MODULE 6

LIFE SPAN PROBLEMS

LESSON 1. DISSOCIATIVE DISORDERS

In this lesson, we will discuss matters related to dissociative disorders to

include their clinical presentation, epidemiology, comorbidity, etiology, and
treatment options. Our discussion will consist of dissociative identity disorder,
dissociative amnesia, and depersonalization/derealization.

**For more detailed discussion of said disorder, read thru on this site
https://opentext.wsu.edu/abnormal-psych/chapter/module-6-dissociative-disorders/

Learning Activity:

Dissociative Identity Disorder Criteria

Within the Movie Sybil

1. How is the essential feature of a dissociative disorder portrayed in the movie?

2. How are the integrative functions of consciousness, memory, identity, or

perception of the environment disrupted in Sybil?

3. Describe Sybil in terms of the Diagnostic criteria for 300.14 Dissociative

Identity Disorder.

4. In the description of course for DID it is stated that the average time period
form first symptom presentation to diagnosis is 6-7 years. Do you feel this is
accurate for Sybil? Why or why not?

5. Sybil had many alters (other identities). List all of them, together with the year
in which each appeared to have dissociated from the central personality and a
 brief description of the personality of each of the alters. The DSM states
females have more identities than do males, averaging 15 or more, whereas
males average approximately 8 identities. What are your thoughts, after seeing
the movie Sybil, about why this may be?

6. The DSM supports individuals with DID as “highly hypnotizable and vulnerable
to suggestive influences.” How does this apply to Sybil as portrayed in the
movie?

7. What is your reaction to the behavior of Sybil’s father in the film?

8. What are your feelings/thoughts about Sybil’s mother?

9. In Sybil arguments were made that Shirley Mason – the real “Sybil” – began
acting as though she had multiple personalities because her psychiatrist
pressured her to behave this way. What do you think/feel about the manner in
which Sybil’s psychiatrist dealt with the child Sybil’s hometown doctor? What
could/should he have done?
What ethical/legal repercussions do you think he might encounter in today’s
society? What drives your thoughts on this matter?

10. People argue about whether MPD/DID is real. What is your opinion? Did it
change after watching Sybil?

LESSON 2. Neurocognitive Disorders

Unlike many of the disorders discussed thus far, neurocognitive disorders often
result from disease processes or medical conditions. Therefore, it is important that
individuals presenting with these symptoms complete a medical assessment to better
determine the etiology behind the disorder.
There are three main categories of neurocognitive disorders- Delirium, Major
Neurocognitive Disorder, and Mild Neurocognitive Disorder. Within major and minor
neurocognitive disorders are several subtypes due to the etiology of the disorder. For
the purpose of this course, we will review diagnostic criteria for both major and
minor neurocognitive disorders, followed by a brief description of the various disease
subtypes in the etiology section.

LEARNING ACTIVITY

1. Students are required to read and make notes on the chapter of Neurocognitive
disorders from the DSM 5 APA. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washington, D.C.: American Psychiatric Association.

Students are directed to extract the main ideas.

2. Students to view posted powerpoint/video presentations
https://www.khanacademy.org/test-prep/mcat/behavior/psychological-
disorders/v/biological-basis-of-parkinsons-disease
https://www.slideshare.net/LisaRosema/neurocognitive-disorders-1

3. Students to analyze case vignette/s.

SUMMATIVE TEST

Case Analysis
Instructions: Read carefully the information provided in the case to be able to:
a) give the proper diagnosis; and,
b) link the specific facts of the case to the different symptoms of the disorder.

A 79-year-old woman with a history of depression is being evaluated at a

nursing home for a suspected urinary tract infection. She is easily distracted,
perseverates on answers to questions, asks the same question repeatedly, is unable to
focus, and cannot answer questions regarding orientation. The mental status changes
evolved over a single day. Her family reports that they thought she “wasn’t herself”
when they saw her the previous evening, but the nursing report this morning indicates
that the patient was cordial and appropriate. What is the most likely diagnosis?

LESSON 3. Neurodevelopmental Disorders

Intellectual disabilities are neurodevelopmental disorders characterized by

significantly impaired intellectual and adaptive functioning.
**For more detailed discussion of said disorder, read thru on this site
https://courses.lumenlearning.com/boundlesspsychology/chapter/neurodevelopment
al-disorders/

LEARNING ACTIVITY

1. Students are required to read and make notes on the chapter of

Neurodevelopmental disorders from the DSM 5 APA. (2013). Diagnostic and statistical
manual of mental disorders (5th ed.). Washington, D.C.: American Psychiatric
Association.

Students are directed to extract the main ideas.

2. Students to analyze case vignette/s.

Case Analysis
Instructions: Read carefully the information provided in the case to be able to:
a) give the proper diagnosis; and,
 b) link the specific facts of the case to the different symptoms of the disorder.
A 10-year-old boy with a history of dyslexia, who is otherwise developmentally
normal, is in a skateboarding accident in which he experiences severe traumatic brain
injury. This results in significant global intellectual impairment (with a persistent
reading deficit that is more pronounced than his other newly acquired but stable
deficits, along with a full-scale IQ of 75). There is mild impairment in his adaptive
functioning such that he requires support in some areas of functioning. He is also
displaying anxious and depressive symptoms in response to his accident and
hospitalization. What is the least likely diagnosis?

A. Intellectual disability (intellectual developmental disorder).

B. Traumatic brain injury.
C. Specific learning disorder.
D. Major neurocognitive disorder due to traumatic brain injury.
E. Adjustment disorder.

LESSON 4 Disruptive, Impulse-Control, and Conduct Disorders

Most kids will act up or become disruptive or defiant sometimes. Disruptive and
conduct disorders, however, involve much more severe and longer-lasting behaviors
than typical, short-lived episodes.
Disruptive, impulse-control and conduct disorders refer to a group of disorders
that include oppositional defiant disorder, conduct disorder, intermittent explosive
disorder, kleptomania and pyromania. These disorders can cause people to behave
angrily or aggressively toward people or property. They may have difficulty
controlling their emotions and behavior and may break rules or laws.
An estimated 6 percent of children are affected by oppositional defiant
disorder or conduct disorder1. Each year, an estimated 2.7 percent of children and
adults in the U.S. are affected by intermittent explosive disorder. Kleptomania and
pyromania are rare, affecting 1 percent or fewer of people in the U.S. 2,3
The angry, aggressive or disruptive behaviors of people with conduct and
disruptive disorders are more extreme than typical behaviors. The behaviors:
are frequent
are long lasting
occur across different situations
cause significant problems
One difference between conduct disorders and many other mental health
conditions is that with conduct disorders, a person's distress is focused outward and
directly affects other people. With most other mental health conditions, such as
depression and anxiety, a person's distress is generally directed inward toward
themselves.
Conduct disorders tend to begin in childhood or adolescence and are more
common in males than females. Several factors make it more likely a person will have
a conduct disorder, including harsh parenting, physical or sexual abuse, or parents
with a history of addiction or problems with law enforcement.
 Key points to be noted here is that the DSM chapter on disruptive, impulse-
control, and conduct disorders brings together several disorders (such as oppositional
defiant disorder, conduct disorder, intermittent explosive disorder, pyromania, and
kleptomania) into one single category.
Conduct disorder (CD) presents itself through a repetitive and persistent
pattern of behavior in which the basic rights of others, or major age-appropriate
norms, are violated.
Oppositional defiant disorder (ODD) involves patterns of anger, irritability,
argumentative or defiant behavior, and/or vindictiveness; unlike CD, children with
ODD are not aggressive toward people, animals, or things.
Intermittent explosive disorder (IED) is a behavioral disorder characterized by
explosive outbursts of anger, often to the point of rage, that are disproportionate to
the situation at hand.
Pyromania is characterized by impulsive and repetitive urges to deliberately
start fires. Kleptomania involves an impulsive urge to steal purely for the sake of
gratification.
Key terms here are:
1. impulsive: Acting momentarily, by transient feelings; inclined to make rapid
decisions without due consideration.
2. antisocial: Unwilling or unable to associate normally with other people;
antagonistic, hostile, or unfriendly toward others; opposed to social order or the
principles of society; hostile toward society.

LEARNING ACTIVITY

1. Students are required to read and take notes on the chapter of Disruptive, Impulse-
Control, and Conduct Disorders from the DSM 5 APA. (2013). Diagnostic and statistical
manual of mental disorders (5th ed.). Washington, D.C.: American Psychiatric
Association.

Students are directed to extract the main ideas identified; to be followed by a sharing
of information.

2. Students to view posted powerpoint/video presentations

https://www.youtube.com/watch?v=XH46Nm1QOcg&t=15s
https://www.slideshare.net/JohnWilliams27/disruptive-disorders-5?
qid=33156b9e-c4dd-4c47-83b1-642bee9e1c08&v=&b=&from_search=1

3. Students to analyze case vignette/s

Case Analysis
Instructions: Read carefully the informations provided in the case to be able to:
a) choose the proper diagnosis; and,
b) link the specific facts of the case to the different symptoms of the disorder.
 A 15-year-old male student in private school, without known psychiatric
history, has been caught stealing other students’ laptops and cell phones, even
though he comes from a wealthy family and his parents continue to purchase the
newest electronics for him in an effort to deter him from stealing. Which of the
following would raise your clinical suspicion that he may have kleptomania? Justify
A. He demonstrates recurrent failure to resist impulses to steal objects that
are not needed for personal use or for their monetary value.
B. He demonstrates recurrent failure to resist impulses to steal objects during
periods of detachment or boredom.
C. He experiences increased tension before committing the theft but does not
experience relief, pleasure, or gratification while committing the theft.
D. He has a strong family history for antisocial personality disorder and conduct
disorder.
E. He has a strong family history for bipolar disorder.

LESSON 5 Personality Disorders

Personality disorders have four defining features which include distorted

thinking patterns, problematic emotional responses, over- or under- regulated
impulse control, and interpersonal difficulties. While these four core features are
common among all ten personality disorders, the DSM-5 divides the personality
disorders into three different clusters based on symptom similarities.
Cluster A is described as the odd/eccentric cluster and consists of Paranoid
Personality Disorder, Schizoid Personality Disorder, and Schizotypal Personality
Disorder. The common feature between these three disorders is social awkwardness
and social withdrawal (APA, 2013). Often these behaviors are similar to those seen in
schizophrenia, however, they tend to be not as extensive or impactful of daily
functioning as seen in schizophrenia. In fact, there is a strong relationship between
cluster A personality disorders among individuals who have a relative diagnosed with
schizophrenia (Chemerinksi & Siever, 2011).
Cluster B is the dramatic, emotional, or erratic cluster and consists of
Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality
Disorder, and Narcissistic Personality Disorder. Individuals with these personality
disorders often experience problems with impulse control and emotional regulation
(APA, 2013). Due to the dramatic, emotional, and erratic nature of these disorders, it
is nearly impossible for individuals to establish healthy relationships with others.
And finally,
Cluster C is the anxious/fearful cluster and consists of Avoidant Personality
Disorder, Dependent Personality Disorder, and Obsessive-Compulsive Personality
Disorder. As you read through the descriptions of the disorders, you will see an
overlap with symptoms within the anxiety and depressive disorders. Likely due to the
similarity in symptoms with mental health disorders that have effective treatment
options, cluster C disorders have the most treatment options of all personality
disorders.
It should be noted that in order to meet criteria for any personality disorder, the
individual must display the pattern of behaviors in adulthood. Children cannot be
diagnosed with a personality disorder. Some children may present with similar
symptoms in childhood such as poor peer relationships, odd or eccentric behaviors, or
peculiar thoughts and language; however, a formal personality disorder diagnosis
cannot be made until the child reaches age 18.
LEARNING ACTIVITY

1. Students are required to read and take notes on the chapter of Personality
Disorders from the DSM 5 APA. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washington, D.C.: American Psychiatric Association.
APA_DSM-5-Personality-Disorder.pdf

Students are directed to extract the main ideas identified.

2. Students to view posted powerpoint/video presentations

https://www.khanacademy.org/test-prep/mcat/behavior/psychological-
disorders/v/personality-disorders

https://www.slideshare.net/katiechin/personality-disorders-25265030?qid=c32c2f43-
f68e-4d6e-ae49-e3f676b9d114&v=&b=&from_search=1

SUMMATIVE TEST

Movie Review
Students to watch the movie titled “Silence of the Lambs”
( https://www.netflix.com/ph/title/80171659), exploring the story of a young F.B.I.
cadet must receive the help of an incarcerated and manipulative cannibal killer to
help catch another serial killer, a madman who skins his victims..

Silence of the Lambs: Diagnosing Dr Lecter

I. CASE HISTORY.
1. Come up with a case report on Dr. Hannibal Lecter as a psychiatric patient. (refer
to the plot of the movie contrasted with discussions in the DSM 5 to answer this)
II. Insights and Judgments
2. How does the fact that Lecter is a psychiatrist affect his character—his personality
and behavior? Why is his being a psychiatrist important to the story?
3. We see flashes of Agent Starling’s memory. What is she remembering and why?
4. Describe the relationship between Lector and Starling.
5. Describe Buffalo Bill’s psychological problems—as we see them and as Hannibal
Lecter describes them. How would you diagnose Buffalo Bill?
6. What personal problems is agent Starling working through?
7. List the diagnostic criteria and associated characteristics of an antisocial
personality disorder as specified by the Diagnostic and Statistical Manual V (DSM-5),
Do these characteristics describe:
o Hannibal Lecter?
o Buffalo Bill?
Give specific examples.
III. Reaction and Afterthoughts
8. What is the “Silence of the Lambs?”