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Psychological Disorders

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Title: Psychological Disorders


1
Psychological Disorders
  • Chapter 16

2
DSM-IV-TR
  • DSM Diagnostic and Statistical Manual of Mental
    Disorders (4th Edition, Text Revision)
  • Book that contains
  • Characteristics that define each disorder
  • Additional features that are usually present
  • How to distinguish this disorder from others
  • List of symptoms that must be present (diagnostic
    criteria)
  • NOS Not Otherwise Specified

3
DSM-IV-TR
  • Axis I - clinical disorders, including major
    mental disorders, (typically what we think the
    diagnosis is)
  • Axis II long standing personality disorders,
    maladaptive traits, and mental retardation
  • Axis III physical disorders, general medical
    conditions (that will impact Axis I, II)
  • Axis IV current stress level, environmental
    factors
  • Axis V Global Assessment of Functioning

4
SIGNS VS. SYMPTOMS
  • Signs any features, feelings, noticed by
    someone that is NOT the client (What the
    psychologist would notice)
  • Symptoms any features, feelings, noticed and
    reported by the patient client (What the client
    usually comes in about)
  • Malingering pretending to have symptoms that
    you do not actually have

5
Disorders Diagnosed in Infancy, Childhood, or
Adolescence
  • Onset must be before age 18
  • Cannot function in daily life as a normal
    person of that age
  • impairments in social interaction, impairments in
    communication, restricted interests and
    repetitive behavior

6
Disorders Diagnosed in Infancy, Childhood, or
Adolescence
  • Mental Retardation (Axis II) Diagnostic
    Criteria
  • IQ is below 70
  • Two or more are below what is expected for the
    persons age 1) Communication, 2) Caring for
    self, 3) Safety, 4) Working, 5) Relating to
    Others, 6) Living at home, 7) Health, 8) Using
    Free Time, 9) Academic Functioning, 10) Directing
    Self, 11) Using Community Resources
  • Begins before age 18

7
Disorders Diagnosed in Infancy, Childhood, or
Adolescence
  • Mental Retardation IQ is below 70

8
  • IQ RANGE CLASSIFICATION
  • 144 up Genius
  • 130-144 Gifted
  • 115-129 Above Average
  • 100-114 Higher Average
  • 85-99 Lower Average
  • 70-84 Below Average
  • 50/55-70 Mild Mental Retardation
  • 35/40-50/55 Moderate M.R.
  • 20/25-35/40 Severe M.R.
  • Below 20/25 Profound M.R.

9
Disorders Diagnosed in Infancy, Childhood, or
Adolescence
  • Autism - impairments in social interaction,
    impairments in communication, restricted
    interests and repetitive behavior
  • Behavior is noticed before age of 2 or 3

10
Disorders Diagnosed in Infancy, Childhood, or
Adolescence
  • Autism Diagnostic Criteria
  • Two or more of the following 1) Deficient
    social interaction via nonverbal behaviors, i.e.,
    eye contact, facial expression, body posture, and
    gestures 2) Inappropriate peer relationships 3)
    Absence of sharing achievements, interests or
    pleasure 4) Absence of social or emotional
    reciprocity

11
Disorders Diagnosed in Infancy, Childhood, or
Adolescence
  • One or more of the following 1) Delayed or
    absent development of spoken language without
    compensation through gestures 2) Unable to begin
    or sustain conversation (of those who can speak)
    3) Repetitive, stereotyped or idiosyncratic
    language 4) social imitative play or
    spontaneous, make-believe play is absent.

12
Disorders Diagnosed in Infancy, Childhood, or
Adolescence
  • One or more of the following 1) Intense
    preoccupation with stereotyped and restricted
    interests, i.e., spinning things 2) Routines or
    rituals with no apparent function 3) Repetitive
    or stereotyped mannerisms, i.e., hand flapping
    4) Absorbed with parts of objects
  • Lack one or more before the age of three 1)
    Social interaction 2) Language used in social
    communication 3) Play that is imaginative and
    symbolic

13
APPLIED BEHAVIOR ANALYSIS
  • http//www.youtube.com/watch?vim04U9Be4mA
  • http//www.youtube.com/watch?vwTTvTweONQQfeature
    related

14
DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR
ADOLESCENCE
  • Aspergers Disorder high functioning Autism
    IQ is more normal, behavior is more normal, but
    social interactions are still not quite there

15
DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR
ADOLESCENCE
  • (A )Qualitative impairment in social interaction,
    as manifested by at least two of the following
  • marked impairment in the use of multiple
    nonverbal behaviors such as eye-to-eye gaze,
    facial expression, body postures, and gestures to
    regulate social interaction
  • failure to develop peer relationships appropriate
    to developmental level
  • a lack of spontaneous seeking to share enjoyment,
    interests, or achievements with other people
    (e.g., by a lack of showing, bringing, or
    pointing out objects of interest to other people)
  • lack of social or emotional reciprocity.

16
DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR
ADOLESCENCE
  • (B)Restricted repetitive and stereotyped patterns
    of behavior, interests, and activities, as
    manifested by at least one of the following
  • encompassing preoccupation with one or more
    stereotyped and restricted patterns of interest
    that is abnormal either in intensity or focus
  • apparently inflexible adherence to specific,
    non-functional routines or rituals
  • stereotyped and repetitive motor mannerisms
    (e.g., hand or finger flapping or twisting, or
    complex whole-body movements)
  • persistent preoccupation with parts of objects

17
DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR
ADOLESCENCE
  • Oppositional Defiant Disorder - ongoing pattern
    of disobedient, hostile and defiant behavior
    toward authority figures which goes beyond the
    bounds of normal childhood behavior

18
DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR
ADOLESCENCE
  • A. A pattern of negativistic, hostile, and
    defiant behavior lasting at least 6 months,
    during which four (or more) of the following are
    present ?(1) often loses temper ?(2) often
    argues with adults ?(3) often actively defies or
    refuses to comply with adults' requests or
    rules ?(4) often deliberately annoys people ?(5)
    often blames others for his or her mistakes or
    misbehavior ?(6) is often touchy or easily
    annoyed by others ?(7) is often angry and
    resentful ?(8) is often spiteful or vindictive 
  • ?Note Consider a criterion met only if the
    behavior occurs more frequently than is typically
    observed in individuals of comparable age and
    developmental level. 

19
DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR
ADOLESCENCE
  • Conduct Disorder - repetitive behavior wherein
    the rights of others or social norms are violated
    takes place in childhood and/or adolescence
    goes beyond normal rebellion

20
DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR
ADOLESCENCE
  • Conduct Disorder Diagnostic Criteria
  • A. A repetitive and persistent pattern of
    behavior in which the basic rights of others or
    major age-appropriate societal norms or rules are
    violated, as manifested by the presence of three
    (or more) of the following criteria in the past
    12 months, with at least one criterion present in
    the past 6 months Aggression to people and
    animals (1) often bullies, threatens, or
    intimidates others ?(2) often initiates physical
    fights ?(3) has used a weapon that can cause
    serious physical harm to others (e.g., abat,
    brick, broken bottle, knife, gun) ?(4) has been
    physically cruel to people ?(5) has been
    physically cruel to animals ?(6) has stolen while
    confronting a victim (e.g., mugging, purse
    snatching, extortion, armed robbery) ?(7) has
    forced someone into sexual activity 

21
  • Destruction of property (8) has deliberately
    engaged in fire setting with the intention of
    causing serious damage ?(9) has deliberately
    destroyed others' property (other than by fire
    setting)Deceitfulness or theft (10) has broken
    into someone else's house, building, or car ?(11)
    often lies to obtain goods or favors or to avoid
    obligations (i.e., "cons" others) ?(12) has
    stolen items of nontrivial value without
    confronting a victim (e.g., shoplifting, but
    without breaking and entering forgery) Serious
    violations of rules (13) often stays out at
    night despite parental prohibitions, beginning
    before age 13 years ?(14) has run away from home
    overnight at least twice while living in parental
    or parental surrogate home (or once without
    returning for a lengthy period) ?(15) is often
    truant from school, beginning before age 13 years 

22
  • B. The disturbance in behavior causes clinically
    significant impairment in social, academic, or
    occupational functioning. 
  • C. If the individual is age 18 years or older,
    criteria are not met for Antisocial Personality
    Disorder. Specify type based on age at
    onset (Childhood or Adolescence)

23
Substance Related Disorders
  • Drug Addiction both psychological (you think
    you need it) and physiological addictions (your
    body needs it, and needs more)
  • Tolerance the body gets used to a certain
    amount of drugs so it needs more and more and
    more and more (this is true even of something
    like Advil)
  • Dependence
  • Abuse
  • Intoxication
  • Withdrawal

24
Schizophrenia Psychotic Disorders
  • thought processes are not based on reality, and
    are expressed in different ways
  • Symptoms
  • Positive Delusions, hallucinations (things
    added)
  • Negative - flat affect (things taken away)
  • Symptoms not due to other medical conditions/drug
    use

25
Schizophrenia Psychotic Disorders
  • Subtypes
  • Paranoid delusions, auditory hallucinations
    (hearing voices)
  • Catatonic remain motionless in unusual
    positions (waxy flexibility)
  • Disorganized inappropriate emotions, laughing
    for no reason
  • Undifferentiated criteria for schizophrenia is
    met, but not paranoid, catatonic, or disorganized
  • Residual still have a few symptoms of
    schizophrenia, but no more delusions/
    hallucinations

26
Schizophrenia Psychotic Disorders
  • Diagnostic Criteria
  • A. Characteristic symptoms Two (or more) of the
    following, each present for a significant portion
    of time during a 1-month period (or less if
    successfully treated) 
  • (1) delusions
  • (2) hallucinations
  • (3) disorganized speech (e.g., frequent
    derailment or incoherence) 
  • (4) grossly disorganized or catatonic behavior
  • (5) negative symptoms, i.e., affective
    flattening, alogia, or avolition 

27
  • Note Only one Criterion A symptom is required if
    delusions are bizarre or hallucinations consist
    of a voice keeping up a running commentary on the
    person's behavior or thoughts, or two or more
    voices conversing with each other. 
  • B. Social/occupational dysfunction For a
    significant portion of the time since the onset
    of the disturbance, one or more major areas of
    functioning such as work, interpersonal
    relations, or self-care are markedly below the
    level achieved prior to the onset (or when the
    onset is in childhood or adolescence, failure to
    achieve expected level of interpersonal,
    academic, or occupational achievement). 

28
  • C. Duration Continuous signs of the disturbance
    persist for at least 6 months. This 6-month
    period must include at least 1 month of symptoms
    (or less if successfully treated) that meet
    Criterion A (i.e., active-phase symptoms) and may
    include periods of prodromal(start) or residual
    (end) symptoms. During these prodromal or
    residual periods, the signs of the disturbance
    may be manifested by only negative symptoms or
    two or more symptoms listed in Criterion A
    present in an attenuated form (e.g., odd beliefs,
    unusual perceptual experiences). 

29
Catatonic Schizophrenia
  • A type of Schizophrenia in which the clinical
    picture is dominated by at least two of the
    following 
  • (1) motoric immobility as evidenced by catalepsy
    (including waxy flexibility) or stupor (2)
    excessive motor activity (that is apparently
    purposeless and not influenced by external
    stimuli) (3) extreme negativism (an apparently
    motiveless resistance to all instructions or
    maintenance of a rigid posture against attempts
    to be moved) or mutism (4) peculiarities of
    voluntary movement as evidenced by posturing
    (voluntary assumption of inappropriate or bizarre
    postures), stereotyped movements, prominent
    mannerisms, or prominent grimacing (5) echolalia
    or echopraxia

30
Disorganized Schizophrenia
  • A type of Schizophrenia in which the following
    criteria are met 
  • A. All of the following are prominent 
  • (1) disorganized speech (2) disorganized
    behavior (3) flat or inappropriate affect 
  • B. The criteria are not met for Catatonic Type.

31
Paranoid Schizophrenia
  • A type of Schizophrenia in which the following
    criteria are met 
  • A. Preoccupation with one or more delusions or
    frequent auditory hallucinations.
  •  B. None of the following is prominent
    disorganized speech, disorganized or catatonic
    behavior, or flat or inappropriate affect.

32
Residual Schizophrenia
  • A type of Schizophrenia in which the following
    criteria are met 
  • A. Absence of prominent delusions,
    hallucinations, disorganized speech, and grossly
    disorganized or catatonic behavior. 
  • B. There is continuing evidence of the
    disturbance, as indicated by the presence of
    negative symptoms or two or more symptoms listed
    in Criterion A for Schizophrenia, present in an
    attenuated form (e.g., odd beliefs, unusual
    perceptual experiences).

33
Undifferentiated Schizophrenia
  • A type of Schizophrenia in which symptoms that
    meet Criterion A are present, but the criteria
    are not met for the Paranoid, Disorganized, or
    Catatonic Type.

34
Schizophrenia Psychotic Disorders
  • Schizoaffective Disorder
  • A. An uninterrupted period of illness during
    which, at some time, there is either a Major
    Depressive Episode, a Manic Episode, or a Mixed
    Episode concurrent with symptoms that meet
    Criterion A for Schizophrenia. Note The Major
    Depressive Episode must include Criterion A1
    depressed mood. 
  • B. During the same period of illness, there have
    been delusions or hallucinations for at least 2
    weeks in the absence of prominent mood symptoms. 
  • C. Symptoms that meet criteria for a mood episode
    are present for a substantial portion of the
    total duration of the active and residual periods
    of the illness. 

35
SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS
  • Schizoaffective Disorder a combination of
    delusions/hallucinations (schizophrenia) with
    mood changes (bipolar)

36
Mood Disorders
  • Manic Episode lasts a week, with at least three
    of the following symptoms
  • (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) (6) increase in
    goal-directed activity (either socially, at work
    or school, or sexually) or psychomotor
    agitation(7) excessive involvement in
    pleasurable activities that have a high potential
    for painful consequences (e.g., engaging in
    unrestrained buying sprees, sexual indiscretions,
    or foolish business investments) 
  • These symptoms must be severe enough to make
    functioning in society impossible and may run the
    risk of hospitalization

37
MOOD DISORDERS
  • Hypomanic Episode displays the same symptoms of
    a manic episode EXCEPT, it lasts around 4 days
    (instead of a week) and the person is still able
    to function properly in society
  • Depressive episode for two weeks includes (at
    least five) symptoms such as depressed mood, loss
    of interest, weight gain/loss, insomnia/hypersomni
    a, restlessness, feelings of worthlessness,
    feelings of guilt, inability to concentrate,
    thoughts of death

38
MOOD DISORDERS
  • Bipolar I your basic bipolar the most people
    have heard of presence of manic (or hypomanic)
    episodes and depressive episodes usually stay in
    each episode for a significant amount of time
    before switching (not just mood swings)
  • Bipolar II bipolar without the presence of a
    manic episode (only hypomanic and major
    depressive)

39
MOOD DISORDERS
  • Major Depressive Disorder a reoccurrence of at
    least two major depressive episodes within two
    months
  • Dysthymic Disorder (Eeyore) for at least two
    years, displaying depressed symptoms more often
    than not (hopelessness, not eating, low
    self-esteem, low energy, etc.) NO
    manic/hypomanic/major depressive episodes this
    is low grade depression

40
MOOD DISORDERS
  • Dysthymic DisorderA. Depressed mood for most of
    the day, for more days than not, as indicated
    either by 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 

41
  • C. During the 2-year 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. No Major Depressive Episode has been present
    during the first 2 years of the disturbance (1
    year for children and adolescents) i.e., the
    disturbance is not better accounted for by
    chronic Major Depressive Disorder, or Major
    Depressive Disorder, In Partial Remission. Note
    There may have been a previous Major Depressive
    Episode provided there was a full remission (no
    significant signs or symptoms for 2 months)
    before development of the Dysthymic Disorder. In
    addition, after the initial 2 years (1 year in
    children or adolescents) of Dysthymic Disorder,
    there may be superimposed episodes of Major
    Depressive Disorder, in which case both diagnoses
    may be given when the criteria are met for a
    Major Depressive Episode. 
  • E. There has never been a Manic Episode, a Mixed
    Episode, or a Hypomanic Episode, and criteria
    have never been met for Cyclothymic Disorder. 

42
MOOD DISORDERS
  • Cyclothymic low grade bipolar no manic
    episodes (only hypomanic) and no major depressive
    (more like dysthymic) symptoms must be present
    for at least 2 years with no longer than 2 months
    without symptoms
  • Seasonal Affective Disorder depression when it
    is cold/dark out (winter) treated with
    fluorescent light (tanning bed)

43
MOOD DISORDERS
  • Major Depressive DisorderA. Presence of two or
    more Major Depressive Episodes. functioning at
    least one of the symptoms is either    (1)
    depressed mood or   (2) loss of interest or
    pleasure. Note Do not include symptoms that are
    clearly due to a general medical condition, or
    mood-incongruent delusions or hallucinations. 
  • Note To be considered separate episodes, there
    must be an interval of at least 2 consecutive
    months in which criteria are not met for a Major
    Depressive Episode. 
  • Major Depressive Episode. Five (or more) of the
    following symptoms have been present during the
    same 2-week period and represent a change from
    previous

44
MOOD DISORDERS
  • Major Depressive Episode(1) depressed mood most
    of the day, nearly every day, as indicated by
    either subjective report (e.g., feels sad or
    empty) or observation made by others (e.g.,
    appears tearful). Note In children and
    adolescents, can be irritable mood. (2) markedly
    diminished interest or pleasure in all, or almost
    all, activities most of the day, nearly every day
    (as indicated by either subjective account or
    observation made by others) (3) significant
    weight loss when not dieting or weight gain
    (e.g., a change of more than 5 of body weight in
    a month), or decrease or increase in appetite
    nearly every day. Note In children, consider
    failure to make expected weight gains. (4)
    Insomnia or Hypersomnia nearly every day 

45
  • (5) psychomotor agitation or retardation nearly
    every day (observable by others, not merely
    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 

46
MOOD DISORDERS
  • Cyclothymic Disorder
  • A. For at least 2 years, the presence of numerous
    periods with hypomanic symptoms (see p. 338) and
    numerous periods with depressive symptoms that do
    not meet criteria for a Major Depressive Episode.
    Note In children and adolescents, the duration
    must be at least 1 year. 
  • B. During the above 2-year period (1 year in
    children and adolescents), the person has not
    been without the symptoms in Criterion A for more
    than 2 months at a time. 

47
  • C. No Major Depressive Episode, Manic Episode, or
    Mixed Episode has been present during the first 2
    years of the disturbance. Note After the
    initial 2 years (1 year in children and
    adolescents) of Cyclothymic Disorder, there may
    be superimposed Manic or Mixed Episodes (in which
    case both Bipolar I Disorder and Cyclothymic
    Disorder may be diagnosed) or Major Depressive
    Episodes (in which case both Bipolar II Disorder
    and Cyclothymic Disorder may be diagnosed). 

48
MOOD DISORDERS
  • Bipolar I
  • Diagnosis of this Bipolar Disorder requires at
    least one Manic episode, but there may be
    episodes of Hypomania or Major Depression as
    well. (This diagnosis conforms to the classic
    concept of manic depressive illness.)

49
MOOD DISORDERS
  • Manic EpisodeA. A distinct period of abnormally
    and persistently elevated, expansive, or
    irritable mood, lasting at least 1 week (or any
    duration if hospitalization is necessary). 
  • B. During the period of mood disturbance, three
    (or more) of the following symptoms have
    persisted (four if the mood is only irritable)
    and have been present to a significant degree 
  • (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) (6) increase in
    goal-directed activity (either socially, at work
    or school, or sexually) or psychomotor
    agitation(7) excessive involvement in
    pleasurable 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 occupational
    functioning or in usual social activities or
    relationships with others, or to necessitate
    hospitalization to prevent harm to self or
    others, or there are psychotic features. 

50
ANXIETY DISORDERS
  • Anxiety a vague, generalized feeling that one
    is in danger
  • Anxiety disorders are usually irrational and
    causes inability to function properly in society

51
ANXIETY DISORDERS
  • Panic (with or without agoraphobia) having
    panic attacks followed by a month of worry about
    having another one, concern of what will happen
    if another one occurs, etc
  • Panic attack four of the following within ten
    minutes increased heart rate, sweating,
    shaking, shortness of breath, feeling of choking,
    chest pain, nausea, dizziness, derealization/deper
    sonalization, fear of going crazy, fear of dying,
    numbness, chills/hot flashes
  • Agoraphobia fear of being in a place where
    escape may be difficult

52
ANXIETY DISORDERS
  • Specific phobia irrational fear of a certain
    thing/situation even the anticipation of that
    thing causes anxiety interferes with daily
    lifeTypes Animal Natural Environment
    (heights, storms), Blood-Injection-Injury,
    Situational (airplanes, enclosed spaces),
    Other

53
ANXIETY DISORDERS
  • Social Phobia fear of acting in a way that will
    be humiliating or embarrassing in front of
    peers/elders or unfamiliar people these
    situations are avoided as much as possible or are
    entered with much anxiety (possible panic attacks)

54
ANXIETY DISORDERS
  • Obsessive Compulsive Disorder (OCD) 1.
    Obsessions recurrent thoughts impulses,
    excessive worries, attempting to ignore thoughts,
  • 2. Compulsions repetitive behaviors aimed to
    reduce stress, are excessive
  • It is understood that the obsessions and
    compulsions are irrational consumes more than
    one hour of the day
  • Not the same as OCPD

55
ANXIETY DISORDERS
  • Posttraumatic Stress Disorder (PTSD)
  • Traumatic Event experience, witness event where
    actual or threatened death is present response
    involves fear helplessness or horror
  • Event is reexperienced through intrusive
    thoughts, dreams, reliving the experience
    (flashbacks/hallucinations), distress when
    external cues occur, physiological response
  • Avoidance of activities, places, recollections,
    detachment, restricted affect (emotions)
  • Acute less than 3 months
  • Chronic more than 3 months

56
Anxiety Disorders
  • Acute Stress very similar to PTSD except the
    duration happens 2 days after event up to 4
    weeks lasting longer may become PTSD
  • Generalized Anxiety excessive worry for at
    least 6 months (more often than not) including
    restlessness or on edge, easily fatigued,
    difficulty concentrating, irritability, muscle
    tension, sleep disturbance

57
SOMATOFORM DISORDERS
  • Defined physical symptoms for which there is no
    apparent physical cause
  • Somatization before age of 30, with no prior
    medical conditions (related) or no lab results
    confirming problems four or more of the
    following at the same time, in four different
    body parts
  • Four general body pain symptoms
  • Two gastrointestinal symptoms
  • One Sexual symptom
  • One Pseudoneurological symptom

58
SOMATOFORM DISORDERS
  • Conversion Disorder a condition in which the
    person is experiencing neurological symptoms
    (numbness, paralysis) and the cause is not
    physiological, but psychological (stressors in
    life)
  • Hypochondriasis for at least 6 months, fears of
    having a serious disease regardless of
    reassurance from a doctor (and is not any other
    disorder)

59
SOMATOFORM DISORDERS
  • Body Dysmorphic Disorder a slight flaw is seen
    as excessively worse than it actually is
    preoccupation with this is so significant that is
    causes problems social/occupational functioning

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SOMATOFORM DISORDERS
  • Body Dysmorphic Disorder
  • A. Preoccupation with an imagined defect in
    appearance. If a slight physical anomaly is
    present, the person's concern is markedly
    excessive. 
  • B. The preoccupation causes clinically
    significant distress or impairment in social,
    occupational, or other important areas of
    functioning. 
  • C. The preoccupation is not better accounted for
    by another mental disorder (e.g., dissatisfaction
    with body shape and size in Anorexia Nervosa).

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SOMATOFORM DISORDERS
  • Conversion Disorder
  • A. One or more symptoms or deficits affecting
    voluntary motor or sensory function that suggest
    a neurological or other general medical
    condition. 
  • B. Psychological factors are judged to be
    associated with the symptom or deficit because
    the initiation or exacerbation of the symptom or
    deficit is preceded by conflicts or other
    stressors. 
  • C. The symptom or deficit is not intentionally
    produced or feigned (as in Factitious Disorder or
    Malingering). 

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SOMATOFORM DISORDERS
  • A. Preoccupation with fears of having, or the
    idea that one has, a serious disease based on the
    person's misinterpretation of bodily symptoms. 
  • B. The preoccupation persists despite appropriate
    medical evaluation and reassurance. 
  • C. The belief in Criterion A is not of delusional
    intensity (as in Delusional Disorder, Somatic
    Type) and is not restricted to a circumscribed
    concern about appearance (as in Body Dysmorphic
    Disorder). 
  • D. The preoccupation causes clinically
    significant distress or impairment in social,
    occupational, or other important areas of
    functioning. 
  • E. The duration of the disturbance is at least 6
    months. 

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SOMATOFORM DISORDERS
  • Somatization Disorder
  • A. A history of many physical complaints
    beginning before age 30 years that occur over a
    period of several years and result in treatment
    being sought or significant impairment in social,
    occupational, or other important areas of
    functioning. 
  • B. Each of the following criteria must have been
    met, with individual symptoms occurring at any
    time during the course of the disturbance 
  • (1) four pain symptoms a history of pain related
    to at least four different sites or functions
    (e.g., head, abdomen, back, joints, extremities,
    chest, rectum, during menstruation, during sexual
    intercourse, or during urination) (2) two
    gastrointestinal symptoms a history of at least
    two gastrointestinal symptoms other than pain
    (e.g., nausea, bloating, vomiting other than
    during pregnancy, diarrhea, or intolerance of
    several different foods) (3) one sexual symptom
    a history of at least one sexual or reproductive
    symptom other than pain (e.g., sexual
    indifference, erectile or ejaculatory
    dysfunction, irregular menses, excessive
    menstrual bleeding, vomiting throughout
    pregnancy) (4) one pseudoneurological symptom a
    history of at least one symptom or deficit
    suggesting a neurological condition not limited
    to pain (conversion symptoms such as impaired
    coordination or balance, paralysis or localized
    weakness, difficulty swallowing or lump in
    throat, aphonia, urinary retention,
    hallucinations, loss of touch or pain sensation,
    double vision, blindness, deafness, seizures
    dissociative symptoms such as amnesia or loss of
    consciousness other than fainting) 

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  • C. Either (1) or (2) 
  • (1) after appropriate investigation, each of the
    symptoms in Criterion B cannot be fully explained
    by a known general medical condition or the
    direct effects of a substance (e.g., a drug of
    abuse, a medication) (2) when there is a related
    general medical condition, the physical
    complaints or resulting social or occupational
    impairment are in excess of what would be
    expected from the history, physical examination,
    or laboratory findings 
  • D. The symptoms are not intentionally feigned or
    produced (as in Factitious Disorder or
    Malingering).

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DISSOCIATIVE DISORDERS
  • Dissociative Amnesia inability to recall
    important information (who you are, where you
    live, who family members are) as a result of
    something extremely stressful, and is not just
    ordinary forgetfulness
  • Dissociative Fugue sudden, unexpected (or
    unplanned) travel away from home where a new
    identity (full or partial) is formed

66
DISSOCIATIVE DISORDERS
  • Dissociative Identity Disorder two or more
    distinct personalities (each with own traits,
    world views, etc.) people with this disorder
    usually have been sexually or verbally abused
  • Not all of the personalities know about each
    other
  • Host the main personality usually the actual
    person but not necessarily their true personality
    (more fearful, reserved)
  • Formerly known as Multiple Personality Disorder
    EXTREMELY rare and highly debated

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DISSOCIATIVE DISORDERS
  • Dissociative Amnesia
  • A. The predominant disturbance is one or more
    episodes of inability to recall important
    personal information, usually of a traumatic or
    stressful nature, that is too extensive to be
    explained by ordinary forgetfulness. 
  • B. The disturbance does not occur exclusively
    during the course of Dissociative Identity
    Disorder, Dissociative Fugue, Posttraumatic
    Stress Disorder, Acute Stress Disorder, or
    Somatization Disorder and is not due to the
    direct physiological effects of a substance
    (e.g., a drug of abuse, a medication) or a
    neurological or other general medical condition
    (e.g., Amnestic Disorder Due to Head Trauma). 
  • C. The symptoms cause clinically significant
    distress or impairment in social, occupational,
    or other important areas of functioning.

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DISSOCIATIVE DISORDERS
  • Dissociative Fugue
  • A. The predominant disturbance is sudden,
    unexpected travel away from home or one's
    customary place of work, with inability to recall
    one's past. 
  • B. Confusion about personal identity or
    assumption of a new identity (partial or
    complete). 

69
DISSOCIATIVE DISORDERS
  • Dissociative Identity Disorder
  • A. The presence of two or more distinct
    identities or personality states (each with its
    own relatively enduring pattern of perceiving,
    relating to, and thinking about the environment
    and self). 
  • B. At least two of these identities or
    personality states recurrently take control of
    the person's behavior. 
  • C. Inability to recall important personal
    information that is too extensive to be explained
    by ordinary forgetfulness. 

70
ADJUSTMENT DISORDERS
  • Adjustment Disorder over a three month period
    (no longer than six months) where a stressor
    causes significant emotional or behavioral
    symptoms (but does not meet criteria for other
    disorders
  • Chronic longer than six months
  • Acute less than six months

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ADJUSTMENT DISORDERS
  • Six types
  • With Anxiety fearful, nervous, worried
  • With Depressed Mood hopeless, tearful, sad
  • With Disturbance of Conduct not following
    rules, violates others rights
  • With Mixed Anxiety and Depressed Mood
  • With Mixed Disturbance of Emotions and Conduct
    both conduct and emotional problems
  • Unspecified problems that are social, physical,
    job related, personal, etc.

72
ADJUSTMENT DISORDERS
  • Adjustment Disorder
  • A. The development of emotional or behavioral
    symptoms in response to an identifiable
    stressor(s) occurring within 3 months of the
    onset of the stressor(s). 
  • B. These symptoms or behaviors are clinically
    significant as evidenced by either of the
    following 
  • (1) marked distress that is in excess of what
    would be expected from exposure to the
    stressor (2) significant impairment in social or
    occupational (academic) functioning 
  • C. The stress-related disturbance does not meet
    the criteria for another specific Axis I disorder
    and is not merely an exacerbation of a
    preexisting Axis I or Axis II disorder. 
  • D. The symptoms do not represent Bereavement. 
  • E. Once the stressor (or its consequences) has
    terminated, the symptoms do not persist for more
    than an additional 6 months. 

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PERSONALITY DISORDERS
  • Personality Disorders are AXIS II
  • Usually can be traced from childhood/adolescence
    and are consistent throughout ones life
  • Thoughts, emotions, interpersonal functioning and
    impulse control deviate from what is normal
    within ones culture

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PERSONALITY DISORDERS
  • Paranoid Personality Disorder
  • Paranoid personality disorder is characterized by
    a distrust of others and a constant suspicion
    that people around you have sinister motives.
    People with this disorder tend to have excessive
    trust in their own knowledge and abilities and
    usually avoid close relationships. They search
    for hidden meanings in everything and read
    hostile intentions into the actions of others.
    They are quick to challenge the loyalties of
    friends and loved ones and often appear cold and
    distant. They usually shift blame to other people
    and tend to carry long grudges.

75
PERSONALITY DISORDERS
  • Schizoid Personality Disorder
  • People with schizoid personality disorder avoid
    relationships and do not show much emotion.
    Unlike avoidants, schizoids genuinely prefer to
    be alone and do not secretly wish for popularity.
    They tend to seek jobs that require little social
    contact. Their social skills are often weak and
    they do not show a need for attention or
    acceptance. They are perceived by others as
    humorless and distant and often are termed
    loners.

76
PERSONALITY DISORDERS
  • Schizotypal Personality Disorder
  • Many believe that schizotypal personality
    disorder represents mild schizophrenia. The
    disorder is characterized by odd forms of
    thinking and perceiving, and individuals with
    this disorder often seek isolation from others.
    They sometimes believe to have extra sensory
    ability or that unrelated events relate to them
    in some important way. They generally engage in
    eccentric behavior and have difficulty
    concentrating for long periods of time. Their
    speech is often over elaborate and difficult to
    follow.

77
PERSONALITY DISORDERS
  • Antisocial Personality Disorder
  • A common misconception is that antisocial
    personality disorder refers to people who have
    poor social skills. The opposite is often the
    case. Instead, antisocial personality disorder is
    characterized by a lack of conscience. People
    with this disorder are prone to criminal
    behavior, believing that their victims are weak
    and deserving of being taken advantage of.
    Antisocials tend to lie and steal. Often, they
    are careless with money and take action without
    thinking about consequences. They are often
    aggressive and are much more concerned with their
    own needs than the needs of others.

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PERSONALITY DISORDERS
  • Borderline Personality Disorder
  • Frantically avoids abandonment, unstable
    relationships, poor self-image, self-damaging
    impulsivity (spending money, reckless driving,
    sex, use of alcohol/drugs, etc.), self-mutilating
    behavior/suicidal, feelings of emptiness/mood
    swings, etc.
  • Very, very needy
  • Borderline personality disorder is characterized
    by mood instability and poor self-image. People
    with this disorder are prone to constant mood
    swings and bouts of anger. Often, they will take
    their anger out on themselves, causing injury to
    their own body. Suicidal threats and actions are
    not uncommon. Borderlines think in very black and
    white terms and often form intense,
    conflict-ridden relationships. They are quick to
    anger when their expectations are not met.

79
PERSONALITY DISORDERS
  • Histrionic Personality Disorder
  • - People with histrionic personality disorder are
    constant attention seekers. They need to be the
    center of attention all the time, often
    interrupting others in order to dominate the
    conversation. They use grandiose language to
    describe everyday events and seek constant
    praise. They may dress provocatively or
    exaggerate illnesses in order to gain attention.
    Histrionics also tend to exaggerate friendships
    and relationships, believing that everyone loves
    them. They are often manipulative.

80
PERSONALITY DISORDERS
  • Narcissistic Personality Disorder
  • Narcissistic personality disorder is
    characterized by self-centeredness. Like
    histrionic disorder, people with this disorder
    seek attention and praise. They exaggerate their
    achievements, expecting others to recognize them
    as being superior. They tend to be choosy about
    picking friends, since they believe that not just
    anyone is worthy of being their friend.
    Narcissists tend to make good first impressions,
    yet have difficulty maintaining long-lasting
    relationships. They are generally uninterested in
    the feelings of others and may take advantage of
    them.

81
PERSONALITY DISORDERS
  • Avoidant Personality Disorder
  • Avoidant personality disorder is characterized by
    extreme social anxiety. People with this disorder
    often feel inadequate, avoid social situations,
    and seek out jobs with little contact with
    others. Avoidants are fearful of being rejected
    and worry about embarrassing themselves in front
    of others. They exaggerate the potential
    difficulties of new situations to rationalize
    avoiding them. Often, they will create fantasy
    worlds to substitute for the real one. Unlike
    schizoid personality disorder, avoidants yearn
    for social relations yet feel they are unable to
    obtain them. They are frequently depressed and
    have low self-confidence.

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PERSONALITY DISORDERS
  • Dependent Personality Disorder
  • Dependent personality disorder is characterized
    by a need to be taken care of. People with this
    disorder tend to cling to people and fear losing
    them. They may become suicidal when a break-up is
    imminent. They tend to let others make important
    decisions for them and often jump from
    relationship to relationship. Dependents often
    remain in abusive relationships. Over-sensitivity
    to disapproval is common. Dependents often feel
    helpless and depressed.

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PERSONALITY DISORDERS
  • Obsessive Compulsive Personality Disorder
  • While Obsessive-Compulsive personality disorder
    (OCDP) sounds similar in name to
    obsessive-compulsive anxiety disorder, the two
    are markedly different disorders. People with
    obsessive-compulsive personality disorder are
    overly focused on orderliness and perfection.
    Their need to do everything right often
    interferes with their productivity. They tend to
    get caught up in the details and miss the bigger
    picture. They set unreasonably high standards for
    themselves and others, and tend to be very
    critical of others when they do not live up to
    these high standards. They avoid working in
    teams, believing others to be too careless or
    incompetent. They avoid making decisions because
    they fear making mistakes and are rarely generous
    with their time or money. They often have
    difficulty expressing emotion.
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