinal cord is about 40 cm long and weighs approximately 30 g. The

spinal cord is attached to the underside of the medulla oblongata, and is organized

to serve four distinct tasks:

 To convey (mainly sensory) information to the brain;

 To carry information generated in the brain to

peripheral targets like skeletal muscles;

 To control nearby organs via the autonomic nervous

system;

 To enable sensorimotor functions to control posture

and other fundamental movements. Limbic system, brain stem,

and spinal cord: An image
of the brain showing the
limbic system in relation to the
brain stem and spinal cord.

(https://courses.lumenlearning.com/boundless-psychology/chapter/structure-and-function-of-the-

brain/)

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Objective: To differentiate between the cortex and the cerebrum.

I. IV. IV. THE CEREBRAL CORTEX

The cerebral cortex is the part of the brain

that functions to make human beings

unique. Distinctly human traits including

higher thought, language and human

consciousness as well as the ability to

think, reason and imagine all originate in

the cerebral cortex. The cerebral cortex is what we see when we look at the brain.

It is the outermost portion that can be divided into the four lobes of the brain. Each

bump on the surface of the brain is known as a gyrus, while each groove is known

as a sulcus. The cerebral cortex, the largest part of the mammalian brain, is the

wrinkly gray outer covering of the cerebrum. While the cortex is less than 1/4″

thick, it is here that all sensation, perception, memory, association, thought, and

voluntary physical actions occur. The cerebral cortex is considered the ultimate

control and information-processing center in the brain.

The cortex is wrinkly in appearance. Evolutionary constraints on skull size

brought about this development; it allowed for the cortex to become larger without

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our brains (and therefore craniums) becoming disadvantageously large. At times it

has been theorized that brain size correlated positively with intelligence; it has also

been suggested that surface area of cortex rather than brain size that correlates

most directly with intelligence. Current research suggests that both of these may be

at least partially true, but the degree to which they correlate is not clear.

The cortex is made of layers of neurons with many inputs; these cortical neurons

function like mini microprocessors or logic gates. It contains glial cells, which

guide neural connections, provide nutrients and myelin to neurons, and absorb

extra ions and neurotransmitters. The cortex is

divided into four different

lobes, each with different

Sulci and gyri: As depicted in this
specific function. The diagram of brain structures, sulci
are the “valleys” and gyri are the
“valleys” of the wrinkles “peaks” in the folds of the brain.

are called sulci; the

“peaks” between wrinkles

are called gyri. While there

are variations from person

to person in their sulci and gyri, the brain has been studied enough to identify

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patterns. One notable sulcus is the central sulcus, or the wrinkle dividing the

parietal lobe from the frontal lobe.

I. IV. IV. I. CEREBRUM

Beneath the cerebral cortex is the

cerebrum, which serves as the main

thought and control center of the

brain. It is the seat of higher-level

thought like emotions and decision

Grey matter and white matter:
A sagittal cross-section of a human brain
showing the distinct layers of grey making. The cerebrum is composed of
matter (the darker outer layer) and
white matter (the lighter inner layer) in
the cerebrum
gray and white matter. Gray matter is

the mass of all the cell bodies, dendrites, and synapses of neurons interlaced with

one another, while white matter consists of the long, myelin-coated axons of those

neurons connecting masses of gray matter to each other.

The frontal lobe handles our thinking, planning, short-term memory, etc. It is also a

seat for most of the dopamine-delicate neurons. At the back of the frontal lobe is a

section known as the motor area. This controls our voluntary actions. The left lobe

also has a section called the Broca’s area, which is responsible for converting

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thoughts into words. Our parietal lobes control inputs like touch, temperature and

taste, in addition to being responsible for our spatial balance and navigation.

Objective: To outline the structure and function of the lobes &

hemispheres of the brain.

I. IV. V. CEREBRAL HEMISPHERES AND LOBES

OF THE BRAIN

I. IV. V. a. BRAIN LATERALIZATION

The brain is divided into two halves, called hemispheres. There is evidence that

each brain hemisphere has its own distinct functions, a phenomenon referred to as

lateralization. The left hemisphere appears to dominate the functions of speech,

language processing and comprehension, and logical reasoning, while the right is

more dominant in spatial tasks like vision-independent object recognition.

However, it is easy to exaggerate the differences between the functions of the left

and right hemispheres; both hemispheres are involved with most processes.

Additionally, neuroplasticity (the ability of a brain to adapt to experience) enables

the brain to compensate for damage to one hemisphere by taking on extra functions

in the other half, especially in young brains.

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I. IV. V. b. COPRPIS CALLOSUM

The two hemispheres communicate with one another through the corpus callosum.

The corpus callosum is a wide, flat bundle of neural fibers beneath the cortex that

connects the left and right cerebral hemispheres and facilitates interhemispheric

communication. The corpus callosum is sometimes implicated in the cause of

seizures; patients with epilepsy sometimes undergo a corpus callosotomy, or the

removal of the corpus callosum.

I. IV. VI. THE FOUR LOBES

The cerebral cortex can be divided into four sections, which are known as lobes.

The frontal lobe, parietal lobe, occipital lobe, and temporal lobe have been

associated with different functions ranging from reasoning to auditory perception.

Lobes of the brain: The

brain is divided into four
lobes, each of which is
associated with different
types of mental
processes. Clockwise
from left: The frontal
lobe is in blue at the
front, the parietal lobe in
yellow at the top, the
occipital lobe in red at
the back, and the
temporal lobe in green
on the bottom.

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I. IV. VI. a. THE

FRONTAL LOBE

The frontal lobe is located at the front of

the brain and is associated with

reasoning, motor skills, higher level

cognition, and expressive language. At

the back of the frontal lobe, near the central sulcus, lies the motor cortex. This area

of the brain receives information from various lobes of the brain and utilizes this

information to carry out body movements. Damage to the frontal lobe can lead to

changes in sexual habits, socialization, and attention as well as increased risk-

taking.

The frontal lobe is associated with executive functions and motor performance.

Executive functions are some of the highest-order cognitive processes that humans

have. Examples include:

 Planning and engaging in goal-directed behavior;

 Recognizing future consequences of current actions;

 Choosing between good and bad actions;

 Overriding and suppressing socially unacceptable responses;

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The frontal lobe is the moral center of the brain because it is responsible for

advanced decision-making processes. It also plays an important role in retaining

emotional memories derived from the limbic system and modifying those emotions

to fit socially accepted norms.

I. IV. VI. b. THE PARIETAL LOBE

The parietal lobe is located in the

middle section of the brain and is

associated with processing tactile

sensory information such as

pressure, touch, and pain. A

portion of the brain known as the somatosensory cortex is located in this lobe and

is essential to the processing of the body's senses. The parietal lobe is associated

with sensory skills. It integrates different types of sensory information and is

particularly useful in spatial processing and navigation. The parietal lobe plays an

important role in integrating sensory information from various parts of the body,

understanding numbers and their relations, and manipulating objects.

It also processes information related to the sense of touch. The parietal lobe is

comprised of the somatosensory cortex and part of the visual system. The

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somatosensory cortex consists of a “map” of the body that processes sensory

information from specific areas of the body. Several portions of the parietal lobe

are important to language and visuospatial processing; the left parietal lobe is

involved in symbolic functions in language and mathematics, while the right

parietal lobe is specialized to process images and interpretation of map.

I. IV. VI. c. TEMPORAL LOBE

The temporal lobe is located on the

bottom section of the brain. This

lobe is also the location of the

primary auditory cortex, which is

important for interpreting sounds

and the language we hear. The hippocampus is also located in the temporal lobe,

which is why this portion of the brain is also heavily associated with the formation

of memories. Damage to the temporal lobe can lead to problems with memory,

speech perception, and language skills. It also creates emotional responses and

controls biological drives such as aggression and sexuality.

The temporal lobe contains the hippocampus, which is the memory center of the

brain. The hippocampus plays a key role in the formation of emotion-laden, long-

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term memories based on emotional input from the amygdala. The left temporal lobe

holds the primary auditory cortex, which is important for processing the semantics

of speech.

I. IV. VI. d. OCCIPITAL LOBE

The occipital lobe is located at the

back portion of the brain and is

associated with interpreting visual

stimuli and information. The

primary visual cortex, which

receives and interprets

information from the retinas of the eyes, is located in the occipital lobe. Damage to

this lobe can cause visual problems such as difficulty recognizing objects, an

inability to identify colors, and trouble recognizing words.

The occipital lobe contains most of the visual cortex and is the visual processing

center of the brain. Cells on the posterior side of the occipital lobe are arranged as

a spatial map of the retinal field. The visual cortex receives raw sensory

information through sensors in the retina of the eyes, which is then conveyed

through the optic tracts to the visual cortex. Other areas of the occipital lobe are

specialized for different visual tasks, such as visuospatial processing, color

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discrimination, and motion perception. Damage to the primary visual cortex can

cause blindness, due to the holes in the visual map on the surface of the cortex

caused by the lesions.

Objective: Summarize the structural elements and functions of

the limbic system.

I. IV. VII. THE LIMBIC SYSTEM

The limbic system is a

complex set of

structures found on the

central underside of the

cerebrum, comprising

inner sections of the

temporal lobes and the

bottom of the frontal lobe. It combines higher mental functions and primitive

emotion into a single system often referred to as the emotional nervous system. It

is not only responsible for our emotional lives but also our higher mental functions,

such as learning and formation of memories. The limbic system is the reason that

some physical things such as eating seem so pleasurable to us, and the reason why

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some medical conditions, such as high blood pressure, are caused by mental stress.

There are several important structures within the limbic system: the amygdala,

hippocampus, thalamus, hypothalamus, basal ganglia, and cingulate gyrus.

I. IV. VII. a. AMYGDALA

The amygdala is one of two almond-shaped groups of

nuclei located deep and medially within the temporal

lobes of the brain in complex vertebrates, including

humans. Known as the emotional center of the brain,

the amygdala is involved in evaluating the emotional

The amygdala: The figure shows the valence of situations (e.g., happy, sad, scary). It
location of the amygdala from the
underside of the human brain, with helps the brain recognize potential threats and
the front of the brain at the top of
the image.
helps prepare the body for fight-or-flight

reactions by increasing heart and breathing rate. The amygdala is also responsible

for learning on the basis of reward or punishment.

Due to its close proximity to the hippocampus, the amygdala is involved in the

modulation of memory consolidation, particularly emotionally-laden memories.

Emotional arousal following a learning event influences the strength of the

subsequent memory of that event, so that greater emotional arousal following a

learning event enhances a person’s retention of that memory. In fact, experiments

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have shown that administering stress hormones to individuals immediately after

they learn something enhances their retention when they are tested two weeks later.

I. IV. VII. b. HIPPOCAMPUS

The hippocampus is a major

component of the brains of

humans and other vertebrates.

Humans and other mammals have

two hippocampi, one in each side

of the brain. The hippocampus

plays important roles in the consolidation of information from short-term memory

to long-term memory, and in spatial memory that enables navigation. The

hippocampus is located under the cerebral cortex and in primates in the medial

temporal lobe.

Damage to the hippocampus usually results in profound difficulties in forming new

memories and may also affect access to memories formed prior to the damage.

Although the retrograde effect normally extends some years prior to the brain

damage, in some cases older memories remain intact; this leads to the idea that

over time the hippocampus becomes less important in the storage of memory.

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I. IV. VII. c. THALAMUS AND HYPOTHALAMUS

Both the thalamus and hypothalamus are associated with changes in emotional

reactivity. The thalamus, which is a sensory “way-station” for the rest of the brain,

is primarily important due to its connections with other limbic-system structures.

The hypothalamus is a small part of the brain located just below the thalamus on

both sides of the third ventricle. Lesions of the hypothalamus interfere with several

unconscious functions (such as respiration and metabolism) and some so-called

motivated behaviors like sexuality, combativeness, and hunger. The lateral parts of

the hypothalamus seem to be involved with pleasure and rage, while the medial

part is linked to aversion, displeasure, and a tendency for uncontrollable and loud

laughter.

I. IV. VII. d. CINGULATE GYRUS

The cingulate gyrus is located in the medial side of the brain next to the corpus

callosum. There is still much to be learned about this gyrus, but it is known that its

frontal part links smells and sights with pleasant memories of previous emotions.

This region also participates in our emotional reaction to pain and in the regulation

of aggressive behavior.

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I. IV. VII. e. BASAL GANGLIA

The basal ganglia are a group of

nuclei lying deep in the

subcortical white matter of the

frontal lobes that organizes

motor behavior. The caudate,

putamen, and globus pallidus are

major components of the basal ganglia. The basal ganglia appear to serve as a

gating mechanism for physical movements, inhibiting potential movements until

they are fully appropriate for the circumstances in which they are to be executed.

The basal ganglia is also involved with the following:

 Rule-based habit learning

 Inhibiting undesired

 Movements and permitting desired ones

 Choosing from potential actions

 Motor planning

 Sequencing

 Predictive control

 Working
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Objective: To explain how neuroplasticity occurs.

I. IV. VIII. NEUROPLASTICITY

Neuroplasticity is the brain’s ability to create new neural pathways to account for

learning and acquisition of new experiences.

The brain is constantly adapting throughout a lifetime, though sometimes over

critical, genetically determined periods of time. Neuroplasticity is the brain’s

ability to create new neural pathways based on new experiences. It refers to

changes in neural pathways and synapses that result from changes in behavior,

environmental and neural processes, and changes resulting from bodily injury.

Neuroplasticity has replaced the formerly held theory that the brain is a

physiologically static organ, and explores how the brain changes throughout life.

Neuroplasticity occurs on a variety of levels, ranging from minute cellular changes

resulting from learning to large-scale cortical remapping in response to injury. The

role of neuroplasticity is widely recognized in healthy development, learning,

memory, and recovery from brain damage.

I. IV. VIII. I. PLASTICITY

Plasticity can be demonstrated over the course of virtually any form of learning.

For one to remember an experience, the circuitry of the brain must change.

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Learning takes place when there is either a change in the internal structure of

neurons or a heightened number of synapses between neurons. Studies conducted

using rats illustrate how the brain changes in response to experience: rats who lived

in more enriched environments had larger neurons, more DNA and RNA, heavier

cerebral cortices, and larger synapses compared to rats who lived in sparse

environments.

A surprising consequence of neuroplasticity is that the brain activity associated

with a given function can move to a different location; this can result from normal

experience, and also occurs in the process of recovery from brain injury. In fact,

neuroplasticity is the basis of goal-directed experiential therapeutic programs in

rehabilitation after brain injury. For example, after a person is blinded in one eye,

the part of the brain associated with processing input from that eye doesn’t simply

sit idle; it takes on new functions, perhaps processing visual input from the

remaining eye or doing something else entirely. This is because while certain parts

of the brain have a typical function, the brain can be “rewired”—all because of

plasticity.

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I. IV. VIII. II. SYNAPTIC PRUNING

Synaptic pruning refers to neurological regulatory processes that facilitate changes

in neural structure by reducing the overall number of neurons and synapses,

leaving more efficient synaptic configurations. Since the infant brain has such a

large capacity for growth, it must eventually be pruned down to remove

unnecessary neuronal structures from the brain. This process of pruning is referred

to as apoptosis, or programmed cell death. As the human brain develops, the need

for more complex neuronal associations becomes much more pertinent, and

simpler associations formed at childhood are replaced by more intricately

interconnected structures.

Pruning removes axons from synaptic connections that are not functionally

appropriate. This process strengthens important connections and eliminates weaker

ones, creating more effective neural communication. Generally, the number of

neurons in the cerebral cortex increases until adolescence. The selection of the

pruned neurons follows the “use it or lose it” principle, meaning that synapses that

are frequently used have strong connections, while the rarely used synapses are

eliminated.

(https://courses.lumenlearning.com/boundless-psychology/chapter/structure-and-function-of-the-

brain/)

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Objective: To provide an overview of the different types of mental

illness.

I. V. TYPES OF MENTAL HEALTH DISORDERS

I. V. I ANXIETY DISORDERS

People with anxiety disorders respond to certain objects or situations with fear and

dread, as well as with physical signs of anxiety or panic, such as a rapid heartbeat

and sweating. An anxiety disorder is diagnosed if the person's response is not

appropriate for the situation, if the person cannot control the response, or if the

anxiety interferes with normal functioning. Anxiety disorders include generalized

anxiety disorder, panic disorder, social anxiety disorder, and specific phobias.

TYPES OF ANXIETY DISORDERS

I. V. I. a. GENERALIZED ANXIETY DISORDER

Generalized Anxiety Disorder, GAD, is an anxiety disorder characterized by

chronic anxiety, exaggerated worry and tension, even when there is little or

nothing to provoke it. This is prolonged (>6 months), excessive worry that is not

easily controlled by a person. Daily life becomes a constant state of worry, fear,

and dread. Eventually, the anxiety so dominates the person's thinking that it

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interferes with daily functioning, including work, school, social activities, and

relationships.

SYMPTOMS:

 Muscle tension

 Automatic hyper-activity

 Vigilance

 Scanning

 Uncontrollable worrying

 Restlessness

 Difficulty concentrating and

 Impaired social functioning.

In addition, people with GAD often have other anxiety disorders (such as panic

disorder or phobias), obsessive-compulsive disorder, clinical depression, or

additional problems with drug or alcohol misuse.

I. V. I. b. OBSESSIVE-COMPULSIVE DISORDER

Obsessive-Compulsive Disorder, OCD, is an anxiety disorder and is characterized

by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors

(compulsions). Repetitive behaviors such as hand washing, counting, checking, or

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cleaning are often performed with the hope of preventing obsessive thoughts or

making them go away. Performing these so-called "rituals," however, provides

only temporary relief, and not performing them markedly increases anxiety. OCD

is diagnosed only when these thoughts, images, and impulses consume the person

or he or she is compelled to act out the behaviors to a point at which they interfere

with personal social, and occupational function. Examples including men who can

no longer work because he spends most of his days aligning and realigning all

items in his apartment or the woman who feels compelled to wash her hands after

touching any object or any person.

SYMPTOMS:

 Checking rituals

 Counting rituals

 Washing and scrubbing until the skin is raw

 Praying and chanting

 Hoarding items

 Ordering

 Exhibiting rigid performance

 Having aggressive urges.

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I. V. I. c. PANIC DISORDER

Panic disorder occurs when you

experience recurring unexpected panic

attacks. The DSM-5 defines panic

attacks as abrupt surges of intense fear

or discomfort that peak within minutes. People with the disorder live in fear of

having a panic attack. You may be having a panic attack when you feel sudden,

overwhelming terror that has no obvious cause. Panic attacks produce intense fear

that begins suddenly, often with no warning. An attack typically lasts for 10 to 20

minutes, but in extreme cases, symptoms may last for more than an hour. The

experience is different for everyone, and symptoms often vary.

SYMPTOMS:

 Racing heartbeat or palpitations

 Shortness of breath

 Dizziness (vertigo)

 Nausea

 Sweating or chills

 Shaking or trembling

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 Changes in mental state, including a feeling of derealization (feeling of

unreality) or depersonalization (being detached from oneself)

 Numbness or tingling in your hands or feet

 Chest pain or tightness

 Fear that you might die

The symptoms of a panic attack often occur for no clear reason. Typically, the

symptoms are not proportionate to the level of danger that exists in the

environment. Because these attacks can’t be predicted, they can significantly affect

your functioning.

Fear of a panic attack or recalling a panic attack can result in another attack.

During panic-level anxiety, the person’s safety is the primary concern. He or she

cannot perceive potential harm and may have no capacity for rational thought.

I. V. I. d. POST-TRAUMATIC STRESS DISORDER

Post-Traumatic Stress Disorder, PTSD, is an anxiety disorder that can develop

after exposure to a terrifying event or ordeal in which grave physical harm

occurred or was threatened. Traumatic events that may trigger PTSD include

violent personal assaults, natural or human-caused disasters, accidents, or military

combat. The person with PTSD was exposed to an event that posed a threat of
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death or serious injury and responded with intense fear, helplessness, or terror. The

person persistently re-experienced the traumas through memories, dreams,

flashbacks, or reactions to external cues about the event and therefore avoids

stimuli associated with the trauma.

The victim feels a numbing of general responsiveness and shows persistent

signs of the following:

 Increased arousals such as insomnias

 Hyperarousal or hypervigilance

 Irritably, or angry outbursts.

 He or she reports losing a sense of connection and control his or her life.

I. V. I. e. SOCIAL PHOBIA

Social Phobia, or Social Anxiety

Disorder, is an anxiety disorder

characterized by overwhelming

anxiety and excessive self-

consciousness in everyday social

situations. Social phobia can be

limited to only one type of situation - such as a fear of speaking in formal or

informal situations, or eating or drinking in front of others - or, in its most severe
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form, may be so broad that a person experiences symptoms almost anytime they

are around other people.

The symptoms are fear of:

 Embarrassment or inability to perform,

 Avoidance or dreaded endurance of behavior or situation

 Recognition that response is irrational or excessive

 Belief that others are judging him or her negatively

 Significant distress or impairment in relationships, work, or social life; anxiety

can be severe or panic level.

I. V. II. MOOD DISORDERS

These disorders, also called affective disorders, involve persistent feelings of

sadness or periods of feeling overly happy, or fluctuations from extreme happiness

to extreme sadness. The most common mood disorders are depression, bipolar

disorder, and cyclothymic disorder.

I. V. II. a. DEPRESSION

Depression is a disorder of emotion rather than a disturbance of thought. It is a

common and highly underdiagnosed and undertreated illness. Fortunately, it is also

treatable. Depression causes feelings of sadness and/or a loss of interest in

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activities once enjoyed. It can lead to a variety of emotional and physical problems

and can decrease a person’s ability to function at work and at home.

Depression symptoms can vary from mild to severe and can include:

 Feeling sad or having a depressed mood

 Loss of interest or pleasure in activities once enjoyed

 Changes in appetite — weight loss or gain unrelated to dieting

 Trouble sleeping or sleeping too much

 Loss of energy or increased fatigue

 Increase in purposeless physical activity (e.g., hand-wringing or pacing) or

slowed movements and speech (actions observable by others)

 Feeling worthless or guilty

 Difficulty thinking, concentrating or making decisions

 Thoughts of death or suicide

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I. V. II. b. BIPOLAR DEPRESSION

Bipolar depression, or

manic-depressive illness,

also has multiple subtypes,

all characterized by episodes

of elation and irritability

(mania) with or without

episodes of depression,

although the occurrence of mania without associated depression (unipolar mania)

is rare.

SYMPTOMS:

 Decreased need for food and sleep,

 Labile mood,

 Irritability,

 Racing thoughts high distractibility,

 Rapid and pressured speech,

 Inflated self-esteem, and

 Excessive environmental with pleasurable activities,

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Some of which may be high risk. In its minor forms, the subjective experience of

mania can be quite pleasurable to the individual, with heightened sense of well-

being and increase alertness.

I. V. II. c. MANIA

Mania, also known as manic syndrome, is a state

of abnormally elevated arousal, affect, and energy

level, or a state of heightened overall activation

with enhanced affective expression together with

liability of affect. Although mania is often

conceived as a "mirror image" to depression, the

heightened mood can be either euphoric or

irritable; indeed, as the mania intensifies,

irritability can be more pronounced and result in violence, or anxiety. Typically,

this period lasts about 1 week but it may be longer for some individuals. At least

three of the following symptoms accompany the manic episode: inflated self-

esteem or grandiosity; decreased need for sleep.

SYMPTOMS:

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 Have a very high sense of self-worth and a feeling of being "on top of the

world"

 Be very talkative and talk so fast that others have trouble following what you

are saying

 Have racing thoughts and trouble concentrating

 Be very restless

 Have more feelings of anxiety and panic

 Go for days with little or no sleep and not feel tired

 Be very irritable and get into fights with others

 Be extremely active and act recklessly, such as going on spending sprees or

having unsafe sex

Though the activities one participates in while in a manic state are not always

negative, those with the potential to have negative outcomes are far more likely.

If the person is concurrently depressed, they are said to be having a mixed episode.

I. V. II. e. SUBSTANCE-INDUCED MOOD DISORDER

Substance-Induced mood disorder is characterized by a prominent and persistent

disturbance in mood that is judged to be a direct physiologic consequence of

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ingested substance such as alcohol,

other drugs, or toxins. Patients with

symptoms of the disorder prior to

engaging in substance use may be

dealing with a co-occurring

condition something that isn’t

uncommon. These disorders can

alter the way a person feels, thinks, and acts for days or sometimes weeks at a time.

Stopping medication once a person has become dependent on it, whether the

medication is legal or illicit, can cause depression and a feeling of loss of control

over actions (mania).

Depending on these factors, the symptoms can sometimes be felt before even

stopping the drugs and sometimes are not felt until a few days after stopping them.

SYMPTOMS:

 Feel sad and uninterested in things you usually enjoy

 Have trouble falling asleep, wake up very early, or sleep too much

 Have changes in your appetite and weight, either up or down

 Have low energy

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 Lose sexual desire

 Feel worthless and guilty

 Not be able to concentrate or remember things

 Feel hopeless or just not care about anything

 Have physical symptoms, such as headaches and joint pain

 Think often about death or suicide

I. V. II. e. DISCOCIATIVE INDETITY DISORDER

Also known as Multiple personality disorder is a mental disorder characterizes by

at least two distinct and relatively during personality states. There is often

remembering certain events, beyond what would be explained by ordinary

forgetfulness. These states alternatively show in a person’s behavior. Presentations,

however are variable. Associated conditions often include borderline personality

disorder, post-traumatic stress disorder, depression, substance misuse disorder, and

self-harm of anxiety. Along with the dissociation and multiple or split

personalities, people with dissociative disorders may experience a number of other

psychiatric problems, including symptoms:

 Depression

 Mood swings

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 Suicidal tendencies

 Sleep disorders (insomnia, night terrors, and sleep walking)

 Anxiety, panic attacks, and phobias (flashbacks, reactions to stimuli or

"triggers")

 Alcohol and drug abuse

 Compulsions and rituals

 Psychotic-like symptoms (including auditory and visual hallucinations)

 Eating disorders

Other symptoms of dissociative identity disorder may include headache, amnesia,

time loss, trances, and "out of body experiences." Some people with dissociative

disorders have a tendency toward self-persecution, self-sabotage, and even

violence.

I. V. II. f. AVOIDANT PERSONALITY DISORDER

Personality are long lived patterns of

behavior that cause problems with

work and relationships. It is a

psychiatric condition characterized by

a lifelong pattern of extreme social

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inhibition, feelings of inadequacy and sensitivity to rejection. People with avoidant

personality disorder may avoid work activities in decline job offers because of

fears of criticism or disappointment from others. They may be inhibited din social

situations as a result of low self-esteem and feeling or inadequacy. Additionally,

they may be preoccupied with their own shortcomings and form relationships with

others only if they think they will not be rejected, Loss and rejections are so

painful to their individuals that they will choose loneliness rather than risk trying to

connect with others.

SYMPTOMS:

 Easily hurt by criticism or disapproval

 No close friends

 Reluctance to become involved with people

 Avoidance of activities or occupations that involve contact with others

 Shyness in social situations out of fear of doing something wrong

 Exaggeration of potential difficulties

 Showing excessive restraint in intimate relationships

 Feeling socially inept, inferior, or unappealing to other people

 Unwilling to take risks or try new things because they may prove embarrassing

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Antidepressant medications can often reduce sensitivity to rejection.

Psychotherapy, particularly cognitive/behavioral approaches, may be helpful. A

combination of medication and talk therapy may be more effective than either

treatment alone. It is important to get help from a health-care provider or a

psychiatrist if shyness or fear of rejection overwhelm one's ability to function in

life and form relationships.

Objectives:

I. V. III. PSYCHOTIC DISORDERS

Psychotic disorders involve distorted awareness and thinking. Two of the most

common symptoms of psychotic disorders are hallucinations -- the experience of

images or sounds that are not real, such as hearing voices -- and delusions, which

are false fixed beliefs that the ill person accepts as true, despite evidence to the

contrary. When symptoms are severe, people with psychotic disorders have trouble

staying in touch with reality and often are unable to handle daily life. But even

severe psychotic disorders usually can be treated.

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I. V. III. a. SCHIZOPHRENIA

Schizophrenia causes distorted

and bizarre thoughts, perceptions,

emotions, movements, and

behavior. It is thought of as a

syndrome or disease process with

many different varieties and symptoms, much like the varieties of cancer.

Schizophrenia usually is diagnosed in late adolescence or early adulthood. Rarely

does it manifest in childhood. The symptoms of schizophrenia are divided two

major categories:

Positive or hard symptoms/signs, which include:

 Delusions,

 Hallucinations, and

 Grossly disorganized thinking

 Speech and

 Behavior

Negative or soft symptoms/signs, which include:

 Flat affect,

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 Lack of volition, and

 Social withdrawal of discomfort.

I. V. III. b. HALLUCINATIONS

One hallmark symptom of schizophrenic psychosis is hallucinations. It is the false

sensory perceptions, or perceptual experiences that do not exist in reality. It can

involve the five senses and bodily sensations, Hallucinations are distinguished

from illusions, which are misperceptions of actual environment stimuli.

I. V. III. c. AUDITORY HALLUCINATIONS

The most common type involves hearing sounds, and most often voices, there may

be one or multiple voices; a familiar or unfamiliar person’s voice may be speaking.

Command hallucinations are voices demanding that the client take action, often to

harm self or others, and are considered dangerous.

I. V. III. d. VISUAL HALLUCINATIONS

It involves seeing images that do not exist at all, such as lights or a dead person, or

distortions such as seeing frightening monster instead of a nurse. They are the

second most common type of hallucination.

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I. V. III. e. OLFACTORY HALLUCINATIONS

It involves smells or odors. They may be a specific scent such as urine or feces or a

more general scent such as a rotten or rancid odor. This type of hallucination often

occurs with dementia, seizures or cerebrovascular accidents.

I. V. III. f. TACTILE HALLUCINATIONS

It refers to sensations such as electricity running through the body or bugs crawling

on the skin. Tactile hallucinations are found most often in people undergoing

alcohol withdrawal: they rarely occur in clients with schizophrenia.

I. V. III. g. GUSTATORY HALLUCINATIONS

It involves a taste lingering in the mouth or the sense that food like something else.

The taste may be metallic or bitter or may be represented as a specific taste.

I. V. III. h. CENESTHETIC HALLUCINATIONS

It involves the client’s report that he or she feels bodily functions that are usually

undetectable. Examples would be the sensation of urine forming or impulses being

transmitted through the brain.

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I. V. III. i. KINESTHETIC HALLUCINATIONS

It occurs when the client is motionless but reports the sensation of bodily

movement. Occasionally, the bodily movement is something unusual, such as

floating above the ground.

Objective: To provide teaching to clients, families, and community

members to increase knowledge and understanding of eating disorders.

I. V. IV. EATING DISORDERS

Eating disorders involve extreme emotions, attitudes, and behaviors involving

weight and food. Anorexia nervosa, bulimia nervosa, and binge eating disorder are

the most common eating disorders.

I. V. IV. a. ANOREXIA NERVOSA

It a life-threating eating disorder characterized by

the person’s refusal or inability to maintain a

minimally normal body weight, intense fear of

gaining weight or becoming fat, significantly

disturbed perception of the shape or size of the

body, and steadfast inability or refusal to

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acknowledge the seriousness of the problem or even that one exists. People with

anorexia have a body weight that is 85% or less of that expected for their age and

height, have experienced amenorrhea for at least three consecutive cycles, and

have a preoccupation with food and food-related activities. People with anorexia

nervosa can be classified into two subgroups depending on how they control their

weight. Those with the binge eating followed by purging. Binge eating means

consuming a large amount of food in a discrete period of usually 2 hours or less.

SYMPTOMS:

 Fear of gaining weight even when severely underweight

 Body image disturbance

 Amenorrhea

 Preoccupation with thoughts of food

 Feelings of ineffectiveness

 Inflexible thinking, and

 Strong need to control environment.

I. V. VI. b. BULIMIA NERVOSA

This eating disorder is characterized by repeated binge eating followed by

behaviors that compensate for the overeating, such as forced vomiting, excessive

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exercise, or extreme use of laxatives or diuretics. Men and women who suffer

from Bulimia may fear weight gain and feel severely unhappy with their body

size and shape.

MAJOR TYPES OF BULIMIA

There are two common types of bulimia nervosa, which are as follows:

 Purging type – This type of bulimia nervosa accounts for most of the cases of

those suffering from this eating disorder. In this form, individuals will

regularly engage in self-induced vomiting diuretics, or enemas.

 Non-Purging type – In this form of bulimia nervosa, the individual will use

other inappropriate methods of compensation for binge episodes. In these

cases, the typical forms of purging, such as self-induced vomiting, are not

regularly utilized.

SYMPTOMS:

 Disappearance of large amounts of food

 Eating in secrecy

 Lack of control when eating

 Switching between periods of overeating and fasting

 Frequent use of the bathroom after meals

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I. V. VI. c. BINGE-EATING DISORDER

Binge-Eating Disorder (BED) is

commonly known by compulsive

overeating or consuming abnormal

amounts of food while feeling

unable to stop and at loss of

control. Binge eating episodes are typically classified as occurring on average a

minimum of twice per week for a duration of six months.

The negative feelings that usually accompany binge eating often lead him or her to

continue to use food to cope; thus, creating a vicious cycle. Managed eating

disorder treatments are extremely important.

SYMPTOMS:

 Continually eating even when full

 Inability to stop eating or control what is eaten

 Stockpiling food to consume secretly later

 Eating normally in the presence of others but gorging when isolated

 Experiencing feelings of stress or anxiety that can only be relieved by eating

 Feelings of numbness or lack of sensation while bingeing

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 Never experiencing satiation: the state of being satisfied, no matter the

amount of food consumed
( https://www.eatingdisorderhope.com/information/eating-disorder )

Objective: to determine the impact of addiction on individuals, families,

peers, and society.

I. V. V. IMPULSE CONTROL AND ADDICTIVE DISORDERS

People with impulse control disorders are unable to resist urges, or impulses, to

perform acts that could be harmful to themselves or others. Pyromania (starting

fires), kleptomania (stealing), and compulsive gambling are examples of impulse

control disorders. Alcohol and drug are common objects of addictions. Often,

people with these disorders become so involved with the objects of their addiction

that they begin to ignore responsibilities and relationships.

I. V. V. I. INTERMITTENT EXPLOSIVE DISORDER

Intermittent explosive disorder is recognizable by persistent temper tantrums, or

explosive episodes, that are out of proportion to the situation at hand. Violence,

aggression, rage, verbal outbursts, threats, and physical harm to people or things

may accompany an episode. These tirades may only last about a half-hour and

come about suddenly, with no warning. A person likely feels energetic and has

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racing thoughts, a tingling in the extremities, heart palpitations, chest pain, and

tremors when experiencing an outburst, and may be fatigued and relieved

immediately thereafter, potentially experience remorse or regret down the line. The

signs and symptoms of IED will vary from child to child based upon individual

makeup, severity of IED, presence of co-occurring mental health disorders, and use

of alcohol or drugs.

SYMPTOMS:

 Low tolerance for frustration

 Mood changes before an outburst

 Intense anger

 Irritability during and between outbursts

 Blinding rage

 Feeling “out of control” before and during an episode

 Depressed mood

 Guilt following episode

 Shame following an episode

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I. V. V. I. a. KLEPTOMANIA

Impulsive and unnecessary stealing of things that

are not needed characterize kleptomania.

Individuals may steal things and hoard them,

give them away, or even return them to the store

they stole them from. The disorder is not about

the things stolen, but instead about the

compulsion to steal and lack of self-control over this compulsion. The journal

Frontiers in Psychiatry estimates that between 3.8 and 24 percent of people who

shoplift may suffer from kleptomania. Individuals may feel intense guilt or shame

after the initial relief that stealing may bring wears off. Legal troubles are common

for individuals battling kleptomania.

SYMPTOMS:

 Inability to resist powerful urges to steal items that you don't need

 Feeling increased tension, anxiety or arousal leading up to the theft

 Feeling pleasure, relief or gratification while stealing

 Feeling terrible guilt, remorse, self-loathing, shame or fear of arrest

 Return of the urges and a repetition of the kleptomania cycle

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I. V. V. I. b. PRYNOMANIA

An individual who repeatedly and

deliberately sets fires may suffer from

pyromania. An attraction or obsession with

fire and fire-setting paraphernalia, along

with a compulsive need to set fires, and

relief and pleasure after doing so characterize this disorder. Individuals do not set

fires for any other reason other than their compulsion or “need” to do so in order to

dispel their mounting tension. While this is a rare disorder, it can have serious

consequences in a person's life.

SYMPTOMS:

 Frequent setting of fires

 Fascination with fire

 Depression

 Suicidal thoughts

 Trouble with interpersonal relationships

 Inability to cope well with stress

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Objective: to identify the essential features of the following

personality disorders: paranoid, schizoid, schizotypal (cluster

A); antisocial, borderline, histrionic, narcissistic (cluster B); and

avoidant, dependent, obsessive-compulsive (cluster C).

I. V. VI. PERSONALITY DISORDERS

People with personality disorders have extreme and inflexible personality traits

that are distressing to the person and/or cause problems in work, school, or social

relationships. In addition, the person's patterns of thinking and behavior

significantly differ from the expectations of society and are so rigid that they

interfere with the person's normal functioning. Examples include antisocial

personality disorder, obsessive-compulsive personality disorder, and paranoid

personality disorder.

I. V. VI. I. CLUSTER A: PERSONALTY DISORDERS

I. V. VI. I. a. PARANOID PERSONALITY DISORDER

Paranoid personality disorder is characterized by pervasive mistrust and

suspiciousness of others. Individuals with this disorder interpret others’ actions as

potentially harmful. During periods of stress, they may develop transient psychotic

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symptoms. This disorder usually begins by early adulthood and appears to be more

common in men than in women.

SYMPTOMS:

 Doubt the commitment, loyalty, or trustworthiness of others, believing

others are using or deceiving them

 Are reluctant to confide in others or reveal personal information due to a

fear that the information will be used against them

 Are unforgiving and hold grudges

 Are hypersensitive and take criticism poorly

 Read hidden meanings in the innocent remarks or casual looks of others

I. V. VI. I. b. SCHIZOTYPAL PERSONALITY DISORDER

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Schizotypal personality disorder is characterized

by a pervasive pattern of social and interpersonal

deficits marked by an acute discomfort with and

reduced capacity for close relationships as well

as by cognitive or perceptual distortions and

behavioral eccentricities. Individuals may experience transient psychotic episodes

in response of extreme stress. Individuals often have an odd appearance that causes

others to notice them. They may be unkempt, and disheveled, and their clothes are

often ill-fitting, do not match, and may be stained or dirty. They may wander

aimlessly and at times become preoccupied with some environmental detail.

Speech is coherent by be loose, digressive, or vague. They often provide

unsatisfactory answers to questions and may be unable to specify or to describe

information clearly. They frequently use words incorrectly, which makes their

speech sound bizarre. More commonly, however, patient beliefs (aliens,

witchcraft, possessing a "sixth sense") are stranger than their behavior, and may

often keep them isolated from normal relationships. Hallucinations, however, are

not a common symptom.

SYMPTOMS:

 Discomfort in social situations

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 Odd beliefs, fantasies or preoccupations

 Odd behavior or appearance

 Odd speech

 Difficulty making/keeping friendships

 Inappropriate display of feelings

 Suspiciousness or paranoia

I. V. VI. II. CLUSTER B: PERSONALITY DISORDERS

I. V. VI. II. a. ANTISOCIAL PERSONALITY DISORDERS

Antisocial personality disorders are characterized by a pervasive pattern of

disregard for and violation of the rights of others – and with the central

characteristics of deceit and manipulation. This pattern also has been referred to as

psychopathy, sociopath, or dissocial personality disorder. Individuals with

antisocial personality disorder often violate the law, becoming criminals. They

may lie, behave violently or impulsively, and have problems with drug and alcohol

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use. Because of these characteristics, people with this disorder typically can't fulfill

responsibilities related to family, work or school.

SYMPTOMS:

 Disregard for right and wrong

 Persistent lying or deceit to exploit others

 Being callous, cynical and disrespectful of others

 Using charm or wit to manipulate others for personal gain or personal pleasure

 Recurring problems with the law, including criminal behavior

 Repeatedly violating the rights of others through intimidation and dishonesty

 Hostility, significant irritability, agitation, aggression or violence

I. V. VI. II. b. BORDERLINE PERSONALITY DISORDER

Borderline personality disorder is characterized by pervasive pattern of unstable

interpersonal relationships, self-image, and affect as w ell as marked impulsivity.

Typically, recurrent self-mutilation is a cry for help, and expression of intense

anger or helplessness, or a form of self-punishment. The resulting physical pain is

also a means to block emotional pain. Individuals who engage in self-mutilation do

so to reinforce that they are still alive; they seek to experience physical pain in the

face of emotional numbing.

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SYMPTOMS:

 Frantic efforts to avoid real or imagined abandonment by friends and

family.

 Distorted and unstable self-image, which affects moods, values, opinions,

goals and relationships.

 Impulsive behaviors that can have dangerous outcomes, such as excessive

spending, unsafe sex, substance abuse or reckless driving.

 Self-harming behavior including suicidal threats or attempts.

 Chronic feelings of boredom or emptiness.

 Inappropriate, intense or uncontrollable anger

I. V. VI. II. c. HISTRIONIC PERSONALITY DISORDER

Histrionic personality disorder is characterized by a long-standing pattern of

attention seeking behavior and extreme emotionality Individuals who have this

disorder want to be the center of attention in any group of people, and they feel

uncomfortable when they are not. While often lively, interesting, and sometimes

dramatic, they have difficulty when people aren’t focused exclusively on them.

People with this disorder may be perceived as being shallow and may engage in

sexually seductive or provocative behavior to draw attention to themselves.

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SYMPTOMS:

 Self-centeredness, feeling uncomfortable when not the center of attention

 Constantly seeking reassurance or approval

 Inappropriately seductive appearance or behavior

 Rapidly shifting emotional states that appear shallow to others

 Overly concerned with physical appearance, and using physical appearance to

draw attention to self

 Opinions are easily influenced by other people, but difficult to back up with

details

 Excessive dramatics with exaggerated displays of emotion

I. V. VI. II. d. NARCISSTIC PERSONALITY DISORDER

Narcissistic personality disorder is

characterized by a long-standing pattern of

grandiosity, an overwhelming need for

admiration, and usually a complete lack of

empathy toward others. Narcissistic traits

are common in adolescence and do not necessarily indicate that a personality

disorder will develop in adulthood. Underlying self-esteem is almost always fragile

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and vulnerable. They assume total concern from others about their welfare. They

discuss their own concerns in lengthy detail with no regard for the needs and

feelings of others and often become impatient or contemptuous of those who

discuss their own needs and concerns.

SYMPTOMS:

 Have an exaggerated sense of self-importance

 Have a sense of entitlement and require constant, excessive admiration

 Expect to be recognized as superior even without achievements that warrant it

 Exaggerate achievements and talents

 Be preoccupied with fantasies about success, power, brilliance, beauty or the

perfect mate

 Believe they are superior and can only associate with equally special people

I. V. VI. III. CLUSTER C: PERSONALITY DISORDER

I. V. VI. III. a. AVOIDANT PERSONALITY DISORDER

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Avoidant personality disorder is

characterized by a pervasive pattern of

social discomfort and reticence, low self-

esteem, and hypersensitivity to negative

evaluation. These feelings of inadequacy

leads the person to be socially inhibited and feel socially inept. Because of these

feelings of inadequacy and inhibition, the person with avoidant personality

disorder will seek to avoid work, school, and any activities that involve socializing

or interacting with others. Individuals with this disorder often vigilantly appraise

the movements and expressions of those with whom they come into contact.

SYMPTOMS:

 Social inhibition

 Feelings of inadequacy

 Hypersensitivity to negative evaluation

 Anxiety about saying or doing the wrong thing

 A need to be well-liked

 Fearful and tense demeanor

 Misinterpreting neutral situations as negative

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I. V. VI. III. b. DEPENDENT PERSONALITY DISORDER

Dependent personality disorder is characterized by a pervasive and excessive need

to be taken care of, which leads to submissive and clinging behavior and fears of

separation. These behaviors are designed to elicit care-taking from others. They

often seem doubtful of their own abilities and skills, and generally see themselves

as worthless or of little value to others. They often have poor self-esteem and little

faith in themselves or their knowledge. Anytime constructive criticism or

disapproval is offered, it is simply seen as proof of their worthlessness. They rarely

want to take on much leadership roles or responsibilities.

SYMPTOMS:

 Difficulty making decisions without reassurance from others

 Problems expressing disagreements with others

 Avoiding personal responsibility

 Devastation or helplessness when relationships end

 Unable to meet ordinary demands of life

 Preoccupied with fears of being abandoned

 Easily hurt by criticism or disapproval

 Willingness to tolerate mistreatment and abuse from others

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I. V. VI. III. c. OBSESSIVE-COMPULSIVE

PERSONALITY DISORDER

Obsessive-compulsive personality disorder is

characterized by a preoccupation with

orderliness, perfectionism, and mental and

interpersonal control, at the expense of

flexibility, openness, and efficiency. When

rules and established procedures do not dictate

the correct answer, decision making may become a time-consuming, often painful

process. Individuals with obsessive-compulsive personality disorder may have

such difficulty deciding which tasks take priority or what is the best way of doing

some particular task that they may never get started on anything.

SYMPTOMS:

 Perfectionism to the point that it impairs the ability to finish tasks

 Stiff, formal, or rigid mannerisms

 Being extremely frugal with money

 An overwhelming need to be punctual

 Extreme attention to detail

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 A rigid adherence to rules and regulations

 An overwhelming need for order

I. V. VI. III. d. DEPRESSIVE PERSONALITY DISORDER

Depressive personality disorder is

characterized by a pervasive pattern of

depressive cognitions and behaviors in

various contexts. It occurs equally in men

and women and more often in people

with relatives who have major depressive disorders. Individuals with this disorder

often seek treatment for their distress and general have a favorable response to

antidepressant medications. They do not experience the severity and long duration

of major depression or the hallmark symptoms of sleep disturbances, loss of

appetite, recurrent thoughts of death, and total disinterest in all activities.

SYMPTOMS:

 Loss of interest in daily activities

 Sadness, emptiness or feeling down

 Hopelessness

 Tiredness and lack of energy

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 Low self-esteem, self-criticism or feeling incapable

 Trouble concentrating and trouble making decisions

 Irritability or excessive anger

 Feelings of guilt and worries over the past

I. V. VI. III. e. PASSIVE-AGGRESSIVE PERSONALITY

DISORDER

Passive-aggressive personality disorder is

characterized by a negative attitude and a

pervasive pattern of passive resistance to

demands for adequate social and

occupational performance. These

individuals may appear cooperative, even

ingratiating, or sullen and withdrawn, depending on the circumstances. Their mood

may fluctuate rapidly and erratically, and they may be easily upset or offended.

They may alternate between hostile self-assertion such as stubbornness or fault

finding and excessive dependence, expressing contrition and guilt.

SYMPTOMS:

 Frequently criticizing or protesting

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 Being disagreeable or irritable

 Procrastinating or being forgetful

 Performing tasks inefficiently

 Acting hostile or cynical

 Acting stubborn

 Blaming others

 Complaining about being unappreciated

Objectives: to help a patient feel cared for and understood and

establish a relationship in which the patient feels free to express

any concerns.

II. THERAPEUTIC INTERVENTIONS

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A therapeutic intervention is an effort made by individuals or groups to improve

the well-being of someone else who either needs help but refusing it or is

otherwise unable to initiate or accept help. The intervention, which can be

psychological, physical, or even pharmacological, may be led or guided by a

professional interventionist or by friends or family members, with or without the

help of a professional, depending on the circumstances. In some cases, an

intervention takes the form of a confrontation or meeting between a person who is

engaged in self-destructive behavior and is resistant to help and concerned friends

or family members. In other cases, where individuals are not able to make

decisions for themselves, an intervention is a decision to act on their behalf. This

method may not work for every person in need.

II. I. TYPES OF THERAPEUTIC INTERVENTIONS

II. I. a. COGNITIVE BEHAVIORAL THERAPY

(CBT) Cognitive behavioral therapy is a short-term, goal-oriented psychotherapy

treatment that takes a hands-on, practical approach to problem-solving. Its goal is

to change patterns of thinking or behavior that are behind people’s difficulties, and

so change the way they feel. It is used to help treat a wide range of issues in a

person’s life, from sleeping difficulties or relationship problems, to drug and

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alcohol abuse or anxiety and depression. CBT works by changing people’s

attitudes and their behavior by focusing on the thoughts, images, beliefs and

attitudes that are held and how these processes relate to the way a person behaves,

as a way of dealing with emotional problems.

SYMPTOMS:

 Anxiety disorders

 Obsessive Compulsive Disorder (OCD)

 Panic Disorder

 Post-Traumatic Stress Disorder (PTSD)

 Phobias

 Eating Disorders – such as anorexia and bulimia

 Sleep Problems – such as insomnia

 Irritable Bowel Syndrome (IBS)

 Chronic Fatigue Syndrome (CFS)

II. I. b. DIALECTICAL BEHAVIOR THERAPY (DBT)

Dialectical behavior therapy treatment is a type of psychotherapy or talk therapy

that utilizes a cognitive-behavioral approach. DBT emphasizes the psychosocial

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aspects of treatment. The theory behind the approach is that some people are prone

to react in a more intense and out-of-the-ordinary manner toward certain emotional

situations, primarily those found in romantic, family and friend relationships. DBT

theory suggests that some people’s arousal levels in such situations can increase far

more quickly than the average person’s, attain a higher level of emotional

stimulation, and take a significant amount of time to return to baseline arousal

levels. Research shows that 6 months to a year of DBT treatment is most effective.

DBT is especially effective for the following challenges and disorders:

 Borderline personality disorder

 Suicidal thinking or behavior

 Self-injury and other self-destructive behaviors

 Anger and anger management

 Impulsive behaviors that can be dangerous

 Difficulty building and maintaining healthy relationships

( https://psychcentral.com/lib/an-overview-of-dialectical-behavior-therapy/ )

II. I. c. INTERPERSONALLY THERAPY

Interpersonal Therapy (IPT) is a short-term treatment for youth with depression

and interpersonal problems. It focuses on relationships, life transitions and how to

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improve the way your youth communicates and relates to others. It can also help

youth deal with specific issues, including grief, conflict, and with major changes at

home, school, work and in their social life. IPT helps youth learn to identify

emotions and the links between events and feelings. With IPT, youth begin to see

how the way they communicate can cause problems. They learn how to think

through issues and express themselves more effectively. IPT is an evidence-based

treatment. It can be delivered in either individual or group format. IPT can be

combined with family therapy for younger teens. IPT usually lasts for 8 to 20

sessions.

IPT can be modified for the treatment of:

 Problems with substance use

 Eating disorders such as bulimia and anorexia nervosa

 Bipolar disorder

 Dysthymia

II. I. d. MINDFULNESS-BASED COGNITIVE THERAPY

Mindfulness-based cognitive therapy is an approach to psychotherapy that was

originally created as a relapse-prevention treatment for depression. Mindfulness

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is paying attention in a way: on purpose and in the present moment. The goal of

mindfulness is to focus less on reacting to something or someone and more on

observing and accepting without judgement. It teaches you to be aware of your

thoughts and feelings and to accept them, but not attach or react to them. This

practice helps you to notice your automatic reaction and to change it to be more of

a reflection. The MBCT program is a group intervention that lasts eight weeks.

During these eight weeks, there is a weekly course, which lasts two hours, and one

day-long class after the fifth week.

Mindfulness therapies are effective treatments for:

 Stress

 Pain

 Anxiety

 Personality disorders (combined with other treatments)

 Depression (combined with other treatments)

II. I. e. PSYCHODYNAMIC THERAPY

Psychodynamic therapy, also known as insight-oriented therapy, focuses on

unconscious processes as they are manifested in a person’s present behavior.

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It focuses on how early childhood and relations with others can affect our

development. It is based on the idea that the unconscious holds onto painful

feelings and memories that are too difficult for the conscious mind to process.

The aim of psychodynamic therapy is to bring the unconscious mind into

consciousness. It helps a child or youth to experience and begin to understand their

true, deep-rooted feelings in order to deal with them.

Psychodynamic therapy focuses on:

 Increasing self-awareness

 Examining thoughts and feelings

 Becoming more resilient

 Being adaptable

The goal of this therapy is to lessen the most obvious symptoms and help children

and youth lead healthier lives.

II. I. f. GROUP PSYCHOTHERAPY

Group psychotherapy is a form of psychotherapy in which one or more therapists

treat a small group of clients together as a group. There are many types of group
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therapy. Some groups are mostly educational and some focus on practice and do

little talking about individual problems. Other groups encourage members to

discuss issues and offer helpful feedback to each other with guidance from the

therapist. All personal information shared in groups is confidential. Group therapy

is effective for a wide range of mental health concerns. Many people are reluctant

to try group treatment, but most become comfortable with the group quite quickly.

Some members do not speak often but learn skills by just being there and listening.

Families often find group treatment gives them a lot of support. They appreciate

the chance to discuss their concerns with others in similar situations.

( https://en.wikipedia.org/wiki/Group_psychotherapy )

II. I. g. EMOTION-FOCUSED THERAPY

Emotion-focused Therapy (EFT) focuses on emotions and the way we deal with

them. It also puts emphasis on the self and the importance of past relationships.

EFT is based on the idea that many mental and physical health concerns are caused

by avoiding emotions and pretending that everything is okay, or by not getting our

emotional needs met. EFT helps individuals resolve unpleasant emotions by

working with these emotions instead of suppressing them. It uses the unpleasant

emotions as a source of information. EFT focuses on how you experience problems

and what they trigger you to do as a way of coping with your emotions.
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EFT is especially effective for the following types of challenges and disorders:

 Moderate depression

 The effects of childhood deprivation or abuse

 Interpersonal problems

 Eating disorders

II. I. h. PLAY THERAPY

Play therapy gives children a caring and confidential environment to play. It places

as few limits as possible, but as many as needed for children to be safe, both

physically and emotionally. Through play therapy, a child or youth may be able to

express their experiences and feelings through play, deal with emotional problems,

increase self-awareness, manage behavior, develop social skills, cope with

symptoms of stress and trauma, and restore a sense of well-being. Play therapists

may work one on one with a child or with small groups. Play therapy is usually

best for children aged 2-11. It can be especially helpful for younger children and

for those who have a hard time talking about their thoughts and feelings. This

depends on the individual.

Play therapy is also known as therapeutic play and can include:

 Art therapy
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 Dance

 Storytelling

 Drama (role play)

 Creative visualization

 Music

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