Abnormal

Psychology
Review
Day Two

Raissa N. Matunog, RPm

Latest data on the mental health scenario in the Philippines
is a study sponsored by the World Health Organisation
in 2007.
WHO-AIMS Report on Mental Health System in The Philippines, WHO and Department of Health, Manila, The Philippines, 2006
 Classification System of
DSM-IV-TR (Review)
• Axis I - all categories of clinical syndromes except personality
disorders and intellectual disorders (mental retardation)

• Axis II - Personality disorders and intellectual disorders

• Axis III - General medical conditions

• Axis IV - Psychosocial stressors (recent stressors, social

resources, sociocultural background) and environmental
problems

• Axis V - Global level of current functioning (overall clinical

rating of degree of impairment)
Schizophrenia & Other
Psychotic Disorders
 Symptoms
• Four Domains

• Disorganized behaviour

• chaotic functioning, bizarre behaviour, odd motor

movements or posturing

• Disturbances in thought & speech

• delusions, disorganized thinking and/or bizarre

communication characterised by nonsensical words &
phrases

• Perceptual disturbances

• hallucinations - projection of internal sensory

experiences onto the outside world (all sensory
modalities)

• Emotional disturbances

• very socially isolated and withdrawn, marked decreases

in motivated, goal-directed behavior, disturbance in
sense of self, poor self/other differentiation

• flat or inappropriate affect

 Symptoms
• Two types

• Positive

• delusions, hallucinations,
speech and thought
incoherence

• errors of commission

• Negative

• flat affect, avolition/apathy,

social withdrawal, anhedonia

• errors of omission
 Diagnostic Criteria
• Two or more of the ff five symptoms must be present in a significant way for
at least 1 month during a period of 6 months:

• delusions

• hallucinations

• markedly disorganized or catatonic symptoms

• negative symptoms

• Patient must have symptoms continuously for at least 6 months, with at

least 1 month of acute symptoms as noted above

• If symptoms are present for at least 1 month but less than 6 months,
diagnosis of schizophreniform disorder is made
Phases of Schizophrenia
• Prodromal phase - early signs of
deterioration, which may last for years.
Typical elements are:

• decreased interest in social activities

• difficulty meeting requirements of daily

living

• some strange behaviour

• Acute phase - full-blown psychotic

(hallucinations and/or delusions develop)

• very difficult to understand or communicate

with the person

• Residual phase - behaviour returns to

prodromal level, but patient still shows
difficulty meeting demands of social roles
 Subcategories
• Paranoid - characterized by delusions and hallucinations, with themes of persecution and/or grandiosity, often
no gross disorganisation of speech and behaviour and no prominent negative symptoms

• Disorganized - (formerly hebephrenic) severe disorganization of behaviour and marked incoherence of thought
and speech; inappropriate or flat affect; odd mannerisms; sometimes poor self-care

• ex: patient might use word salad (bizarre stream of words) or neologisms (made-up words)

• Catatonic - at least 2 of the following:

• stupor or motoric immobility

• excitement

• marked negativism

• strange, stereotyped movements, mannerisms, gestures

• echolalia (automatic repetition of voices) or echopraxia (automatic repetition of another person’s movements)

• Undifferentiated - does not meet criteria for any of the other three types but does meet criteria for
schizophrenia
 Other Psychotic Disorders
• Schizophreniform disorder - meets criteria for less than 6 months but more than 1 month

• Brief psychotic disorder - 1 or more of the following symptoms for at least 1 day but less
than 1 month with eventual full return to premorbid functioning: delusions, hallucinations,
disorganised speech or behavior

• Shared psychotic disorder - (folie a deux) two people in a close relationship who share
the same delusion

• Schizoaffective disorder - meets criteria for both schizophrenia and a mood disorder. Has
delusions or hallucinations for at least 2 weeks in the absence of significant mood
symptoms. Can be either bipolar type or depressive type.

• Substance-induced psychotic disorder

• Delusional disorder - for at least 1 month, clear non bizarre delusions. No indication of
main schizophrenia symptoms. Behaviour outside delusional beliefs is not grossly impaired
(ex: erotomania - delusional belief that a person of higher status is in love with you)
 Possible Etiologies
• Biological

• Genetic factors - degree of risk correlates

with degree of shared genes, but
concordance rates for identical twins (50%)
leave room for environmental & other
factors

• Structural brain abnormalities - reduction

in gray matter; low metabolic rates in
prefrontal cortex and larger cerebral
ventricles; all imply loss of brain cells

• Dopamine hypothesis - positive

symptoms related to excess dopamine
activity in the brain

• Pregnancy complications - possible

maternal influenza during gestation
 Possible Etiologies
• Psychological

• Adverse family environment leads to

increased stress and higher relapse rates

• high ‘expressed’ emotion - negative criticism

by hostile, over involved family members

• Communication deviance

• double-bind message - inconsistent,

contradictory messages

• Behavioral theories stress that schizophrenics

have not learned appropriate social skills and
acceptable social responses

• Cognitive theories focus on patient’s

delusional beliefs as ways of understanding
peculiar perceptions that are biologically caused
 DSM 5 Changes
• Bizarre delusions and ‘conversation-like’ auditory
hallucinations are eliminated

• At least 1 positive symptom is needed to diagnose

• Schizophrenia subtypes are eliminated

• Schizoaffective disorder - mood disorder needs to

be diagnosed after schizophrenia symptoms are
verified
Depressive & Bipolar
Disorders
Types
• Unipolar disorders

• Major depression

• Main symptoms - for more than 2 weeks, 5 or more

symptoms

• depressed mood, crying, sleep problems, weight

loss/gain, psychomotor agitation/retardation, suicidal
ideation, poor concentration, low self-esteem and
feelings of worthlessness/guilt, fatigue

• Several subtypes - melancholic, catatonic or psychotic

features; postpartum onset; seasonal pattern (SAD)

• Dysthymic disorder - similar symptoms at much milder rate

for 2 years

• Double depression - major depressive episode + dysthymic

disorder
 Types
• Bipolar disorders

• Bipolar I (manic episode) - elevated mood;

inflated, grandiose self-image; more talkative; little
sleep; flight of ideas; pressured speech; high risk-
taking. Patient meets criteria for mania and also
major depression. Episodes of m & d may alternate
in more or less rapid cycles or be mixed.

• Bipolar II (hypomanic episode) - same but much

milder, no history of manic episode. Alternating
periods of major depressive episodes and
hypomanic episodes (similar to manic but shorter,
less severe and impairing)

• Cyclothymic disorder - alternation of depressive

symptoms (in the dysthymic range) and hypomanic
episodes for at least 2 years
 Possible Etiologies
• Biological

• Genetic predisposition -
stonger for bipolar disorders

• Neurotransmitter
dysregulation

• depression results from

decreased levels of
norepinephrine

• depression results from

decreased levels of
serotonin
 Possible Etiologies
• Behavioral
Reduction in
Social
Life stress positive Depression
withdrawal reinforcement

• Learned Helplessness Theory (Seligman) - states

that one gives up after learning that one’s efforts are
futile in avoiding pain and frustration

Perceived Generalized
Uncontrollable
bad events lack of helpless
control behavior
Possible Etiologies
• Cognitive Triad (Beck) - negative
view of self, others & the future

• Schemas are rigid, negative,

dysfunctional

• show indications of
overgeneralization, excessive sense
of responsibility, all-or-nothing
thinking

• negative automatic thoughts and

cognitive distortions promote and
maintain depression
1. Filtering.
We take the negative details and magnify them while filtering out all positive aspects of a
situation. For instance, a person may pick out a single, unpleasant detail and dwell on it exclusively so
that their vision of reality becomes darkened or distorted.
2. Polarized Thinking (or “Black and White” Thinking).
In polarized thinking, things are either “black-or-white.” We have to be perfect or we’re a failure —
there is no middle ground. You place people or situations in “either/or” categories, with no shades of
gray or allowing for the complexity of most people and situations. If your performance falls short of
perfect, you see yourself as a total failure.
3. Overgeneralization.
In this cognitive distortion, we come to a general conclusion based on a single incident or a
single piece of evidence. If something bad happens only once, we expect it to happen over and over
again. A person may see a single, unpleasant event as part of a never-ending pattern of defeat.
4. Jumping to Conclusions.
Without individuals saying so, we know what they are feeling and why they act the way they
do. In particular, we are able to determine how people are feeling toward us. For example, a person
may conclude that someone is reacting negatively toward them but doesn’t actually bother to find out if
they are correct. Another example is a person may anticipate that things will turn out badly, and will feel
convinced that their prediction is already an established fact.
5. Catastrophizing.
We expect disaster to strike, no matter what. This is also referred to as “magnifying or minimizing.”
We hear about a problem and use what if questions (e.g., “What if tragedy strikes?” “What if it happens
to me?”). For example, a person might exaggerate the importance of insignificant events (such as their
mistake, or someone else’s achievement). Or they may inappropriately shrink the magnitude of
significant events until they appear tiny (for example, a person’s own desirable qualities or someone
else’s imperfections).
6. Personalization.
Personalization is a distortion where a person believes that everything others do or say is some
kind of direct, personal reaction to the person. We also compare ourselves to others trying to
determine who is smarter, better looking, etc. A person engaging in personalization may also see
themselves as the cause of some unhealthy external event that they were not responsible for. For
example, “We were late to the dinner party and caused the hostess to overcook the meal. If I had only
pushed my husband to leave on time, this wouldn’t have happened.”
7. Control Fallacies.
If we feel externally controlled, we see ourselves as helpless a victim of fate. For example, “I can’t
help it if the quality of the work is poor, my boss demanded I work overtime on it.” The fallacy of internal
control has us assuming responsibility for the pain and happiness of everyone around us. For example,
“Why aren’t you happy? Is it because of something I did?”
8. Fallacy of Fairness.
We feel resentful because we think we know what is fair, but other people won’t agree with us. As
our parents tell us when we’re growing up and something doesn’t go our way, “Life isn’t always fair.”
People who go through life applying a measuring ruler against every situation judging its “fairness” will
often feel badly and negative because of it. Because life isn’t “fair” — things will not always work out in
your favor, even when you think they should.
9. Blaming.
We hold other people responsible for our pain, or take the other track and blame ourselves for
every problem. For example, “Stop making me feel bad about myself!” Nobody can “make” us feel any
particular way — only we have control over our own emotions and emotional reactions.
10. Shoulds.
We have a list of ironclad rules about how others and we should behave. People who break the
rules make us angry, and we feel guilty when we violate these rules. A person may often believe they
are trying to motivate themselves with shoulds and shouldn’ts, as if they have to be punished before they
can do anything. For example, “I really should exercise. I shouldn’t be so lazy.” Musts and oughts are
also offenders. The emotional consequence is guilt. When a person directs should statements toward
others, they often feel anger, frustration and resentment.
11. Emotional Reasoning.
We believe that what we feel must be true automatically. If we feel stupid and boring, then we must
be stupid and boring. You assume that your unhealthy emotions reflect he way things really are — “I feel
it, therefore it must be true.”
12. Fallacy of Change.
We expect that other people will change to suit us if we just pressure or cajole them enough. We
need to change people because our hopes for happiness seem to depend entirely on them.
13. Global Labeling.
We generalize one or two qualities into a negative global judgment. These are extreme forms of
generalizing, and are also referred to as “labeling” and “mislabeling.” Instead of describing an error in
context of a specific situation, a person will attach an unhealthy label to themselves. For example, they
may say, “I’m a loser” in a situation where they failed at a specific task. When someone else’s behavior
rubs a person the wrong way, they may attach an unhealthy label to him, such as “He’s a real jerk.”
Mislabeling involves describing an event with language that is highly colored and emotionally loaded. For
example, instead of saying someone drops her children off at daycare every day, a person who is
mislabeling might say that “she abandons her children to strangers.”
14. Always Being Right.
We are continually on trial to prove that our opinions and actions are correct. Being wrong is
unthinkable and we will go to any length to demonstrate our rightness. For example, “I don’t care how
badly arguing with me makes you feel, I’m going to win this argument no matter what because I’m right.”
Being right often is more important than the feelings of others around a person who engages in this
cognitive distortion, even loved ones.
15. Heaven’s Reward Fallacy.
We expect our sacrifice and self-denial to pay off, as if someone is keeping score. We feel bitter
when the reward doesn’t come.
 Suicide
• up to 70% of all suicides result from a mood
disorder

• Warning signs - social withdrawal, decline in

school functioning, loss of appetite, sleep
problems. More apt to occur when
depression has lifted somewhat.

• stressful life events also contribute to

serious illness. Important losses lead to
sense of hopelessness and negative
expectations, depression.

• suicide does not necessarily occur

because someone is psychotic
Three Types (Durkheim)

• Egoistic - people who are alienated and are

unconcerned with social norms

• Anomic - people who feel let down by society

and/or have experienced major change

• Altruistic - believe it will benefit society

 DSM 5 Changes
• Bipolar disorder - emphasis on changes in activity and energy as well as mood

• “With mixed features” instead of mania + major depressive episode

• added anxious distress specifier

• Depressive disorders

• disruptive mood dysregulation - for children up to age 18 years who display

persistent irritability and frequent episodes of extreme behavioral dyscontrol

• premenstrual dysphoric disorder

• dysthymia & chronic major depressive disorder is now persistent depressive

disorder

• bereavement is now recognised as a severe psychosocial stressor that can

precipitate an episode of MDD
Substance-Use
Disorders
 Types
• Substance use disorders

• Substance dependence - involves 3 or more of the ff:

• physiological dependence, indicated by tolerance or withdrawal

• strong focus on obtaining the substance

• impaired functioning due to use of substance

• inability to curtail or control use of substance

• Substance abuse - maladaptive pattern due to substance use as seen by 1 or more of the ff:

• continued use despite interpersonal difficulties, legal problems or physically hazardous situations

• continued use despite interference with major responsibilities

• Types of substance used - depressants, stimulants, narcotics, hallucinogens

• Substance-induced disorders - psychosis, sleep disorder

 Possible Etiologies

• Biological • Stressful emotions

• Hereditary influences • Behavioral undercontrol (associated with

rebelliousness, novelty-seeking, risk-taking
• Dopamine reward/stress pathways and impulsivity)

• Brain activity levels • Coping with life transitions

• Psychological
 Possible Etiologies
• Social

• Parental and peer models

• Social pressures

• Childhood stressors

• Sociocultural

• Norms and values

• Media influences

• Societal stressors
 DSM 5 changes
• Addition of gambling disorder - some behaviours, like gambling, activate the
brain reward system with effects similar to those of drugs of abuse

• No more separation of abuse and dependence

• Criteria instead are provided for intoxication, withdrawal,

substance/medication-induced disorders and unspecified substance-induced
disorders

• recurrent legal problems deleted

• new criterion - craving or a strong desire or urge to use a substance

• severity has been added - 2-3 criteria (mild), 4-5 criteria (moderate), 6 or
more criteria (severe)

• new substance - cannabis withdrawal and caffeine withdrawal

Personality Psychopathology
• chronic patterns of maladaptive, pervasive, stable
and distressing behavior and inner experience

• clustered into three main categories

• A: Odd/Eccentric

• B: Dramatic/Erratic

• C: Anxious/Fearful
 Name Symptoms

excessively mistrustful and suspicious of

other people without any justification. Tends
Paranoid to not confide in others, expects others to do
them harm.

pattern of detachment from social

relationships, limited range of emotions in
Schizoid interpersonal situations. Seem aloof, cold
and indifferent to others

typically socially isolated, behave in ways

that would seem unusual to rest of us. Tend
Schizotypal to be suspicious and have odd beliefs about
the world. Tend to have ideas of reference.
 Name Symptoms

history of failing to comply with social norms.

perform actions most of us would find
Antisocial unacceptable. tend to be irresponsible,
impulsive and deceitful.

lack stability in moods and in relationships

with others. usually have poor self-esteem.
Borderline individuals often feel empty and are at great
risk of suicide.

tend to be overly dramatic and often appear

Histrionic to be acting

think highly of themselves - beyond their real

abilities. consider themselves somehow
Narcissistic different from others and deserving of special
treatment
 Name Symptoms

extremely sensitive to the opinions of others

and therefore avoid social relationships.
Avoidant extremely low self-esteem + fear of rejection
= reject the attention of others

rely on others to the extent of letting them

make everyday decisions and major ones.
Dependent results in unreasonable fear of being
abandoned.

characterized by a fixation on things being

done the “right way”. preoccupation with
Obsessive-Compulsive details prevents them from completing much
of anything.
 Possible Etiologies
• Psychodynamic

• Freud - unresolved Oedipal conflicts (antisocial PD)

• Kohut - (narcissistic) lack of parental empathy and

support sets stage for pathological narcissism

• Kernberg - (borderline) patients cannot synthesize

contradictory (positive and negative) elements of
themselves and others into complete, stable wholes

• Mahler - (borderline) disrupted separation-individuation

process
• Learning

• childhood experiences shape pattern of maladaptive habits that constitute

personality disorders

• (dependent) children are regularly discouraged from speaking their minds

• (ocpd) excessive parental discipline

• (histrionic) social reinforcers, like parental attention, are connected to child’s

appearance and willingness to perform for others, especially when reinforcers are
dispensed inconsistently; may have parents who are dramatic, emotional and
attention-seeking

• social cognitive - role of reinforcement

• (antisocial) early learning experiences lacked consistency and predictability, as

adults do not place much value on what other people expect

• (antisocial) often have difficulty ‘reading’ emotions in other people’s faces and
have hostile cognitive biases
 Possible Etiologies
• Family - disturbances in family relationships

• (borderline) tend to have early memories that paint

significant others as malevolent or evil

• (borderline) childhood physical or sexual abuse/neglect

• (dependent) parental overprotection and authoritarianism,

resulting to extreme fears of abandonment and clingy
behaviours

• (ocpd) may emerge within a strongly moralistic and rigid

family environment
• Biological

• (antisocial, narcissistic, paranoid, borderline) genetic factors

• (antisocial) lack of anxiety in response to threatening

situations; lack of emotion responsiveness in general

• (antisocial) exaggerated cravings for stimulation; possibly

require higher-than-normal threshold of stimulation to maintain
an optimum state of arousal

• (borderline and antisocial) dysfunctions in parts of brain

involved in regulating emotions and restraining impulsive
behaviours; prefrontal cortex and deeper brain structures in
the limbic system
 DSM 5 Personality Disorder
Types
Name Symptoms Gender Differences

peculiar thoughts and behaviors, poor

Schizotypal interpersonal relationships higher in males

intense fluctuations in mood, self-image, and

Borderline interpersonal relationships higher in females

fear of rejection and humiliation, reluctance

Avoidant to enter into social relationships none
exaggerated sense of self-importance,
Narcissistic exploitativeness, relationships largely higher in males
superficial

perfectionism, interpersonally controlling,

Obsessive Compulsive devotion to details, and rigidity higher in males
failure to conform to social or legal codes,
Antisocial lack of anxiety and guilt, irresponsible higher in males
behaviours
Neurodevelopmental
Disorders
 Conduct disorder and
Oppositional defiant disorder
• Characteristics

• CD - person violates rights of others and

societal norms for appropriate, rule-bound
behaviour

• ODD - negative, irritable, uncooperative,

argumentative; less severe than conduct
disorder

• Contributing factors

• difficult temperament, parental violence, poor

parental supervision and uninvolvement,
serotonin imbalances, lower physiological
arousal to punishment, increased testosterone
levels, genetic predisposition
Separation Anxiety Disorder
• Excessive fear and distress
on separation from
caregivers

• Causes - parental behaviors

that encourage fear;
childhood traumas;
behavioural inhibition (an
innate inhibited and fearful
temperament)
Elimination disorders
• disturbances in bladder and
bowel control

• Enuresis - unintended urination at

least twice per week for more
than 3 months in a child over five

• Encopresis - unintended
defecation at least once per
month for 3 months in a child over
four
• Motor skills disorder (developmental coordination disorder) - developmental
delays or difficulties especially with motor skills

• Communication disorders - deficits in verbal communication (eg. stuttering)

• Expressive language disorder - difficulty learning or retrieving words

• Learning disorders - performance in reading, math or writing is below that

expected for age, grade or IQ
 Tic Disorders
• Involuntary, repetitive movements or
vocalizations, occasionally persists into
adulthood

• Stress can increase frequency & intensity of tics

• Tourette’s disorder - multiple motor tics and one

or more vocal tics

• can include involuntary coprolalia or motor

movements involving self-harm

• Comorbid conditions include poor anger control,

adhd, ocd, impulsive behaviour and poor social
skills
 Attention-deficit hyperactivity
disorder
• characterized by attentional
problems and/or impulsive,
hyperactive behaviours that are
atypical fo the child’s age and
developmental level

• significantly interfere with social,

academic or occupational activities

• poor regulation of attentional

processes = distractibility and
intense focus on irrelevant
environmental stimuli

Inattention
Poor attention to detail
Difficulty sustaining attention
Does not seem to listen
Poor follow-through
Difficulty organizing tasks
Avoids sustained mental effort
Loses objects
Easily distracted
Forgetful
Hyperactivity &
Impulsivity
Fidgets
Restless
Moves excessively
Excessively loud
Talks excessively
Blurts out answers
Difficulty waiting for turn
Interrupts or intrudes on others
Impatient
 Etiology
• Biological

• ADHD is highly heritable (80% of factors explainable by

genetic factors)

• Brain structure abnormalities and neurotransmitter

dysregulation (dopamine and associated
neurotransmitters)

• Prematurity, oxygen deprivation during birth, very low

birth weight, lead and PCB exposure, viral infections,
meningitis, encephalitis and maternal smoking/drug use
during pregnancy
 Etiology

• Psychological, Social and Sociocultural

• sociocultural and social adversity

• problems at home and with the child with ADHD

• negative interactions with ADHD child and

associated interpersonal conflict
Autism Spectrum Disorders
• characterized by significant impairment in
social communication skills and the display
of stereotyped interests and behaviours

• can range from mild to severe

• often not diagnosed until age 3 or later

• infants may have difficulty attending to

human motion or demonstrating interest in
human faces

• symptoms can sometimes appear after a

period of apparently normal social and
intellectual development
 Symptoms
• Deficits in social communication and social interaction

• atypical social-emotional reciprocity

• atypical nonverbal communication

• difficulties developing and maintaining relationships

• Repetitive behavior or restricted interests or activities involving at least 2 of the ff:

• repetitive speech, movement or use of objects

• intense focus on rituals or routines and strong resistance to change

• intense fixations or restricted interests

• atypical sensory reactivity

 Autistic Savants

• display ‘splinter skills’

• they do well on isolated tasks but perform poorly

on verbal tasks and tasks that require language
skills and symbolic thinking
 Etiology
• Biological

• neurological findings

• unique patterns of metabolic brain activity

• poor connectivity involving amygdala and other brain regions associated with autistic
symptoms

• correlations between biochemicals in amygdala and severity of symptoms

• abnormally high levels of serotonin in males with ASD and those with high functioning autism

• decreasing size of occipital cortex, region responsible for visual processing

• possibly accelerated head growth (biomarker for ASD)

• genetic mutations in familial autism

• children with autism seem to have an innate vulnerability later triggered by environmental factors
 Etiology
• Psychological

• autism affects the way the child interacts with the

world, which also affects the way the world interacts
with the child

• possibly lack a ‘theory of mind’ - they seem unable

to understand that others think and have beliefs

• isolation due to problems with communication and

establishing social relationships
 Intellectual Disability
• involves lifelong
cognitive deficits
characterized by
significant limitations in
intellectual functioning
and adaptive
behaviours

• usually have coexisting

disorders
 Intellectual Disability
• defined as involving:

• significantly subaverage general intellectual functioning

(usually interpreted as a score of 70 or less on an
individually administered IQ test)

• deficiencies in adaptive behavior that are lower than

would be expected based on age or cultural background

• skills required for communication, self care, social

interactions, health and safety, work and leisure
activities
 Adaptive characteristics
associated with ID
Level Approximate IQ Range Characteristics

daily living and social interactions mildly affected; adaptive

difficulties involve conceptual and academic understanding;
Mild 50-70 may need assistance with job skills or independent living;
may marry and raise children

may have functional self-care skills and ability to

Moderate 35-49 communicate basic needs; may read a few basic words;
lifelong support and supervision required

may recognise familiar people, limited communication skills;

Severe 20-34 lifelong support required

Profound Below 20 similar to severe intellectual disability

 Etiology
• mild ID is idiopathic (having no known cause)

• more pronounced ID is often related to genetic factors, brain abnormalities or

brain injury

• genetic factors - chromosomal abnormalities (ex: Down syndrome), conditions

resulting from inheritance of a single gene (ex: fragile x syndrome)

• nongenetic factors - usually preventable environmental influences during

prenatal, perinatal or postnatal period

• prenatal - severe malnutrition, alcohol or illicit drugs

• perinatal - severe prematurity, birth trauma, lack of oxygen

• infancy/childhood - untreated PKU, nutritional deficiencies, iodine deficiency,

head injury, brain infection
• Psychological factors

• socioeconomically disadvantaged background

• crowded living conditions, lack of adequate health

care, poor nutrition, inadequate educational
opportunities

• possibly being raised by parents with mild ID

Delirium, Dementia,
Amnesia and Other
Cognitive Disorders
 Types
• Delirium - disturbance in conscious experience, with
attentional/perceptual and memory deficits caused by a medical or
physiological condition

• Dementia

• Alzheimer’s type - memory impairment, cognitive impairment (agnosia,

apraxia or aphasia) not due to other factors

• Vascular dementia - progressive dementia like Alzheimer’s, but begins

abruptly often due to stroke; cognitive dysfunctions may be more
localised rather than pervasive

• Amnestic Disorders - disorders of an organic nature involving loss of

memory; may be transient or chronic; caused by drug use or medication
 DSM 5 changes

• Delirium criteria is updated

• Dementia and amnestic disorders now under major

neurocognitive disorder

• There is now also a category for mild MCD

 Neurocognitive Disorders
• Mild Neurocognitive Disorder - minor decline in
performance in one or more cognitive areas;
compensatory strategies may be required to maintain
independence

• Major Neurocognitive Disorder - Significant decline in

performance in one or more cognitive area; severity of
deficit interferes with independence

• Delirium - sudden changes in cognition, including

diminished awareness and impaired attention and focus;
can occur independent of -above disorders-
Trauma and Stress
Related Disorders
Acute Stress Disorder (ASD) & Post
Traumatic Stress Disorder (PTSD)
• involve exposure to a traumatic event, resulting
in intrusive memories of the occurrence,
attempts to forget or repress the memories,
emotional withdrawal and increased arousal

• ASD - anxiety and dissociative symptoms that

occur within one month after exposure to
traumatic stressor

• PTSD - anxiety, dissociative, evasion of stimuli

associated with trauma, alterations of cognitions
and mood, heightened autonomic arousal or
reactivity involving symptoms (such as
irritability, aggressive, reckless or self-
destructive behavior) that last for more than 1
month and that occur as a result of exposure to
extreme trauma
 Etiology
• Biological • Social

• sensitized autonomic system • history of childhood neglect or abuse

• hypothalamic - pituitary - adrenal • lack of social support

axis dysfunction (stress reactions)
• social isolation
• hippocampus atrophy
• Sociocultural
• sensitized neural circuits
• low socioeconomic status
• Psychological
• gender differences
• pre-existing anxiety or depression
• women more than men
• dysfunctional cognitions
• immigration/refugee status
• interpretation of trauma
Anxiety and Obsessive-
Compulsive Related
Disorders
Anxiety
• a fundamental human emotion that
produces bodily reactions that
prepare us for fight or flight

• anxiety is anticipatory - the dreaded

event has not yet occurred

• a state of unpleasant apprehension

and tension in which a person fears
some type of future negative
experience
Types of Anxiety
Disorders
Phobias
• characterized by disruptive and intense, irrational fears
of specific objects or situations.

• fears are disproportionate to actual danger caused by

object/event

• Specific phobias - excessive, irrational fear caused

by particular object/event (animals, blood, injections,
heights, etc)

• Social phobia - constant, irrational fear of specific or

general situations that involve other people, fear of
social performance & being judged by others.

• sufferer avoids social situations that could be

embarrassing, result in a negative evaluation, or
show that he/she is anxious

• performance only subset

 Panic Disorder
• characterized by intermittent
anxiety and by a sudden attack of
symptoms called panic attacks

• people with this disorder fear

losing control, going crazy, or
dying and experience
depersonalisation and
derealisation.

• can occur with or without

agoraphobia
Panic Disorder
• Panic attacks - episodes of intense fear
and 4 more symptoms (heart palpitations,
nausea, chest pain, dizziness, sweating,
trembling, choking sensations, difficulty
breathing, terror, intense apprehension)

• attacks tend to be brief but are recurrent

and unexpected

• Depersonalization - state of feeling

estranged from the body

• Derealization - state of feeling as if the

world or surroundings are not real
Generalized Anxiety Disorder
(GAD)
• sufferer experience chronic, uncontrollable and
pervasive low-level anxiety and worry

• symptoms include

• difficulty concentrating and sleeping

• irritability

• muscle tension

• pounding heart

• sweating

• restlessness

• upset stomach
 Obsessive-Compulsive
Disorder (OCD)
• sufferer is compelled to repeat acts
(compulsions) and/or is flooded with
uncontrollable and persistent thoughts
(obsessions), which can cause distress
and interfere with daily functioning

• Obsessions - uncontrollable, intrusive,

and repetitive thoughts, images and
impulses that cause anxiety

• Compulsions - repetitive behavior or

mental act that is performed to
counteract the distress of the obsessive
thoughts (eg. hand washing or counting)
 OCD (DSM 5 changes)
• has its own chapter

• new disorders within this chapter (hoarding,

excoriation [skin-picking], substance/medication
induced ocd, ocd and related disorder due to
another medical condition, trichotillomania, body
dysmorphic disorder)

• individuals can be classified good/fair insight, poor

insight and ‘absent insight/delusional ocd beliefs’
Body Dysmorphic Disorder

• Preoccupation with imagined

defects in appearance or
excessive concern with slight
defects if they exist
 Etiology
• Biological

• neurotransmitter dysregulation - deficiency of

GABA in generalized anxiety disorder

• increased physiological sensitivity - some people

are more reactive and easily aroused

• genetic factors
 Etiology
• Behavioral

• learned alarms - mild physical cues become linked

with panic attacks

• classical conditioning creates fear of non-

dangerous objects and operant conditioning
maintains avoidance of feared stimuli

• modeling - observational learning

Etiology
• Cognitive

• misinterpretations - overestimate
probability of negative event,
underestimate own ability to cope

• sense of unpredictability and lack of

safety/control

• magical thinking - thinking that

worrying or performing compulsion
may superstitiously prevent feared
event
Dissociative Disorders
Dissociative Disorders

• Aspects of one’s identity,

consciousness or memory
become split off from one
another. These disorders
usually follow heightened
stress or trauma
Dissociative Identity Disorder
(DID)
• formerly known as multiple personality disorder

• separate personalities coexisting in the same person

• given personality may or may not be aware of the existence of alters (other
personalities)

• alters may have different names, different ways of speaking and relating to
others, and even may have different physiological reactions
 Dissociative Fugue

• person loses all memory of

his/her identity, moves to a
new place, and assumes a
new identity

• can last for days or years,

usually occurs during
adulthood
 Dissociative Amnesia
• loss of memory for significant personal facts, usually
related to a traumatic experience

• localized amnesia - failure to recall events about the

first few hours or days after a traumatic experience

• selective amnesia - failure to recall some of these

events

• generalized amnesia - failure to recall anything about

one’s prior life
 Depersonalization Disorder

feelings of detachment, as though one is an outside

observer of one’s self or mental processes
 SOMATIC
DISORDERS
 Types
• Conversion disorder - symptoms or deficits in sensory and motor
function, often suggestive of a neurological condition but without
physical basis (eg hand paralysis)

• Somatization disorder - history of bodily complaints with no apparent

physical basis

• Pain disorder - history of complaints about pain, not fully explained by

physical cause

• Hypochondriasis - chronic worry that one has a physical illness

without physical evidence

• (in DSM IV TR) Body dysmorphic disorder - excessive

preoccupation with a part of one’s body that one believes is defective
 DSM 5 Changes
• Complex somatic symptom disorders (CSSD) - extreme distress over
somatic symptoms that are accompanied by high levels of health related
anxiety (6 months or more)

• … with somatisation features

• … with pain features

• Illness anxiety disorder - formerly hypochondriasis

• Functional neurological symptom disorder - formerly conversion disorder

• Factitious disorder and Factitious disorder imposed on another

• note: not malingering

Eating Disorders
Anorexia nervosa
• refusal to maintain a body weight
above the minimum normal weight
for one’s age and height

• an intense fear of becoming obese

that does not diminish with weight
loss

• body image distortion

• undue self-evaluation based on

weight or body shape
 Two Subtypes

• Restricting type - accomplishes weight loss

through dieting or exercising

• Binge-eating/purging type - accomplishes weight

loss through use of self-induced vomiting, laxatives
or diuretics, often after binge eating
 Bulimia nervosa
• recurrent episodes of binge eating (rapid consumption
of large quantities of food) at least once a week for
three months, during which the person loses control
over eating

• Subtypes

• Purging type - individual regularly vomits or uses

laxatives, diuretics or enemas

• Nonpurging type - excessive exercise or fasting is

used in an attempt to compensate for binges

• Persistent focus on body image and weight

• May have insight and may be frustrated by that

knowledge; disgust and shame are felt, usually binges
occur in private,
 Sexual Dysfunction
and Gender Dysphoria
Sexual Interest Disorders
• problems during the
appetitive phase/desire
phase

• Hypoactive sexual desire

disorder - absent or low
sexual interest/desire

• Sexual aversion disorder

- avoidance of/aversion
to sexual intercourse
Sexual Arousal Disorders
• problems of sexual pleasure or
physiological changes involving sexual
excitement

• Erectile disorder (ED) - inability to

attain/maintain an erection sufficient for
sexual intercourse and/or psychological
arousal during sexual activity

• Female sexual arousal disorder -

inability to attain/maintain physiological
response and/or psychological arousal
during sexual activity
 Orgasmic Disorders
• problems with the orgasm
phase

• Female/male orgasmic disorder

- persistent delay or inability to
achieve orgasm after reaching
excitement phase

• Early (premature) ejaculation -

ejaculation with minimal sexual
stimulation before, during or
shortly after penetration
 Genital-Pelvic
Pain/Penetration Disorders

• Dyspareunia - genital pain in a man or woman not

primarily due to lack of lubrication in the vagina or
vaginismus

• Vaginismus - involuntary spasm of the outer third of

the vaginal wall that prevents or interferes with
sexual intercourse
 Etiology
• Biology - physical and medical conditions; hormonal
deficiencies; ans reactivity to anxiety

• Psychological - situational or coital anxiety/guilt;

performance anxiety; negative attitudes towards sex; fear of
pregnancy, HIV infection or venereal disease

• Social - relational problems with partner; negative parental

attitudes towards sex in childhood; rape or sexual
molestation/abuse; strict religious & moralistic upbringing

• Sociocultural - cultural scripts; gender roles; age-related

changes
Gender Dysphoria

• characterized by a marked
incongruence between one’s
experienced/expressed gender
and assigned gender as male or
female

• gender dysphoria is not equal to

sexual orientation