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Reviewer: Abnormal Psych

Module 1: UNDERSTANDING MENTAL HEALTH AND ABNORMAL BEHAVIOR

Mental Health

STATISTICS

The World Health Organization (WHO) statistics on the year 2001 revealed that a ratio
of one (1) out of four (4) people worldwide tends to be affected by mental health
problems at some point in their lives. On year 2001, the mentioned organization
obtained a total number of 450 million people around the world who are suffering from
these conditions.

The ―Our World in Data‖ website estimated that around one (1) billion people globally
have a mental or substance use disorder for the year 2017.

The Philippine WHO Special Initiative for Mental Health conducted in the early part of
2020 shows that at least 3.6 million Filipinos suffer from one kind of mental,
neurological, and substance use disorder.

What is Mental Health?

The World Health Organization (WHO) defined mental health as a state of well-being
where a person can realize his or her abilities to cope with the normal stresses
of life and work productively

Mental Hygiene - study of mental health

Criteria for Positive Mental Health

1. Self-Awareness
2. Autonomy
3. Perceptive Ability
4. Integral Capacity
5. Self Actualization
6. Mastery of One’s Environment
7. Optimal Functioning - the highest possible level of functioning, especially in
relationships, work, education, and subjective well-being

Stress, as Hans Selye defined it, is a nonspecific response of the body to any demand
that it is encountering or experiencing.
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Type of Stress

Distress- Bad Stress

Eustress- Good Stress

Adaptation a persistent continuous process

that occurs along time continuum that are
present from birth and last until death (Smeltzer, 1992).

Humans, as what psychoanalytic perspective views it, are using defense

mechanisms as a way of adaptation to stressors they are experiencing. Defense
Mechanism is said to be a hypothetical construct that is automatic and usually
unconscious. This operates to protect the ego from any anxiety-provoking events. The
common defense mechanisms are the following:

1. Denial - is said to be the common pathological dense mechanism.

This refers to failure to acknowledge an intolerable thought, feeling & experience
or reality.
2. Displacement is an unconscious defense wherein urges are redirected to a less
threatening object
3. Projection refers to attributing one's own characteristics, feelings, or thoughts to
other people.
4. Reaction Formation refers to the expression of one’s opposite feeling, emotion
or thought
5. is a coping strategy of turning back to earlier periods of behaviour when
Regression under stress
6. Repression is the unconscious forgetting of any undesirable and painful
experiences from the past.
7. Sublimation pertains to the reinvestment of unacceptable urg into a socially
acceptable ways.

Crisis occurs when people are experiencing ineffective coping. This refers to a
serious interruption and disturbance of one's equilibrium or homeostasis. This
interruption results to potentially dangerous, self-destructive or socially unacceptable
behaviour.

Types of Crisis

1. Maturational/Developmental Crisis - This crisis is expected, predictable &

internally motivated. Ex of this crisis are puberty, adolescence, old age, marriage.
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2. Situational/Accidental Crisis. Unlike maturational crisis, this kind of crisis is

unexpected, unpredictable and externally motivated. Examples of this crisis are
economic difficulty, illness, accident, rape, divorce or death.
3. Social/Adventitious Crisis. This crisis occurs due to acts nature such as natural
calamities

Crisis Intervention is widely used by mental health professionals to restore the

optimum level of functioning (OLOF) of an individual who are experiencing any of the
above mentioned crisis.

ABNORMAL PSYCHOLOGY

Abnormal Psychology is a branch of psychology which deals with the study of

unusual patterns of human behavior, thoughts and emotions. This covers the
aspects such as description, etiology, effect, and treatment or intervention of
psychological disorders.

What defines Psychological Disorder?

Psychological disorder is also known as mental disorder, mental illness, abnormal

behaviour and psychopathology.

Diagnostic Statistical Manual of Mental Disorders Fourth Edition (DSM IV) -

described abnormal behaviour as behavioural, emotional, or cognitive dysfunctions
that are unexpected in their cultural context and associated with personal distress or
substantial impairment in functioning.

Diagnostic Statistical Manual of Mental Disorders Fifth Edition (DSM V) - defined

mental disorder as a syndrome characterized by clinically significant disturbance
in an individual's cognition, emotion regulation, or behaviour that reflects a dysfunction
in the psychological, biological, or developmental processes underlying mental
functioning.

The Four D’s of Abnormality

1. Psychological Dysfunction - this pertains to the interference of one’s

behavioral, emotional, or cognitive function to the extent wherein his or her daily
living is hindered or impede.
2. Distress - This criteria of abnormal behaviour emphasized extreme upset
feeling, thought and behaviour that is experienced by an individual as a response
to a stressful situation.
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3. Deviance – a behavior is considered abnormal when it violates social norms.

4. Dangerousness - Abnormality is present when the behaviour being manifested
by an individual causes potential harm to himself/herself and other people.

Historical Conceptions on Abnormality

a. The Supernatural Tradition

 This approach explained psychological behaviour based on supernatural
causes. During ancient times, people suspected that odd behaviors were
influenced by evil spirits and that trephination were used to treat those
people.
 Whereas, during the medieval period (last quarter of the 14th century),
deviant and unusual behaviour were believed to be caused by demon
possessions and witchcrafts. The treatment that is used to counter this
assumed cause is exorcism & other religious and inhumane approaches.
 Paracelsus(1493 to 1541) proposed that psychological functioning is
influenced by the movements of the moon and the positions of the stars.
From this theory, the word ―lunatic‖ was emerged. The term ―lunatic‖ was
labelled to a person who manifests behavioural changes during full moon.

b. The Biological Tradition - This perspective views abnormal behavior as a

physical illness caused by abnormal body conditions. This perspective was first
founded by Hippocrates who is known as the father of modern western
medicine. Hippocrates and his colleagues emphasized psychological disorders
as those that can be treated using similar treatments of physical illness in their
writing entitled, Hippocratic Corpus. Aside from physical cause, they also
believed that psychological disorders may also be a result of brain pathology and
genetics. Galen, a Roman Physician, took on this idea of Hippocrates and his
colleagues. Their combined assumptions about psychological functioning
resulted in the first-ever theory associating mental disorders to a chemical
imbalance, this is known as the Hippocratic-Galenic Approach.

Hippocratic-Galenic Approach – The theory mentioned the role of four

identified bodily fluids or humor in psychological functioning. These are blood,
black bile, yellow bile, and phlegm.
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 They proposed that the blood humor came from the heart, wherein too
much of it will lead to temperament known as Sanguine (I). People who
are classified as Sanguine have characteristics of being amorous, happy.
 On the other hand, too much black bile produced in the gall bladder was
said to have the temperament of Melancholic (A) which is an indicator of
having characteristics of being sentimental, introspective, and sympathetic.
 Moreover, too much yellow bile regulated by the spleen leads to the
temperament of Choleric (P) which is attributed to characteristics of
violent, vengeful, volatile, and ambitious.
 Lastly, too much phlegm in the lungs is attributed to Phlegmatic
temperament which is characterized by being sluggish, lazy, and cowardly.
 Furthermore, the aforementioned famous persons also suggest that these
humor imbalances can be treated by regulating the environment to
increase or decrease heat, dryness, moisture, or cold, depending on which
humor was out of balance. Sample of these treatments is a bloodletting,
vomiting, and others.

During the 19th century, John P. Grey as a newly appointed superintendent of the
Utica State Hospital in New York, the largest hospital in the United States at that time,
begun to treat a mental illness using rest, diet, and proper room temperature and
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ventilation. This is due to his propositions that mental illness is always associated with
physical illness and so its treatment must also accord to the latter.

Among the biological treatments that were discovered in the 19th century were:

 Insulin Shock Therapy –  Rauwolfia Serpentine

 Electroconvulsive Therapy  Benzodiazepines
Emil Kraepelin (1856–1926) was the dominant figure during this period and one of the
founding fathers of modern psychiatry. He is the first personality who classified mental
disorders based on their age of onset, time course, clusters of presenting symptoms,
and cause.

c. The Psychological Tradition

o This approach viewed abnormal behavior as a result of traumas, such as
bereavement, or chronic stress. The view that mental illness is covered by
emotional or psychological factors, led to the emergence of moral treatment
to institutionalized patients in a setting that encouraged and reinforced
normal social interaction (Bockoven, 1963).
o The moral therapy was instigated by the French physician known as
Philippe Pinel (1745-1826) and his close associate Jean-Baptiste Pussin
(1746-1811). Patients from the hospitals that were supervised under them
were freed from chains and shackles.
o William Tube contributed to the spread of moral therapy in England,
whereas, Benjamin Rush adopted the same treatment in the United
States.
o The mental hygiene movement was established by Dorothea Dix (1802–
1887). The said movement aims to maintain humane treatment to mentally
ill people not only in the United States but also in various countries.
o Among the theories that were proposed to describe human behavior based
on psychological context are the Psychoanalytic theory of Sigmund
Freud, the Hierarchy of Needs of Abraham Maslow, the Person-
centered theory of Carl Rogers, the Classical Conditioning of Ivan
Pavlov, Operant Conditioning of B.F. Skinner, and Theory of
Connectionism by E.L. Thorndike.

MODULE 2: INTEGRATIVE APPROACH TO PSYCHOPATHOLOGY

A. Biological Dimension - This perspective views genetic components and

neuroscience as the source of abnormal behavior.
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1. Genetic Predispositions

Genes have undoubtedly significant contributions to human behavior. Genes are the
basic units of heredity that are made up of DNA. Genetic researches claimed that
human behavior, personality, and intelligence are a by-product of many genes
(polygenic).

2. Brain Structures

In this viewpoint, psychological disorders are associated with brain damage or lesion.
Specific parts of the brain play a different role in human behavior. The largest part of
the brain is the cerebrum which is said to be responsible for higher thought processes,
such as memory, judgment, creativity, and reason.

3. Biochemical Imbalances

Human behavior under the biological approach is also explained by looking at

neurotransmitters. Neurotransmitters are biochemical released by axon into the
synapse when nerve impulse occurs. It is responsible for the regulation of movement,
learning, memory, sleep, feelings, and emotion. It also activates mental and physical
vigilance.

4. Endocrine System

The Endocrine system is made up of twenty (20) glands which secrete chemical
messengers called hormones. These hormones facilitate bodily processes associated
with growth and development, reproduction, metabolism, and coping strategies during
emergencies. They are passed directly into the bloodstream and are distributed
throughout the different parts of the body. Hormones set off actions once get through
the organs they affect.

B. Psychological Dimension

This approach highlights different factors such as behavioral, cognitive processes,

unconscious processes, and others in psychopathology.

C. Emotional Influence

Emotion pertains to a tendency to respond in a certain way to an external event. Basic

emotions like fear, anger, sadness, or distress, and excitement may lead to
psychological disorders when they become too intense.

D. Socio-Cultural Context
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This point of view emphasizes environmental factors such as society and culture as
major factors influencing psychological problems.

E. Developmental Impact

Experiences during different periods of development are re-analyzed to look for its
influence on one's vulnerability to other types of stress or differing psychological
disorders.

The Diathesis-Stress Model

This model views psychological disorder as a product of biological, psychological, and

sociocultural factors. This model proposes that some people have enduring
vulnerability factor or predisposing factor (diathesis) that when combined with stressor
leads to psychological problems. Neither diathesis nor stressor alone is not sufficient to
activate psychological disorders, both of them must be present.

MODULE 3: ASSESSMENT & DIAGNOSIS OF ABNORMALITY

Clinical Assessment of Psychological Functioning

Clinical Assessment - process of evaluating and measuring the biological,

psychological, & social factors of an individual who tends to have a psychological
problem.

Common Terms use in Clinical Assessment

Prevalence. This term is used to describe the number of entire populations who have
the disorder.

Jan 30, 2020 - Globally, more than 264 million people of all ages suffer from
depression
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Incidence. This refers to the number of new cases in a certain mental disorder during
a specific period.

It’s estimated that 16.2 million adults in the United States, or 6.7% of American adults
are added to the number of people having at least 1 major depressive episode in a
given year.

Sex Ratio - This term is used to describe the percentage of males and females who
have the disorder

Course - This pertains to the individual pattern of the disorder

1. Disorder with a Time limited course is only present in a short period thus, the
condition will be improved even without treatment
2. In the Episodic Course an individual with a certain disorder tends to recover
within a few months but, will recur at a later time
3. The most severe among the courses being described is Chronic Course which
is characterized by long term or enduring pattern of psychological disorder

Onset - This term is used to describe when does disorder begins or starts Acute
Onset begins suddenly compare to Insidious Onset that is manifested gradually over
an extended period

Assessment Tools

 Clinical Interview  Psychological Testing

 Physical Examination  Psychophysiological Assessment
 Behavioral Assessment

Clinical Interview . An interview is a method used to gather relevant data about the
present and past behavior , attitudes, and emotions of an individual through the
reciprocal verbal exchange of communication between the interviewer (mental health
professional) and the interviewee (client). This method is also used to support or
compare the result of testing.

Five (5) Categories of Mental Status Exam

1. Appearance and Behavior . The first aspect that must be done by the clinician
in using MSE is to take note of the observable physical appearance and behavior
of the client during the interview
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2. Thought Process. This category assesses the speech pattern and content of
the client’s responses
3. Mood and Affect. The mood and affect of the client must also be observed
during the interview Mood refers to the more persistent emotion of the individual
while affect refers to a tentative emotional tone that determines one’s action and
words
4. Intellectual Functioning. This category encompasses the individual's
intellectual functioning by just analyzing the way the client speaks and any
indications of memory or attention difficulties
5. Sensorium. This category targets to identify the general awareness of the client
towards their surroundings.

Types of Interview

A structured Interview is composed of a prepared list of questions in advance which

are organized in a particular order These sets of questions are asked to every
interviewee uniformly Due to being structured, scoring can be set provided that the
attributes of the interviewee are similar to the sample norms The limitation of this kind
of interview is that no follow ups or other related questions can be added during the
exchange of cues because the interviewer needs to rely and stick on the questions
written or printed before the interview.
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Unstructured Interview w/c is consists of questions that are based on what comes in
the mind of the interviewer and on the responses of the interviewee as well. Like the
former kind, the unstructured interview has its limitation. This kind of interview is said to
be low in terms of validity and reliability

Semi-Structured Interview combines the first two types of interviews Here, there are
already a set of validated questions before the interview and aside from that,
interviewers may ask follow up questions related to the response given by the
respondent This is commonly used today for it provides a reliable and valid set of
questions with follow up questions to be able to provide more elaborate responses
from the respondent.

Physical Examination. This type of examination is recommended to clients to

determine the medical conditions and drug use and abuse that may play a significant
role in the presenting problem of the client.

Behavioral Assessment. This assessment tool uses direct observation to examine an

individual's way of thinking, feeling, and behaving in a specific situation. Observation
may be done in a natural setting, analogue setting, or laboratory setting.
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Self-monitoring may also be used when the behaviour tends to be in private. This
refers to a modality where the client himself or herself examines his or her behaviour to
find patterns.

The problem that is experienced by the clinicians using behavioural assessment is the
client’s reactivity. Reactivity is a phenomenon where people change their behaviour
due to the presence of an observer.

Psychological Testing. This method uses a specific device to assess the cognitive,
emotional, or behavioural functioning of the individual and its relationship to a specific
disorder.

Personality tests are used to assess the long-standing thoughts, feelings, & behavior
of a client.

Two Categories of personality tests:

1. The Structured Test 2. The Projective Test

Structured or Objective Test is uniformly administered under the same condition to a

group of test-takers. The examples of extensively used structured personality tests are
Minnesota Multiphasic Personality Inventory (MMPI), Basic Personality Inventory (BPI),
California Psychological Inventory (CPI), Sixteen Personality Factor Questionnaire
(16PF), and NEO Personality Inventory (NEO PI-R).

Projective or Subjective Test measures personality by describing the presented

ambiguous stimuli or illustrating stimuli that are subject to the interpretation of the
latent meaning or projection of responses. The examples of the widely use projective
tests are Draw a Person Test, Thematic Apperception Test, Rorschach Inkblot Test,
and House, Tree, Person Test.

Intelligence test which is design to measure the general level of intellectual

functioning of a certain individual.

Individually Administered Intelligence Tests…

a. Wechsler Adult Intelligence Scale (WAIS),

b. Wechsler Intelligence Scale for Children (WISC),
c. Stanford Binet Intelligence Test, and
d. Ravens Progressive Matrices (RPM)

Group Intelligence Tests

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1. MD5 Mental Ability Test 2. Culture Fair Intelligence Test (CFIT)

The neuropsychological test is used to measure possible brain (damage in an
individual, specifically in areas such as receptive language, attention, & concentration,
memory, motor skills, perceptual abilities, and learning. An example of this test is
Bender Visual Motor Gestalt Test.

Psychophysiological Assessment. This method is used to determine the significant

changes in the nervous system that are related to emotional or psychological events.
An example of the device used in this assessment is the electroencephalogram
(ECG)

Diagnosing Psychological Disorders

Diagnosis is a process of describing whether the presenting problem experienced by

an individual accord to all criteria for a given psychological disorder, as provided in the
Diagnostic and Statistical Manual of Mental Disorders (DSM 5 Diagnosing one's
disorder is based on how disorders are classified or assigned based on their
commonalities (e.g attributes or relations)

Three (3) Types of Diagnostic Classification

1. Classical (pure) categorical approach- rooted in the works of Emil Kraepelin and
biological viewpoint in explaining abnormal behavior. This classification is based
on the assumption that mental illness has a biological cause.
2. Dimensional approach- uses scale to discover an individual's dysfunctions in
cognition, mood, and behavior.
3. Prototypical approach- classification is based on the identification of certain
essential characteristics of a mental disorder, yet nonessential variations are also
stated without changing the classification. The DSM-5 is based on this approach.

Any system of classification is said to be psychometrically sound when it has a good

reliability and validity estimate. A classification system is reliable if a group of clinicians
see and measure a similar set of behaviors and emotions to a client at separate times
on the same day. Moreover, validity refers to the measure of what the classification
aims or designs to measure.

Three (3) Types of Diagnostic Validity

1. Construct Validity refers to the accuracy of associating the selected signs and
symptoms and differentiating it from other categories.
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2. Predictive or criterion validity refers to the ability of the classification system to

predict the course of the disorder and the possible effect of one treatment or
another.
3. Content validity refers to the agreement of the clinicians in the created criteria
for the diagnosis of a specific disorder.

The Emergence of Classification Systems for Mental Disorders

In 1883, Emil Kraepelin published the first modern classification system emphasizing
mental disorders under a biological perspective. He is the first person who identified
dementia praecox that is now named as schizophrenia and manic depressive
psychosis 1948or the now called bipolar disorder.

By the year, the World Health Organization (WHO) included the classifications of
mental illness to the sixth edition of the International Classification of Diseases and
Related Health Problems (ICD-6).

The American Psychiatric Association published the 1st edition of the Diagnostic
and Statistical Manual (DSM- I) in the year 1951. The need to classify disorders
during World War I arose as a response to the great number of mental problems
reported at that time. The criteria used under this classification system had vague
descriptions for it is based on psychoanalytic theory.

In 1968, the 2nd edition of DSM (DSM- II) was published to add some newly
recognized disorders.

Due to low reliability and abstract and vague criteria of the second revision, the 3rd
version of the DSM was published under the presidency of Robert Spitzer in the year
1980. This version of the DSM applied an atheoretical approach to diagnosis;
wherein, it relied on the specific descriptions of the disorders based on how the
clinician perceived them than applying biological and psychoanalytic theories. The
criteria in this DSM were also made specific which in turn made the study of its
reliability and validity possible.

Multiaxial System : Five (5) axes

1. Schizophrenia or mood disorders (Axis I)

2. Disorders of personality (Axis II)
3. Physical disorders and conditions present (Axis III)
4. Amount of psychological stress (Axis IV)
1. 5.Level of Adaptive Functioning (Axis V)
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Another edition of the DSM came into public by the year 1987 and was named as
DSM-III-R.

The next published edition of DSM which is DSM-IV (1994) was a result of the
compatibility of criteria for mental disorders between the said classification system
and the ICD (10th edition). This version of DSM maintained the multiaxial system;
however, there were changes made. The Axis I was now comprised of all mental
disorders except personality disorders and intellectual disability, Axis II was
composed of personality disorder and intellectual disability, Axis III remained the
same, Axis IV was now tagged for psychosocial and environmental problems,
and Axis V remained the same. Minor revisions were made to the next publication
of the said classification system, which is now called DSM-IV-TR.

The latest edition of the DSM is now in its 5th version (DSM-V). This edition was
published in the year 2013 in collaboration with the experts who were also working for
the eleventh edition of the ICD (ICD-11). The most notable change in this version was
the exclusion of the multiaxial system. The DSM-IV axes I, II, and III had been
combined, and the Global Assessment of Functioning in DSM-IV was now
discarded and replaced by the World Health Organization Disability Assessment
Schedule (WHODAS 2.0).

MODULE 4: NEURODEVELOPMENTAL DISORDERS

1. Attention-Deficit/ Hyperactivity Disorder (ADHD). This is a condition which

involves pattern of inattention or of hyperactivity or impulsivity, or both for at least
six (6) months.
 Inattention is manifested by the inability to concentrate on a given tasks, to
listen to others, and to be organized on things, at levels that are inconsistent with
age or developmental level.
 Hyperactivity implies fidgeting, difficulty to stay seated for a long period of time,
and being always on the go. Whereas, impulsivity entails blurting out answers
before questions have been completed and inability to wait—symptoms that are
excessive for age or developmental level.
 Specifiers: such as combined presentation (the presence of both inattention
and hyperactivity and impulsivity), predominantly inattentive presentation
(criteria for inattention is met but not for hyperactivity and impulsivity),
predominantly hyperactive/impulsive presentation (criteria for hyperactivity
and impulsivity is met but not for inattention) are used to specify the symptoms
manifested by the individual with attention- deficit/hyperactivity disorder.
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 Statistics: 2.2% of children and adolescents (aged <18 years) are estimated to
have ADHD (ADHD Institute, 2021).
Gender ratios varied by country ranging from 1:3 to 1:16 in females : males
(ADHD Institute, 2021).

Causes

Hereditary

 More common in families in which one person has the disorder.

 Mutations occur either create extra copies of a gene on one chromosome or
result in the deletion of genes (called copy number variants—CNVs)
 Neurochemical dopamine, although norepinephrine, serotonin, and gamma-
aminobutyric acid (GABA) are also implicated in the cause of ADHD.

Gene-Environment Interactions

 Prenatal smoking seemed to interact with this genetic predisposition to increase

the risk for hyperactive and impulsive behavior.
 Additional environmental factors, such as maternal stress and alcohol use, and
parental marital instability and discord.

Brain Dysfunction

Overall volume of the brain in those with this disorder is slightly smaller (3% to 4%)
than in children without this disorder (Taylor, 2012). A number of areas in the brains of
those with ADHD appear affected, especially those involved in self-organizational
abilities (Valera, Faraone, Murray, & Seidman, 2007).

Toxins

Allergens and food additives have been considered as possible causes of ADHD over
the years, although little evidence supports the association.

Psychological and Social Dimensions

Negative responses by parents, teachers, and peers to the affected child's impulsivity
and hyperactivity may contribute to feelings of low self-esteem, especially in children
who are also depressed (Anastopoulos, Sommer, & Schatz, 2009).

Treatment

Psychosocial interventions
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For Children:

 Improving academic performance.

 Reinforcement programs

Other parent education programs teach families how to respond constructively to their
child's behaviors and how to structure the child's day to help prevent difficulties

Social skills training For Adult:

 Cognitive-Behavioral Intervention

Biological Interventions

Drugs such as methylphenidate (Ritalin, Adderall) and several non-stimulant

medications such as atomoxetine (Strattera), guanfacine (Tenex), and clonidine have
proved helpful in reducing the core symptoms of hyperactivity and impulsivity and in
improving concentration on tasks (Subcommittee on Attention-Deficit/ Hyperactivity
Disorder & Management, 2011).

2. Specific Learning Disorder. This kind of disorder is usually presented by

symptoms of significant difficulty of a child or person in learning leading to lower
level of academic performance when compared to a typical age group, intelligence
quotient (IQ) score, and educational background.
 Statistics: Difficulties with reading are the most common of the learning
disorders and occur in some form in 4% to 10% of the general population
(Pennington & Bishop, 2009). Mathematics disorder appears in approximately
1% of the population (Tannock, 2009a), but there is limited information about
the prevalence of disorder of written expression among children and adults.
 Early studies suggested that boys were more likely to have a reading disorder
than girls, although more recent research indicates that boys and girls may be
equally affected by this disorder (Feinstein & Phillips, 2006).

Causes

Genetic Factor vs. Environmental Factor

Most research to date focuses on problems with word recognition, and there is
evidence that some develop these problems primarily through their genes, whereas
others develop problems as a result of environmental factors

Brain Impairment
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Treatment

Educational Intervention

 specific skills instruction, and

 strategy instruction

One approach that has received considerable research support is called Direct
Instruction.

3. Communication Disorders. This includes language disorder, speech sound

disorder, social communication disorder, and childhood-onset fluency disorder.
a. Language Disorder. This is characterized by difficulty in language
acquisition and use across all modalities due to problem in comprehension
or production of vocabulary semantics, grammar, or discourse.
b. Speech Sound Disorder. This pertains to a difficulty in producing speech.
People with this kind of disorder have problems with phonological
knowledge of speech sounds and the ability to coordinate movements for
speech in varying degrees.
c. Social (Pragmatic) Communication Disorder. A condition characterized
by difficulty in using verbal and nonverbal communication in social
purposes. There must be no presence of restricted and repetitive behaviors
like of autism spectrum disorder.
d. Childhood-Onset Fluency Disorder (Stuttering). This kind of
disorder involves problems with speaking fluently such as frequent
repetition of
syllables or
words,
prolonged sound
production,
making obvious
pauses, or
substituting
words to replace
ones that are
difficult to
articulate.
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4. Autism Spectrum Disorder (ASD). This is a kind of neurodevelopmental disorder

that is featured by persistent impairment in communication skills (prosody, use
others as a tool, echolalia, etc.) and stereotypical behavior; interests and
activities (maintenance of sameness, stereotyped and ritualistic behaviors, etc.).
 This is commonly diagnosed in early childhood, at age of two (2), and
significantly disrupt daily functioning.
 Some individuals with ASD possess savant skills caused by having a
superior working memory and highly focused attention . Only 1/3rd of
individuals with ASD has this kind of exceptional ability.
 The DSM-V introduced three (3) levels of Autism Spectrum Disorder
based on their level of impairment to social communication or interaction and
restricted, repetitive behavior. Level 1 is diagnosed to an individual with this
condition "Requiring support/'. Level 2 is diagnosed for those "Requiring
substantial support," and Level 3 is diagnosed for those ―Requiring very
substantial support.
 Autism spectrum disorder encompasses disorders previously referred to as
early infantile autism, childhood autism, Kanner's autism, high-
functioning autism, atypical autism, pervasive developmental disorder
not otherwise specified, childhood disintegrative disorder, and
Asperger's disorder.
 Statistics: About 1 in 160 children has an ASD(1). Analysis estimated about
4.2 boys with autism for every girl.
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Causes

Biological Dimensions

Genetic Influences

 Families that have one child with ASD have about a 20% chance of having
another child with the disorder (Ozonoff et al., 2011).
 There appears to be an increased risk of having a child with ASD among older
parents.

Neurobiological Influence

 Adults with and without the disorder have amygdalae of about the same size but
that those with ASD have fewer neurons in this structure
 Some research on children with ASD found lower levels of oxytocin in their blood

Treatment

Psychosocial Treatments : Behavioral approaches based on the early work of

Charles Ferster (1961) and Ivar Lovaas

Biological Treatments: A variety of pharmacological treatments are used to

decrease agitation, with the major tranquilizers and serotonin-specific reuptake
inhibitors being most helpful (Volkmar et al., 2009).

5. Intellectual Disability (Intellectual Developmental Disorder). This kind of

disorder features deficiency in general mental abilities and impairment to adaptive
functioning in conceptual, social, and developmental aspects. In testing, individuals
with intellectual disability gain scores that are two standard deviations or more
below the mean. For instance, on a test with a standard deviation of 15 and a mean
of 100, an IQ score of below 70 means intellectual difficulty.
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 The intellectual disability is diagnosed when confirmed by both clinical

assessment and intelligence testing. In cases when children under the age of
five (5] years fails to meet expected developmental milestones of intellectual
functioning, the right diagnosis is known as "Global Development Delay.”
 Statistic: Approximately 6.5 million people in the United States have an
intellectual disability. Approximately 1 - 3 percent of the global population has an
intellectual disability—as many as 200 million people.

Causes

Psychological and Social Dimensions:

 Environmental: For example, deprivation, abuse, and neglect

 Prenatal: For instance, exposure to disease or drugs while still in the womb
 Perinatal: Such as difficulties during labor and delivery
 Postnatal: For example, infections and head injury.

Biological Dimension:

Genetic Influences:

Multiple genetic influences appear to contribute to ID, including chromosomal disorders

(e.g., having an extra 21st chromosome, as in Down syndrome), single-gene disorders,
mitochondrial disorders (defects in mitochondria, w/c are compartments found in most
human cells that generate the majority of energy needed by the cells to function) &
multiple genetic mutations (Kaski, 2012).

 Phenylketonuria
 Lesch Nyhan syndrome
 Chromosomal Influences:
o Down Syndrome o Fragile X syndrome
Treatment

 Severe: teach them the skills they need to become more productive and
independent.
 The skill is broken into its component parts (a procedure called a task analysis),
and people are taught each part in succession until they can perform the whole
skill.
 Communication training
 22

 Creative researchers, however, use alternative systems that may be easier for
these individuals, including sign language, used primarily by people with hearing
disabilities, and augmentative communication strategies.

6. Motor Disorders
a. Developmental Coordination Disorder. The acquisition and execution of
coordinated motor skills is substantially below that expected given the individual's
chronological age and opportunity for skill learning and use. Difficulties are
manifested as clumsiness (e.g., dropping or bumping into objects) as well as
slowness and inaccuracy of performance of motor skills (e.g., catching an object,
using scissors or cutlery, handwriting, riding a bike, or participating in sports)
b. Stereotypic Movement Disorder. Repetitive, seemingly driven, and apparently
purposeless motor behavior (e.g., hand shaking or waving, body rocking, head
banging, self-biting, hitting own body).
c. TIC DISORDERS. Note: A tic is a sudden, rapid, recurrent, non-rhythmic motor
movement or vocalization. Onset is before age 18 years. The tics may wax and
wane in frequency but have persisted for more than 1 year since first tic onset.
 Tourette’s Disorder : Both multiple motor and one or more vocal tics have
been present at some time during the illness, although not necessarily
concurrently.
 Persistent (Chronic) Motor or Vocal Tic Disorder: Single or multiple
motor or vocal tics have been present during the illness, but not both motor
and vocal.

MODULE 5: SCHIZOPHRENIA SPECTRUM & OTHER PSYCHOTIC DISORDERS

Psychosis - Any unusual behaviour

Schizophrenia - is a severe, chronic mental disorder characterized by disturbances in

thought, perception and behavior (DSM-5, 2013).

Hospitalization & Intensive Care - Individuals w/ schizophrenia are more likely

stigmatized by the society than the other mental illness. (Thornicroft, Brohan, &
Kassam, 2012).

Recovery: Despite of modern advances for the treatment of schizophrenia, the

recovery of individuals with this kind of disorder is very rare.
 23

Early Figures in Diagnosing Schizophrenia

John Haslam - first described the symptoms of schizophrenia on his writing entitled,
―Observations on Madness and Melancholy‖ that was published in 1809.

Philippe Pinel (1801/1809) studied cases of individuals with schizophrenia.

Benedict Morel (1852) coined the term ―démence précoce‖ because of its onset
occurring during adolescence.

Emil Kraepelin (1898/1899) unified the term catatonia, hebephrenia, and paranoia to
a single category which he called as dementia praecox.

Eugen Bleuler (1908), a Swiss psychiatrist who introduced the term ―schizophrenia‖
which means split mind. This term reflected the term, reflected Bleuler’sbelief that
underlying all the unusual behaviors shown by people with this disorder was an
associative splitting of

Symptoms of Schizophrenia
 24

Positive Symptoms - the experience of distorted reality. This includes delusions,

hallucinations, disorganized thinking and behaviour.

1. Hallucination. This is characterized by the experience of sensory event without

any presence of external stimuli. This involves auditory hallucination, visual
hallucination, tactile hallucination.
2. Delusion (disorder of thought content).This term is used to describe false belief
or misrepresentation of reality.
 Persecutory Delusion. This is a false belief that one is going to be
conspired, harmed, harassed, and so forth against by others.
 Grandiose Delusion. This is a false belief of being exceptional,
knowledgeable, famous, and powerful person.
 Erotomanic Delusion. This is an irrational belief that another person is in
love with him or her.
 Nihilistic Delusions. This involve the conviction that a major catastrophe
will occur.
 Somatic Delusions. An individual with this kind of delusion experienced
distress upon the preoccupations of physical defect or other medical
conditions.
3. Disorganized Thinking (Speech). This symptom of schizophrenia is also known
as formal thought disorder. People with schizophrenia are experiencing
impairment in effective communication, enumerated as follows:
 Tangentiality This pertains to answers that are obliquely related or
completely unrelated to the question.
 Derailment or Loose Associations. A kind of speech/thought disturbance
manifested when shifting a topic from one subject to another in a somewhat
unrelated way.
 Incoherence or "Word Salad." This refers to incoherent mixture of words
and phrases.
 Neologisms . This is described as the pathological coining of words
 Clang Association. This term is used to refer to the associations between
words based on the sounds or rhythms.
4. Disorganized or Catatonic Behavior. People with schizophrenia
are also manifesting bizarre behaviors in response to their delusion or
hallucination, or both. Catatonia is a disorganized behavior characterized by
unresponsiveness to the environment.

Negative Symptoms - the absence or insufficiency of normal behavior.

 25

1. Restricted/Flat Affect. People with schizophrenia are experiencing reduction or

lack of emotional expression. They avoid eye contact, do not usually express
nonverbal cues, and speak in a flat and toneless intonation.
2. Avolition. This term was derived from the prefix ―a‖ meaning ―without‖ and
―volition‖ meaning ―act of willing, deciding or choosing.‖ Moreover, avolition
refers to decrease of initiation or motivation to perform purposeful activities.
3. Alogia - refers to the diminished or absence of speech.
4. Asociality is described as the apparent lack of desire to engage to social
interactions.
5. Anhedonia - pertains to the loss of ability to experience pleasure in doing out of
positive stimuli.

Schizophreniform Disorder. This psychotic disorder is considered to be quite similar

to the given criteria of schizophrenia, the only difference is the duration. The total
duration of the illness, including prodromal, active, and residual phases, is at least 1
month but less than 6 months. This kind of disorder does not interfere activities of daily
living unlike schizophrenia.

Schizoaffective Disorder. To diagnose with this condition, an individual must suffer

from both psychotic features manifested in schizophrenia (criteria A) and all
features of mood disorder. To differentiate this kind of disorder from mood disorders,
hallucinations and delusions must be present for at least two (2) weeks without the
occurrence of a major mood episode (depressive or manic) at some point during the
lifetime duration of the illness. This also involves specifier such as bipolar type and
depressive type.

 Bipolar Type: Characterized by the presence of manic episodes and major

depressive episodes.
 Depressive Type: Characterized by the presence of only major depressive
episodes.

Delusional Disorder. This kind of disorder involves one or more delusions with a
duration of 1 month or longer. In order to meet the criteria of this disorder,
hallucinations and other criteria stated in criteria A of schizophrenia must never be met.
An individual with this condition does not have bizarre or odd behavior and problem to
functioning. The DSM-5 acknowledges the delusional specifiers such as erotomanic,
grandiose, jealous, persecutory, and somatic type.
 26

Unlike the previous DSMs, DSM-5 includes shared psychotic disorder (folie a deux)
under delusional disorder as a specifier to identify whether the psychotic feature is a
result of close relationship to a person with delusion.

Brief Psychotic Disorder. This is an acute but less chronic form of psychoses
wherein positive symptoms enumerated in the discussion of schizophrenia are
experienced to a duration of 1 day to one (1) month.

Prevalence and Causes of Schizophrenia

Statistics:

Schizophrenia occurs throughout the world. The prevalence of schizophrenia (ie, the
number of cases in a population at any one time point) approaches 1 % internationally.
The incidence (the number of new cases annually) is about 1.5 per 10,000 people.
Age of onset is typically during adolescence; childhood and late-life onset (over
45 years) are rare. Slightly more men are diagnosed with schizophrenia than women
(on the order of 1.4:1), and women tend to be diagnosed later in life than men.
Modal age of onset is between 18 and 25 for men and between 25 and 35 for
women, with a second peak occurring around menopause. There is also some
indication that the prognosis is worse in men.

Development

 Could be signs of other problems, such as the neurodevelopmental disorders to

be able to say for sure that a particular child will later develop schizophrenia.
 Up to 85% of people who later develop schizophrenia go through a prodromal
stage—a 1- to 2-year period before the serious symptoms occur but when less
severe yet unusual behaviors start to show themselves (Jablensky, 2012).

Cause

Cultural Factors

 Some have argued that ―schizophrenia‖ does not really exist but is a derogatory
label for people who behave in ways outside the cultural norm
 The course and outcome of schizophrenia vary from culture to culture.

Genetic Influences: Genes are responsible for making some individuals vulnerable to
schizophrenia.

1. Family Studies
 27

 In 1938, Franz Kallmann published a

major study of the families of people
with schizophrenia (Kallmann, 1938).
Kallmann examined family members
of more than 1,000 people diagnosed
with schizophrenia in a Berlin
psychiatric hospital.
 The more severe the parent’s
schizophrenia, the more likely the
children were to develop it. Another
observation was important: All forms
of schizophrenia (for example, the
historic categories such as catatonic
and paranoid) were seen within the
families.
 In a classic analysis, Gottesman (1991) summarized the data from about 40
studies of schizophrenia.
2. Twin Studies - If they are raised together, identical twins share 100% of their
genes and 100% of their environment, whereas fraternal twins share only about
50% of their genes and 100% of their environment. If the environment is solely
responsible for schizophrenia, we would expect little difference between identical
and fraternal twins with regard to this disorder. If only genetic factors are
relevant, both identical twins would always have schizophrenia (be concordant)
and the fraternal twins would both have it about 50% of the time.
3. Adoption Studies - the risk that
the adopted child would have one
of these disorders rose to about
22% (Tienari et al., 2003; Tienari,
Wahlberg, & Wynne, 2006). Even
when raised away from their
biological parents, children of
parents with schizophrenia have a
much higher chance of having the
disorder themselves.
4. The Offspring of Twins
 28

5. Linkage and Association Studies - researchers have looked at several sites for
genes that may be responsible for schizophrenia.
6. Endophenotypes

Neurobiological Influences

 Dopamine  Brain Structure

 Prenatal and Perinatal Influences

Psychological and Social Influences

 Stress
 Families and Relapse

Treatments

Biological Treatments

 Antipsychotic Medications

Psychosocial Interventions

 traditional psychodynamic or psychoanalytic approach

 19th Century- moral treatment,‖
 token economy
 Deinstitutionalization
 behavioral family therapy
 assertive community treatment (ACT) program

MODULE 6: Bipolar & Related Disorders and Depressive Disorders

What is Mood?

APA
Dicti
onar
y
 29

I. MOOD DISORDERS

Depression is an intense feeling of

sadness or worthlessness
associated with disturbed cognitive
and physical functions.

Major Depressive Episode is the most common and most severe form of depression.
To be diagnosed with a major depressive episode, an individual must manifest
depressive mood or loss of interest or pleasure most of the day or almost every day
within at least two (2) weeks leading to impairment in activity of daily living (ADL). A
major depressive episode can also be seen through cognitive and physical aspects.

Cognitive Symptoms:

 worthlessness  recurrent thoughts of death

 indecisiveness
 30

Physical Dysfunctions:

 Lack or too much appetite  Psychomotor agitation or

 Sleep deprivation retardation
 Weigh loss or gain  Fatigue or loss of energy

Anhedonia or loss of interest in everything in life is said to be the hallmark of

depression.

Mania is used to describe an abnormal and exaggerated feeling of elation, joy, or

irritability most of the day or almost every day lasting for one (1) week.

 An individual who is in a manic state tends to have an extreme interest in every

activity resulting in sleep deprivation, grandiosity, risk-taking behavior, goal
increase, and distractibility

Flight of ideas or racing thoughts is the hallmark of mania that can be expressed
through a rapid stream of
fantastic thoughts when
speaking or behaving. The
less severe form of mania
is the hypomania.
Hypomania does not
interfere with an individual's
activities of daily living
(ADL] and lasts only for four
(4) days.
 31

Mood disorders may be classified

as a unipolar mood disorder or
bipolar mood disorder, or both. A
mood disorder may be considered
as unipolar mood disorder when
it has only one (1) pole of mood
either depression or mania, while
bipolar mood disorder involves
alternate mood of the depression-
elation continuum. Mixed features
are characterized by the presence
of manic symptoms but feel somewhat depressed or vice versa.

Depressive Disorders

5 Types of Depressive Disorders

1. Major Depressive Disorder. A major depressive disorder is diagnosed when an

individual has experienced at least one (1) depressive episodes without any
symptoms of mania or hypomania lasting for two (2) weeks or more. The DSM-5
indicates severity rating (mild, moderate, or severe] and eight (8) basic specifiers to
describe depression.

Eight (8) Basic Specifiers

a. With Psychotic Features. Noted when during the period of depression,

hallucination and delusion are experienced by an individual.
b. With Anxious Distress. Diagnosed when depression is accompanied by
anxiety symptoms or anxiety disorders.
c. With Mixed Features. The depressive mood is dominant; however,
symptoms of mania are also observed.
d. With Melancholic Features. Diagnosed when more severe somatic
symptoms occur to an individual with a major depressive disorder such as
early-morning awakenings, weight loss, loss of libido (sex drive), excessive or
inappropriate guilt and anhedonia.
e. With Catatonia. This is characterized by the absence of movement or
catalepsy or excessive but random or purposeless movement.
f. With Atypical Features. This involves characteristics that are not commonly
seen or diagnosed to a person with depression such as oversleeping and
 32

overeating leading to weight gain, showing interest or pleasure to some

things.
g. With Peripartum Onset. Depression is experienced by women during the
period of pregnancy and the 6 month period immediately following childbirth.
h. With Seasonal Pattern. An individual with this condition experiences
recurrent major depressive disorder during certain seasons and is also known
as Seasonal Affective Disorder (SAD).
2. Dysthymia (Persistent Depressive Disorder )

This condition is more chronic than the former wherein few as two (2) symptoms of
depressive episodes are experienced but the symptoms of depression continue to
manifest for at least two (2) years for adults and one (1) year for children.

3. Double Depression. A condition where an

individual suffers from both major depressive
episodes and persistent depression.

4. Premenstrual DysphoricDisorder (PMDD).

This kind of disorder is common for women for it
occurs during the final week before and after the
most menstrual period. During the said period,
women with this disorder tend to experience lability of affect (mood swings),
irritability, depression, or anxiety. However, this disorder can only be diagnosed
when the aforementioned symptoms continue to preceding years.
 Difficulty Concentrating  Appetite Changes
 Loss of Interest in Things  Decreased Energy
 Intense Physical Symptoms  Sleep Problems
 Sudden Mood Changes  Depression
5. Disruptive Mood Dysregulation Disorder. A condition experienced by children
age 6 to 18 years old. Children with this condition are characterized by severe
irritability or outburst that may be expressed through verbal or action.

Understanding Depression

―Health is a state of complete physical, mental & social well-being & not merely the
absence of disease or infirmity. Mental health is an integral part of this definition.‖
- World Health Organization
 33

II. Bipolar Disorders

The distinguishable feature of bipolar disorders from depressive disorders is the

tendency of manic episodes to alternate with depressive episodes.

In addition to the specifiers being discussed under depressive disorders, bipolar

disorders include Rapid-Cycling Specifier. This specifier highlights condition of
quick alteration of manic episodes to a depressive episode or vice versa.

Three (3) Common Bipolar Disorders

1. Bipolar II Disorder. A bipolar

disorder that is characterized by at
least one (1) major depressive
episodes accompanied by at least
one (1) hypomanic episodes
without attaining the criteria of
mania
2. Bipolar I Disorder. The individual
experiences a full manic episode
preceded by major depressive episodes or hypomania.
3. Cyclothymic Disorder. This kind of disorder is a milder but chronic version of
bipolar disorders. To be diagnosed with a cyclothymic disorder, a person must
have manic or hypomanic and depressive symptoms for at least two (2) years
without reaching the symptoms of manic and depressive episodes

Causes

Biological Dimensions

 Familial & Genetic  Sleep & Circadian Rhythms

Influences  Additional Studies of Brain
 Neurotransmitter Systems Structure & Function
 The Endocrine System

Psychological Dimensions

 Stressful Life Events  Learned Helplessness

 Stress and Depression  Negative Cognitive Styles
 Stress and Bipolar Disorder
 34

Social and Cultural Dimensions

 Marital Relations  Social Support

 Mood Disorders in Women

Treatment of Mood Disorders

Medications

 Antidepressants  Lithium
Electroconvulsive Therapy and Transcranial Magnetic Stimulation

Psychological Treatments for Depression

 Cognitive-Behavioral Therapy  Interpersonal Psychotherapy

Psychological Treatments for Bipolar Disorder

 Interpersonal & Social Rhythm Therapy (IPSRT)

 Family Therapy

Suicide

 Based on the statistics provided by the World Health Organization for the year
2016, an estimated 800, 000 people worldwide die due to suicide every year,
which may be converted to one (1) person every 40 seconds.
 Moreover, WHO (2016) mentioned that suicide is known to be the second leading
cause of death among 15 to 29-year- olds worldwide.
 Whereas, according to the Union of Catholic Asian News (2020), the WHO
revealed that during the periods of the CoViD-19 pandemic, the Philippine mental
health practitioners received an average of 30 to 35 calls a day from March to May
concerning issues of depression, compared with 13 to 15 daily calls before the
pandemic (May 2019 to February 2020). The said news also gave citation that as
of May 31, 2020, the monthly average calls related to suicide also increased to 45
calls per month.
 In terms of age, data from WHO (2011) showed that in the Philippines, people who
belong to old age have a greater number of suicide death rates compare to
younger age group; and, in terms of gender, males than females have more
number of suicide death per 100, 000 population.
 35

Definition of Terms

 Suicidal Ideation. The thought of committing suicide.

 Suicidal Plan. Formulation of medium or method to kill oneself.
 Suicidal Attempt. The suicide was committed yet the person survives.
 Attempters. People who harm their own selves with the intent to die.
 Gesturers. People who harm their own self not to die but to seek support or to
influence somebody.

Causes and Treatments

Emil Durkheim, a well- known sociologist, introduced four (4) types of suicide
explaining the role of the socio-cultural dimension to suicide.

1. Altruistic Suicide. This is a courageous act of killing oneself for the benefit of
others. An example of this suicide type is hara-kiri in Japan.
2. Egoistic Suicide. Suicide is committed due to isolated feelings or loss of support
to society or to loss of purpose to live.
3. Anomic Suicide. A person commits suicide due to a stressful situation or
significant changes in life such as killing one's own life after bankruptcy.
4. Fatalistic Suicide. Suicide is committed due to excessive social regulations that
hinder individuation or free will

 Family history, low level of serotonin, the contribution of an existing psychological

disorder, and stressful life events are also considered as risk factors of suicide.
 Treatments such as Cognitive-Behavioral Therapy, telephone hotlines, and other
crisis intervention services, or immediate hospitalization are advised depending on
the severity and circumstances.

MODULE 7: Anxiety, Trauma-& Stressor-Related, & Obsessive-Compulsive &

Related Disorders

Anxiety - unpleasant emotional state characterized by physiological (e.g elevated

heart rate, muscle tension, etc and psychological (e.g decreased perceptive ability, use
of defense mechanisms, etc tension due to anticipation of unreal or imagined danger in
the future.

Fear is an immediate emotional reaction to a new and potentially threatening situation

resulting in the activation of the autonomic nervous system which enables people to
flee or fight back. This emergency response is known as the ―flight or fight response.
 36

 Fear is considered maladaptive when (1) it is completely unrealistic, (2) it is too

excessive given the objective threat, (3) it continues after the threat has passed,
and (4) it results in dangerousness and dysfunctions.

The sudden experience of fear in an inappropriate time associated with somatic

symptoms, including shortness of breath, chest pain, heart palpitations, muscle
tension, and others lasting within minutes is called a panic attack.

“Panic was originated from the Greek god Pan who terrified travellers with
bloodcurdling screams”

Two (2) Types of Panic Attack

1. An expected (cued) panic attack occurs to certain situations or objects and not
anywhere else
2. Unexpected (uncued) panic attack occurs without knowing or awareness when
or where the next panic attack will happen.

In the previous version of DSM which is DSM-IV-TR, there are four (4) categories of
anxiety disorders that are mentioned; however, in the recent DSM (DSM-V), there are
two additional disorders that are included under this classification: they are
separation anxiety disorder and selective mutism.

1. Generalized Anxiety Disorder. People with GAD is characterized by excessive

worry about many things in such a way that the worry continues in another task or
situation even if the current one is already resolved or can set the problem aside
and revert to another problem or crisis.

Generalized Anxiety Disorder (GAD) Symptoms

 Excessive anxiety & worry  Fatigue

 Increased muscle aches or  Irritability
soreness  Restlessness
 Impaired concentration  Difficulty sleeping
 Fatigue

 Briefly, GAD pertains to nonstop worrying about general aspects of life. To be

diagnosed as people with GAD, the DSM specified that the person must experience
within more days, than not for at least 6 months, three (3) or more of the following
symptoms: restlessness or feeling keyed up or on edge, being easily fatigued,
difficulty concentrating or mind going blank, irritability, muscle tension and sleep
 37

disturbance (difficulty falling or staying asleep or restless, unsatisfying sleep). The

DSM also clarified that having only one of the aforementioned physical symptoms in
children is also an indicator of GAD.

CAUSES

 Individuals with GAD show less responsiveness

on most physiological measures
 Individuals with GAD are highly sensitive to
threat in general, particularly to a threat that has
personal relevance.
 In summary, some people inherit a tendency to
be tense (generalized biological vulnerability),
and they develop a sense early on that important
events in their lives may be uncontrollable and
potentially dangerous (generalized psychological
vulnerability). Significant stress makes them
apprehensive & vigilant. This sets off intense
worry with resulting physiological changes, leading to GAD

TREATMENT

o Benzodiazepines are most often prescribed for generalized anxiety, and the
evidence indicates that they give some relief, at least in the short term.
o There is stronger evidence for the usefulness of antidepressants in the treatment
of GAD, such as paroxetine (also called Paxil) & venlafaxine (also called
Effexor).
o Cognitive-Behavioral Treatment (CBT)
o Meditational approaches

2. Panic Disorder and Agoraphobia. In DSM-IV, panic disorder and agoraphobia

were combined, far from its recent version (DSM-V) that separates the two
disorders due to a series of research that shows cases of panic disorders without
agoraphobia.

Panic disorder pertains to the recurrent occurrence of unexpected panic attacks

causing people with this disorder anxious over the tendency of having another attack
and its consequences. This disorder is known due to a terrifying fear or discomfort
arises "out of the blue‖ or the panic attack occurs in the absence of any specific
 38

environmental trigger accompanied by four or more physical symptoms as mentioned

in the GAD within minutes.

Statistics:

o Prevalence: about 3 to 5 percent of people will develop the panic disorder at

some time
o Age of Onset: usually between late adolescence and the midthirties.
o Sex Ratio: more common in women with a percentage of 75 or more
o Course: tends to be chronic

Agoraphobia is characterized by fear or anxiety

about two or more of the following five situations:
public transportation (e.g. cars, trains, buses,
planes, etc.), open spaces (wide streets, fields,
etc.), enclosed places (tunnels, subways,
elevators, etc.), standing in line or being in a
crowd, and being outside the home alone.

o The fear or anxiety in the given situations

shall last for at least six (6) months and are
caused by the belief that escape might be difficult or help might not be available
in the event of developing panic-like symptoms or other incapacitating or
embarrassing symptoms
that's why when being far
from home or staying at
home, they always seek for a
companion.

CAUSES
 39

TREATMENT

Meditation

A large number of drugs affecting the noradrenergic, serotonergic, or GABA-

benzodiazepine neurotransmitter systems, or some combination, seem effective in
treating panic disorder, including high-potency benzodiazepines, the newer selective-
serotonin reuptake inhibitors (SSRIs) such as Prozac and Paxil, and the closely related
serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine.

Psychological Intervention

 Exposure-based treatments  Calm Tools for Living

 Panic control treatment (PCT)

3. Specific Phobia. Specific phobia is an

irrational fear to a certain object or situation
leading to distress and maladaptive
behavior in important areas of life. In
children, crying, tantrums, freezing, or
clinging is a manifestation of this disorder.
To meet the criteria of phobia, the phobic
object must always trigger immediate fear
or anxiety lasting for at least six (6) months.

Four (4) Subtypes of Specific Phobia

a) Animal Phobia. This pertains to exaggerated fear of animals and insects.

Examples of phobic animals are spiders, cats, snakes, and others.
b) Natural Environment Phobia. In this category, fear happens when exposed to
specific situations or events occurring in nature. The examples of phobic object
or situation under this category are heights, water, and storms.
c) Blood-Injection-Injury Phobia. This phobia highlights the fear of seeing blood
or an injury. In contrast to other types of phobia, this type of phobia leads to a
significant drop in heart rate and blood pressure and is likely to faint.
d) Situational Phobia. type of phobia refers to the fear of situations such as public
transportation or enclosed places.
 40

CAUSES

 Direct experience
 Experiencing a false alarm (panic attack) in a specific situation,
 Observing someone else experience severe fear (vicarious experience), or,
 Under the right conditions, being told about danger.

TREATMENT

Structured and Consistent Exposure-Based Exercises

 If an individual fear having another unexpected panic attack in this situation, it is

helpful to direct therapy at panic attacks in the manner described for panic
disorder.
 For separation anxiety, parents are often included to help structure the exercises
and also to address parental reaction to childhood anxiety.
 Finally, in cases of blood-injection-injury phobia, where fainting is a real
possibility, graduated exposure-based exercises must be done in specific ways.
Individuals must tense various muscle groups during exposure exercises to keep
their blood pressure sufficiently high to complete the practice.

4. Social Anxiety Disorder (also known as social phobia). This disorder is

characterized by an individual's intense fear of social situations due to the belief that
 41

others will scrutinize, evaluate, judge, and embarrass them. This problem shall be
last at least six (6) months. In children, crying, tantrums, freezing, clinging,
shrinking, or failing to speak in social situations is a sign of this disorder.

TREATMENT

Cognitive Behavioral Treatment

 Cognitive therapy program that emphasized real-life experiences during

therapy to disprove automatic perceptions of danger.
 Social mishap exposures directly target the patients' beliefs by confronting
them with the actual consequences of such mishaps, such as what would
 42

happen if you spilled something all over yourself while you were talking to
somebody for the first time.
 Family-based treatment approaches for youth with social anxiety
 Since 1999, the SSRIs Paxil, Zoloft, and Effexor have received approval from
the Food and Drug Administration for treatment of SAD based on studies
showing effectiveness compared with placebo
5. Separation Anxiety Disorder. Separation anxiety disorder is most commonly
diagnosed with children in which children have an unrealistic and persistent fear of
being separated from their primary caregiver.
 Children w/ separation anxiety disorder worry about the possible event that
may happen to their caregiver or to their own selves that may separate them
from the attachment figure such as being lost, kidnapped, killed, or hurt in an
accident. They are hesitant of going away from home, of going to school, & of
sleeping alone due to intense fear of separation from loved ones. The anxiety
is too intense in a way that the theme manifested in nightmares are about
separation. If untreated, this disorder may continue until adulthood.
 In treating separation anxiety in children, parents are often included to help
structure the exercises and also to address parental reaction to childhood
anxiety.

6. Selective Mutism. This disorder refers to a constant lack of speech in specific

social situations in which there is an expectation for speaking. Children with
selective mutism can speak in other situations except to a specific social situation
such as school. This is the reason why children with this disorder have difficulty in
academics, occupational achievement, or interpersonal relations.
 Treatment employs many of the same cognitive behavioral principles used
successfully to treat social anxiety in children but with a greater emphasis on
speech.

Trauma-and Stressor-Related Disorders

Trauma and Stressor-related disorders are a group of disorders where intense

emotional responses such as rage, horror, guilt, shame, and others emerge after a
stressful and terrifying life event.

 Physical Abuse  Natural Calamities

 Accident  Loss of Loved One
 43

1. Posttraumatic Stress Disorder. People who are diagnosed with PTSD had a
history of being either directly exposed to a traumatic event or witness of other
people's experience in the traumatic event, or inexperienced indirectly the stressor
such as learning about how traumatic the event is for the family member or other
relevant social member and experiencing repetitive exposure to traumatic or
aversive events.
 PTSD was first named in 1980 in DSM-III (American Psychiatric Association,
1980), but it has a long history. In 1666, the British diarist Samuel Pepys
witnessed the Great Fire of London, which caused substantial loss of life and
property and threw the city into chaos for a time. He captured the events in an
account that is still read today. But Pepys did not escape the effects of the
horrific event. Six months later, he wrote, ―It is strange to think how to this very
day I cannot sleep a night without great terrors of fire; and this very night could
not sleep to almost 2 in the morning through thoughts of fire‖ (Daly, 1983, '6).
Pepys described his guilt at saving himself and his property while others died.
He also experienced a sense of detachment and a numbing of his emotions
concerning the fire, common experiences in PTSD (Keane & Miller, 2012).
 The hallmarks of this disorder are flashbacks and nightmares that may arise
within one (1) to three (3) months of exposure to the traumatic event and last
more than one (1) month. Furthermore, the DSM-5 added the presence of a
specifier in diagnosing PTSD. This specifier includes dissociative symptoms
either depersonalization or de-realization and delayed expression.

Survivors Guilt

CAUSES

 A family history of anxiety suggests a generalized biological vulnerability for

PTSD.
 Also, there seems to be a generalized psychological vulnerability described in
the context of other disorders based on early experiences with unpredictable or
uncontrollable events.
 Finally, social factors play a major role in the development of PTSD (Ruzek,
2012; King et al., 2012). The results from a number of studies are consistent in
showing that, if you have a strong and supportive group of people around you, it
is much less likely you /ill develop PTSD after a trauma (Friedman, 2009).
 44

 PTSD involves a number of

neurobiological systems, particularly
elevated or restricted corticotropin-
releasing factor (CRF), which
indicates heightened activity in the
HPA axis.
 The ―alarm reaction‖ that is a panic
attack is similar in both panic disorder
& PTSD but that in panic disorder the
alarm is false. In PTSD, the initial
alarm is true in that real danger is
present .If the alarm is severe
enough, we may develop a
conditioned or learned alarm reaction
to stimuli that remind us of the
trauma. We may also develop anxiety
about the possibility of additional
uncontrollable emotional experiences
(such as flashbacks, w/c are common in PTSD)

TREATMENTS

In psychoanalytic therapy, reliving emotional trauma to relieve emotional suffering is

called catharsis. The trick is in arranging the reexposure so that it will be therapeutic
rather than traumatic.

Imaginal exposure, in which the content of the trauma and the emotions associated
with it are worked through systematically, has been used for decades under a variety
of names. At present, the most common strategy to achieve this purpose with
adolescents or adults is to work with the victim to develop a narrative of the traumatic
experience that is hen reviewed extensively in therapy.

Cognitive therapy to correct egative assumptions about the is often part of treatment.

Drugs can also be effective for symptoms of PTSD. Some of the drugs, such as SSRIs
(e.g., Prozac and Paxil), that are effective for anxiety disorders in general have been
shown to be helpful for PTSD.

2. Acute Stress Disorder. This kind of disorder also manifest symptoms similar to
those experienced by an individual with PTSD. But, unlike the latter, the symptoms
 45

of the former is severe and arises within four (4) weeks or one (1) month of
exposure to the traumatic event and last for three (3) days to one (1) month.

3. Adjustment Disorder (also known as Exogenous, Reactive, or Situation

Depression). AD when compared to the first two disorders mentioned under
Trauma- and Stressor-Related Disorders are generally milder, but the behavioral
and emotional symptoms caused by an identifiable stressor are clinically significant
to the extent that distress and dysfunctions are experienced in multiple life areas.
Symptoms of AD occur within three (3) months.

4. Reactive Attachment Disorder. This disorder emerges before five (5) years of age
(infancy or early childhood). A child with this disorder minimally or rarely seeks
comfort, support, protection, and nurturance from an adult caregiver. Similarly, the
child is often unresponsive to emotional attachments from the caregiver. This kind of
disorder was aligned to Trauma- and Stressor-Related Disorders because the DSM
requires the experience of extreme insufficient or inadequate care from the
caregiver to be diagnosed with this disorder.

5. Disinhibited Social Engagement Disorder. This kind of disorder is also specific to

infants or children and is caused by inadequate child-rearing consequences.
However, a child with disinhibited social engagement disorder manifests no
inhibition to any unfamiliar adult or strangers. The child develops an inappropriately
intimate behavior towards a relative stranger with minimal or without checking back
with the adult caregiver.

Obsessive Compulsive and Related Disorders

In DSM-IV, the Obsessive-Compulsive disorder was included in anxiety disorders,

the hoarding disorder and body dysmorphic disorder was included from somatoform
disorders, and trichotillomania was included from impulse control disorders.
Moreover, the DSM-5 added a new disorder known as "excoriation

1. Obsessive-Compulsive Disorder. OCD can be diagnosed with the presence of

either obsessions, compulsions, or both.
 Obsessions are intrusive and recurrent thoughts, images, or urges that the
individual tries to resist or eliminate.
 Compulsions are the repetitive thoughts or actions performed to
overpower obsessions aiming for relief of anxiety.
 46

TREATMENTS

 The most effective drugs on OCD seem to be

those that specifically inhibit the reuptake of
serotonin, such as clomipramine or the SSRIs,
which benefit up to 60% of patients with OCD, with no particular advantage to one
drug over another.
 The most effective approach is called exposure and ritual prevention (ERP), a
process whereby the rituals are actively prevented and the patient is
systematically and gradually exposed to the feared thoughts or situations.
 Psychosurgery is one of the more radical treatments for OCD.
Psychosurgery" is a misnomer that refers to neurosurgery for a psychological
disorder.

2. Body Dysmorphic Disorder (also referred to as

dysmorphophobia or "fear of ugliness"). People
with Body Dysmorphic Disorder are preoccupied
with physical body flaws and defects despite a
reasonably normal look.

CAUSES

 Individuals with BDD react to what they think

is a horrible or grotesque feature. Thus, the
psychopathology lies in their reacting to a
―deformity‖ that others cannot perceive. Social
and cultural determinants of beauty and body image largely define what is
―deformed.‖
 47

 There is no meaningful information on biological or psychological predisposing

factors or vulnerabilities. Psychoanalytic speculations are numerous, but most
center on the defensive mechanism of displacement—that is, an underlying
unconscious conflict would be too anxiety provoking to admit into consciousness,
so the person displaces it onto a body part.

Patients with BDD believe they are physically deformed in some way and go to medical
doctors to attempt to correct their deficits (Woolfolk & Allen, 2011).

TREATMENTS

 Drugs that block the re-uptake of serotonin, such as clomipramine (Anafranil)

and fluvoxamine (Luvox), provide relief to at least some people.
 Exposure and response prevention, the type of cognitive- behavioral therapy
effective with OCD, has also been successful with BDD.

3. Hoarding Disorder. An individual with hoarding disorder suffers from difficulty in

discarding possessions. The obsession is too intense that possessions are still kept
or saved regardless of actual value.

4. Trichotillomania (also known as ―Hair Pulling Disorder‖). People with

trichotillomania experience recurrent urge in pulling out their hair with a strong
desire to stop or decrease the said abnormality. Consequently, this behavior leads
to hair loss.

5. Excoriation (also known as “Skin Picking Disorder”). This kind of disorder is

characterized by a repetitive urge to skin picking, the reason why an individual with
excoriation has an observable skin lesion. Just like trichotillomania, people with this
condition also have a strong desire to st decrease skin picking behavior.