Abnormal Psychology PPT PDF

LESSON 1: ABNORMAL PSYCHOLOGY INTRODUCTION, HISTORICAL ROOTS OF ABNORMAL seems clear: the criterion is satisfied if the individual is BEHAVIOR AND METHODS OF RESEARCH extremely upset....

LESSON 1: ABNORMAL PSYCHOLOGY INTRODUCTION, HISTORICAL ROOTS OF ABNORMAL seems clear: the criterion is satisfied if the individual is BEHAVIOR AND METHODS OF RESEARCH extremely upset. ​ The concept of impairment is useful, although not entirely Mental Disorder defined: The best current definition of mental satisfactory. For example, many people consider disorder is one that contains several characteristics. The themselves shy or lazy. This doesn’t mean that they’re definition of mental disorder presented in the 5th edition of the abnormal. But if you are so shy that you find it impossible American diagnostic manual, the Diagnostic and Statistical to date or even interact with people and you make every Manual of Mental Disorders (DSM-5), includes a number of attempt to avoid interactions even though you would like to characteristics essential to the concept of mental disorder have friends, then your social functioning is impaired. including the following: ​ Atypical or not culturally expected. At times, something is ​ The disorder occurs within the individual. considered abnormal because it occurs infrequently; it ​ It involves clinically significant difficulties in thinking, deviates from the average. The greater the deviation, the feeling, or behaving. more abnormal it is. ​ It involves dysfunction in processes that support mental functioning. The Mental Health Professions ​ It is not a culturally specific reaction to an event (e.g., ​ Although there is a great deal of overlap, counseling death of a loved one). psychologists tend to study and treat adjustment and ​ It is not primarily a result of social deviance or conflict with vocational issues encountered by healthy individuals, and society. clinical psychologists usually concentrate on more severe ​ 4 key characteristics that any comprehensive mental psychological disorders. disorder definition ought to have (4Ds of abnormal ​ Psychiatrists first earn an M.D. degree in medical school behavior) and then specialize in psychiatry during residency training ○​ Dysfunction that lasts 3 to 4 years. ○​ Deviance ○​ Distress Psychopathology Jargons 101 ○​ Dangerousness of behavior ​ Prevalence - is the figure that shows how many people in the population have the disorder. ​ Psychological disorder, a psychological dysfunction within ○​ E.g., In 2017, there were an estimated 46.6 million an individual associated with distress or impairment in adults aged 18 or older in the United States with functioning and a response that is not typical or culturally any mental illness (AMI). This number represented expected. 18.9% of all U.S. adults. The prevalence was higher ​ Psychological dysfunction refers to a breakdown in among women (22.3%) than men (15.1%). cognitive, emotional, or behavioral functioning. ​ Incidence - is the statistics on how many new cases occur ​ That the behavior must be associated with distress to be during a given period, such as a year. classified as abnormal adds an important component and  ○​ E.g., The overall incidence rate of depression was ​ Multidimensional integrative approach to understanding 9.47/1000 person-years (PYs) (10.72/1000 PYs for psychopathology follows a framework which attributes the women and 8.27/1000 PYs for men). course of a disorder in a systematic way. Most disorders follow a somewhat individual pattern, or course: ​ According to psychoanalytic theory, early mother-child ​ Chronic course - disorders that tend to last a long time, dynamics lead to difficulty with a child establishing a sense sometimes a lifetime. E.g. Schizophrenia. of separateness from the mother. ​ Episodic course - the individual is likely to recover within a ​ Polygenic - influenced by many factors. The genetic few months only to suffer a recurrence of the disorder at a influence on much of the development and most of our later time. E.g. mood disorders behavior, personality, and even IQ is polygenic. ​ Time-limited course - the disorder will improve without ​ Mesmer developed a technique known as mesmerism and treatment in a relatively short period. E.g. acute stress that all people possessed magnetic forces used to ​ Prognosis - is the anticipated course of a disorder. So, we influence and treat mental disorders. might say, “the prognosis is good”, meaning the individual will probably recover, or “the prognosis is guarded”, Historical Conceptions of Abnormal Behavior meaning the probable outcome doesn’t look good. ​ Etiology - the study of origins, has to do with why a The Supernatural Tradition disorder begins (what causes it) and includes biological, ​ Humans have always supposed that agents outside our psychological, and social dimensions. bodies and environment influence our behavior, thinking, and emotions. Psychopathology ​ These agents—which might be divinities, demons, spirits, ​ The study of mental illness which includes a long list of or other phenomena such as magnetic fields or the moon elements: symptoms, behavior, causes, (genetics, biology, or the stars—are the driving forces behind the social, psychological), course, development, supernatural model. categorization, treatments, strategies, and more. The Biological Tradition Review Pointers ​ The Greek physician Hippocrates is considered to be the ​ Developmental Psychopathology - refers to the study of father of modern Western medicine. He and his associates pathological changes / abnormal behavior of young left a body of work called the Hippocratic Corpus, written individuals in behavior over time. Studying changes in between 450 and 350 B.C., in which they suggested that behavior over time is known as developmental psychology. psychological disorders could be treated like any other ​ Generalizability - is defined as the extent to which results disease. apply to everyone with a particular disorder. This means ​ Physicians believed that disease resulted from too much or that the study applies to people other than the subjects of too little of one of the humors; for example, too much black the study in other settings. bile was thought to cause melancholia (depression).  ​ The humoral theory was, perhaps, the first example of ​ Serotonin is believed to influence a great deal of our associating psychological disorders with a “chemical behavior, particularly the way we process information. imbalance”, an approach that is widespread today. ​ The serotonin system regulates our behavior, moods, and ​ Terms derived from the four humors are still sometimes thought processes. Extremely low activity levels of applied to personality traits. For example, sanguine (literal serotonin are associated with less inhibition and with meaning “red, like blood”) describes someone who is instability, impulsivity, and the tendency to overreact to ruddy in complexion, presumably from copious blood situations. flowing through the body, and cheerful and optimistic, ​ Low serotonin activity has been associated with although insomnia and delirium were thought to be caused aggression, suicide, impulsive overeating, and excessive by excessive blood in the brain. sexual behavior. ​ Melancholic means depressive (depression was thought to ​ Several classes of drugs primarily affect the serotonin be caused by black bile flooding the brain). system, including the tricyclic antidepressants such as ​ A phlegmatic personality (from the humor phlegm) imipramine (known by its brand name, Tofranil). indicates apathy and sluggishness but can also mean ​ The class of drugs called selective-serotonin reuptake being calm under stress. inhibitors (SSRIs), including fluoxetine (Prozac), affects ​ A choleric person (from yellow bile or choler) is hot serotonin more directly than other drugs tempered. ​ SSRIs are used to treat a number of psychological ​ Hippocrates also coined the word hysteria to describe a disorders, particularly anxiety, mood, and eating disorders. concept he learned about from the Egyptians, who had identified what we now call the somatic symptom Clinical Assessment and Diagnosis disorders. In these disorders, the physical symptoms ​ Clinical assessment is the systematic evaluation and appear to be the result of a medical problem for which no measurement of psychological, biological, and social physical cause can be found, such as paralysis and some factors in an individual presenting with a possible kinds of blindness. psychological disorder. ​ Diagnosis is the process of determining whether the The Psychological Tradition particular problem afflicting the individual meets all criteria ​ Asylums had appeared in the 16th century, but they were for a psychological disorder, as set forth in the fifth edition more like prisons than hospitals. of the Diagnostic and Statistical Manual of Mental ​ It was the rise of moral therapy in Europe and the United Disorders, or DSM-5. States that made asylums habitable and even therapeutic. ​ Affect refers to the feeling state that accompanies what we LESSON 2: REVIEW OF NEUROTRANSMITTERS & THEIR FUNCTIONS, GLUTAMATE, SEROTONIN, say at a given point. Usually our affect is “appropriate”; that NOREPINEPHRINE, EPINEPHRINE Monoamine Neurotransmitters is, we laugh when we say something funny or look sad when we talk about something sad. Serotonin ​ Several more recently developed procedures give greater resolution (specificity and accuracy) than a CT scan  without the inherent risks of X-ray tests. A now commonly Abnormal Psychology in Science and Clinical Practice used scanning technique is called nuclear magnetic What Is Psychological Abnormality? resonance imaging (MRI). The patient’s head is placed in a ​ Patterns of psychological abnormality are typically high-strength magnetic field through which radio frequency ○​ deviant signals are transmitted. These signals “excite” the brain ○​ distressing tissue, altering the protons in the hydrogen atoms. This ○​ dysfunctional gives an image of the brain structure. ○​ and possibly dangerous The Diagnostic and Statistical Manual of Mental Disorders (DSM) Deviance & Abnormality ​ The manual is divided into three main sections. The first ​ Deviant - different, extreme, unusual, perhaps even bizarre section introduces the manual and describes how best to ​ Distressing - unpleasant and upsetting to the person use it. The second section presents the disorders ​ Dysfunctional - interfering with the person's ability to themselves, and section 3 includes descriptions of conduct daily activities in a constructive way disorders or conditions that need further research before they can qualify as official diagnoses. This woman, like many others from certain tribes in Myanmar ​ In DSM-5 the term “mental retardation” has been dropped (Burma), has permanently tattooed her entire face with an in favor of the more accurate term “intellectual disability”, elaborate pattern of black lines, a tradition that began centuries which is consistent with recent changes by other ago to repel invaders and discourage kidnappings. In Western organizations. society, even with the enormous popularity of body ink, total facial ​ Individuals are often diagnosed with more than one disfigurement of this kind would break behavioral norms and psychological disorder at the same time, which is called might well be considered abnormal. comorbidity. A disease or medical condition that is simultaneously with another or others in a patient. Ex. Norms - a society's stated and unstated rules for proper conduct. “patient with cardiovascular or renal comorbidities”. ​ Abnormal behavior, thoughts, and emotions are those that differ markedly from a society's ideas about proper LESSON 1.2: ABNORMAL PSYCHOLOGY functioning. ABNORMAL PSYCHOLOGY ​ Each society establishes norms - -stated and unstated rules for proper conduct. What Is Psychological Abnormality? ​ Behavior that breaks legal norms is considered to be ​ Abnormal functioning is generally considered to be criminal. deviant, distressful, dysfunctional, and dangerous. ​ Behavior, thoughts, and emotions that break norms of ​ Behavior must also be considered in the context in which it psychological functioning are called abnormal. occurs, however, and the concept of abnormality depends Culture - a people's common history, values, institutions, habits, on the norms and values of the society in question. skills, technology, and arts.  ​ Judgments about what constitutes abnormality vary from society to society. Eccentric ​ A society's norms grow from its particular culture - history, ​ Eccentric, but not abnormal Tran Van Hay holds his values, institutions, habits, skills, technology, and arts. hair-more than 20 feet in length-around his body, as if it ​ A society that values competition and assertiveness may were a cobra. accept aggressive behavior, whereas one that emphasizes ​ By the time of his death in 2010, he had not had a haircut cooperation and gentleness may consider aggressive for 50 years and had washed his hair only a few times. behavior unacceptable and even abnormal. ​ The married Vietnamese man otherwise lived and worked as a highly respected and productive herbalist who Distress successfully cared for many people in need. ​ According to many clinical theorists, behavior, ideas, or ​ He just liked his hair on the long side-longer than any other emotions usually have to cause distress before they can person on earth. be labeled abnormal. ​ Weeks suggests that eccentrics do not typically suffer from mental disorders. Whereas the unusual behavior of Dysfunction persons with mental disorders is thrust upon them and ​ Abnormal behavior tends to be dysfunctional; that is, it usually causes them suffering, eccentricity is chosen freely interferes with daily functioning. and provides pleasure. In short, "Eccentrics know they're ​ It so upsets, distracts, or confuses people that they cannot different and glory in It" (Weeks & James, 1995, p. 14). care for themselves properly, participate in ordinary social ​ Similarly, the thought processes of eccentrics are not interactions, or work productively. severely disrupted and do not leave these persons dysfunctional. In fact, Weeks found that eccentrics in his Danger study actually had fewer emotional problems than ​ Perhaps the ultimate psychological dysfunction is behavior individuals in the general population. Perhaps being an that becomes dangerous to oneself or others. "original" is good for mental health. ​ Individuals whose behavior is consistently careless, ​ In short, while we may agree to define psychological hostile, or confused may be placing themselves or those abnormalities as patterns of functioning that are deviant, around them at risk. distressful, dysfunctional, and sometimes dangerous, we should be clear that these criteria are often vague and What behaviors were considered deviant before but are now subjective. acceptable? Tattoos, vegan lifestyles, single parenthood, breast implants, and Treatment - a systematic procedure designed to change even jogging were once considered deviant but are now widely abnormal behavior into more normal behavior. Also called accepted. The change process usually takes some time and may therapy. be accompanied by significant disagreement, especially for social norms that are viewed as essential. Therapy - a systematic process for helping people overcome their MythBuster psychological problems. Therapy consists of a client (patient), a Although it is popularly believed that a full moon is regularly trained therapist, and a series of contacts between them. accompanied by significant increases in crime, strange and No, since there is no systematic process between a client who is Bill and a abnormal behaviors, and admissions to mental hospitals, Is this considered therapy? trained therapist. Although the advices from his friends and family were quite helpful, it is nonetheless, not considered as a therapy. decades of research have failed to support this notion. (Chaput et Bill's thoughts, feelings, and behavior interfered with all aspects al., 2016; Bakalar, 2013; McLay et al., 2006) of his life in February. Yet most of his symptoms had disappeared by July. All sorts of factors may have contributed to Bill's Improvement-advice from friends and family members, a new job How Was Abnormality Viewed and Treated in the Past? or vacation, perhaps a big change in his diet or exercise regimen. ​ Expelling evil spirits. The two holes in this skull recovered from ancient times indicate that the person underwent Any or all of these things may have been useful to Bill, but they trephination, possibly for the purpose of releasing evil could not be considered treatment or therapy. Those terms are spirits and curing mental dysfunction. usually reserved for special, systematic procedures for helping ​ The history of psychological disorders stretches back to people overcome their psychological difficulties. ancient times. Prehistoric societies apparently viewed abnormal behavior as the work of evil spirits. According to a pioneering clinical theorist, Jerome Frank, all ​ There is evidence that Stone Age cultures used forms of therapy have three essential features: trephination, a primitive form of brain surgery, to treat ​ A sufferer who seeks relief from the healer. abnormal behavior. People of early societies also sought ​ A trained, socially accepted healer, whose expertise is to drive out evil spirits by exorcism. accepted by the sufferer and his or her social group. ​ A series of contacts between the healer and the sufferer, Greeks and Romans through which the healer tries to produce certain changes Physicians of the Greek and Roman empires offered more in the sufferer's emotional state, attitudes, and behavior. enlightened explanations of mental disorders. Hippocrates believed that abnormal behavior was caused by an imbalance of A woman writes down her feelings on a sticky note and attaches the four bodily fluids, or humors. it to a wall at the Union Square subway station in New York City. It's part of a project named "Subway Therapy”, started the day The Middle Ages after the emotion-arousing U.S. presidential election of 2016. In the Middle Ages, Europeans returned to demonological explanations of abnormal behavior. The clergy was very Expressing feelings, concerns, and/or hopes in this way may influential and held that mental disorders were the work of the indeed be therapeutic for many people, but it is not therapy. It devil. As the Middle Ages drew to a close, such explanations and lacks, for example, a "trained healer" and a series of systematic treatments began to decline, and people with mental disorders contacts between healer and sufferer. were increasingly treated in hospitals instead of by the clergy. The Renaissance ​ There have been major changes over the past 50 years in ​ Care of people with mental disorders continued to improve the understanding and treatment of abnormal functioning. during the early part of the Renaissance. In the 1950s, researchers discovered a number of new ​ Certain religious shrines became dedicated to the humane psychotropic medications, drugs that mainly affect the treatment of such individuals. brain and reduce many symptoms of mental dysfunction. ​ By the middle of the sixteenth century, however, persons ​ Their success contributed to a policy of with mental disorders were being warehoused in asylums. process of reducing the population of deinstitutionalization, under which hundreds of thousands individuals residing in large psychiatric of patients were released from public mental hospitals. The Nineteenth Century hospitals or institutions and ​ Some clinicians believe that violent video games may ​ Care of those with mental disorders started to improve promoting their integration into contribute to the development of antisocial behavior. And, again in the nineteenth century. community-based settings in the opinion of many clinicians, constant texting, ​ In Paris, Phippe Pinel started the treatment toward moral tweeting, and Internet browsing may become an addictive treatment. behavior or may help lead to shorter attention spans. ​ In the United States, Dorothea Dix spearheaded a ​ A number of clinicians also worry that social networking movement to ensure legal rights and protection for people can contribute to psychological dysfunction in certain with mental disorders and to establish state hospitals for cases. On the positive side, research indicates that, on their care. average, social media users are particularly likely to ​ Unfortunately, the moral treatment movement disintegrated maintain close relationships, receive social support, be by the late nineteenth century, and mental hospitals again trusting, and lead active lives (ACOG, 2016; Rainie et al., became warehouses where inmates received minimal 2011). care. ​ But, on the negative side, there is research suggesting that social networking sites may increase peer pressure and The Early Twentieth Century social anxiety in some adolescents (Houston, 2016; Nesi & ​ The turn of the twentieth century saw the return of the Prinstein, 2015). somatogenic perspective, the view that abnormal ​ The sites may, for example, cause some people to develop psychological functioning is caused primarily by physical fears that others in their network will exclude them socially. factors. Similarly, such sites may facilitate shy or socially anxious ​ The same period saw the rise of the psychogenic people's withdrawal from valuable face-to-face perspective, the view that the chief causes of abnormal relationships. functioning are psychological. Sigmund Sigmund Freud's ​ In addition, the face of clinical treatment is constantly psychogenic approach, psychoanalysis, eventually gained changing in our fast moving digital world. For example, wide acceptance and influenced future generations of telemental health, the use of various technologies to clinicians. deliver mental health services without the therapist being physically present, is growing by leaps and bounds (Comer Recent Decades and Current Trends et al., 2017; Maheu, Drude, & Wright, 2017). Telemental Health Technology and Mental Health ​ Long-distance therapy between clients and therapists The breathtaking rate of technological change that characterizes using videoconferencing, therapy offered by computer today's world has begun to have significant effects-both positive programs, and Internet-based support groups. and negative-on the mental health field, and it will undoubtedly ​ And literally thousands of smartphone. apps are devoted affect the field even more in the coming years. to relaxing people, cheering them up, giving them feel-good advice, helping them track their shifting moods LESSON 3: CLASSIFICATION AND ASSESSMENT OF ABNORMAL BEHAVIOR and thoughts, or otherwise improving their psychological CLASSIFICATION AND ASSESSMENT OF ABNORMAL states. BEHAVIOR ​ The use of digital technologies to deliver mental health services without the therapist being physically present. DIAGNOSIS AND CLINICAL ASSESSMENT What kinds of problems might result from the growing availability What is a Diagnosis (Dx)? and use of mental health apps in today's world? It is the label or name given for a syndrome. Moving Forward Syndrome defined: How, then, should you proceed in your study of abnormal 1.​ Disease or disorder that involves a particular group of psychology? signs and symptoms. (Merriam-Webster) ​ To begin with you need to learn about the basic tools and 2.​ A collection or set of signs and symptoms that characterize perspectives used by today's scientists and practitioners. or suggest a particular disease. ​ This is the task we turn to in the next several chapters. 3.​ Combination of signs and symptoms. Later chapters will then help you to appreciate in depth the ○​ Signs - are objective observation of the syndrome major categories of psychological abnormality as well as by a physician or clinician; signs are visible the leading explanations and treatments for each of them. externally. (e.g. weight loss, skin rash) In the final chapter, you will see how the science of ○​ Symptoms - are subjective. It is the patient’s abnormal psychology and its professionals interact with observation of the syndrome. It can only be legal, social, and other institutions in our world. described by the person feeling them. (e.g. pain, ​ In addition, outpatient treatment has become the primary dizziness, numbness, fatigue, vision disturbance, approach for most people with mental disorders, both mild lightheadedness) and severe; prevention programs are growing in number and influence; the field of multicultural psychology has begun to influence how clinicians view and treat Why is diagnosis important? abnormality; and insurance coverage is having a 1.​ It allows the clinician to describe base rates, causes, and significant impact on the way treatment is conducted. treatment.  2.​ Often, a diagnosis can help a person begin to understand 4.​ Add the ICD-10 code found at the top of the diagnostic why certain symptoms are occuring, which can be a huge criteria (Starting October 2014, ICD-10 codes should be relief. used) 3.​ It enables clinicians and scientists to communicate accurately with one another about cases or research. REMEMBER! In case of multiple diagnosis or comorbidity, the 4.​ It is important for research on causes or treatments. principal diagnosis is listed first, followed by the other diagnoses in descending order of clinical importance. Disease vs. Disorder 3 Main Types of Cultural Concepts Disease - resulting from a pathophysiological response to 1.​ Cultural Syndromes - are clusters of symptoms and external or internal factors. It is mostly: attributions that tend to co-occur among individuals in 1.​ Organic in nature or has an organic cause. specific cultural groups, communities, or contexts and that 2.​ Observed because of structural changes to patients. are recognized locally as coherent patterns of experience. Physical changes may be seen in patients. 2.​ Cultural Idioms of Distress - are ways of expressing 3.​ Can be confirmed through laboratory tests. distress that may not involve specific symptoms or Disorder - a disruption to the normal or regular functions in the syndromes, but that provide collective, shared ways of body or a part of the body. The effect of disorder is mostly: experiencing and talking about personal or social 1.​ Functional; there is an interference with the person’s daily concerns. (e.g. “nausog”) life (e.g. to hold a job or form relationships.) 3.​ Cultural Explanations or Perceived Causes - are labels, 2.​ The detection of a disorder is dependent on the symptoms. attributions, or features of an explanatory model that 3.​ Not confirmed by laboratory tests. indicate culturally recognized meaning or etiology for symptoms, illness, or distress. Clinical Assessment ​ Is the process of collecting information about an individual Why are Cultural Concepts important? for understanding and arriving at an informed decision. 1.​ To avoid misdiagnosis: Cultural variation in symptoms and ​ It is a systematic evaluation and measurement of in explanatory models associated with these cultural psychological, biological, and social factors in an individual concepts may lead clinicians to misjudge the severity of a presenting with a possible psychological disorder. problem or assign the wrong diagnosis (e.g., unfamiliar spiritual explanations may be misunderstood as psychosis) How to write a correct DSM-5 diagnosis? 2.​ To obtain useful clinical information: Cultural variations in 1.​ Determine the disorder that meets the criteria. symptoms and attributions may be associated with 2.​ Write the name of the disorder. particular features of risk, resilience, and outcome. 3.​ Add any subtype or specifiers of the disorder. 3.​ To improve clinical rapport and engagement: “Speaking the language of the patient”.  4.​ To improve therapeutic efficacy: Cultural influences the Risk Factors - these are factors that increase the possibility of an psychological mechanism of disorder, which need to be individual to develop a disorder. Protective Factors - influences understood and addressed to improve clinical efficacy. For that modify a person’s response to an environmental stressor, example, culturally specific catastrophic cognitions can lessening the impact of stress. (e.g. resilience of Filipinos) contribute to symptom escalation into panic attacks. Trauma and Stress-Related Disorders: Understanding and 5.​ To guide clinical research: Locally perceived connections Healing between cultural concepts may help identify patterns of LESSON 4:Understanding Trauma and Stress comorbidity and underlying biological substrates. Trauma and stress can have a profound impact on our lives, affecting our physical, emotional, and mental well-being. This Examples of Culture Bound Syndromes presentation explores the complexities of trauma and 1.​ Amok - “murderous frenzy”, is a dissociative episode that stress-related disorders, providing insights into their causes, is characterized by a period of depression followed by an symptoms, and effective treatment approaches. outburst of violent, aggressive, or homicidal behavior. Patients return to premorbid states following the episode. It Understanding Trauma and Stress seems to be prevalent only among males. The term “amok” originated in Malaysia, but similar behavior Trauma patterns can be found in Laos, Philippines, Polynesia Trauma refers to a deeply distressing or disturbing experience (cafard or cathard), Papua New Guinea, and Puerto Rico that overwhelms an individual's ability to cope. It can be caused (mal de pelea), and among the Navajo (iich’aa). by a single event or multiple events, such as abuse, neglect, a cause or Precipitants: Feelings of loss, shame, anger, or lowered accidents, natural disasters, or witnessing violence. Trauma can stimulus that precipitates self-esteem although specific triggers were very diverse in have lasting effects on a person's physical, emotional, and mental a particular condition: nature and presentation. health, leading to a range of symptoms like anxiety, depression, 2.​ Ataque de Nervios - is an idiom of distress principally and post-traumatic stress disorder (PTSD). reported among Latinos from the Caribbean, but recognized among many Latin American and Latin Stress Mediterranean groups. Commonly reported symptoms Stress is a normal human response to challenging or demanding include uncontrollable shouting, attacks of crying, situations. It can be triggered by a variety of factors, such as work trembling, heat in the chest rising into the head, and verbal deadlines, financial worries, relationship problems, or major life or physical aggression. A general feature of an ataque de changes. While stress can be a motivator, prolonged or nervios is a sense of being out of control. overwhelming stress can lead to physical and mental health 3.​ Possession Syndrome - involuntary possession trance problems. Symptoms of stress include headaches, fatigue, states are very common presentations of emotional irritability, difficulty concentrating, and sleep disturbances. distress around the world. Types of Trauma and Stress-Related Disorders Post-Traumatic Stress Disorder (PTSD) ○​ Active efforts to avoid reminders of the traumatic PTSD is a mental health condition that develops after a person event, such as places, people, or activities that experiences or witnesses a traumatic event, such as a serious trigger distress. accident, violent crime, or natural disaster. Symptoms include ​ Negative Thoughts and Feelings flashbacks, nightmares, avoidance of reminders, emotional ○​ Persistent negative beliefs about oneself, the world, numbness, and hypervigilance or the future, difficulty remembering aspects of the event, feeling detached from others, and inability to Generalized Anxiety Disorder experience positive emotions. GAD is characterized by excessive worry and anxiety about a ​ Hyperarousal wide range of issues, often lasting for at least six months. ○​ Increased vigilance, exaggerated startle response, Individuals with GAD may experience physical symptoms like difficulty sleeping, irritability, and difficulty restlessness, muscle tension, and difficulty sleeping. concentrating. Acute Stress Disorder Causes and Risk Factors for Trauma and Stress-Related Similar to PTSD, ASD develops in response to a traumatic event, Disorders but symptoms are more immediate and typically last less than a month. If symptoms persist beyond one month, ASD may develop ​ Traumatic Events into PTSD. ○​ Exposure to traumatic events, such as physical or sexual abuse, neglect, accidents, natural disasters, Panic Disorder war, or violence, can significantly increase the risk Panic Disorder involves recurring panic attacks, which are of developing trauma-related disorders. These sudden episodes of intense fear or discomfort accompanied by events can overwhelm an individual's coping physical symptoms like rapid heartbeat, dizziness, and shortness mechanisms and leave lasting psychological of breath. Individuals with panic disorder may develop a fear of effects. having another attack and avoid situations that trigger them. ​ Early Childhood Experiences ○​ Adverse childhood experiences, such as abuse, Symptoms and Diagnostic Criteria neglect, or witnessing domestic violence, can have ​ Duration of Symptoms a profound impact on brain development and ○​ Symptoms must be present for at least one month emotional regulation, increasing the risk of and significantly impair daily functioning. developing trauma-related disorders later in life. ​ Intrusive Memories ​ Genetic Predisposition ○​ Recurrent, involuntary, and intrusive memories of ○​ Genetics play a role in vulnerability to trauma and the traumatic event, including flashbacks, stress-related disorders. Some individuals may nightmares, or distressing thoughts. inherit a genetic predisposition to anxiety or ​ Avoidance depression, making them more susceptible to  developing these conditions following traumatic experiences. 4.​ Cardiovascular System ​ Social and Environmental Factors ○​ Stress can lead to increased heart rate, blood ○​ Social and environmental factors, such as poverty, pressure, and risk of heart disease. Trauma can discrimination, lack of social support, and exposure also contribute to cardiovascular issues through its to violence in the community, can contribute to impact on the nervous and endocrine systems. increased stress levels and vulnerability to trauma-related disorders. 5.​ Digestive System ○​ Stress and trauma can disrupt digestion, leading to The Physiological Impact of Trauma and Stress symptoms like nausea, constipation, and irritable bowel syndrome. The gut-brain connection Trauma and stress can significantly disrupt the body's highlights the close link between emotional and physiological processes, affecting multiple systems and digestive health. contributing to both short-term and long-term health challenges. This section explores the intricate ways in which trauma and Evidence-Based Treatment Approaches stress impact our physical well-being, shedding light on the Navigating the journey of healing from trauma and stress-related complex interplay between mind and body. disorders can be challenging. Understanding the different evidence-based treatment approaches available is crucial in 1.​ Nervous System finding the right path toward recovery and resilience. The ○​ The sympathetic nervous system, responsible for following section outlines some of the most effective therapeutic the "fight-or-flight" response, is often triggered by methods for addressing the complexities of trauma and stress. trauma. This can lead to hyperarousal, anxiety, and difficulty regulating emotions. Psychotherapy Psychotherapy, also known as talk therapy, is a cornerstone of 2.​ Endocrine System treatment for trauma and stress-related disorders. Different types ○​ Trauma and stress can disrupt the endocrine of psychotherapy focus on understanding and processing system, leading to hormonal imbalances that affect traumatic experiences, developing coping mechanisms, and mood, sleep, and energy levels. This can contribute building resilience. to conditions like depression and anxiety. Cognitive-Behavioral Therapy (CBT) CBT is a highly effective approach that helps individuals identify 3.​ Immune System and challenge negative thoughts and behaviors associated with ○​ Prolonged stress can weaken the immune system, trauma. By learning to replace these patterns with more adaptive making individuals more susceptible to illness and ones, individuals can gain control over their reactions to stressful infection. Chronic inflammation, a hallmark of situations. stress, is linked to a range of health problems. Eye Movement Desensitization and Reprocessing (EMDR) ​ Develop Coping Skills EMDR is a specific type of therapy that uses eye movements or ○​ CBT equips individuals with practical coping skills to other bilateral stimulation to help individuals process traumatic manage distress and triggers. This includes memories. By accessing and processing these memories in a techniques like relaxation exercises, mindfulness safe and controlled manner, individuals can reduce their intensity practices, and problem-solving strategies. and emotional impact. ​ Behavioral Activation ○​ This component focuses on increasing engagement Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in positive and meaningful activities to combat TF-CBT is a specialized form of CBT designed specifically for avoidance behaviors and promote a sense of children and adolescents who have experienced trauma. It purpose and well-being combines various elements of CBT with trauma-specific techniques to help individuals develop coping skills, manage Mindfulness and Relaxation Techniques distressing emotions, and address the impact of trauma. Mindfulness and relaxation techniques are powerful tools for managing stress, reducing anxiety, and promoting overall well Cognitive-Behavioral Therapy for Trauma being. They help to cultivate awareness of the present moment, Cognitive-Behavioral Therapy (CBT) is a widely used and reduce intrusive thoughts, and promote a sense of calm and inner effective treatment approach for trauma and stress-related peace. These techniques are often incorporated into disorders. It focuses on identifying and modifying negative trauma-informed therapy approaches, empowering individuals to thoughts and behaviors that contribute to distress and develop self-regulation skills and enhance their ability to cope dysfunction. with challenging emotions and situations. ​ Identify Distorted Thoughts ​ Meditation ○​ CBT helps individuals recognize and challenge ○​ Meditation involves focusing on the present moment negative or irrational thoughts that perpetuate through techniques like breath awareness, body trauma-related symptoms. These thoughts often scan, or guided imagery. It helps to quiet the mind, involve blaming oneself, catastrophizing, or reduce stress, and cultivate a sense of inner peace. overgeneralizing. ​ Yoga ○​ Yoga combines physical postures, breathing exercises, and meditation to improve flexibility, ​ Challenge Negative Beliefs strength, and reduce stress. It promotes a sense of ○​ Once identified, these distorted thoughts are balance and mindfulness, fostering a connection challenged and examined for evidence to support or between the body and mind. refute them. Through this process, individuals learn ​ Deep Breathing to develop more balanced and realistic ○​ Deep breathing exercises, such as diaphragmatic perspectives. breathing, slow down the heart rate, lower blood  pressure, and promote relaxation. These techniques ○​ Through the process of healing, individuals develop are easy to learn and can be practiced anytime, resilience and coping mechanisms that equip them anywhere. to handle future challenges. They learn to manage ​ Progressive Muscle Relaxation stress, regulate emotions, and maintain a sense of ○​ This technique involves systematically tensing and hope and optimism. relaxing different muscle groups in the body, ​ Strengthened Relationships reducing tension and promoting a sense of calm. It ○​ The journey of healing often involves strengthening is a powerful tool for managing physical and relationships and building new connections. This emotional stress. can lead to a deeper sense of belonging, support, and love, fostering a sense of community and Resilience and Post-Traumatic Growth connection. The journey of healing from trauma is not always linear. While it ​ Personal Growth involves addressing symptoms and recovering from the ○​ Post-traumatic growth can lead to significant immediate impact, it can also be a catalyst for personal growth personal growth and transformation. Individuals and transformation. Post-traumatic growth refers to the positive may discover hidden strengths, develop new skills, changes that individuals may experience following a traumatic and gain a deeper understanding of themselves and event, leading to a deeper understanding of oneself, a greater their purpose in life. appreciation for life, and a stronger sense of purpose. LESSON 5: Generalized Anxiety Disorder ​ Facing the Trauma Generalized Anxiety Disorder ○​ Acknowledging and processing the traumatic ​ A disorder marked by persistent and excessive feelings of experience is the first step toward growth. This anxiety and worry about numerous events and activities. involves confronting the pain and emotions ​ People with Generalized Anxiety Disorder experience associated with the event, seeking support, and excessive anxiety under most circumstances and worry understanding the impact it has had on one's life. about practically anything. ​ Developing New Meaning ​ Their problem is sometimes described as free-floating ○​ As individuals begin to heal, they may find a deeper anxiety. appreciation for life, a renewed sense of purpose, ​ The symptoms last at least 6 months (APA, 2013) and lead and a stronger understanding of their values. The to a reduced quality of life (Comer, Pincus, & Hofmann, experience can lead to a shift in perspective and a 2012) greater sense of gratitude for the present moment. ​ Nevertheless, many people with the disorder are able, although with some difficulty, to carry on social relationships and job activities. ​ Building Resilience Diagnosis (Dx) TABLE: 5-1. DX Checklist are "going crazy" with worry or losing out in life because of Generalized Anxiety Disorder worrying. The net effect of all this worrying: generalized 1.​ For 6 months or more, a person experiences anxiety disorder. disproportionate, uncontrollable, and ongoing anxiety and worry about multiple matters. TABLE: 5-3. Worrying About Worrying: Items from the 2.​ The symptoms include at least three of the following: Meta-Worry Questionnaire irritable/ edginess, fatigue, poor concentration, irritability, muscle ​I am going crazy with worry. tension, sleep problems. ​My worrying will escalate and I'll cease to function. 3.​ Significant distress of impairment. ​I'm making myself ill with worry. ​I'm abnormal for worrying. Newer Cognitive-Behavioral Explanations ​My mind can't take the worrying. ​ In recent years, several additional cognitive-behavioral ​I'm losing out in life because of worrying. explanations for generalized anxiety disorder have ​My body can't take the worrying. emerged. ​ Each of them builds on the work of Ellis and Beck and their ​ Proponents of this theory believe people with generalized emphasis on danger. anxiety disorder keep worrying and worrying in their efforts ​ The metacognitive theory, developed by the researcher to find "correct" solutions for various situations in their lives Adrian Wells suggests that people with generalized anxiety and to restore certainty to the situations. disorder implicitly hold both positive and negative beliefs ​ However, because they can never really be sure that a about worrying (Knowles et al., 2016; Wells, 2014, 2011, given solution is a correct one, they are always left to 2005). grapple with intolerable levels of uncertainty, triggering ​ On the positive side, they believe that worrying is a useful new rounds of worrying and new efforts to find correct way of appraising and coping with threats in life. And so solutions. they look for and examine all possible signs of danger-that ​ Studies have found, for example, that people with is, they worry constantly. generalized anxiety disorder display higher levels of ​ At the same time, Wells argues, people with generalized intolerance of uncertainty than people with normal degrees anxiety disorder also hold negative beliefs about worrying, of anxiety (Koerner et al., 2017; Dugas et al., 2012, 2004). and these negative attitudes are the ones that open the ​ Research also suggests that intolerance of uncertainty door to the disorder. develops in early childhood (Osmanağaoğlu et al., 2018; ​ Because society teaches them that worrying is a bad thing, Sanchez et al., 2017) and can be passed on from parents they come to believe that their repeated worrying is in fact to children (Sanchez, Kendall, & Comer, 2016) harmful (mentally and physically) and uncontrollable. ​ According to another more recent explanation for ​ Now they further worry about the fact that they always generalized anxiety disorder, the intolerance of uncertainty seem to be worrying (so-called meta-worries) (see Table theory, certain individuals cannot tolerate the knowledge 5-3). Their meta-worries may include concerns that they  that negative events may occur, even if the possibility of ​ The disorder also is twice as common among women as occurrence is very small. men and among poor people as wealthy people (Bandelow ​ Inasmuch as life is filled with uncertain events, these & Michaelis, 2015; Sareen et al., 2011). Around 46 percent individuals worry constantly that such events are about to of those with agoraphobia receive treatment for it (NIΜΗ, occur. Such intolerance and worrying leave them highly 2017). vulnerable to the development of generalized anxiety disorder (Koerner, Mejia, & Kusec, 2017; Dugas et al., TABLE: 5-6. Dx Checklist 2012, 2010, 2004). Agoraphobia Phobias 1.​ Pronounced, disproportionate, or repeated fear about A phobia is a persistent and unreasonable fear of a particular being in at least two of the following situations: object, activity, or situation. People with a phobia (from the Greek ○​ Public transportation (e.g., auto or plane travel) word for "fear") become fearful if they even think about the object ○​ Parking lots, bridges, or other open spaces or situation they dread, but they usually remain comfortable as ○​ Shops, theaters, or other confined places long as they avoid it or thoughts about it. ○​ Lines or crowds ○​ Away from home unaccompanied TABLE: 5-5. Dx Checklist 2.​ Fear of such agoraphobic situations derives from a Specific Phobia concern that it would be hard to escape or get help if 1.​ Marked, persistent, and disproportionate fear of a panic, embarrassment, or disabling symptoms were to particular object or situation; usually lasting at least 6 occur months 3.​ Avoidance of the agoraphobic situations 2.​ Exposure to the object produces immediate fear 4.​ Symptoms usually continue for at least 6 months 3.​ Avoidance of the feared situation 5.​ Significant distress or impairment 4.​ Significant distress or impairment ​ In the 1920s, a clinician described the case of a young Agoraphobia woman who apparently acquired a specific phobia of ​ People with agoraphobia are afraid of being in public running water through classical conditioning (Bagby, places or situations where escape might be difficult or help 1922). When she was 7 years old she went on a picnic unavailable, should they experience panic or become with her mother and aunt and ran off by herself into the incapacitated (APA, 2013). woods after lunch. ​ This is a pervasive and complex phobia. Around 1.7 ​ While she was climbing over some large rocks, her feet percent of the population experience agoraphobia in any became caught between two of them. The harder she tried given year; around 2.6 percent display it at some point in to free herself, the more trapped she became. No one their lives (Bandelow & Michaelis, 2015; Kessler et al., heard her screams, and she grew more and more terrified. 2012). In the language of behaviorists, the entrapment was eliciting a fear response.  response (UR) of fear. The running water represented a How Are Fears Learned? conditioned stimulus (CS), a formerly neutral stimulus that ​ Many cognitive-behavioral theorists propose classical became associated with entrapment in the child's mind and came conditioning as a common way of acquiring phobic also to elicit a fear reaction. The newly acquired fear was a reactions. conditioned response (CR). ​ Two events that occur close together in time become strongly associated in a person's mind, and the person Systematic Desensitization then reacts similarly to both of them. An exposure treatment that uses relaxation training and a fear hierarchy to help clients with phobias react calmly to the objects Entrapment - Fear response or situations they dread. As she struggled to free her feet, the girl heard a waterfall nearby. The sound of the running water became linked in her mind to her Flooding terrifying battle with the rocks, and she developed a fear of An exposure treatment for phobias in which clients are exposed running water as well. repeatedly and intensively to a feared object and made to see Running water - Fear response that it is actually harmless. Eventually the aunt found the screaming child, freed her from the rocks, and comforted her, but the psychological damage had Modeling been done. From that day forward, the girl was terrified of running ​ It is the therapist who confronts the feared object or water. For years family members had to hold her down to bathe situation while the fearful person observes (Bandura, 2011, her. When she traveled on a train, friends had to cover the 1977, 1971; Bandura et al., 1977). The therapist acts as a windows so that she would not have to look at any streams. The model to demonstrate that the person's fear is groundless. young woman had apparently acquired a specific phobia through ​ After several sessions many clients are able to approach classical conditioning. the objects or situations calmly. In one version of modeling, participant modeling, the client is actively encouraged to How Are Phobias Treated? join in with the therapist. The major cognitive-behavioral approach to treating them is exposure treatment, an approach in which people are exposed to TABLE: 5-7. Dx Checklist the objects or situations they dread (Choy, 2016). There are Social Anxiety Disorder actually a number of different exposure techniques. Three of the 1.​ Pronounced, disproportionate, and repeated anxiety about oldest, and most famous, are systematic desensitization, social situation(s) in which the individual could be exposed flooding, and modeling. relaxation techniques. Systematic Desensitization involves gradual exposure to a feared stimulus while practicing to possible scrutiny by others; typically lasting 6 months or Flooding entails immediate and intense exposure to the feared situation without gradual steps. Modeling involves learning through observation and imitation of others' behaviors. more US: Entrapment - UR: Fear | CS: Running water - CR: Fear 2.​ Fear of being negatively evaluated by or offensive to In conditioning terms, the entrapment was an unconditioned others stimulus (US) that understandably elicited an unconditioned  3.​ Exposure to the social situation almost always produces inept- showing no skill; clumsy: ○​ Believing that inept behaviors in social situations will anxiety inevitably lead to terrible consequences. 4.​ Avoidance of feared situations ○​ Believing they have no control over feelings of 5.​ Significant distress or impairment anxiety that emerge in social situations. Social Anxiety Disorder World-renowned singer Adele performs in front of 60,000 people ​ People with social anxiety disorder experience severe and at a stadium in Melbourne, Australia, during her "Adele Live persistent anxiety about social or performance situations in 2017" concert tour. When the gifted artist mesmerizes her fans in which they may be scrutinized by others or be such venues, it is hard to believe that she has struggled for years embarrassed. with severe performance anxiety and related panic attacks, ​ Cognitive-behavioral theorists believe that the disorder is particularly when singing before large crowds. particularly likely to develop among people who hold certain dysfunctional social beliefs and expectations and Social Skills Training learn to perform corresponding avoidance and safety A therapy approach that helps people learn or improve social behaviors. skills and assertiveness through role playing and rehearsing of ​ Therapists who treat social anxiety disorder typically desirable behaviors. distinguish two components of this disorder: social fears and poor social skills. Panic Disorder ​ They try to reduce social fears by drug therapy and/or ​ Panic attacks are periodic, discrete bouts of panic that cognitive-behavioral therapy (including exposure occur suddenly. techniques). ​ Sufferers of panic disorder experience panic attacks ​ The leading explanation for social anxiety disorder has repeatedly and unexpectedly and without apparent reason. been proposed by cognitive-behavioral theorists (Thurston Panic disorder may be accompanied by agoraphobia in et al., 2017; Heimberg et al, 2010). some cases, leading to two diagnoses. ​ The explanation features an interplay of both cognitive and ​ Many biological theorists believe that panic disorder is behavioral factors. caused by a hyperactive panic circuit, a brain circuit that ​ These can include: includes structures such as the amygdala, hippocampus, ○​ Holding unrealistically high social standards and so ventromedial nucleus of the hypothalamus, central gray believing that they must perform perfectly in social matter, and locus coeruleus. Biological therapists use situations. certain antidepressant drugs or benzodiazepines to treat ○​ Believing they are unattractive social beings. people with this disorder. ○​ Believing they are socially unskilled and inadequate. TABLE: 5-9. Dx Checklist ○​ Believing they are always in danger of behaving Panic Disorder incompetently in social situations. 1.​ Unforeseen panic attacks occur repeatedly.  2.​ One or more of the attacks precedes either of the following Depressive and Bipolar Disorders symptoms: a.​ At least a month of continual concern about having Depression - A low, sad state marked by significant levels of additional attacks sadness, lack of energy, low self-worth, guilt, or related b.​ At least a month of dysfunctional behavior changes symptoms. associated with the attacks (for example, avoiding Mania - A state or episode of euphoria or frenzied activity in new experiences) which people may have an exaggerated belief that the world is theirs for the taking. ​ Cognitive-behavioral theorists suggest that panic-prone people become preoccupied with some of their bodily Emotional Symptoms sensations, misinterpret them as signs of medical ​ Most people who are depressed feel sad and dejected. catastrophe, have panic attacks, learn to display ​ They describe themselves as feeling "miserable," "empty," avoidance and safety behaviors that help control their and "humiliated." bodily sensations, and in some cases develop panic ​ They tend to lose their sense of humor, report getting little disorder. pleasure from anything, and in some cases display ​ Cognitive-behavioral therapists teach clients to interpret anhedonia, an inability to experience any pleasure at all. their physical sensations more accurately and to cope ​ A number also experience anxiety, anger, or agitation. better with anxiety. Motivational Symptoms Obsessive-Compulsive Disorder ​ Depressed people typically lose the desire to pursue their A disorder in which a person has recurrent obsessions, usual activities. Almost all report a lack of drive, initiative, compulsions, or both. and spontaneity. ​ They may have to force themselves to go to work, talk with TABLE: 5-10. Dx Checklist friends, eat meals, or have sex. Obsessive-Compulsive Disorder 1.​ Occurrence of repeated obsessions, compulsions, or both Behavioral Symptoms 2.​ The obsessions or compulsions take up considerable time. ​ Depressed people are usually less active and less 3.​ Significant distress or impairment productive. ​ They spend more time alone and may stay in bed for long Hoarding Disorder periods. A disorder in which individuals feel compelled to save items and ​ One man recalls, "My eyes would open at the crack of become very distressed if they try to discard them, resulting in an dawn, but getting out of bed was impossible. I just stayed excessive accumulation of items. there, and stayed there, and stayed there some more, virtually paralyzed, knowing that a day filled with misery LESSON 6:Depressive and Bipolar Disorders awaited me."  ​ Depressed people may also move and even speak more ​ In extreme cases, the episode may include psychotic slowly. symptoms, ones marked by a loss of contact with reality, such as delusions-bizarre ideas without foundation-or Cognitive Symptoms hallucinations- perceptions of things that are not actually ​ Depressed people hold extremely negative views of present. themselves. ​ A depressed man with psychotic symptoms may imagine ​ They consider themselves inadequate, undesirable, that he cannot eat "because my intestines are deteriorating inferior, perhaps even evil (Lyness, 2016). and will soon stop working," or he may believe that he ​ They also blame themselves for nearly every unfortunate sees his dead wife. event, even things that have nothing to do with them, and they rarely credit themselves for positive achievements. Persistent Depressive Disorder ​ Another cognitive symptom of depression is pessimism. A chronic form of unipolar depression marked by ongoing and Sufferers are usually convinced that nothing will ever repeated symptoms of either major or mild depression. improve, and they feel helpless to change any aspect of their lives. Because they expect the worst, they are likely TABLE: 7-2 Dx Checklist to procrastinate. Major Depressive Episode ​ Their sense of hopelessness and helplessness makes 1.​ For a 2-week period, a person displays an increase in them especially vulnerable to suicidal thinking (Lyness, depressed mood for the majority of each day and/or a 2016; Shiratori et al.) decrease in enjoyment or interest across most activities for the majority of each day. Physical Symptoms 2.​ For the same 2 weeks, person also experiences at least 3 ​ People who are depressed frequently have such physical or 4 of the following symptoms: ailments as headaches, indigestion, constipation, dizzy ○​ Considerable weight change or appetite change spells, and general pain (Lyness, 2016). ○​ Daily insomnia or hypersomnia ​ Disturbances in appetite and sleep are particularly ○​ Daily agitation or decrease in motor activity common (Chang et al., 2017; Baxter, 2016). ○​ Daily fatigue or lethargy ​ Most depressed people eat less, sleep less, and feel more ○​ Daily feelings of worthlessness or excessive guilt fatigued than they did prior to the disorder. ○​ Daily reduction in concentration or decisiveness ​ Some, however, eat and sleep excessively. ○​ Repeated focus on death or suicide, a suicide plan, or a suicide attempt. Diagnosing Unipolar Depression 3.​ Significant distress or impairment. ​ According to DSM-5, a major depressive episode is a period of two or more weeks marked by at least five Major Depressive Disorder symptoms of depression, including sad mood and/or loss 1.​ Presence of a major depressive episode of pleasure. 2.​ No pattern of mania or hypomania -> elevated mood, increased energy, and heightened behavior. It is a less severe form of mania and is commonly part of bipolar disorder. Persistent Depressive Disorder 3.​ Significant distress or impairment. 1.​ Person experiences the symptoms of major or mild Bipolar I Disorder depression for at least 2 years. 1.​ Occurrence of a manic episode. 2.​ During the 2-year period, symptoms are not absent for 2.​ Hypomanic or major depressive episodes may precede or more than 2 months at a time. follow the manic episode. 3.​ No history of mania or hypomania. three stages: hypomania, or stage I; acute Bipolar II Disorder mania, or stage II; and delirious mania, or 4.​ Significant distress or impairment.. stage III. 1.​ Presence or history of major depressive episode(s). 2.​ Presence or history of hypomanic episode(s). Diagnosing Bipolar Disorders 3.​ No history of a manic episode. dito, yung hypomania ay hindi nagpprecede sa major depressive episodes and hindi rin ​ People are considered to be in a full manic episode when sumusunod ang manic episode. for at least one week they display an abnormally high or Bipolar I Disorder - A type of bipolar disorder marked by full irritable mood, increased activity or energy, and at least manic and major depressive episodes. three other symptoms of mania. Bipolar II Disorder - A type of bipolar disorder marked by mildly ​ The episode may even include psychotic features such as manic (hypomanic) episodes and major depressive episodes. delusions or hallucinations. When the symptoms of mania are less severe (causing little impairment), the person is said to be having a hypomanic episode (APA, 2013) Suicide TABLE: 7-5 Dx Checklist Suicidal Ideations Manic Episode Suicidal ideations are suicidal thoughts. These thoughts can 1.​ For 1 week or more, a person displays a continually come frequently or occasionally, they can be severe and abnormal, inflated, unrestrained, or irritable mood as well all-consuming to less intense and fleeting. as continually heightened energy or activity, for most of every day. Passive Suicidal Ideation 2.​ Person also experiences at least three of the following You might experience thoughts about suicide, but you have no symptoms: plans or intent to carry them out. ○​ Grandiosity or overblown self-esteem ○​ Reduced sleep need Examples of Passive Suicidal Thoughts ○​ Increased talkativeness, or drive to continue talking 1.​ I don't feel like living anymore ○​ Rapidly shifting ideas or the sense that one's 2.​ I hope someone runs into me on the road and kills me thoughts are moving very fast 3.​ Maybe I'll get a terminal illness and die quickly ○​ Attention pulled in many directions 4.​ People would be better off without me ○​ Heightened activity or agitated movements 5.​ I wish I could just die in my sleep ○​ Excessive pursuit of risky and potentially 6.​ I wish I could just die problematic activities. Active Suicidal Ideation Not every self-inflicted death is a suicide. A man who crashes his You have had thoughts of suicide and are developing or have car into a tree after falling asleep at the steering wheel is not developed a plan to carry it out. trying to kill himself. Thus Edwin Shneidman (2005, 1993, 1963), a pioneer in this field, defined suicide as an intentioned death-a Signs Someone is Actively Suicidal self-inflicted death in which one makes an intentional, direct, and 1.​ They talk a lot about death, dying, or not being around in conscious effort to end one's life. the future 2.​ They might withdraw socially Suicide - A self-inflicted death in which the person acts 3.​ They start giving away possessions intentionally, directly, and consciously. 4.​ They stop going to work or engaging in their social activities What Triggers a Suicide? 5.​ They begin making amends or start talking as if they are Suicidal acts may be connected to recent events or current saying goodbye conditions in a person's life. Although such factors may not be the 6.​ They increase harmful or risky behaviors like drugs, basic motivation for the suicide, they can precipitate it. Common alcohol, and self-harm triggering factors include stressful events, mood and thought changes, alcohol and other drug use, mental disorders, and Intrusive Suicidal Thoughts modeling. ​ Scary and unwanted ​ Not seen as an option for relief TABLE: 9-2 Common Predictors of Suicide ​ Focused on the fear of losing control 1.​ Depressive disorder and certain other mental disorders ​ Are ego-dystonic 2.​ Alcoholism and other forms of substance abuse ​ They are fear-based 3.​ Suicidal ideation, talk, preparation; certain religious ideas 4.​ Prior suicide attempts When should you seek help for suicidal thoughts? 5.​ Availability of lethal weapons As soon as possible. Even if your suicidal thoughts are passive or 6.​ Social withdrawal, isolation, living alone, loss of support intrusive and you don't want to carry them out, they indicate 7.​ Hopelessness, feeling trapped, cognition rigidity something happening underneath the surface. 8.​ Impulsivity and risk-taking behavior 9.​ Being an older white American male Risk Assessment 10.​Modeling, suicide in the family, genetics A risk assessment determines if your thoughts are passive or 11.​Economic or work problems; certain occupations active and whether or not you might carry out a plan to harm 12.​Marital problems, family pathology yourself. 13.​Dramatic changes in mood 14.​Anxiety What Is Suicide? 15.​Stress and stressful events 16.​Anger, aggression, irritability  17.​Psychosis is to such social groups as the family, religious institutions, and 18.​Physical illness community. The more thoroughly a person belongs, the lower the 19.​Sleep problems. risk of suicide. Conversely, people who have poor relationships with their society are at higher risk of killing themselves. He What Are the Underlying Causes of Suicide? defined several categories of suicide, including egoistic, altruistic, Most people faced with difficult situations never try to kill and anomic suicide. themselves. In an effort to understand why some people are more prone to suicide than others, theorists have proposed more The Biological View fundamental explanations for self-destructive actions than the For years, biological researchers relied largely on family pedigree immediate triggers considered in the previous section. The studies to support their position that biological factors contribute leading theories come from the psychodynamic, sociocultural, to suicidal behavior. They repeatedly found higher rates of suicide and biological models. Some of these hypotheses have, however, among the parents and close relatives of suicidal people than received limited research support and fail to address the full among those of nonsuicidal people (Petersen et al., 2014; Roy, range of suicidal acts. Thus the clinical field currently lacks a 2011). Such findings may suggest that genetic, and so biological, satisfactory understanding of suicide. factors are at work. The Psychodynamic View Is Suicide Linked to Age? Many psychodynamic theorists believe that suicide results from Although people of all ages may try to kill themselves, the depression and from anger at others that is redirected toward likelihood of dying by suicide steadily increases with age up oneself. This theory was first stated by Wilhelm Stekel at a through middle age, then decreases during the early stages of old meeting in Vienna in 1910, when he proclaimed that "no one kills age, and then increases again beginning at age 75 (see Figure himself who has not wanted to kill another or at least wished the 9-2). Currently, 2 of every 100,000 people under 15 years of age death of another" (Shneidman, 1979). Some years later Sigmund in the United States kills himself or herself each year, compared Freud (1920) wrote, "No neurotic harbors thoughts of suicide with 11 of every 100,000 people between 15 and 24 years old, 16 which he has not turned back upon himself from murderous of every 100,000 people between 25 and 44 years old, 20 of impulses against others." Agreeing with this notion, the influential every 100,000 between 45 and 64 years old, 16 of every 100,000 psychiatrist Karl Menninger called suicide "murder in the 180th between 65 and 74, and 21 of every 100,000 people over age 75 degree." (CDC, 2016). The exceptional rate of suicide among those who are middle-aged is a relatively recent phenomenon and is not Durkheim's Sociocultural View fully understood (Schreiber & Culpepper. 2016). Up until 2006, Toward the end of the nineteenth century, Emile Durkheim (1897), that rate had been considerably lower than the current rate and a sociologist, developed a broad theory of suicidal behavior. always lower than that of elderly people. Today this theory continues to be influential and is often supported by research (Fernquist, 2007). According to Durkheim, the probability of suicide is determined by how attached a person Suicide Prevention Program spotting who's vulnerable to commit suicide. 1.​ False cr