Lesson 1 (Part 1): Abnormal Behavior in
Historical Context not define problematic abnormal behavior.
Psychological Disorder
- The most widely accepted definition used in
the Diagnostic and Statistical Manual of
Mental Disorders (5th ed.; DSM-5;
American Psychiatric Association, 2013)
- Describes behavioral, psychological, or
biological dysfunctions that are unexpected
in their cultural context and associated with
present distress and impairment in
functioning, or increased risk of suffering,
death, pain, or impairment.
Criteria for Psychological Disorder:
1. Psychological dysfunction
- refers to a breakdown in cognitive,
emotional, or behavioral functioning.
Extra Notes:
➔ To know the presence of dysfunction, it can
be in the form of (1) interview, and (2)
assessment procedures
➔ Breakdown in Cognitive Functioning
◆ thought process (i.e. “Word Salad”
is a confused or unintelligible
mixture of seemingly random
words and phrases )
➔ Breakdown in Emotional Functioning
◆ I.e. From being a cheerful person
to someone who always cries.
➔ Breakdown in Behavioral Functioning
◆ I.e. Client started to wear strange
clothes he doesn't usually wear.
2. Distress or Impairment
- That the behavior must be associated with
distress to be classified as a disorder adds
an important component and seems clear.
- The criterion is satisfied if the individual is
extremely upset.
- But remember, by itself this criterion does
- For some disorders, by definition, suffering
and distress are absent.
Extra Notes:
➔ Presence or absence of distress or
impairment
➔ Client’s way of expressing distress or
impairment is beyond the norms (i.e. loss
of loved ones, then partying)
3. Atypical or not Culturally Expected
- The criterion that the response be atypical
or not culturally expected is important but
also insufficient to determine if a disorder is
present by itself.
- At times, something is considered abnormal
because it occurs infrequently; it deviates
from the average.
- The greater the deviation, the more
abnormal it is.
Extra Notes:
➔ “Cultural Sensitivity” - considering client’s
cultural background
Abnormal Psychology
- Area of scientific study aimed at describing,
explaining, predicting, and modifying
behaviors that are considered unusual or
strange.
- It uses psychodiagnosis: attempts to
describe, assess, and systematically draw
inferences about psychological disorders.
Psychopathology
- is the scientific study of psychological
disorders.
The Scientist-Practitioner
- The most important development in the
recent history of psychopathology is the
adoption of scientific methods to learn more
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 about the nature of psychological disorders,
their causes, and their treatment.
- Mental health practitioners may function as
scientist-practitioners in one or more of
three ways:
1. They may keep up with the latest scientific
developments in their field and therefore use the
most current diagnostic and treatment procedures.
2. Scientist-practitioners evaluate their own
assessments or treatment procedures to see
whether they work.
3. Scientist-practitioners might conduct research,
often in clinics or hospitals, that produces new
information about disorders or their treatment,
thus becoming immune to the fads that plague our
field, often at the expense of patients and their
families.
Functioning as a scientist-practitioner
Mental Health Professional
1. Consumer of science - enhancing the practice
2. Evaluator of science - determining the
effectiveness of the practice
3. Creator of science - conducting research that
leads to new procedures useful in practice
Three major categories make up the study and
discussion of psychological disorders:
1. Clinical description
2. Causation (etiology)
3. Treatment and outcome
Clinical Description
- In hospitals and clinics, we often say that a
patient “presents” with a specific problem.
- "Presents" is a traditional shorthand way of
indicating why the person came to the clinic.
- The word clinical refers both to the types of
problems or disorders that you would find in
a clinic or hospital and to the activities
connected with assessment and treatment.
Common Clinical Terms:
● Prevalence
● Incidence
● Sex ratio
● Course
● Chronic Course
● Episodic Course
● Time limited course
● Acute onset
● Insidious onset
● Prognosis
Mentally ill are frequently stereotyped: Common
Myths:
● Mentally disturbed people can always be
recognized by their abnormal behavior
● Mentally disturbed have inherited their
disorder
● Mental illness is incurable
● People become mentally ill because they
are weak
● Mental illness is always a deficit Mentally ill
are unstable and potentially dangerous
Causation, Treatment, and Etiology outcomes
Etiology
- Or the study of origins
- Has to do with why a disorder begins
(what causes it) and includes biological,
psychological, and social dimensions.
Treatment
- Is often important to the study of
psychological disorders.
- If a new drug or psychosocial treatment is
successful in treating a disorder, it may give
us some hints about the nature of the
disorder and its causes.
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 - Similarly, if a psychological treatment
designed to help clients regain a sense of
control over their lives is effective with a
certain disorder, a diminished sense of
control may be an important psychological
component of the disorder itself.
Psychopathology
- Is rarely simple because the effect does not
necessarily imply the cause.
- To use a common example, you might take
an aspirin to relieve a tension headache you
developed during a grueling day of taking
exams.
- If you then feel better, that does not mean
that the headache was caused by a lack of
aspirin.
- Nevertheless, many people seek treatment
for psychological disorders, and treatment
can provide interesting hints about the
nature of the disorder.
—-----------------------------------------------------------------
Historical Conceptions of Abnormal Behavior
Three major models that have guided us in
understanding abnormal behavior date back to
the beginnings of civilization.
Supernatural Model
- Humans have always supposed that agents
outside our bodies and environment
influence our behavior, thinking, and
emotions.
- These agents—which might be divinities,
demons, spirits, or other phenomena such
as magnetic fields or the moon or the
stars— are the driving forces behind the
supernatural model.
Biological Model & Psychological Model
- In addition, since the era of ancient Greece,
the mind has often been called the soul or
the psyche and considered separate from
the body.
- Although many have thought that the mind
can influence the body and, in turn, the
body can influence the mind, most
philosophers looked for causes of abnormal
behavior in one or the other.
- This split gave rise to two traditions of
thought about abnormal behavior,
summarized as the biological model and
the psychological model.
These three models—the supernatural, the
biological, and the psychological—are very old
but continue to be used today.
The Supernatural Tradition
● Demons and witches
● Stress and melancholy
● Treatments for possession
● Mass hysteria
● Modern mass hysteria
● The moon and the stars
Supernatural treatments include exorcism to rid the
body of the supernatural spirits.
Extra Notes:
➔ Witches - women who are progressive and
intelligent
➔ Moon and stars - their movements have
interpretation
The Biological Tradition
● Hippocrates and Galen
● The 19th Century: Syphilis, John P. Gray
● Development of Biological Treatments
● Consequences of the Biological Tradition
Biological treatments typically emphasize physical
care and the search for medical cures, especially
drugs.
Extra Note:
➔ Hippocrates believe that physical and
mental illnesses need medicine.
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Humoral Theory of Disorders by Hippocrates
and Galen
The four humors were related to the Greeks'
conception of the four basic qualities: heat,
dryness, moisture, and cold.
Each humor was associated with one of these
qualities. Terms derived from the four humors are
still sometimes applied to personality traits.
For example:
● Sanguine (literal meaning "red, like blood")
describes someone who is ruddy in
complexion, presumably from copious blood
flowing through the body, and cheerful and
optimistic, although insomnia and delirium
were thought to be caused by excessive
blood in the brain.
● Melancholic means depressive (depression
was thought to be caused by black bile
flooding the brain).
● A Phlegmatic personality (from the humor
phlegm) indicates apathy and sluggishness
but can also mean being calm under stress.
● A Choleric person (from yellow bile or
choler) is hot-tempered (Maher & Maher,
1985a).
Excesses of one or more humors were treated by
regulating the environment to increase or decrease
heat, dryness, moisture, or cold, depending on
which humor was out of balance.
Hippocrates assumed that normal brain functioning
was related to four bodily fluids or
humors:
● Blood came from the heart
● Black bile from the spleen
● Phlegm from the brain, and
● Choler or yellow bile from the liver
Physicians believed that disease resulted from too
much or too little of one of the humors; for example,
too much black bile was thought to cause
melancholia (depression). In fact, the term
melancholer, which means "black bile," is still used
today in its derivative form melancholy to refer to
aspects of depression.
The humoral theory was, perhaps, the first example
of associating psychological disorders with a
"chemical imbalance," an approach that is
widespread today.
The Psychological Tradition
● Moral Therapy
● Asylum Reform and the Decline of Moral
Therapy
● Psychoanalytic Theory
● Humanistic Theory
● The Behavioral Model
Psychological approaches use psychosocial
treatments, beginning with moral therapy and
including modern psychotherapy.
The Present: the Scientific Method
With the increasing sophistication of our scientific
tools, and new knowledge from cognitive science,
behavioral science, and neuroscience, we now
realize that no contribution to psychological
disorders ever occurs in isolation.
Our behavior, both normal and abnormal, is a
product of a continual interaction of psychological,
biological, and social influences.
—-----------------------------------------------------------------
Timeline of Significant Events
(400 B.C. - 1875)
400 B.C.
- Hippocrates suggests that psychological
disorders have both biological and
psychological causes.
200 C.E.
- Galen suggests that normal and abnormal
behaviors are related to four bodily fluids, or
humors.
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1300s
- Superstition runs rampant, and mental
disorders are blamed on demons and
witches; exorcisms are performed to rid
victims of evil spirits.
1400s
- Enlightened view that insanity is caused
by mental or emotional stress gains
momentum, and depression and anxiety
are again regarded by some as disorders.
1400 – 1800
- Bloodletting and leeches are used to rid the
body of unhealthy fluids and restore
chemical balance.
1500s
- Paracelsus suggests that the moon and the
stars, not possession by the devil, affect
people’s psychological functioning.
1793
- Philippe Pinel introduces moral therapy and
makes French mental institutions more
humane.
Extra Note:
➔ 1793 - Beginning of movement and reform
on mental hospitals
1825 – 1875
- Syphilis is differentiated from other types of
psychosis in that is caused by a specific
bacterium; ultimately, penicillin is found to
cure syphilis
Timeline of Significant Events
(1930 – 1968)
1930
- Insulin shock therapy, electric shock
treatments, and brain surgery begin to be
used to treat psychopathology.
1938
- B.F. Skinner publishes The Behavior of
Organisms, which describes the principles
of operant conditioning.
1943
- The Minnesota Multiphasic Personality
Inventory is published.
1946
- Anna Freud published Ego and the
Mechanisms of Defense.
1950
- The first effective drugs for severe psychotic
disorders are developed.
- Humanistic psychology (based on ideas of
Carl Jung, Alfred Adler, and Carl Rogers)
gains some acceptance.
1952
- The first edition of the Diagnostic and
Statistical Manual (DSM - I) is published.
1958
- Joseph Wolpe effectively treats patients with
phobias using systematic desensitization
based on principles of behavioral science.
1968
- DSM–II is published.
Timeline of Significant Events
(1848 - 1920)
1848
- Dorothea Dix successfully campaigns for
more humane treatment in U.S. mental
institutions.
1854
- John P. Grey, head of New York’s Utica
Hospital, believes that insanity is the result
of physical causes, thus de-emphasizing
psychological treatments.
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1870
- Louis Pasteur develops his germ theory of
disease, which helps identify the bacterium
that causes syphilis.
1895
- Josef Breuer treats the “hysterical” Anna O.,
leading to Freud’s development of
psychoanalytic theory.
1900
- Sigmund Freud publishes The Interpretation
of Dreams.
1904
- Ivan Pavlov received the Nobel Prize for his
work on the psychology of digestion, which
leads him to identify conditioned reflexes in
dogs.
1913
- Emil Kraepelin classifies various
psychological disorders from a biological
point of view and publishes work on
diagnosis.
1920
- John B. Watson experiments with
conditioned fear in Little Albert, using a
white rat.
Timeline of Significant Events
(1980 - 2013)
1980
- DSM-III is published.
1987
- DSM-III-R is published.
1900s
- Increasingly sophisticated research
methods are developed
- no one influence – biological or
environmental – is found to cause
psychological disorders in isolation from the
other.
1994
- DSM-IV is published.
2010
- DSM-IV-TR is published.
2013
- DSM-5 is published.
_________________________________________
Lesson 1 (Part 2): An Integrative
Approach to Psychopathology
One-Dimensional versus Multidimensional Models
One-Dimensional
- To say that psychopathology is caused by a
physical abnormality or by conditioning is to
accept a linear or one-dimensional model,
which attempts to trace the origins of
behavior to a single cause.
Extra Note:
➔ One condition (cause) that may be causing
the behavior (effect)
Multidimensional Model
- But most scientists and clinicians believe
abnormal behavior results from multiple
influences.
- A system, or feedback loop, may have
independent inputs at many different points,
but as each input becomes part of the
whole, it can no longer be considered
independent.
- This perspective on causality is systemic,
which derives from the word system; it
implies that any particular influence
contributing to psychopathology cannot be
considered out of context.
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Causes: Extra Notes:
➔ Another word for “Generic Vulnerability”
1. Biological Influences ➔ The greater the vulnerability of the person in
- Inherited overreactive sinoaortic baroreflex a disorder, the less stress is needed to
arc trigger a disorder
- Vasovagal syncope: heart rate and blood
pressure increase, body overcompensates b. The Gene-Environment Correlation Model
- Light-headedness and quesiness
- Judy faints

2. Behavioral Influences
- Conditioned response to sight of blood:
similar situations - even words - produce the
same reaction.
- Tendency to escape and avoid situations
involving blood. Extra Notes:
➔ Needs to be combined with environmental
3. Emotional and Cognitive Influences factors for it to be developed in a full-blown
- Fear of fainting, worrying about health disorder.

4. Social Influences Epigenetics and the Nongenomic “Inheritance” of

- Judy’s fainting causes disruptions in school Behavior
and home:
● Friends and family rush to help her In epigenetics, the immediate effects of the
● Principal suspends her environment (such as early stressful experiences)
● Doctors say nothing is physically influence cells that turn certain genes on or off.
wrong
This effect may be passed down through several
—----------------------------------------------------------------- generations.
Genetic Contributions to Psychopathology
Robert Sapolsky, a prominent neuroscientist,
- The nature of genes concluded, “genetic influences are often a lot less
- New developments in the study of genes powerful than is commonly believed. The
and behavior environment, even working subtly, can still
- The interactions of genes and the mold and hold its own in the biological
environment interactions that shape who we are” (Sapolsky,
2000, p. 15).
a. The Diathesis-Stress Model
—-----------------------------------------------------------------
Neuroscience and its Contributions to
Psychopathology

- The central nervous system

- The structure of the brain
- The peripheral nervous system
- Neurotransmitters
- Implications to Psychopathology
- Psychosocial influences to brain structure
and function

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 - Interactions of Psychosocial factors and
neurotransmitter systems
- Psychosocial effects on the development of
brain structure and function
Brain science and the field of neuroscience promise
much as we try to unravel the mysteries of
psychopathology.
Within the nervous system, levels of
neurotransmitter and neuroendocrine activity
interact in complex ways to modulate and regulate
emotions and behavior and contribute to
psychological disorders.
Divisions of the nervous system
Central Nervous System & Peripheral Nervous
System
Reference: Divisions of the nervous system.
(Reprinted from Kalat, J. W. (2009). Biological
Psychology, 10th edition, 2009 Wadsworth.)
—-----------------------------------------------------------------
Behavioral and Cognitive Science
- Conditioning and cognitive processes
- Learned helplessness
- Social learning
- Prepared learning
- Cognitive science and the unconscious
The relatively new field of cognitive science
provides a valuable perspective on how
behavioral and cognitive influences affect the
learning and adaptation each of us experience
throughout life.
Clearly, such influences not only contribute to
psychological disorders but also may directly
modify brain functioning, brain structure, and even
genetic expression.
—-----------------------------------------------------------------
Emotions
- The physiology and purpose of fear
- Emotional phenomena
- The component of emotion
- Anger and your heart
- Emotions and psychopathology
Emotions have a direct and dramatic impact on
our functioning and play a central role in many
mental disorders.
Mood, a persistent period of emotionality, is often
evident in psychological disorders.
Emotion has three important and overlapping
components: behavior, cognition, and physiology:
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 - How someone copes with impairment
resulting from physical causes may have a
profound effect on that person’s overall
functioning.

- In considering a multidimensional
integrative approach to psychopathology, it
is important to remember the principle of
equifinality, which reminds us that we must
consider the various paths to a particular
outcome, not just the result.

—-----------------------------------------------------------------
4P Factor Model and Biopsychosocial
Approach

With the increasing sophistication of our scientific

—-----------------------------------------------------------------
Cultural, Social, and Interpersonal Factors
- Voodoo, the evil eye and other fears
- Gender
- Social effects on health and behavior
- Social and interpersonal influences on the
elderly
- Social stigma
Extra Notes:
➔ Evil Eye - “the glance” that may cause evil
thing to other people just by looking (i.e.
reason maybe because of jealousy)
tools, and new knowledge from cognitive science,
behavioral science, and neuroscience, we now
realize that no contribution to psychological
disorders ever occur in isolation.
Our behavior, both normal and abnormal,
is a product of a continual interaction of
psychological, biological, and social influences.
Extra Note:
➔ It is already a 5P Factor Model. The 5th P
represents “Presenting Problem”. However,
4P is used since there are still differences
between the 4Ps.

➔ Voodoo - sorcery and spirit possession

4P Factor Biopsychosocial Approach
Model
Social and interpersonal influences profoundly Biological Psychologi Social
affect both psychological disorders and biology. cal

—----------------------------------------------------------------- Genetic Attachment Domestic

vulnerabilit style, violence,
Lifespan Development
y, toxic personality poverty and
Predisposi exposure in traits, adversity,
The Principle of Equifinality ng utero, birth isolation, unstable
- According to his principle, we must consider complicatio insecurities, home life,
a number of paths to a given outcome ns, fear of divorce
(Cicchetti, 1991). traumatic abandonme
brain injury nt since
childhood
- Different paths can also result from the
interaction of psychological and biological Precipitati Iatrogenic Recent loss, School
factors during various stages of ng reaction, stress, stressors,
development. poor sleep, reexperienc loss of

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 2. Diagnosis
substance e significant
use/misuse abandonme relationship, - This is the process of determining whether
nt/ fears loss of the particular problem afflicting the
home individual meets all criteria for a
psychological disorder, as set forth in
Perpetuati Poor Personality Role of the fifth edition of the Diagnostic and
ng response to traits, stigma to
Statistical Manual of Mental Disorders, or
medication, coping access
chronic mechanism, treatment, DSM-5 (American Psychiatric Association,
illness/pain beliefs of poor 2013).
self, others finance,
and the ongoing Key Concepts in Assessment
world transition
● The clinician begins by collecting a lot of
Protective Adequate Insightful Community,
diet, sleep, and family and information across a broad range of the
good cognitive faith individual's functioning to determine where
genes, behavior support, the source of the problem may lie.
physical strategies, financial or
exercise, coping disability ● After getting a preliminary sense of the
resilience, skills, support, GP
overall functioning of the person, the
intelligence psychologic support
ally minded clinician narrows the focus by ruling out
problems in some areas and concentrating
on areas that seem most relevant.
Extra Notes:
➔ Predisposing - already given to the client ● To understand the different ways clinicians
which is hard to change. Maybe because of assess psychological problems, we need to
(1) the event was done already, and (2) the understand three basic concepts that help
personality of the person. determine the value of our assessments:
reliability, validity, and standardization
➔ Precipitating - the event was done recently (Ayearst & Bagby, 2010)
that may have triggered the disorder
Reliability
➔ Perpetuating - happening in the present - is the degree to which a measurement is
consistent.
➔ Protective - approaches/dimensions used to
help the client cope Validity
_________________________________________ - is whether something measures what it is
designed to measure.
Lesson 2 (Part 1): Clinical Assessment and
Diagnosis Standardization
- is the process by which a certain set of
Assessing Psychological Disorders standards or norms is determined for a
technique to make its use consistent across
1. Clinical Assessment different measurements.
- This is the systematic evaluation and
measurement of psychological, biological, Extra Note:
and social factors in an individual presenting ➔ Standardization is the standard of norming
with a possible psychological disorder ➔ How the standards are set, the validity of
the scale, & the theoretical framework used

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 ➔ The step-by-step process of administering,
scoring, and interpreting a test
Procedures in Clinical Assessment
Clinical assessment consists of a number of
strategies and procedures that help clinicians
acquire the information they need to understand
their patients and assist them.
These procedures include:
1. a clinical interview and, within the context
of the interview, a mental status exam that
can be administered either formally or
informally often a thorough physical
examination;
2. behavioral observation and assessment
3. psychological tests (if needed)
Extra Note:
➔ Psychological Tests used when applying for
an employee position in the government:
◆ Test for intellectual functioning,
personality test, screening for
psychopathology, and projective
technique
—-----------------------------------------------------------------
I. The Clinical Interview
The Mental Status Exam
- The interview gathers information on
current and past behavior, attitudes, and
emotions, as well as a detailed history of
the individual's life in general and of the
presenting problem.
- Clinicians determine when the specific
problem started and identify other events
(for example, life stress, trauma, or physical
illness) that might have occurred about the
same time.
- In essence, the mental status exam involves
the systematic observation of an individual's
behavior.
- This type of observation occurs when any
one person interacts with another.
- Mental status exams can be structured and
detailed (Wing, Cooper, & Sertorius, 1974:
Wiger & Mooney. 2015), but mostly they are
performed relatively quickly by experienced
clinicians in the course of interviewing or
observing a patient.
The exam covers five categories:
1. Appearance and behavior
2. Thought Processes
3. Mood and Affect
4. Intellectual Functioning
5. Sensorium
—-----------------------------------------------------------------
II. Semi-structured Clinical Interviews
Semistructured interviews
- are made up of questions that have been
carefully phrased and tested
- To elicit useful information in a consistent
manner so that clinicians can be sure they
have inquired about the most important
aspects of particular disorders(Galletta,
2013; Summerfeldt, Kloosterman, & Antony,
2010).
- Clinicians may also depart from set
questions to follow up on specific
issues-thus the label "semistructured."
—-----------------------------------------------------------------
III. Physical Examination
If the patient presenting with psychological
problems has not had a physical exam in the
past year, a clinician might recommend one, with
particular attention to the medical conditions
sometimes associated with the specific
psychological problem.
—-----------------------------------------------------------------
IV. Behavioral Assessment
Behavioral assessment
- uses the process of direct observation to
formally assess an individual's thoughts,
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 feelings, and behavior in specific situations
or contexts.
- may be more appropriate than an interview
in terms of assessing individuals who are
not old enough or skilled enough to report
their problems and experiences.
—-----------------------------------------------------------------
V. Psychological Tests
Psychological tests
- include specific tools to determine cognitive
emotional, or behavioral responses that
might be associated with a specific disorder
and more general tools that assess
longstanding personality features, such as a
tendency to be suspicious.
- For example, intelligence testing is
designed to determine the structure and
patterns of cognition.
- Psychological Tests: Projective Testing,
Personality Inventories, Intelligence Testing
—-----------------------------------------------------------------
VI. Neuropsychological Testing
Neuropsychological testing
- Determines the possible contribution of
brain damage or cognitive dysfunction to the
patient's condition.
- Neuroimaging uses sophisticated
technology to assess brain structure and
function.
—-----------------------------------------------------------------
VII. Neuroimaging: Images of the Brain
Neuroimaging can be divided into two categories:
● One category includes procedures that
examine the structure of the brain,
○ such as the size of various parts and
whether there is any damage.
● In the second category are procedures that
examine the actual functioning of the brain
by
○ mapping blood flow and other
metabolic activity
—-----------------------------------------------------------------
VIII. Psychophysiological Assessment
Psychophysiology
- refers to measurable changes in the
nervous system that reflect emotional or
psychological events.
- The measurements may be taken either
directly from the brain or peripherally from
other parts of the body.
Examples:
● Biofeedback Technique
● Electroencephalograph (EEG)
● Electromyograph (EMG)
● Event-related Potential (ERP)
—-----------------------------------------------------------------
Diagnosing Psychological Disorders
Idiographic Strategy
- If we want to determine what is unique
about an individual's personality, cultural
background, or circumstances, we use what
is known as an idiographic strategy
(Barlow&Nock, 2009).
- This information lets us tailor our treatment
to the person.
Nomothetic Strategy
- To utilize the information already
accumulated on a particular problem or
disorder, we must be able to determine a
general class of problems to which the
presenting problem belongs.
- This is known as a nomothetic strategy.
- In other words, we are attempting to name
or classify the problem.
- When we identify a specific psychological
disorder, such as a mood disorder, in the
clinical setting, we are making a diagnosis.
Taxonomy
- The classification of entities for scientific
purposes, such as insects, rocks, or-if the
subject is psychology-behaviors.
Nosology
- If you apply a taxonomic system to
psychological or medical phenomena or
other clinical areas.
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Nomenclature
- describes the names or labels of the
disorders that make up the nosology (for
example, anxiety or mood disorders).
- A clinician refers to the DSM-5 to identify a
specific psychological disorder in the
process of making a diagnosis.
—-----------------------------------------------------------------
Classification Issues
➔ I.e. I always “ming” food to my co-workers.
The word “ming” should actually be “bring”
3.Derailment
- Synonymous with loose associations
- A breakdown in both the logical connection
between ideas and the overall sense of goal
directedness.
- The words make sentences, but the
sentences do not make sense

● Categorical and Dimensional Approaches 4. Flight of ldeas

● Reliability - a succession of multiple associations so
● Validity that thoughts seem to move abruptly from
—----------------------------------------------------------------- idea to idea;
- often (but not invariably) expressed through
Classification of Psychopathology rapid, pressured speech

● Diagnosis before 1980 Extra Note:

● DSM-IIl and DSM-|ll-R ➔ Flight of Ideas is jumping from one topic to
● DSM-IV and DSM-IV-TR another
● DSM-5
● Social and Cultural Considerations in 5. Neologism
DSM-5 - the invention of new words or phrases or
● Criticisms of DSM-5 the use of conventional words in
● A Caution about Labelling and Stigma idiosyncratic ways

—-----------------------------------------------------------------
6. Perseveration
Signs and Symptoms of Psychiatric Disorders - repetition of out of context words, phrases
or ideas
I. Formal Thought Disorders
7. Tangentiality
1.Circumstantiality - in response to a question, the patient gives
- overinclusion of trivial or irrelevant details a reply that is appropriate to the general
that impede the sense of getting to the topic without actually answering the
point. question

Extra Note: 8. Thought Blocking

➔ The client add unnecessary information in - a sudden disruption of thought or a break in
answering to the question the flow of ideas

2.Clang Associations Reference: Sadock, B., & Ruiz, P. (2015). Kaplan

- thoughts are associated by the sound of &Sadock's Synopsis of Psychiatry: Behavioral
words rather than by their meaning Sciences. Walters Kluwer.

Extra Note:
➔ The client change the sound of words

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II. Delusions being controlled by external forces (thought
withdrawal, thought insertion, thought
Delusion broadcasting, thought control)
- a disturbance in thought content, not a
solitary sign, but a part of psychotic illness. 9.Delusion of infidelity
- person's jealousy is morbid
It is a false belief with three characteristics:
1. False Presumption 10. Erotomania - another person, usually a
2. Not consistent with patient's intelligence and stranger, high status or famous person is in love
cultural background with her or him
3. Cannot be corrected by reasoning
III. Catatonia
Types of Delusions:
Catatonia
1. Delusion of persecution - is a psychomotor syndrome which has
- being harassed, cheated or persecuted historically been associated with
schizophrenia
2. Delusion of grandeur
- exaggerated conception of importance,
power or identity
Symptom Description of
pathology
3. Delusion of reference
- behavior of others refers to the patient Decreased response to
Stupor external stimuli,
Extra Note: hypoactive behavior
➔ The client feels the events happening Akinetic behavior,
around are connected to him/her. Immobility resistance to being
moved
4. Nihilistic delusion
- self, others, or the world is nonexistent Waxy flexibility Slight resistance to
being moved
5. Delusion of poverty Mutism Verbally unresponsive,
- to be bereft of material possessions refusal to speak

Extra Note: Purposely maintaining

Posturing a position for long
➔ They believed that they are poor
periods of time

6.Somatic delusion Excitement frantic , stereotyped or

- involving functioning of the body purposeless activity

Echolalia Senseless repetition of

Extra Note:
the words of others
➔ Believes that there is something wrong with
their body (i.e. internal organs) Echopraxia Mimicking the
movements of others
7. Delusion of self-accusation
- feeling of remorse or guilt Staring Eyes fixed and open for
long periods of time
8. Delusion of control Catalepsy The passive adoption
- person 's wil, thoughts, or feelings are of a posture

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Extra Notes: Disturbances of Perception
➔ Can be one or combination of the symptoms
Hallucination
➔ Stupor - false sensory perception not associated with
◆ the individual is not responding well real external stimuli
to the external stimuli

➔ Posturing Types of Hallucinations:

◆ Most common
◆ usually strange bodily position, and 1. Hypnagogic Hallucination
for a longer period
- false sensory perception occurring while
falling asleep
➔ Waxy Flexibility
◆ a condition in which a patient's limbs 2. Hypnopompic Hallucination
retain any position into which they
are manipulated by another person - false perception occurring while awakening
and from sleep
◆ which occurs especially in catatonic 3. Auditory Hallucination
schizophrenia
- false perception of sound, usually voices but
➔ Immobility also other noises such as music
◆ Client is resistant
4. Visual Hallucination
➔ Mutism - false perception involving sight, consisting
◆ Mute of formed images and unformed images

➔ Excitement 5. Olfactory Hallucination

◆ pacing to and fro - false perception of smell
◆ (i.e. balik-balik sa loob ng kwarto) - Example: The scent of flower when
someone died
➔ Echolalia
◆ Copying the words of others without 6. Gustatory Hallucination
an obvious reason - false perception of taste

➔ Echopraxia 7. Tactile Hallucination

◆ Copying the movement of others
- false perception of touch or surface
sensation or under the skin
➔ Staring
◆ fixed eyes and usually don’t blink Extra Note:

➔ Catalepsy ➔ common to the substance related,

◆ i.e. kapag inupo siya, uupo lang siya especially to those with withdrawal
symptoms or if the effect of drugs is too
much in the body
8. Command Hallucination
- false perception or orders that a person may
feel obliged to obey or unable to resist
9. Somatic Hallucination
- false perception of things occurring in, or to
the body
--------------------------------------------------------------------

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10. Mood Congruent Hallucination 4. Restricted or Constricted Affect
- content is consistent with either a - reduction of intensity of feeling tone less
depressed or manic mood (for example, a severe than blunted affect
manic patient hears voices saying that the
5. Flat Affect
patient is of inflated worth, power or
knowledge - absence or near absence of any signs of
affective expression, voice is monotonous,
Extra Notes:
face is immobile
➔ If the client is in depressed mood -> “wala
6. Labile Affect
kang kwenta”, “wala kang halaga”
➔ if the client is in manic mood -> “kakaiba ka - rapid and abrupt changes in emotional
talaga noh?”, “you’re one of a kind” feeling tone, unrelated to external stimuli
11. Mood Incongruent Hallucination Extra Note:
- content is not consistent with either ➔ has mood swings during evaluations
depressed or manic mood of the patient ◆ very happy and very down
—----------------------------------------------------------------- —-----------------------------------------------------------------
Disturbances of Affect Disturbances of Mood
Affect Mood
- refers to the behavioral expression of mood - a pervasive and sustained emotion
subjectively experienced and reported by a
patient and observed by others
Extra Note:
➔ Expression of moods, facial expression, and
way of speaking Types of Mood:
1. Dysphoric Mood
Types of Affect: - an unpleasant mood
1. Appropriate Affect 2.Euthymic Mood
- condition in which the emotional tone is in - normal range of mood implying absence or
harmony with the accompanying idea, depressed or elated mood
thought, or speech;
- also described as, Broad Full Affect 3. Irritable Mood

2. Inappropriate Affect - a state in which a person is easily annoyed

and provoked to anger
- disharmony between the emotional feeling
tone and the idea, thought or speech 4. Labile Mood (Mood Swings)
accompanying it - oscillation between euphoria and
- i.e. masaya siya pero umiiyak siya nang depression or anxiety
masakit
5. Elevated Mood
3. Blunted Affect
- air of confidence or enjoyment, a mood
- disturbance in affect manifested by a severe more cheerful than usual
reduction in the intensity of externalizing
feeling tone 6. Elation
- feeling of joy, euphoria, intense
self-satisfaction, or optimism

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7. Euphoria The aspect
manipulated or
- intense elation with feelings of grandeur Independent Variable thought to influence the
8. Ecstasy change in the
dependent variable
- feeling of intense rapture
The extent to which the
9. Depression results of the study can
Internal Validity be attributed to the
- psychopathological feeling of sadness
independent variable.
10.Anhedonia
The extent to which the
- loss of interest in and withdrawal from all results of the study
regular and pleasurable activities, often External Validity can be generalized or
associated with depression applied outside the
immediate study.
11.Grief or Mourning
- feeling of sadness appropriate to real loss --------------------------------------------------------------------
12. Alexythymia Types of Research Methods
- inability or difficulty in describing or being ● Studying Individual Cases
aware of one's emotions or moods ● Research by Correlation
● Research by Experiment
● Single-Case Experimental Designs
Lesson 2 (Part 2): Research Methods in
Psychopathology —-----------------------------------------------------------------
Genetics and Behavior across Time and
Cultures
Basic Components of a Research Study
● Studying Genetics
Component Description Extra Note:
An educated guess or ➔ i.e. how could sibling be different and same
Hypothesis statement to be while growing up in different environment ->
supported by data. if may role ba ang genetics sa heritability

The plan for testing ● Studying Behavior over Time

the hypothesis.
● Studying Behavior across Cultures
Research Design Affected by the
Extra Note:
question addressed, by
➔ i.e. what are the cultural differences of the
the hypothesis, and by
practical people
considerations.
● Power of a Program of Research
Some aspect of the Extra Note:
phenomenon that is ➔ Has capacity to generate topics or subtopics
measured and is which can be studied by other researchers
Dependent Variable expected to be
changed or ● Replication
influenced by the Extra Note:
independent variable. ➔ “Replication crisis” -> same method but
different result

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 ● Research Ethics
Extra Note:
➔ Be sensitive in designing the research
Lesson 3: Anxiety, Trauma, and
Stressor-Related, and Obsessive-Compulsive
and Related Disorders
The Complexity of Anxiety Disorders
Anxiety
- is complex and mysterious, as Sigmund
Freud realized many years ago.
- In some ways, the more we learn about it,
the more baffling it seems
- is a specific type of disorder, but it is more
than that.
- It is an emotion implicated so heavily
across the full range of psychopathology.
Fear
- a somewhat different but clearly related
emotion
- Related to fear is a panic attack, which we
propose is fear that occurs when there is
nothing to be afraid of and, therefore, at an
inappropriate time.
- With these important ideas clearly in mind,
we focus on specific anxiety and related
disorders
Anxiety, Fear, and Panic: Some Definitions
Anxiety
- Is a negative mood state characterized by
bodily symptoms of physical tension and
by apprehension about the future
(American Psychiatric Association, 2013,
Barlow, 2002)
- In humans, it can be a subjective sense of
unease, a set of behaviors (looking worried
and anxious or fidgeting), or a physiological
response originating in the brain and
reflected in elevated heart rate and muscle
tension.
Extra Notes:
➔ Anxiety can’t be totally eliminated but we
could develop effective coping methods to
live with anxiety.
➔ It is not healthy when anxiety was totally
eliminated -> there are types of anxiety
which are helpful for survival
Fear
- Is an immediate alarm reaction to danger.
- Like anxiety, fear can be good for us.
- Purpose: It protects us by activating a
massive response from the autonomic
nervous system (increased heart rate and
blood pressure, for example), which, along
with our subjective sense of terror,
motivates us to escape (flee) or, possibly, to
attack (fight).
- As such, this emergency reaction is often
called the flight or fight response.
Extra Note:
➔ The third one is “freeze”
◆ which is our tendency to freeze
when scared (this is beyond our
control)
Panic
- Is sudden overwhelming reaction which
came to be known as panic, after the Greek
god Pan who terrified travelers with
bloodcurdling screams.
- In psychopathology, a panic attack is
defined as an abrupt experience of intense
fear or acute discomfort, accompanied by
physical symptoms that usually include
heart palpitations, chest pain, shortness of
breath, and, possibly, dizziness.
2 Types:
● Expected (cued) panic attack
● Unexpected (uncued) panic attack
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The relationships among anxiety, fear and panic 11.Derealization (feelings of unreality) or
attack depersonalization (being detached from oneself)
12. Fear of losing control or going crazy
Emotional State 13. Fear of dying
1. Anxiety
- Negative affect
- Somatic symptoms of tension
- Future-oriented
- Feelings that one cannot predict or control
upcoming events

2. Fear
- Negative affect
- Strong sympathetic nervous system arousal
- Immediate alarm reaction characterized by
strong escapist tendencies in response to
present danger or life-threatening
emergencies

3. Panic Attack
- Fear occurring at an inappropriate time
- Two types: Expected and Unexpected
—----------------------------------------------------------------- —-----------------------------------------------------------------

Panic Attack Some Psychological Grounding Techniques

Table 5.1 Diagnostic Criteria for Panic Attack Grounding

(DSM-5) - is a practice that can help you pull away
An abrupt surge of intense fear or intense from flashbacks, unwanted memories, and
discomfort that reaches a peak within minutes, and negative or challenging emotions.
during which time four (or more) of the following
symptoms occur:
- It may help distract you from what you're
1. Palpitations, pounding heart, or accelerated experiencing and refocus on what's
heart rate happening in the present moment.
2. Sweating
3. Trembling or shaking - Grounding yourself isn't always easy. It may
4. Sensations of shortness of breath or smothering take some time before the techniques work
well for you. but don't give up on them.
5. Feeling of choking
1. Put your hands in water
6. Chest pain or discomfort
- Focus on the water's temperature and how
7. Nausea or abdominal distress it feels on your fingertips, palms and the
backs of your hands. Does it feel the same
8. Feeling dizzy, unsteady lightheaded, or faint
in each part of your hand?
9. Chills or heat sensations - Use warm water first. then cold. Next. try
cold water first, then warm. Does it feel
10. Paresthesias (numbness or tingling sensations)

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 different to switch from cold to warm water
versus warm to cold?
2. Savor a food or drink
- Take small bites or sips of a food or
beverage you enjoy. letting yourself fully
taste each bite.
- Think about how it tastes and smells and
the flavors that linger on your tongue.
3. Savor a scent
- Is there a fragrance that appeals to you?
This might be a cup of tea, an herb or spice,
a favorite soap, or a scented candle.
- Inhale the fragrance slowly and deeply and
try to note its qualities (sweet, spicy, sharp,
citrusy, and so on)
4. Touch something comforting
- This could be your favorite blanket, a much
loved T-shirt. a smooth stone. a soft carpet,
or anything that feels good to touch. Think
about how it feels under your fingers or in
your hand.
- If you have a favorite sweater, scarf, or pair
of socks. put them on and spend a moment
thinking about the sensation of the fabricon
your skin
—-----------------------------------------------------------------
Causes of Anxiety and Related Disorders
1. Biological Contributions
2. Psychological Contributions
3. Social Contributions
4. An Integrated Model – triple vulnerability theory
Figure 5.3 : Integrated Model or Triple Vulnerability
Theory
The three vulnerabilities that contribute to the
development of anxiety disorders. If individuals
possess all three, the odds are greatly increased
that they will develop an anxiety disorder after
experiencing a stressful situation. (From Barlow, D.
H. (2002). Anxiety and its disorders: The nature
and treetment of enxiety and penic (2nd ed.). New
York: Guilford Press.
Extra Notes:
➔ Biological Vulnerability
◆ Heritable contribution to negative
affect
◆ Genetics -> our way of thinking or
perceiving the world around us that
might have been inherited
◆ When we see something, we
interpret it in a negative way
➔ Specific Psychological Vulnerability
◆ How the person interpret their
physical sensations that are
happening in their body
➔ Generalized Psychological Vulnerability
◆ Feeling that the person cannot
control events
◆ Person who has social anxiety ->
feel that they’re being evaluated
negatively
—-----------------------------------------------------------------
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 Anxiety Disorders: Generalized Anxiety F. The disturbance is not better explained by
Disorder another mental disorder (eg anxiety or
worry about having panic attacks in panic
Table 5.2 Diagnostic Criteria for Generalized
disorder, negative evaluation in social
Anxiety Disorder
anxiety disorder)
A. Excessive anxiety and worry (apprehensive
expectation), occurring more days than not
for at least 6 months about a number of
events or activities (such as work or
school performance)

B. The individual finds it difficult to control

the worry

Extra Note:
➔ Free Floating Anxiety
◆ a general sense of uneasiness that
is not tied to any particular object or
specific situation

C. The anxiety and worry are associated with

at least three (or more) of the following
six symptoms (with at least some
symptoms present for more days than not
for the past 6 months)
[Note: Only one item is required in children];
1. Restlessness or feeling keyed up or on
edge
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
Extra Notes:
4. Irritability
5. Muscle tension ➔ Intense Cognitive Processing
6. Sleep disturbance (difficulty falling or ◆ overthinking
staying asleep or restless, unsatisfying ➔ Avoidance of Imagery
sleep) ◆ pag-iwas sa pag-iisip sa bagay na
yun samantalang need siyang
D. The anxiety, worry or physical symptoms bigyan ng solution
cause clinically significant distress or
impairment in social occupational, or other —-----------------------------------------------------------------
important areas of functioning Anxiety Disorders: Panic Disorder and
Extra Note: Agoraphobia
➔ Has an effect in daily living
Table 5.3 Diagnostic Criteria for Panic Disorder
E. The disturbance is not due to the direct
A. Recurrent unexpected panic attacks are
physiological effects of a substance (eg.
present.
a drug of abuse, a medication) or a general
medical condition (eg. hyperthyroidism)
B. At least one of the attacks has been
followed by 1 month or more of one or
both of the following:

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 (a) Persistent concern or worry about
additional panic attacks or their
consequences (eg. losing control. having a
heart attack, "going crazy"% or

(b) A significant maladaptive change in

behavior related to the attacks (eg.
behaviors designed to avoid having panic
attacks, such as avoidance of exercise or
unfamiliar situations)

C. The disturbance is not attributable to the

physiological effects of a substance (eg.
a drug of abuse, a medication) or another
medical condition (eg. hyperthyroidism,
cardiopulmonary disorders).

D. The disturbance is not better explained by

Extra Note:
another mental disorder (eg. the panic
attacks do not occur only in response to ➔ Panic Disorder and Agoraphobia is learned
feared social situations, as in social anxiety ◆ we can use behavioral techniques to
disorder). help a person overcome this
disorder

Extra Note:
Agoraphobia vs Panic Disorder
➔ Panic Disorder happens unexpectedly
➔ while in Agoraphobia, the person knows
the situation (may cue) which can trigger
his/her panic attacks kaya iniiwasan niya ito

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Extra Notes:
Panic Attack vs Panic Disorder
➔ Panic Attacks
◆ are sudden feeling of fear and
anxiety without knowing the reason
◆ part sa Panic Disorder
◆ possible na once lang
➔ Panic Disorder
◆ occurs repeatedly (unexpected)
Generalized Anxiety Disorder vs Social Anxiety
➔ Generalized
◆ there is apprehension with the future
➔ Social Anxiety
◆ limited to social interaction and
performance in public
—-----------------------------------------------------------------
Anxiety Disorders: Panic Disorder and
Agoraphobia
Table 5.4 Diagnostic Criteria for Agoraphobia
A. Marked fear or anxiety about two or more
of the following five situations: Public
transportation, open spaces, enclosed
places, standing in line or being in a crowd,
being outside the home alone
B. The individual fears or avoids these
situations due to thoughts 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 (eg. fear of
falling in the elderly, fear of incontinence).
C. The agoraphobic situations almost always
provoke fear or anxiety
D. The agoraphobic situations are actively
avoided, require the presence of a
companion, or are endured with intense
fear or anxiety
E. The fear or anxiety is out of proportion to
the actual danger posed by the agoraphobic
situations, and to the sociocultural context
F. The fear, anxiety or avoidance is persistent,
typically lasting for 6 months or more.
G. The fear, anxiety or avoidance causes
clinically significant distress or
impairment in social, occupational or ocher
important areas of functioning
H. If another medical condition (eg.
inflammatory bowel disease, Parkinson's
disease) is present, the fear anxiety or
avoidance is clearly excessive.
I. The fear, anxiety or avoidance is not better
explained by the symptoms of another
mental disorder, eg, the symptoms are not
confined to specific phobia, situational type,
do not involve only social situations (as in
social anxiety disorder) and are not related
exclusively to obsessions (as in
obsessive-compulsive disorder), perceived
deficits or flaws in physical appearance (as
in body dysmorphic disorder), reminders of
traumatic events (as in posttraumatic stress
disorder), or fear of separation (as in
separation anxiety disorder)
—-----------------------------------------------------------------
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 Anxiety Disorders: Specific Phobia 4. Situational (eg. Planes, elevators or
enclosed places)
Table 5.5 Diagnostic Criteria for Specific Phobia
5. Other (eg. phobic avoidance of situations
A. Marked fear or anxiety about a specific that may lead to choking vomiting or
object or situation (e.g. flying, heights, contracting an illness: or in children,
animals, receiving an injection, seeing avoidance of loud sounds, or costumed
blood) characters)

B. The phobic object or situation almost

always provokes immediate fear or
anxiety.
- Note in children, the anxiety may
be expressed by crying, tantrums,
freezing or clinging

C. The phobic object or situation is actively

avoided or endured with intense fear or
anxiety

D. The fear or anxiety is out of proportion to

the actual danger posed by the specific
object or situation, and to the sociocultural
context

E. The fear, anxiety or avoidance is persistent,

typically lasting for 6 months or more

F. The fear, anxiety or avoidance causes

clinically significant distress or
impairment in social occupational or other
important areas of functioning

G. The disturbance is not better explained by

the symptoms of another mental
disorders, including fear, anxiety and
avoidance of situations associated with
panic-like symptoms or other incapacitating
symptoms (as in agoraphobia); objects or
situations related to obsessions (as in
obsessive-compulsive disorder), reminders
of traumatic events (as in
posttraumatic-stress disorder); separation
from home or attachment figures (as in
separation anxiety disorder or social
situations (as in social anxiety disorder)
Specify type: Extra Notes:
1. Animal Integrated model for Generalized biological
2. Natural environment (eg. Heights, storms, vulnerability
and water)
3. Blood-injection-injury ➔ Has possibility that it is associated in
heritable tendency

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 ➔ can be direct experience - Note: in children, the fear or anxiety
➔ “Learned Alarm” may be expressed by crying,
◆ treatment for phobia depends if it’s tantrums, freezing. clinging,
learned -> target is the behavior shrinking, or failing to speak in social
◆ behavioral intervention by situations (selective mutism)
exposing/educate the client to
challenge their thoughts and D. The social situations are avoided or
behaviors until there is no endured with intense fear or anxiety.
maladaptive response
E. The fear or anxiety is out of proportion to
Treatment for Phobia:
the actual threat posed by the social
➔ Flooding situation, and to the sociocultural context.
◆ a technique in behavior therapy by
flooding or bibiglain ang person to F. The fear, anxiety or avoidance is persistent,
the stimulus hanggang hindi na siya typically lasting for 6 months or more.
natatakot (i.e. sa aso)
➔ Systematic Desensitization G. The fear, anxiety or avoidance causes
◆ dahan-dahan ine-expose sa feared clinically significant distress or impairment in
object/situation social, occupational or other important
areas of functioning
—-----------------------------------------------------------------
Anxiety Disorders: Social Anxiety Disorder H. The fear, anxiety or avoidance is not
(Social Phobia) attributable to the effects of a substance
(eg. a drug of abuse, a medication) or
Table 5.6 Diagnostic Criteria for Social Anxiety another medical condition
Disorder
I. The fear, anxiety or avoidance is not better
Extra Note:
explained by the symptoms of another
➔ Another term for Social Anxiety Disorder is mental disorder, such as panic disorder
Negative Evaluatism (eg, anxiety about having a panic attack) or
separation anxiety disorder (eg., fear of
being away from home or a close relative)
A. Marked fear or anxiety about one or more
social situations in which the person is J. If another medical condition (eg. stuttering,
exposed to possible scrutiny by others. Parkinson’s disease, obesity, disfigurement
Examples include social interactions (eg. from burns or injury) is present, the fear,
having a conversation, meeting unfamiliar anxiety or avoidance is clearly unrelated or
people), being observed (eg. eating or is excessive.
drinking), or performing in front of others
(eg. giving a speech). Specify if:
- Note: In children, the anxiety must
● Performance only: If the fear is restricted
occur in peer settings and not just
to speaking or performing in public.
in interactions with adults.

B. The individual fears that he or she will act

in a way, or show anxiety symptoms, that
will be negatively evaluated (ie, will be
humiliating, embarrassing, lead to rejection,
or offend others).

C. The social situations almost always

provoke fear or anxiety.

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Note: Criterion A4 does not apply to exposure
through electronic media, television, movies. or
pictures, unless this exposure is work related
Extra Notes:
➔ Based on the figure above, nagsstart
maging vulnerable ang tao with stress, with
the combination of Generalized
Psychological Vulnerability and
Generalized Biological Vulnerability
either because of direct experience or with
the anxious apprehension
➔ Possible treatment -> CBT (Cognitive
Behavioral Treatment) which is kasama ang
mindfulness
—-----------------------------------------------------------------
Trauma and Stressor-Related Disorders:
Post-traumatic Stress Disorder
Note:
➔ To determine the presence of PTSD -> look
at the history of client (traumatic
experience/s)
Table 5.7 Diagnostic Criteria for Posttraumatic -
Stress Disorder
A. Exposure to actual or threatened death,
serious injury or sexual violence in one
(or more) at the following ways:
1. Directly experiencing the traumatic
event(s)
2. Witnessing, in person, the event(s) as
they occurred to others
3. Learning that the event(s) occurred to a
close relative or close friend. In cases of
actual or threatened death of a family
member or friend the event(s) must
have been violent or accidental
4. Experiencing repeated or extreme
exposure to aversive details of the
traumatic event(s) (eg. first responders
collecting human remains, police offices
repeatedly exposed to deals of child
abuse)
B. Presence of one (or more) of the following
intrusion symptoms associated with the
traumatic event(s), beginning after the
traumatic event(s) occurred
1. Recurrent, involuntary and intrusive
distressing memories of the
traumatic event(s), Note. In young
children, repetitive play may occur in
which themes or aspects of the
traumatic event(s) are expressed
2. Recurrent distressing dreams in
which the content and/or affect of the
dream are related to the traumatic
events) Note: In children, there may be
frightening dreams without recognizable
content.
3. Dissociative reactions (eg flashbacks)
in which the individual feels or acts as if
the traumatic event(s) were recurring
(Such reactions occur on a continuum,
with the most extreme expression being
a complete loss of awareness of present
surroundings) Note: In young children,
trauma specific reenactment may occur
in a play
4. Intense or prolonged psychological
distress alt exposure to internal or
external cues that symbolize or
resemble an aspect of the traumatic
event(s)
5. Marked physiological reactions to
internal or external cues that symbolize
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 or resemble an aspect of the traumatic
event(s)
C. Persistent avoidance of stimuli associated
with the traumatic event(s) beginning after
the traumatic event(s) occurred. as
evidenced by one or both of the following:
1. Avoidance of or efforts to avoid
distressing memories, thoughts,
feelings, or conversations about or
closely associated with the traumatic
events
2. Avoidance of or efforts to avoid
external reminders (people, places,
conversations, activities. objects,
situations) that arouse distressing
memories, thoughts or feelings
about or closely associated with the
traumatic event(s)
D. Negative alterations by two in cognitions
and mood associated with the traumatic
event(s) beginning or worsening after the
traumatic event(s) occurred as evidenced
by two (or more) of the following:
1. Inability to remember an important
aspect of the traumatic event(s)
(typically due to dissociative amnesia
and not to other factors such as head
injury, alcohol, or drugs
2. Persistent and exaggerated negative
beliefs or expectations about oneself,
other or the world (eg. “I am bad”, “no
one can be trusted”, “the world is
completely dangerous", "My whole
nervous system is permanently ruined”)
3. Persistent distorted cognitions about the
cause or consequences of the traumatic
event(s) thar lead the individual to blame
himself/herself or others
4. Persistent negative emotional scare (eg.
fear, horror, anger, guilt, or shame)
5. Markedly diminished interest or
participation in significant activities
6. Feelings of detachment or
estrangement from others
7. Persistent inability to experience
positive emotions (eg. inability to
experience happiness, satisfaction, or
loving feelings)
E. Marked alterations in arousal and
reactivity associated with the traumatic
event(s), beginning or worsening after the
traumatic event(s) occurred, as evidenced
by two (or more) of the following:
1. Irritable behavior and angry
outbursts (with little or no
provocation) typically expressed as
verbal or physical aggression toward
people or objects
2. Reckless or self-destructive
behavior
3. Hypervigilance.
4. Exaggerated startle response
5. Problems with concentration
F. Sleep disturbance (e.g. difficulty falling or
staying asleep or restless sleep). Duration
of the disturbance (Criteria B&.C D and E) is
more than one month.
G. The disturbance causes clinically significant
distress or impairment in social,
occupational, or other important areas of
functioning
H. The disturbance is not attributable to the
physiological effects of a substance (eg.
medication, alcohol) or another medical
condition.
Specify if:
● With delayed expression: If the full
diagnostic criteria are not met until at least
6 months after the event (although it is
understood that onset and expression of
some symptoms may be immediate)
Specify whether:
● With Dissociative Symptoms: The
individual's symptoms meet the criteria for
posttraumatic stress disorder, and in
addition, in response to the stressor the
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 individual experiences persistent or
recurrent symptoms of either
depersonalization or derealization
Extra Notes:
➔ Individuals who have experienced
something life-threatening may not
necessarily develop PTSD
➔ Depends with the vulnerability of the person
➔ Experience trauma result to “True Alarm”
◆ Learned Alarm that could lead to
“Anxious Apprehension”
—-----------------------------------------------------------------
Obsessive-Compulsive and Related Disorders:
Obsessive-Compulsive Disorder (OCD)
Table 5.8 Diagnostic Criteria for OCD
A. Presence of obsessions, compulsions or
both:
Obsessions are defined by 1 and 2:
1. Recurrent and persistent thoughts,
urges, or images that are experienced, at
some time during the disturbance, as
intrusive and inappropriate and that in most
individuals cause marked anxiety or distress
2. The individual attempts to ignore or
suppress such thoughts impulses, or
images, or to neutralize them with some
other thought or action
Compulsions are defined by 1 and 2:
1. Repetitive behaviors (eg. handwashing,
ordering, checking) or mental acts (eg.
praying counting, repeating words silently)
that the individual feels driven to perform
in response to an obsession, or according
to rules that must be applied rigidly
Extra Note:
➔ nagiging compulsion lang kapag in
response sa obsession
2. The behaviors or mental acts are
aimed at preventing or reducing distress
or preventing some dreaded event or
situation; however, these behaviors or
mental acts either are not connected in a
realistic way with what they are designed to
neutralize or prevent or are clearly
excessive
B. The obsessions or compulsions are
time-consuming (eg. Take more than 1
hour per day), or cause clinically significant
distress or impairment in social,
occupational or other important areas of
functioning
C. The disturbance is not due to the direct
physiological effects of a substance (eg.
a drug of abuse, a medication) or another
medical condition.
D. The disturbance is not better explained by
the symptoms of another mental
disorder (eg. excessive worries, as in
generalized anxiety disorder, or
preoccupation with appearance, as in body
dysmorphic disorder)
Specify if:
● With good or fair insight: the individual
recognizes that obsessive compulsive
disorder beliefs are definitely or probably
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 not true or that they may or may not be
true.
● With poor insight: The individual thinks
obsessive-compulsive disorder beliefs are
probably true
● With absent insight/delusional: the
person is completely convinced that
obsessive-compulsive disorder beliefs
are true
Specify if:
● Tic-related: The individual has a current or
past history of a tic disorder
Obsessive Compulsive Disorder (OCD)
- Is a mental health disorder that occurs when
a person gets caught in a cycle of
obsessions and compulsions
Obsessions
- Are unwanted, intrusive thoughts, images or
urges that trigger intensely distressing
feelings such as:
● Becoming contaminated by shaking
hands with someone
● Intense distress when objects are
disordered or asymmetric
● Wondering if a door was left
unlocked
Compulsions
- Are behaviors to attempt to get rid of the
obsessions and/or decrease distress such
as:
● Handwashing
● Reordering objects to achieve
symmetry
● Repeatedly checking locks, alarms,
appliances
—-----------------------------------------------------------------
Obsessive-Compulsive and Related Disorders:
Body Dysmorphic Disorder
Table 5.9 Diagnostic Criteria for Body Dysmorphic
Disorder
A. Preoccupation with one or more defects or
flaws in physical appearance that are not
observable or appear slight to others
B. At some point during the course of the
disorder, the individual has performed
repetitive behaviors (eg. mirror checking
excessive grooming skin picking,
reassurance seeking) or mental acts (eg.
comparing his or her appearance with that
of others) in response to the appearance
concerns
C. The preoccupation causes clinically
significant distress or impairment in
social, occupational or other important
areas of functioning
D. The appearance preoccupation is not
better explained by concerns with body
fat or weight in an individual whose
symptoms meet diagnostic criteria for an
eating disorder
Specify if:
● With good or fair insight: The individual
recognizes that the body dysmorphic
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 disorder beliefs are definitely or probably ➔ Harm obsessions with checking
not true or that they may or may not be compulsions
true. ◆ hindi makalabas ng bahay dahil
nag-aalala na meron naiwang bagay
● With poor insight: The individual thinks na nakasaksak, or di nila na-lock
that the body dysmorphic disorder beliefs ang pinto, etc.
are probably true.
_________________________________________
● With absent insight/delusional beliefs: Lesson 4: Somatic Symptom and Related
the individual is completely convinced that Disorders and Dissociative Disorders
the body dysmorphic disorder beliefs are
true
Somatic symptom and dissociative disorders
● With muscle dysmorphia: The individual is
preoccupied with the idea that his or her - are strongly linked historically, and evidence
body build is too small or insufficiently indicates they share common features
muscular. This specifier is used even if the (Kihlstrom, Glisky, &Anguilo, 1994; Prelior,
individual is preoccupied with other body Yutzy, Dean, &Wetzel, 1993).
areas, which is often the case.
Extra Note:
Example:
➔ Under the category of Dissociative disorder:
- People with obsessive-compulsive hoarding ◆ Depersonalization
are so afraid they may throw something ◆ Derealization
important away that clutter piles up in their ◆ Dissociative identity or previously
homes known “multiple personality”

- They used to be categorized under one

Extra Notes: general heading, "hysterical neurosis."

➔ Contamination obsessions with cleaning

compulsions
- The tem hysteria - which dates back to the
◆ feel or believed they can easily get
Greek physician Hippocrates, and the
germs
Egyptians before him-suggests that the
➔ Hoarding
cause of these disorders, which were
◆ Collecting things that aren’t
thought to occur primarily in women, can be
necessary
traced to a "wandering uterus."
➔ Symmetry obsessions with ordering
compulsions Extra Note:
◆ Arranging things based on color,
size, etc. ➔ before, naniniwala sila na kapag unstable
yung babae emotionally, nagwwander ang
uterus sa buong katawan

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 ➔ kaya ang ginagawa nila para bumalik ang
uterus is through pagpapausok -> making
a woman be stable again.
➔ But the term hysterical came to refer more
generally to physical symptoms without
known organic cause or to dramatic or
"histrionic" behavior thought to be
characteristic of women.
- Sigmund Freud (1894-1962) suggested that
in a condition called conversion hysteria,
unexplained physical symptoms
indicated the conversion of unconscious
emotional conflicts into a more acceptable
form.
Extra Notes:
➔ Sigmund Freud developed his
psychoanalysis theory
➔ Sigmund Freud and Josef Breuer did a case
analysis of Anna O. (Bertha Pappenheim)
➔ Conversion Hysteria -> the unconscious
emotional conflicts to be the cause of
physical symptoms
- The term neurosis, as defined in
psychoanalytic theory, suggested a specific
cause for certain disorders.
- Specifically,
● neurotic disorders resulted from
underlying unconscious conflicts,
● Anxiety that resulted from those
conflicts, and
● The implementation of ego
defense mechanisms.
Extra Notes:
➔ There are defense mechanism which are
healthy (do not result to neuroticism)
➔ while there are defense mechanism which
result to neuroticism such as depression,
conversion
- Somatic symptom disorders and
dissociative disorders are not well
understood, but they have intrigued
psychopathologists and the public for
centuries.
- A fuller understanding provides a rich
perspective on the extent to which normal,
everyday traits found in all of us can evolve
into distorted, strange, and incapacitating
disorders.
—-----------------------------------------------------------------
Somatic Symptom Disorder
Extra Notes:
➔ may naffeel talagang pain sa katawan,
however, their anxiety is not proportionate
➔ nagccause ng difficulty sa buhay ng client
pero hindi naman ganoon katindi yung
nararamdaman niya physically to
experience that level of anxiety.
In 1859, Pierre Briquet, a French physician,
described patients who came to see him with
seemingly endless lists of somatic complaints
for which he could find no medical basis
(American Psychiatric Association, 1980)
Despite his negative findings, patients returned
shortly with either the same complaints or new
lists containing slight variations.
For many years, this disorder was called Briquet's
syndrome, but now would be considered somatic
symptom disorder.
Table 6.1 Diagnostic Criteria for Somatic Symptom
Disorder
A. One or more somatic symptoms that are
distressing and/or result in significant
disruption of daily life.
B. Excessive thoughts, feelings and
behaviors related to the somatic
symptoms or associated health concerns
as manifested by at least one of the
following:
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 1. Disproportionate and persistent thoughts
about the seriousness of one's symptoms
2. High level of health-related anxiety
3. Excessive time and energy devoted to these
symptoms or health concerns
C. Although any one symptom may not be
continuously present, the state of being
symptomatic is persistent (typically more than 6
months)
Specify if:
With predominant pain (previously pain
disorder): This specifier is for individuals whose
somatic complaints predominantly involve pain.
Specify current severity
Mild: Only one of the symptoms in Criterion B is
fulfilled.
Moderate: Two or more of the symptoms
specified in Criterion B are fulfilled
Severe: Two or more of the symptoms specified in
Criterion B are fulfilled, plus there are multiple
somatic complaints (or one very severe somatic
symptom).
—-----------------------------------------------------------------
Illness Anxiety Disorder
Illness anxiety disorder
- was formerly known as "hypochondriasis,"
which is still the term widely used among
the public.
- physical symptoms are either not
experienced at the present time or are very
mild,
- but severe anxiety is focused on the
possibility of having or developing a
serious disease.
- If one or more physical symptoms are
relatively severe and are associated with
anxiety and distress, the diagnosis would
be somatic symptom disorder.
Extra Notes:
➔ Iba siya sa somatic symptom disorder kasi
may mga physical symptom talaga na 1
or 2 symptoms that are distressing or
result insignificant disruptions of daily
life
Table 6.2 Diagnostic Criteria for Illness Anxiety
Disorder
A. Preoccupation with fears of having or
acquiring a serious illness
B. Somatic symptoms are not present or, if
present are only mild in intensity. If
another medical condition is present or
there is a high risk for developing a medical
condition (eg strong family history is
present) the preoccupation is clearly
excessive or disproportionate
C. There is a high level of anxiety about
health, and the individual is easily
alarmed about personal health status
D. The individual performs excessive
health-related behaviors (eg. repeatedly
checks his or her body for signs of illness)
or exhibits maladaptive avoidance (eg.
avoids doctors' appointments and hospitals)
E. Illness preoccupation has been present for
at least 6 months but the specific illness
that is feared may change over that
period of time
F. The illness-related preoccupation is not
better explained by another mental disorder,
such as somatic symptom disorder,
generalized anxiety disorder, or
obsessive-compulsive disorder
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Specify whether:
Care-seeking type: Medical care, including
physician visits or undergoing tests and
procedures is frequently used
Care-avoidant type: Medical care is rarely used
Extra Notes:
➔ It starts with the trigger (information, event,
illness, image)
➔ Because of the trigger, there is a threat
leading to apprehension
—-----------------------------------------------------------------
Conversion Disorder
(Functional Neurological Symptom Disorder)
The term conversion has been used off and on
since the Middle Ages (Mace, 1992) but was
popularized by Freud.
Freud believed the anxiety resulting from
unconscious conflicts somehow was
"converted' into physical symptoms to find
expression
This allowed the individual to discharge some
anxiety without actually experiencing it.
As in phobic disorders, the anxiety resulting from
unconscious conflicts might be "displaced"
onto another object.
In DSM-5. "functional neurological symptom
disorder" is a subtitle to conversion disorder
because the term is more often used by
neurologists who see the majority of patients
receiving a conversion disorder diagnosis, and
because the term is more acceptable to patients.
"Functional'' refers to a symptom without an organic
cause (Stone, Lafrance, Levenson, & Sharpe,
2010). It is likely that the old term"conversion" will
be dropped in future editions of the DSM.
Table 6.3 Diagnostic Criteria for Conversion
Disorder (Functional Neurological Symptom
Disorder)
A. One or more symptoms of altered
voluntary motor or sensory function
Extra Note:
➔ Possible to experience paralysis,
loss of eyesight
B. Clinical findings provide evidence of
incompatibility between the symptom and
recognized neurological or medical
conditions
Extra Note:
➔ the patient may report being
paralyzed, but no clinical findings
C. The symptom or deficit is not better
explained by another medical or mental
disorder
D. The symptom or deficit causes clinically
significant distress or impairment in
social, occupational, or other important
areas of functioning or warrants medical
evaluation
—-----------------------------------------------------------------
Factitious Disorders
More puzzling is a set of conditions called
factitious disorders, which fall somewhere
between malingering and conversion disorders.
The symptoms are under voluntary control, as
with malingering, but there is no obvious reason
for voluntarily producing the symptoms except,
possibly, to assume the sick role and receive
increased attention
Tragically, this disorder may extend to other
members of the family. An adult, almost always a
mother, may purposely make her child sick
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evidently for the attention and pity given to her as
the mother of a sick child.
When an individual deliberately makes someone
else sick, the condition is called factitious
disorder imposed on another.
It was also known previously as Munchausen
syndrome by proxy.
In any case, it is really an atypical form of child
abuse (Check, 1998).

Extra Notes:
Table 6.4 Diagnostic Criteria for Factitious
Disorders ➔ Usually starting with an adult
➔ Motivation to vicariously experience a “sick
A. Falsification of physical or psychological role” and imposed to another (i.e. a child, an
signs or symptoms, or induction of injury or aging family or a pet) who is falsely
disease, associated with identified presented as ill, impaired, or injured
deception.

Difference between Typical and Atypical Child

B. The individual presents himself or herself to Abuse
others as ill impaired or injured.

C. The deceptive behavior is evident even in

the absence of obvious external rewards
Extra Note:
➔ pwedeng internally motivated si
client

D. The behavior is not better accounted for

by another mental disorder such as
delusional belief system or acute psychosis.

Specify if:
Single episode
Recurrent episodes: Two or more events of
falsification of illness and/or induction of injury

—-----------------------------------------------------------------

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 Dissociative Disorders
When individuals feel detached from themselves
or their surroundings, almost as if they are
dreaming or living in slow motion, they are
having dissociative experiences.
Morton Prince, the founder of the Journal of
Abnormal Psychology, noted more than 100 years
ago that many people experience something like
dissociation occasionally (Prince, 1906-1907)
Extra Notes:
➔ When a person experience dissociation, it
doesn’t automatically mean that he/she had
a disorder
➔ When dissociative was experience, it is a
must to trace when it started
It might be likely to happen áfter an extremely
stressful event, such as an accident (Spiegel,
2010).
It also is more likely to happen when you're tired
or sleep deprived from staying up all night
cramming for an exam (Giesbrecht, Smeets,
Leppink, Jelicic, & Merckelbach, 2007)
Translent experiences of dissociation will occur
in about half of the general population at some
point in their lives, and studies suggest that if a
person experiences a traumatic event, between
3196 and 66 will have this feeling at that time
(Hunter, Sierra, & David, 2004; Keane, Manx,
Sloan& DePrince, 201),.
Because it's hard to measure dissociation, the
connection between trauma and dissociation is
controversial (Giesbrecht, Lynn, Lillenfeld, &
Merckelbach, 2008)
2 types of dissociative
During an episode of (1) depersonalization
- your perception alters so that you
temporarily lose the sense of your own
reality, as if you were in a dream and you
were watching yourself.
During an episode of (2) derealization
- your sense of the reality of the external
world is lost
Things may seem to change shape or size;
people may seem dead or mechanical.
These sensations of unreality are characteristic of
dissociative disorders because, in a sense, they
are a psychological mechanism whereby one
"dissociates" from reality.
Depersonalization
- is often part of a serious set of conditions
in which reality, experience, and even
identity seem to disintegrate.
Extra Note:
➔ Reality Testing
◆ still intact
◆ they still know where they are, and
know who they are
But what happens if we can't remember why we are
in a certain place or even who we are? What
happens if we lose our sense that our surroundings
are real?
Finally, what happens if we not only forget who we
are but also begin thinking we are somebody
else-somebody who has a different personality,
different memories, and even different physical
reactions, such as allergies we never had?
These are examples of disintegrated experience
(Dell &O'Nell, 2009, Spiegel, 2010, Spiegel et al,
2013;van der Hart & Nijenhuis, 2009).
In each case, there are alterations in our
relationship to the self, to the world, or to memory
processes.
—-----------------------------------------------------------------
Depersonalization-Derealization Disorder
When feelings of unreality are so severe and
frightening that they dominate an individual's life
and prevent normal functioning, clinicians may
diagnose the rare depersonalization-derealization
disorder.
Extra Notes:
➔ The person is aware of the surroundings
(reality intact). However, vision and
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 perception of what is happening including
themselves is distorted or strang
➔ Different from schizophrenia or panic
disorder
Table 6.5 Diagnostic Criteria for Depersonalization -
Derealization Disorder
A. The presence of persistent or recurrent
experiences of depersonalization,
derealization, or both:
Depersonalization: Experiences of
unreality, detachment, or being an outside
observer with respect to one's thoughts
feelings sensations, body or actions (eg.
perceptual alterations distorted sense of
time, unreal or absent self, emotional and/or
physical numbing)
Derealization: Experiences of unreality or
detachment with respect to surroundings
(eg, individuals or objects are experienced
as unreal, dreamlike, foggy, lifeless, or
visually distorted).
B. During the depersonalization or
derealization experience, reality testing
remains intact.
C. The symptoms cause clinically significant
distress or impairment in social
occupational, or other important areas of
functioning
D. The disturbance is not attributable to the
physiological effects of a substance (eg. a
drug of abuse, medication) or another
medical condition (eg. seizures)
E. The disturbance is not better explained by
another mental disorder, such as
schizophrenia or panic disorder.
Extra Notes:
➔ What it’s like to live with a depersonalization
disorder for the last 3 years (Comic
Illustration)
Depersonalization:
- feels like watching yourself from inside your
head
- sometimes from outside your body
- feeling really spaced out
-
Derealization
- Everything looks like a dream
- we often feel “alienated”
- and others feel “robot-like”
“I often feel disconnected from myself and the
world, my vision is blurred as if there was a glass in
front of my face”
“Looking into a mirror is hard cause i have a hard
time to recognize myself… I know it’s me but
everything looks so unfamiliar”
“Sometimes even looking at my own hands is hard
because they don’t feel and look like mine”
“It’s horrible when people you love or surroundings
you know well are appearing strange and
unfamiliar.”
“I am sorry I can’t look at you your face is so
strange.”
“Personally, I always have a hard time when I talk
to people… I feel so “robot-like” that I don’t really
feel I’m the one talking”
“We have no loss of reality we know that all of
those symptoms are “not real” but it causes a lot of
anxiety and fear”
—-----------------------------------------------------------------
Dissociative Amnesia
People who are unable to remember anything,
including who they are, are said to suffer from
generalized amnesia.
Generalized amnesia may be lifelong or may
extend from a period in the more recent past,
such as 6 months or a year previously.
Far more common than general amnesia is
localized or selective amnesia, a failure to recall
specific events, usually traumatic, that occur
during a specific period.
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Dissociative amnesia is common during war
(Cardeña & Gleaves, 2003; Spiegel et al., 2013)
Table 6.5 Diagnostic Criteria for Depersonalization -
Derealization Disorder
A. The presence of persistent or recurrent
experiences of depersonalization,
derealization, or both:
Depersonalization: Experiences of
unreality, detachment, or being an outside
observer with respect to one's thoughts
feelings, sensations, body or actions (eg.
perceptual alterations distorted sense of
time, unreal or absent self, emotional and/or
physical numbing)
Derealization: Experiences of unreality or
detachment with respect to surroundings
(eg. individuals or objects are experienced
as unreal, dreamlike, foggy, lifeless, or
visually distorted)
B. During the depersonalization or
derealization experience, reality testing
remains intact.
C. The symptoms cause clinically significant
distress or impairment in social
occupational, or other important areas of
functioning
D. The disturbance is not attributable to the
physiological effects of a substance (eg. a
drug of abuse, medication) or another
medical condition (eg. seizures).
E. The disturbance is not better explained by
another mental disorder, such as
schizophrenia or panic disorder.
Dissociative fugue (Ross, 2009)
- is a sub-type of dissociative amnesia with
fugue literally meaning "flight" (fugitive is
from the same root).
- In these curious cases, memory loss
revolves around a specific incident-an
unexpected trip (or trips).
- Mostly, individuals just take off and later find
themselves in a new place, unable to
remember why or how they got there
- Usually they have left behind an intolerable
situation. During these trips, a person
sometimes assumes a new identity or at
least becomes confused about the old
identity.
—-----------------------------------------------------------------
Dissociative Identity Disorder
People with dissociative identity disorder (DID) may
adopt as many as 100 new identities, all
simultaneously coexisting although the average
number is closer to 15.
In some cases, the identities are complete, each
with its own behavior, tone of voice, and physical
gestures.
But in many cases, only a few characteristics are
distinct, because the identities are only partially
independent, so it is not true that there are
"multiple" complete personalities.
Therefore, the name of the disorder was changed
in the last edition of the DSM, DSM-IV, from
multiple personality disorder to DID.
Extra Notes:
➔ Multiple Personality Disorder
◆ passed name of DID
◆ Changed because the characters
that form/manifest to the client are
interlapping
◆ Thus, if multiple, they are totally
independent from one another
➔ Dissociative Identity Disorder
◆ In some cases, the character knows
each other while some don’t
◆ There is conflict/relationship
between the characters
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 ◆ Not all clinicians are convinced or
believed in the disorder
(skepticism)
◆ Controversial link between trauma
and DID:
● For many reported cases of
DID, they have a history of
trauma (abuse)
● The characters were
appeared as the client’s
way of coping in the
traumatic event
Table 6.7 Diagnostic Criteria for Dissociative
Identity Disorder
A. Disruption of identity characterized by two
or more distinct personality states, which
may be described in some cultures as an
experience of possession. The
disruption of marked discontinuity in
sense of self and sense of agency,
accompanied by related alterations in affect,
behavior, consciousness, memory,
perception, cognition, and/or sensory-motor
functioning. These signs and symptoms
may be observed by others or reported
by the individual
B. Recurrent gaps in the recall of everyday
events, important personal information,
and/or traumatic events that are
inconsistent with ordinary forgetting
C. The symptoms cause clinically significant
distress or impairment in social,
occupational or other important areas of
functioning
D. The disturbance is not a normal part of a
broadly accepted cultural or religious
practice.
- Note: In children, the symptoms are
not attributable to imaginary
playmates or other fantasy play.
E. The symptoms are not attributable to the
physiological effects of a substance (eg.
blackouts or chaotic behavior during alcohol
intoxication) or another medical condition
(eg. complex partial seizures)
_________________________________________
Lesson 5: Mood Disorders and Suicide
An Overview of Depression and Mania
The disorders described in this lesson used to be
categorized under several general labels, such as
“depressive disorders,” ”affective disorders,” or
even “depressive neuroses.”
Beginning with the third edition of the
Diagnostic and Statistical Manual (DSM-III),
published by the American Psychiatric Association
in 1980, these problems have been grouped under
the heading mood disorders because they are
characterized by gross deviations in mood.
The fundamental experiences of depression and
mania contribute, either singly or together, to all the
mood disorders.
Extra Notes:
➔ When a person has normal mood
◆ euthymic
➔ elevated mood
◆ possible mania/euphoria
➔ low mood
◆ depression/dysphoria
➔ Hedonism
◆ someone who seeks pleasure
◆ associated to having lavish material
things or lifestyle
Anhedonia
- (loss of energy and inability to engage in
pleasurable activities or have any “fun”)
is more characteristic of severe episodes of
depression than are, for example, reports of
sadness or distress (Pizzagalli, 2014).
- This anhedonia reflects that these episodes
represent a state of low positive affect and
not just high negative affect.
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Mania
- individuals find extreme pleasure in every
activity
- some patients compare their daily
experience of mania with a continuous
sexual orgasm.
- They become extraordinarily active
(hyperactive), require little sleep, and
may develop grandiose plans, believing
they can accomplish anything they desire.
- DSM-5 highlights this feature by adding
criteria “persistently increased
goal-directed activity or energy”.
- Speech is typically rapid and may become
incoherent, because the individual is
attempting to express so many exciting
ideas at once; this feature is typically
referred to as flight of ideas.
- DSM-5 criteria for a manic episode require
a duration of only 1 week, less if the
episode is severe enough to require
hospitalization.
- Irritability is often part of a manic episode,
usually near the end.
- Paradoxically, being anxious or depressed
is also commonly part of mania.
Hypomania
- DSM-5 also defines a hypomanic episode, a
less severe version of a manic episode
that does not cause marked impairment
in social occupational functioning and need
last only 4 days rather than a full week.
- (Hypo means “below”; thus the episode is
below the level of a manic episode.)
- A hypomanic episode is not in itself
necessarily problematic, but its presence
does not contribute to the definition of
several mood disorders.
Extra Notes:
➔ milder form of mania
➔ hypomania is a criteria in other forms of
bipolar disorders
--------------------------------------------------------------------
Types of Mood Disorders
1. Depressive (Unipolar)
a.) Major Depressive Disorder
● Symptoms of major depressive
disorder:
● Begin suddenly, often triggered by
a crisis, change, or loss
● Are extremely severe, interfering
with normal functioning
● Can be long term, lasting months
or years if untreated
● Some people have only one
episode but the pattern usually
involves repeated episodes or
lasting symptoms.
b.) Persistent Depressive Disorder
(Dysthymia)
- Long-term unchanging symptoms
of mild depression, sometimes
lasting 20 to 30 years if untreated.
- Daily functioning is not as severely
affected, but over time impairment
is cumulative.
Extra Note:
➔ long term and chronic (continuous)
c.) Double Depression
- Alternating periods of major
depression and dysthymia.
2. Bipolar
People who have a bipolar disorder live on an
unending emotional roller coaster.
This reviewer is NOT FOR SALE.
 ◆ loss of interest and motivation
Types of Bipolar Disorders
a.) Bipolar I: major depression and full ➔ Anhedonia is a symptom of depression
mania
b.) Bipolar II: major depression and mild Table 7.1: Criteria for Major Depressive Episode
mania A. Five (or more) of the following symptoms
c.) Cyclothymia: mild depression with mild have been present during the same 2-week
mania, chronic and long term. period and represent a change from
previous functioning; at least one of the
Extra Note: symptoms is either (1) depressed mood or
➔ Cyclothymia: (2) loss of interest or pleasure.
◆ rarely diagnose disorder
◆ mild which may last Note: Do not include symptoms that are clearly
chronically and long term due to a general medical condition or
mood-incongruent delusions or hallucinations.
During the Depressive Phase, the person may:
● Lose all interest in pleasurable activities and 1. Depressed mood most of the day,
friends nearly every day, as indicated by
● Feel worthless, helpless, and hopeless either subjective report (e.g.., feels
● Have trouble concentrating sad or empty) or observation made
● Lose or gain weight without trying by others (e.g., appears tearful).
● Have trouble sleeping or sleep more than - Note: in children and
usual adolescents can be irritable
● Feel tired all the time mood.
● Feel physical aches and pains that have no
medical cause 2. Markedly diminished interest or
● Think about death or attempt suicide pleasure in all, or almost all,
activities most of the day, nearly
During the Manic Phase, the person may: every day (as indicated by either
● Feel extreme pleasure and joy from every subjective account or observation
activity made by others) - or anhedonia
● Be extremely active, planning excessive
daily activities 3. Significant weight loss when not
● Sleep little without getting tired dieting or weight gain (e.g., a
● Develop grandiose plans leading to change of more than 5% of body
reckless behavior: unrestrained buying weight in a month), or decrease or
sprees, sexual indiscretions, foolish increase in appetite nearly every
business investments, etc. day.
● Have “racing thoughts” and talk on and on - Note: in children, consider
● Be easily irritated and distracted failure to make expected
weight gains.
—-----------------------------------------------------------------
Major Depressive Episode 4. Insomnia or hypersomnia nearly
every day.
Extra Notes:
Anhedonia vs Depression 5. Psychomotor agitation or
➔ Depression retardation nearly every day
◆ combination of different behavior (observable by others, not merely
➔ Anhedonia

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 subjective feelings of restlessness or
being slowed down).
6. Fatigue or loss of energy nearly
every day.
7. Feelings of worthlessness or
excessive or inappropriate guilt
(which may be delusional) nearly
every day (not merely self-reproach
or guilt about being sick).
8. Diminished ability to think or
concentrate, or indecisiveness,
nearly every day (either by
subjective account or as observed
by others).
9. Recurrent thoughts of death (not
just fear of dying), recurrent suicidal
ideation without a specific plan, or a
suicide attempt or a specific plan for
committing suicide.
B. The symptoms cause clinically
significant distress or impairment in
social, occupational, or other important
areas of functioning.
C. The symptoms are not due to the direct
physiological effects of a substance
(e.g., a drug of abuse, a medication) or a
general medical condition (e.g.,
hypothyroidism).
—-----------------------------------------------------------------
Manic Episode
Table 7.2: Criteria for Manic Episode
A. A distinct period of abnormally and
persistently elevated, expansive or irritable
mood and abnormally and persistently
increased goal-directed activity or energy,
lasting at least 1 week and present most of
the day, nearly every day (or any duration
if hospitalization is necessary).
B. During the period of mood disturbance and
increased energy or activity, three (or more)
of the following symptoms (four if the mood
is only irritable) are present to a
significant degree and represent a
noticeable change from usual behavior:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (e.g.,
feels rested after only 3 hours of
sleep)
3. More talkative than usual or
pressure to keep talking.
4. Flight of ideas or subjective
experience that thoughts are racing
5. Distractibility (i.e., attention too
easily drawn to unimportant or
irrelevant external stimuli), as
reported or observed
6. Increase in goal-directed activity
(either socially, at work or school, or
sexually) or psychomotor agitation
(e.g., purposeless non-goal directed
activity)
7. Excessive involvement in activities
that have a high potential for painful
consequences (e.g., engaging in
unrestrained buying sprees, sexual
indiscretions, or foolish business
investments).
C. The mood disturbance is sufficiently
severe to cause marked impairment in
social or occupational functioning or to
necessitate hospitalization to prevent
harm to self or others, or there are psychotic
features.
D. The episode is not attributable to the
physiological effects of a substance
(e.g., a drug of abuse, a medication, other
treatment) or to another general medical
condition.
Note: A full manic episode that emerges during
antidepressant treatment (e.g., medication,
electroconvulsive therapy) but persists at a fully
syndromal level beyond the physiological effect of
that treatment is sufficient evidence of a manic
episode and, therefore, a bipolar I diagnosis.
—-----------------------------------------------------------------
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 Major Depressive Disorder
Table 7.3: Diagnostic Criteria for Major Depressive
Disorder

A. At least one major depressive episode

(DSM-5 Table 7.2 Criteria A-C).

B. The occurrence of the major depressive

episode is not better explained by
schizoaffective disorder , schizophrenia,
schizophreniform disorder, delusional
disorder, or other specified and unspecified
schizophrenia spectrum and other psychotic
disorders.

C. There has never been a manic episode or

hypomanic episode.

- Note: This exclusion does not apply

if all of the manic-like or
hypomanic-like episodes are
substance-induced or are
attributable to the direct
physiological effects of another
medical condition.
Extra Notes:
Specify the clinical status and/or features of the
➔ In the image above, black flat line
current or most recent major depressive episode:
symbolizes normal mood
● Single episode or recurrent episode
➔ blue, represents depressed mood
● Mild, moderate, severe
➔ Since nasa baba lahat ng blue -> unipolar
● With anxious distress
mood/depression sila
● With mixed features
➔ Yung vertical line -> time (weeks, months,
● With melancholic features
or years)
● With atypical features
● With mood-congruent psychotic features
Some Examples:
● With mood-incongruent psychotic features
- panel a -> nonchronic major depressive
● With catatonia
disorder -> may times na walang depression
● With peripartum onset - symptoms that
- panel b & d -> chronic depression
begin during pregnancy or within four weeks
- panel b -> dysthymia na walang
of delivery
● With seasonal pattern (recurrent episode halong depression
only) - panel d -> chronic siya dahil
● In partial remission, in full remission naka-isang episode pero
nagtuloy-tuloy
--------------------------------------------------------------------

Persistent Depressive Disorder (Dysthymia)

This reviewer is NOT FOR SALE.


Extra Note:
➔ Chronic type na mild depression pero may
have severity
Table 7.4: Diagnostic Criteria for Persistent
Depressive Disorder (Dysthymia)
A. Depressed mood for most of the day, for
more days than not, as indicated by either
subjective account or observation by others,
for at least 2 years
- Note: In children and adolescents,
mood can be irritable and duration
must be at least 1 year.
B. Presence, while depressed, of two (or more)
of the following:
1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration or difficulty
making decisions
6. Feelings of hopelessness
C. During the 2-year old period (1 year for
children or adolescents) of the disturbance,
the person has never been without the
symptoms in criteria A and B for more than
2 months at a time.
D. Criteria for major depressive disorder may
be continuously present for 2 years.
E. There has never been a manic episode or
a hypomanic episode, and criteria have
never been met for cyclothymic disorder.
F. The disturbance is not better explained by a
persistent schizoaffective disorder,
schizophrenia, delusional disorder, or other
specified or unspecified schizophrenia
spectrum and other psychotic disorder.
G. The symptoms are not attributable to the
physiological effects of a substance (e.g., a
drug of abuse, a medication) or another
medical condition (e.g., hypothyroidism)
H. The symptoms cause clinically significant
distress or impairment in social,
occupational, or other important areas of
functioning.
Specify if:
● Current severity: Mild, moderate, severe
● With anxious distress
● With mixed features
● With melancholic features
● With atypical features
● With mood-congruent psychotic features
● With mood-incongruent psychotic features
● With peripartum onset
● Early onset: If onset is before age 21 years
● Late onset: If onset is at age 21 years or
older
● Specify (for most recent 2 years of
dysthymic disorder)
● With pure dysthymic syndrome if full
criteria for a major depressive episode
have been met throughout the preceding
2-year period.
● With intermittent major depressive
episodes, with current episode, if full criteria
for a major depressive episode are currently
met, but there have been periods of at least
8 weeks in at least the preceding 2 years
with symptoms below the threshold for a full
major depressive episode.
● With intermittent major depressive
episodes, without current episode if full
criteria for a major depressive episode are
not currently met, but there has been one or
more major depressive episodes in at least
the preceding 2 years in full remission, in
partial remission.
—-----------------------------------------------------------------
This reviewer is NOT FOR SALE.
 Grief
TABLE 7.2: Normal and Complicated Grief
Common symptoms of acute grief that are within
normal limits within the first 6-12 months after:
- Recurrent, strong feelings of yearning,
wanting very much to be reunited with
the person who died; possibly even a wish
to die In order to be with deceased loved
one
- Pangs of deep sadness or remorse,
episodes of crying or sobbing, typically
interspersed with periods of respite and
even positive emotions
- Steady stream of thoughts or images of
deceased, may be vivid or even entail
hallucinatory experiences of seeing or
hearing deceased person
- Struggle to accept the reality of the
death, wishing to protest against it; there
may be some feelings of bitterness or anger
about the death
- Somatic distress, e.g., uncontrollable
sighing, digestive symptoms, loss of
appetite, dry mouth, feelings of hollowness,
sleep disturbance, fatigue, exhaustion or
weakness, restlessness, aimless activity,
difficulty initiating or maintaining organized
activities, and altered sensorium
- Feeling disconnected from the world or
other people, indifferent, not interested, or
irritable with others
Symptoms of integrated grief that are within
normal limits:
- Sense of having adjusted to the loss
- Interest and sense of purpose, ability to
function, and capacity for joy and
satisfaction are restored
- Feelings of emotional loneliness may persist
- Feelings of sadness and longing tend to be
in the background but still present
- Thoughts and memories of the deceased
person accessible and bittersweet but no
longer dominate the mind
- Occasional hallucinatory experiences of the
deceased may occur
- Surges of grief in response to calendar days
or other periodic reminders of the loss may
occur
Complicated grief
- Persistent intense symptoms of acute grief
- The presence of thoughts, feelings, or
behaviors reflecting excessive or
distracting concerns about the
circumstances or consequences of the
death
—-----------------------------------------------------------------
Premenstrual Dysphoric Disorder
Table 7.5 Diagnostic Criteria for Premenstrual
Dysphoric Disorder
A. In the majority of menstrual cycles, at least
five symptoms must be present in the final
week before the onset of menses, start to
improve within a few days after the onset
of menses, and become minimal or
absent in the week postmenses.
B. One (or more) of the following symptoms
must be present:
1. Marked affective liability (e.g.,
mood swings, feeling suddenly sad
or tearful, or increased sensitivity to
rejection).
2. Marked irritability or anger or
increased interpersonal conflicts.
3. Marked depressed mood, feelings
of hopelessness, or self-depreciating
thoughts.
4. Marked anxiety, tension, and/or
feelings of being keyed up or on
edge.
C. One (or more) of the following symptoms
must additionally be present, to reach a
This reviewer is NOT FOR SALE.
 total of five symptoms when combined
with symptoms from Criterion B above:
1. Decreased interest in usual activities
(e.g., work, school, friends, hobbies).
2. Subjective difficulty in concentration.
3. Lethargy, easy fatigability, or marked
lack of energy.
4. Marked change in appetite;
overeating or specific food cravings.
5. Hypersomnia or insomnia.
6. A sense of being overwhelmed or
out of control.
7. Physical symptoms such as breast
tenderness or swelling, joint or
muscle pain, a sensation of
“bloating” or weight gain.
Note: The symptoms in Criteria A-C must have
been met for most menstrual cycles that occurred
in the preceding year.
D. The symptoms are associated with
clinically significant distress or
interference with work, school, usual
social activities, or relationships with
others (e.g., avoidance of social activities,
decreased productivity and efficiency at
work, school, or home).
E. The disturbance is not merely an
exacerbation of the symptoms of another
disorder, such as major depressive
disorder, panic disorder, persistent
depressive disorder (dysthymia), or a
personality disorder (although it may
co-occur with any of these disorders).
F. Criterion A should be confirmed by
prospective daily ratings during at least two
symptomatic cycles.
Note: The diagnosis may be confirmed by
prospective daily ratings during at least two
symptomatic cycles.
G. The symptoms are not attributable to the
physiological effects of a substance
(e.g., a drug of abuse, a medication) or
another medical condition (e.g.,
hypothyroidism).
--------------------------------------------------------------------
Disruptive Mood Dysregulation Disorder
Table 7.5 Diagnostic Criteria for Disruptive Mood
Dysregulation Disorder
A. Severe recurrent temper outburst
manifested verbally (e.g., verbal rages)
and/or behaviorally (e.g., physical
aggression toward people or property) that
are grossly out of proportion in intensity or
duration to the situation or provocation.
B. The temper outbursts are inconsistent
with developmental level.
C. The temper outbursts occur, on average,
three or more times per week.
D. The mood between temper outbursts is
persistently irritable or angry most of the
day, nearly every day, and is observable by
others (e.g.) parents, teachers, peers).
E. Criteria A-D have been present for 12 or
more months. Throughout that time, the
individual has not had a period lasting 3 or
more consecutive months without all of the
symptoms in Criteria A-D.
F. Criteria A and D are present in at least two
or three settings (i.e., at home, at school,
with peers) and are severe in at least one of
these.
G. The diagnosis should not be made for the
first time before age 6 years or after age
18 years.
H. By history or observation, the age at onset
of Criteria A-E is before 10 years.
I. There has never been a distinct period
lasting more than 1 day during which the
full symptom criteria, except duration, for a
manic or hypomanic episode have been
met.
This reviewer is NOT FOR SALE.

Note: Developmentally appropriate mood elevation,
such as occurs in the context of a highly positive
event or its anticipation, should not be considered
as a symptom of mania or hypomania.
J. The behaviors do not occur exclusively
during an episode of major depressive
disorder and are not better explained by
another mental disorder (e.g. autism
spectrum disorder, post-traumatic stress
disorder (e.g., autism spectrum disorder,
post-traumatic stress disorder, separation
anxiety disorder, persistent depressive
disorder [dysthymia]).
K. The symptoms are not attributable to the
physiological effects of a substance or to
another medical or neurological condition.
--------------------------------------------------------------------
Cyclothymic Disorder
Table 7.7: Diagnostic Criteria for Cyclothymic
Disorder
Extra Note:
➔ combination of mild depression and mild
mania which is chronic and long term
A. For at least 2 years (at least 1 year in
children and adolescents) there have been
numerous periods with hypomanic
symptoms that do not meet criteria for a
hypomanic episode and numerous periods
with depressive symptoms that do not meet
criteria for a major depressive episode.
B. During the above 2-year period (1 year in
children and adolescents), the hypomanic
and depressive periods have been present
for at least half of the time and the individual
has not been without the symptoms for
more than 2 months at a time.
C. Criteria for a major depressive, manic, or
hypomanic episode have never been met.
D. The symptoms in criterion A are not better
explained by schizoaffective disorder,
schizophrenia, schizophreniform disorder,
delusional disorder or other specified or
unspecified schizophrenia spectrum and
other psychotic disorder.
E. The symptoms are not attributable to the
physiological effects of a substance (e.g., a
drug of abuse, a medication) or another
medical condition (e.g., hyperthyroidism).
F. The symptoms cause clinically significant
distress or impairment in social
occupational, or other important areas of
functioning.
Specify if:
With anxious distress
—-----------------------------------------------------------------
Bipolar II Disorder
Table 7.8: Diagnostic Criteria for Bipolar II Disorder
A. Criteria have been met for at least one
hypomanic episode and at least one
major depressive episode. Criteria for a
hypomanic episode are identical to those for
a manic episode (see DSM-5 Table 7.2),
with the following distinctions:
1) Minimum duration is 4 days;
2) Although the episode represents
a definite change in functioning, it is
not severe enough to cause marked
social or occupational impairment or
hospitalization;
3) There are no psychotic features.
B. There has never been a manic episode.
C. The occurrence of the hypomanic
episode(s) and major depressive episode(s)
is not better explained by schizoaffective
disorder, schizophrenia, schizophreniform
disorder, delusional disorder or other
This reviewer is NOT FOR SALE.
 specified or unspecified schizophrenia
spectrum and other psychotic disorder.

D. The symptoms of depression or the

unpredictability caused by frequent
alternation between periods of depression
and hypomania causes clinically significant
distress or impairment in social
occupational, or other important areas of
functioning.

Specify current or most recent episode:

● Hypomanic: If currently (or most recently)
in a hypomanic episode
● Depressed: if currently (or most recently)
in a major depressive episode

Specify if:
● With anxious distress
● With mixed features
● With rapid cycling
● With mood-congruent psychotic features
● With mood-incongruent psychotic features
● With catatonia
● With peripartum onset
● With seasonal pattern

Specify course if full criteria for a mood episode are

Integrative Model for Mood Disorders
not currently met: In full remission, in partial
remission

Specify severity if full criteria for a mood episode

are currently met: Mild, moderate, severe

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 - Lithium is the preferred drug for bipolar
Exploring Mood Disorders disorder; side effects can be serious; and
dosage must be carefully regulated

● Cognitive-Behavioral Therapy

- Helps depressed people:

- leam to replace negative
depressive thoughts and
attributions with more
positive one’s
- develop more effective
coping behaviors and skills
Extra Note:
➔ Not that much advisable since it has
negative effect (may cause memory
loss, or memory loss functions)

● Interpersonal Psychotherapy
- Helps depressed people:
- focus on the social and
interpersonal triggers for their
depression (such as the loss
-------------------------------------------------------------------- of a loved one)
Treatment of Mood Disorders - develop skills to resolve
interpersonal conflicts and
Treatment build new relationships
● Medication
- Antidepressants can help to control ● Electroconvulsive Therapy (ECT)
symptoms and restore - For severe depression, ECT is used
neurotransmitter functioning. when other treatments have been
Extra Note: ineffective.
➔ recommended to go to a psychiatrist for - It usually has temporary side effects,
proper medical treatment such as memory loss and lethargy.
- In some patients, certain intellectual
Common types of antidepressants: and/or memory functions may be
- Tricyclics (Tofranil, Elavil) permanently lost.

- Monamine oxidase inhibitors (MAO ● Light Therapy

inhibitors): (Nardil, Parmate); MAO inhibitors - For seasonal affective disorder
can have severe side effects, especially
when combined with certain foods or --------------------------------------------------------------------
over-the-counter medications Suicide

- Selective-serotonin reuptake inhibitors or Past Conceptions

SSRls (Prozac, Zoloft) are newer and cause - The great sociologist Emile Durkeim (1951)
fewer side effects than tricyclics or MAO defined a number of suicide types, based
inhibitors on the social and cultural conditions in
which they occurred.

This reviewer is NOT FOR SALE.

 - Durkheim’s work was important in alerting than outward to the person or situation
us to the social contribution of suicide. causing the anger.
- Indeed, suicide victims often seem to be
Suicide Types: psychologically “punishing” others who
a. Altruistic Suicide: may have been rejected them or caused
- One type is “formalized” suicides that were some other personal hurt.
approved of, such as the ancient custom of
hara-kiri in Japan

- in which an individual who brought

dishonor to himself or his family was
expected to impale himself on a sword.
Durkeim referred to this as altruistic suicide.

b. Egoistic Suicide:
- Durkheim also recognized the loss of
social supports as an important
provocation for suicide;
- he called this egoistic suicide.
- (Older adults who kill themselves after
losing touch with their friends or family fit
into this category).
- A recent study found that suicide attempters
perceived themselves to have lower social
support than did non-attempters
(Rihikami, Vuorilehto, Melartin, Haukka, &
Isometsa, 2013).

c. Anomic Suicide
- Anomic suicides are the result of marked
disruptions, such as the sudden loss of a
high-prestige job. (Anomie is feeling lost
and confused.)

d. Fatalistic Suicide
- Finally, fatalistic suicides result from a loss
of control over one’s own destiny.
- The mass suicide of 39 Heaven’s Gate cult
members in 1997 is an example of this type
because the lives of those people were
largely in the hands of Marshall
Applewhite, a supreme and charismatic
leader.

Sigmund Freud (1917/1957)

- believed that suicide (and depression, to
some extent) indicated unconcious
hostility directed inward to the self rather

This reviewer is NOT FOR SALE.