ABNORMAL PSYCHOLOGY (LAST DISCUSSION)

Psychopathology - scientific study of psychological disorders

● Clinical description - unique combination of behaviors, thoughts and feelings that make
up a specific disorder.
● Etiology - origins and cause which includes biological, psychological and social
dimensions.
● Treatment and outcome - pharmacology, psychological or combined.

Clinical description

● Presenting problem - why the person came to the clinic

● Prevalence - how many people in the population have the disorder
● Incidence - how many new cases occur during a given period

Course - individual pattern of a disorder

● Chronic - last a long time
● Episodic - recover and suffer a recurrence at a later time
● Time-limited - it will improve without treatment

Onset - start of the disorder

● Acute - begin suddenly
● Insidious - develop gradually over an extended period

Prognosis - anticipated course of a disorder

● "The prognosis is good"
● "The prognosis is guarded"

Psychological disorder
- a psychological dysfunction within an individual that is associated with distress or
impairment in functioning and a response that is not typical or culturally expected.

Psychological dysfunction
- breakdown in cognitive, emotional or behavioral functioning

Personal distress
- situation is extremely upsetting

Atypical or Not Culturally expected

- it deviates from the average (norms)
- violation of social norms

Disability
 - impairment in some important areas in life

Danger
- to self and others

Models in Explaining Abnormalities

Diathesis Stress Model

- individual inherit tendencies to express certain traits or behaviors, which may then be
activated under conditions of stress

Diathesis (inherited tendencies) + Stress (Stressors) = Disorder

Gene- Environment Correlation Model

- Reciprocal Gene-Environment Model
- Genetic endowment may increase the probability that an individual will experience
stressful life events
- "Influence of Genes"

Neuroscience Model
- how the brain works is central to any understanding behaviors, emotions and cognitive
processes

Psychological

Psychological School/ Perspective Cause of the Disorder

Psychoanalytic/ Psychodynamic Internal, unconscious drives, root in childhood

Humanistic Failure to strive to one's potential or being,

out of touch with one's feelings, being too
sensitive to other's criticisms/judgements,
lack of positive regard as a child

Behavioral Reinforcement history, the environment. At

some point, the abnormal behavior has been
rewarded or reinforced and is now an
established pattern of behavior

Cognitive Irrational, illogical, dysfunctional thoughts or

ways of thinking lead us to misperceive the
world (leading to abnormal behavior)
BioPsychoSocial

Biological Psychological Sociocultural

Brain Psychodynamic Social ills

Genes Learning Poverty
Neurotransmitters Humanistic Racism
Cognitive Ethnicity

Clinical Assessment and Diagnosis

Assessing Psychological Disorders

Clinical Assessment
- systematic evaluation and measurement of psychological, biological and social factors in
an individual presenting with a possible psychological disorder

Diagnosis
- process of determining whether the particular problem afflicting the individual meets all
criteria for a psychological disorder, as set forth in the fifth edition of the Diagnostic and
Statistical Manual of Mental Disorders or DSM-V

Reliability - consistency

Validity - measure what it is designed to measure

Standardization - application of certain standards to ensure consistency across different

measurements

Mental Status Examination

1. Appearance and Behavior
- overt behavior
- attire
- appearance, posture, expression
2. Thought process
- rate or flow of speech
- delusions
- hallucinations
3. Mood and Affect
- down, elated, depressed?
 - inappropriate, blunted or flat?
4. Intellectual functioning
- vocabulary
- memory
5. Sensorium
- general awareness
- person, place, time

Clinical Assessment
1. Physical Assessment
- medical condition
2. Behavioral Assessment
- direct observation
- rating scales
3. Psychological Testing
- projective test
- personality inventories
- intelligence testing
- neuropsychological testing

Symptoms
- subjective
- from patient/client
Signs
- objective
- from the psychologist psychiatrist
- can be measured by assessment tools

Case Formulation

1. Presenting problem
- chief complaints
2. Precipitating factors
- trigger
- actual events
3. Predisposing factors
- Vulnerabilities
4. Perpetuating factors
- maintaining factors
5. Protecting factors
- areas of competency, skills, talents, interests and supportive elements
Autism Spectrum Disorder
1. Persistent impairment in reciprocal social communication and social interaction (Criterion
A), and
2. Restricted repetitive patterns of behavior, interests, activities (Criterion B)
3. Symptoms are present in early childhood and limit or impair everyday functioning
(Criterion C and D)

Attention-Deficit/Hyperactivity Disorder
1. A persistent pattern of inattention and/or hyperactivity-impulsivity, interferes with
functioning and development
2. Inattention manifest behaviorally in ADHD as wandering off task, lacking persistence,
having difficulty sustaining focus, and being disorganized and is not due to defiance or
lack of comprehension
3. Hyperactivity refers to excessive motor activity (such as a child running about) when it is
not appropriate, or excessive fidgeting, tapping or talkativeness
4. Impulsivity refers to hasty actions that occur in the moment without forethought and that
have high potential for harm to the individual (e.g. darting into the street without looking)
5. Specify whether (for y months)
a. combined presentation
b. predominantly inattentive presentation
c. predominantly hyperactive/ impulsive presentation

Specific Learning Disorder

1. Persistent difficulties learning keystone academic skills (Criterion A), with onset during
the years of formal schooling (i.e. developmental period) (6 months)
2. Impairment in reading (Dyslexia)
3. Impairment in Mathematics (Dyscalculia)

MOTOR DISORDERS

Developmental Coordination Disorder

● The acquisition and execution of coordinated motor skills is substantially below that
expected given the individual's chronological age and opportunity for skill learning and
use

Stereotypic Movement Disorder

● Repetitive seemingly driven, and apparently purposeless motor behavior

Tic Disorders
 ● Presence of motor and/or vocal tics before 18 years old

TIC DISORDERS
- A tic is a sudden, rapid, recurrent, nonrhythmic, motor movement or vocalization

Tourette's Disorder
● Both multiple motor and one or more vocal tic
● More than 1 year

Persistent (Chronic) Motor or Vocal Tic Disorder

● Only motor or only vocal tics are present
● More than 1 year

Provisional Tic Disorder

● Motor and/or vocal tics may be present
● Less than 1 year

DELUSIONS
- Fixed beliefs that are no amenable to change on light of conflicting evidence

1. Persecutory - one is going to be harmed

2. Jealous - spouse or lover in unfaithful
3. Grandiose - exceptional abilities, wealth or fame
4. Erotomanic - another person is in love with him or her
5. Somatic - health and organ function
6. Referential - gestures, comments, environmental cues are directed at oneself
7. Nihilistic - major catastrophe will occur

BIZARRE DELUSIONS
- Implausible and not understandable same culture peers and do not derive from ordinary
experiences

1. Thought withdrawal - one's thoughts have been "removed" by some outside force
2. Thought insertion - alien thoughts have been put into one's mind
3. Delusions of control - one's body or actions are being acted on or manipulated by some
outside force

HALLUCINATIONS
- perception-like experiences that occur without an external stimulus

1. Visual
 2. Auditory
3. Tactile
4. Proprioceptive - flying or floating

Hypnagogic - while falling asleep

Hypnopompic - waking up

Broca's Area
- production of speech
- most active during auditory hallucination

Wernicke's Area
- comprehension of speech

DISORGANIZED THINKING (SPEECH)

- formal thought disorder

1. Derailment or Loose Association - switch from one topic to another

2. Tangentiality - answers yo questions may be obliquely related or completely related
3. Incoherence or "Word Salad" - severely organized that it is nearly comprehensible

ABNORMAL MOTOR BEHAVIOR

1. Catatonia - marked decrease in reactivity to the environment

2. Negativism - resistance to instructions
3. Mutism and Stupor - lack of verbal and motor responses
4. Catatonic Excitement - purposeless and excessive motor activity without obvious
cause

Key features the define the Psychotic Disorders

✓ Delusions
✓ Hallucinations
✓ Disorganized thinking (Speech)
✓ Grossly Disorganized or Abnormal Motor Behavior (Including Catatonia)
✓ Negative symptoms

NEGATIVE SYMPTOMS
 1. Diminished emotional expression - reductions in the expression of emotion
2. Avolition - decrease in motivated self-initiated purposeful activities
3. Alogia - diminished speech output
4. Anhedonia - decreased ability to experience pleasure
5. Asociality - lack of interest in social interactions

Delusional Disorder
● One or more delusions in one month or longer
● Nit met the criteria for schizophrenia
● Impairments in psychosocial functioning
● Subtypes:
○ Erotomanic
○ Grandiose
○ Jealous
○ Persecutory
○ Somatic
○ Mixed
○ Unspecified

PSYCHOTIC DISORDERS

Brief Psychotic Disorders

● Disturbance and sudden onset of positive symptoms
● 1 day to less than one month

Schizopreniform Disorder
● Symptoms of schizophrenia
● 1 to 6 months

Schizophrenia
● Two or more of the following:
○ Delusions
○ Hallucinations
○ Disorganized speech
○ Grossly disorganized or catatonic speech
○ Negative symptoms
● Impairment in functioning
● At least 6 months

Phases of Schizophrenia
 Prodromal Active Residual

Mild or subthreshold forms of Noticeable psychotic Fewer obvious symptoms

symptoms symptoms

Schizoaffective Disorder
● There is a major mood episode (major depressive or manic) concurrent with Criterion A
of schizophrenia
● Delusions or hallucinations must be present for at least 2 weeks in the absence of major
mood episode (depressive or manic) at some point during the lifetime duration of the
illness

BIPOLAR DISORDERS

Bipolar I Disorder
● It is necessary to meet the criteria for a manic episode
● The manic episode may have been preceded by and may be followed

Bipolar II Disorder
● It is necessary to meet the criteria for a current or past hypomanic episode and for a
current or past major depressive disorder.

Mania Hypomania

Symptoms Same Same

Duration 1 week 4 days

Severity Interfere with occupational or Must be noticeable to others

social functioning and but not severe enough to
requires hospitalization impair functioning or require
hospitalization

Cyclothymic Disorder
● 2 years (at least 1 year in children and adolescents)
● Numerous periods with hypomanic symptoms that do not meet the criteria for a
hypomanic episode
● Numerous periods with depressive symptoms that do not meet the criteria for depressive
episode
DEPRESSIVE DISORDERS

Disruptive Mood Dysregulation Disorder

● Chronic, severe persistent irritability
● This severe irritability has two prominent clinical manifestations:
○ frequent temper outbursts
○ chronic, persistent irritable or anger mood that is present between the severe
temper outbursts
● Present for 12 or more months
● Age of onset of the symptoms is before 10 years

Major Depressive Disorder

● Five or more symptoms for 2 weeks
○ Feeling sad
○ Lost of interest or pleasure
○ Changes in appetite- weight loss or gain unrelated to dieting
○ Trouble sleeping or sleeping too much
○ Loss of energy or increase in fatigue
○ Increase in purposeless physical activity or slowed movements or speech
○ Feeling worthless or guilty
○ Difficulty thinking, concentrating or making decisions
○ Thoughts of death or suicide

SUICIDE

Suicidal Ideation
- thinking seriously about suicide

Suicidal Plan
- formulation of a specific method for killing oneself

Suicidal Attempt
- the person survives

Complete Suicide

Types of Suicide by Emile Durkeim

A. Altruistic - killing oneself will serve a greater societal good
B. Egoistic - loss of social support
C. Anomic - sudden and unexpected changes in situations
D. Fatalistic - loss of control over one's own destiny
Persistent Depressive Disorder
● Depressed mood for most of the day, for more days than not, for at least two years or at
least 1 year for children and adolescents
● Two or more of the following:
○ Poor appetite or overeating
○ Insomnia or hypersomnia
○ Low energy or fatigue
○ Low self-esteem
○ Poor concentration or difficulty making decisions
○ Feeling of hopelessness

Premenstrual Dysphoric Disorder

● Expression of mood lability, irritability, dysphoria and anxiety symptoms that occur
repeatedly during the premenstrual phase of the cycle and remit around the onset of
menses or shortly thereafter.
● These symptoms may be accompanied by behavioral and physical symptoms.
● Symptoms must have occurred in most of the menstrual cycle during the past year and
must have an adverse effect on work or social functioning.

ANXIETY DISORDERS

Fear is the emotional response to real or perceived imminent threat.

Anxiety is anticipation of future threats.

Separation Anxiety Disorder

● Excessive fear or anxiety concerning separation from home or attachment figures.
● They experience recurrent excessive distress when separation from home or major
attachment figures is anticipated or occurs.
● They worry about the well being or death of attachment figures, particularly when
separated from them and they need to know the whereabouts of their attachment figures
and want to stay in touch with them.
● They also worry about untoward events to themselves such as getting lost, kidnapped,
or having an accident, they would keep them from ever being reunited with their major
attachment figure.
● At least 4 weeks in children and adolescents; 6 months or more in adults

Selective Mutism
 ● Consistent failure to speak in a specific social situations in which there is an expectation
for speaking (e.g. at school) despite speaking in other situations
● The disturbance interferes with educational or occupational achievement or with social
communication.
● The duration of the disturbance is at least 1 month (not limited to the first month of
school)
● The failure to speak is not attributable to a lack of knowledge of or comfort with, the
spoken language required in the social situation.

Specific Phobia
● Marked fear or anxiety about specific object or situation (e.g. flying, heights, animals,
receiving an injection, blood)
● The phobic object or situation almost always provokes immediate fear or anxiety.
● The phobic object or situation is actively avoided or endured with intense fear or anxiety.
● The fear or anxiety out of proportion to the actual danger posed by the specific object or
situation and to the sociocultural context.
● The fear, anxiety, and avoidance is persistent, typically lasting for 6 months and more.
● The fear, anxiety, and avoidance causes clinically significant distress or impairment in
social, occupational and other important areas of functioning.

SPECIFIC PHOBIA

● Animal - (e.g. spiders, insects, dogs)

● Natural environment - (e.g. heights, storms, water)
● Blood-injection-injury - (e.g. needles, invasive medical procedures)
● Situational - (e.g. airplanes, elevators, enclosed places)
● Other - (e.g. situations that may lead to choking or vomiting; in children loud sounds or
costumed characters)

Social Anxiety Disorder (Social Phobia)

● Marked, or intense fear, or anxiety of social situations in which the individual may be
scrutinized by others.
● When exposed to such a social situation, the individual fears that he or she will be
negatively evaluated.
● The social situations almost always provoke fear or anxiety.
● The social situations are avoided or endired with intense fear or anxiety.
● The fear or anxiety is out of proportion to the actual threat posed by the social situation
and sociocultural context.
● The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more.
 ● The fear, anxiety, and avoidance causes clinically significant distress or impairment in
social, occupational and other important areas of functioning.

Panic Disorder
● Recurrent unexpected panic attacks.
● A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a
peak within minutes, and during which time four or more of a list of 13 physical and
cognitive symptoms occur.

Agoraphobia
● Marked, or intense, or anxiety triggered by the anticipated exposure o a wide of
situations where escape might be difficult or help might not be available
● The diagnosis requires endorsement of symptoms occurring in at least two of the
following five situations:
○ Using public transportation, such as automobiles, buses, trains, ships, or planes
○ Being in open spaces, such as parking lots, marketplaces or bridges
○ Being in enclosed places, such as shops, theaters, or cinemas
○ Standing in line or being in a crowd; or being outside of the home alone

Generalized Anxiety Disorder

● Excessive anxiety and worry (apprehensive expectation) occurring more days or for at
least 6 months, about a number of events, or activities (such as work or school
performance)
● The individual finds it difficult to control the worry
● The anxiety or worry are associated with three (or more) of the following six symptoms
(with at least some symptoms having been present for more days than not for the past 6
months);
○ Restlessness or being keyed up or on edge
○ Being easily fatigue
○ Difficulty concentrating or mind going black
○ Irritability
○ Muscle tension
○ Sleep disturbance (difficulty staying or falling asleep or restless unsatisfying
sleep)
● The anxiety, worry or physical symptoms causes clinically significant distress or
impairment in social, occupational, or other important areas of functioning.
● The disturbance is not attributable to the physiological effects of a substance.

Obsessive-Compulsive Disorder
● Presence of obsessions, compulsions or both:
 ○ Obsessions
■ Recurrent and persistent thoughts, urges and images that are
experienced at some time during the disturbance, as intrusive and
unwanted, and that in most individuals cause marked anxiety or distress.
■ The individual attempts to ignore or suppress such thoughts, urges, or
images, or to neutralize them with some other thought or action (i.e. by
performing a compulsion)
○ Compulsions
■ Repetitive behaviors (e.g. handwashing, ordering, checking) or mental
acts (e.g. praying, counting, repeating words silently)
■ The behaviors or mental acts are aimed at preventing or reducing anxiety
or distress or preventing some dreaded event or situation; however, these
behaviors or mental acts are not connected in a realistic way with what
they are designed to neutralize or prevent or are clearly excessive.

The obsessions and compulsions are time-consuming (e.g. take more than one hour per day) or
cause clinically significant distress or impairment in social, occupational or other important areas
of functioning.

Body Dysmorphic Disorder

● Preoccupation with one or more perceived defects or flaws in physical appearance that
are not observable or appear slightly to others.
● At some point during the course of the disorder, the individual has performed repetitive
behaviors (e.g. mirror checking, excessive grooming, skin picking, reassurance seeking)
or mental acts (e.g. comparing his or her appearance with that of others) in response to
the appearance concern.
● The preoccupation causes clinically significant distress or impairment in social,
occupational, and other important areas of functioning.
● 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.

Hoarding Disorder
● Persistent difficulty discarding or parting with possessions, regardless of their actual
value.
● This difficulty is due to perceived need to save items and to distress associated with
discarding them.
● The difficulty discarding possessions results in the accumulation of possessions that
congest and clutter active living areas and substantially compromises their intended use.
If living areas are uncluttered, it is only because of interventions of third parties (e.g.
family members, cleaners, authorities)
 ● The hoarding causes clinically significant distress and impairment in social, occupational,
and other important areas of functioning (including maintaining a safe environment for
self and others)

Trichotillomania (Hair-pulling Disorder)

● Recurrent pulling out of one's hair, resulting in hair loss.
● Repeated attempts to decrease or stop hair-pulling.
● The hair-pulling causes clinically significant distress or impairment in social, occupational
and other important areas in functioning.
● The hair-pulling or hair loss is not attributable to another medical condition (e.g. a
dermatological condition)
● The hair-pulling is not better explained by the symptoms of another mental disorder (e.g.
attempts to improve a perceived defect or flaw in appearance in the body dysmorphic
disorder)

Excoriation (Skin-picking) Disorder

● Recurrent skin picking resulting in skin lesions.
● Repeated attempts to decrease or stop skin picking. The skin picking causes clinically
significant distress or impairment in social, occupational and other important areas in
functioning.
● The skin picking is not attributable to the physiological effects of a substance (e.g.
cocaine) or another medical condition (e.g. scabies).

TRAUMA AND STRESSOR-RELATED DISORDER

Disorders related to Attachment

Reactive Attachment Disorder

● Child rarely or minimally turns preferentially to an attachment figure for comfort, support,
protection and nurturance.
● Absent or grossly underdeveloped attachment between the child and putative caregiving
adults.
● Evident before age 5 years and has developmental age of at least 9 months.

Disinhibited Social Engagement Disorder

● Culturally inappropriate, overly familiar behavior with relative strangers.
● Developmental age of at least 9 months.

Posttraumatic Stress Disorder

● Exposure to actual or threatened death, serious injury, or sexual violence.
 ● Presence of one (or more) intrusion symptoms.
● Persistent avoidance of stimuli associated with traumatic event(s), beginning after the
traumatic event(s) occurred.
● Negative alterations in cognition and mood associated with the traumatic event(s).
● Marked alterations in arousal and reactivity associated with the traumatic event(s).
● More than 1 month.

Acute Stress Disorder

● Development of characteristic symptoms lasting from 3 days to 1 month following the
exposure to one or more traumatic events.

Adjustment Disorders
● The development of emotional or behavioral symptoms in response to identifiable
stressor(s) occurring within 3 months of the onset of the stressor(s).
● These symptoms or behaviors are clinically significant, as evidence by one or both of the
following:
○ Marked distress that is out of proportion to the severity or intensity of the stressor,
taking into account the external context and cultural factors that might influence
symptom severity and presentation.
○ Significant impairment in social, occupational and other important areas in
functioning.
● The stress-related disturbance does not meet the criteria for another mental disorder and
is not merely an exacerbation of preexisting mental disorder.
● The symptoms do not represent abnormal bereavement.
● Okce the stressor or its consequences have terminated, the symptoms do not persist for
more than additional 6 months.

Dissociative Identity Disorder

● Disruption of identity characterized by two or more distinct personality states, which may
be described in some cultures as an experience of possession.
● Recurrent gaps in the recall of everyday events, important personal information and/or
traumatic events that are inconsistent with ordinary forgetting.
● The symptoms cause clinically significant distress or impairment in social, occupational
and other important areas functioning.
● The disturbance is not a normal part of a broadly accepted cultural or religious practice.

Dissociative Amnesia
● An inability to recall important autobiographical information, usually of a traumatic or
stressful nature, that is inconsistent with ordinary forgetting.
 ● The symptoms cause clinically significant distress or impairment in social, occupational
and other important areas in functioning.
● The disturbance is not attributable to the physiological effects of a substance or of a
neurological or other medical condition.

Localized Amnesia
● Failure to recall events during a circumscribed period of time.

Selective Amnesia
● Can recall some, but not all.

Generalized Amnesia
● A complete loss of memory for one's life history.

Systematized Amnesia
● Memory for a specific category or information.

Continuous Amnesia
● Forgets new events as it occurs.

Depersonalization/ Derealization Disorder

● The presence of persistent or recurrent experience of depersonalization, derealization or
both;
○ Depersonalization: Experience of unreality, detachment or being an outside
observer with respect to one's thought, feelings, actions, body or sensation.
○ Derealization: Experience of unreality or detachment of one's surroundings.
● During the depersonalization or derealization experiences, reality testing remains intact.
● The symptoms cause clinically significant distress or impairment in social, occupational
and other important areas in functioning.

Somatic Symptom Disorder

● One or more somatic symptoms that are distressing or result in significant disruption in
life.
● Excessive thoughts, feelings or behaviors related to somatic symptoms or associated
health concerns as manifested by at least one of the following;
○ Disproportionate and persistent thoughts about the seriousness of one's
symptoms.
○ Persistently high level of anxiety about health or symptoms.
○ Excessive time and energy devoted to these symptoms or health concerns.
● Although any one somatic symptom may not be continuously present, the state of being
symptomatic is persistent (typically more than 6 months).
SOMATIC SYMPTOM AND RELATED DISORDERS

Illness Anxiety Disorder

● Preoccupation with having or acquiring a serious illness.
● Somatic symptoms are not present or, if present, are only mild in intensity.
● There is a high level of anxiety about health and the individual is easily alarmed about
personal health status.
● The individual performs excessive health-related behaviors (e.g. repeatedly checks
his/her body for signs of illness) or exhibits maladaptive avoidance (e.g. avoids doctor
appointments and hospitals)
● Illness preoccupation has been present for at least 6.