Chapter 1: Psychopathology In Historical Context PDF

CHAPTER 1: PSYCHOPATHOLOGY also treat disorders, often concentrating on family problems associated with them. IN HISTORICAL CONTEXT...

CHAPTER 1: PSYCHOPATHOLOGY also treat disorders, often concentrating on family problems associated with them. IN HISTORICAL CONTEXT Psychiatric Nurses have advanced degrees, such as a master’s or even a Ph.D., and PSYCHOLOGICAL DISORDER - Also called as specialize in the care and treatment of patients abnormal disorder is a psychological dysfunction with psychological disorders, usually in within an individual associated with distress or hospitals as part of a treatment team. impairment in functioning and a response that is not Marriage and Family Therapists & Mental typical or culturally expected. Health Counselors typically spend 1 to 2 years PSYCHOLOGICAL DYSFUNCTION - Refers to a earning a master’s degree and are employed to breakdown in cognitive, emotional, or behavioral provide clinical services by hospitals or clinics, functioning. usually under the supervision of a doctoral- level clinician. DISTRESS/IMPAIRMENT - The behavior must be associated with distress to be classified as a disorder SCIENTIST-PRACTITIONERS - Mental health adds an important component and seems clear: The professionals who take a scientific approach to their criterion is satisfied if the individual is extremely upset. clinical work. Studies psychological disorders that focus on clinical description, causation (etiology), and ATYPICAL/NOT CULTURALLY EXPECTED - treatment and outcome. Something is considered abnormal if it occurs infrequently and deviates from the average or norm. The PRESENTS - A traditional shorthand way of indicating greater the deviation, the more abnormal it is. why the person came to the clinic. HARMFUL DYSFUNCTION - This assumes that we Mental Health Professional: know what the evolutionary function of a behavior is, 1. Consumer of Science. Enhancing the practice. which is often not the case. Another possibility is to determine whether the behavior is out of the individual’s 2. Evaluator of Science. Determining the control. effectiveness of the practice. PROTOTYPE - Patients may have only some features 3. Creator of Science. Conducting research that leads or symptoms of the disorder and still meet criteria for to new procedures useful in practice. the disorder because their set of symptoms is close to the prototype. CLINICAL DESCRIPTION - The unique combination of behaviors, thoughts, and feelings that PSYCHOPATHOLOGY - The scientific study of make up a specific disorder. It aims to specify what psychological disorders. makes the disorder different from normal behavior or from other disorders. Clinical Psychologists & Counseling psychologists receive the Ph.D., doctor of CLINICAL - Refers both to the types of problems or philosophy, degree (or sometimes an Ed.D., disorders that you would find in a clinic or hospital and doctor of education, or Psy.D., doctor of to the activities connected with assessment and psychology) and follow a course of graduate- treatment. level study lasting approximately 5 years, which prepares them to conduct research into PREVALENCE - Proportion of individuals in a the causes and treatment of psychological population who have a particular condition or disease at disorders and to diagnose, assess, and treat a specific point in time or over a defined period. these disorders. INCIDENCE - The rate at which new cases of a Psychiatrists first earn an M.D. degree in condition or disease occur in a population over a medical school and then specialize in specified period of time. psychiatry during residency training that lasts 3 COURSE - The course of a disease or condition to 4 years. describes its progression over time, including its onset, Psychiatric Social Workers typically earn a duration, and eventual outcome or resolution. master’s degree in social work as they develop CHRONIC COURSE - Tend to last a long time, expertise in collecting information relevant to sometimes a lifetime. the social and family situation of the individual with a psychological disorder. Social workers EPISODIC COURSE - The individual is likely to optimistic, although insomnia and delirium were recover within a few months, only to suffer a recurrence thought to be caused by excessive blood in the brain. of the disorder at a later time. MELANCHOLIC - Depressive. TIME-LIMITED COURSE - The disorder will PHLEGMATIC PERSONALITY (from the humor improve without treatment in a relatively short period phlegm) - Indicates apathy and sluggishness but can with little or no risk of recurrence. also mean being calm under stress. ACUTE ONSET - They begin suddenly; others CHOLERIC PERSON (from yellow bile/choler) - A develop gradually over an extended period, which is is hot tempered. sometimes called an insidious onset. BLEEDING/BLOODLETTING - A carefully PROGNONSIS - Anticipated course of a disorder. The measured amount of blood removed from the body, forecast or prediction of the likely course and outcome often with leeches. of a disease or medical condition. SOMATIC SYMPTOM DISORDERS - Group of DEVELOPMENTAL PSYCHOPATHOLOGY - The mental health conditions characterized by the presence study of changes in behavior over time. of physical symptoms that are distressing and DEVELOPMENTAL PSYCHOLOGY - The study of significantly disrupt a person’s daily life. changes in abnormal behavior. SYPHILIS - Behavioral and cognitive symptoms of LIFE-SPAN DEVELOPMENTAL what we now know as advanced syphilis, a sexually PSYCHOPATHOLOGY - The study of abnormal transmitted disease caused by a bacterial microorganism behavior across the entire age span. entering the brain. ETIOLOGY - The study of origins or roots of a disease GENERAL PARESIS - a progressive neurological or disorder. disorder that was historically associated with late-stage syphilis. It represents the severe manifestation of GRANGER CAUSALITY - When a series of events neurosyphilis and is characterized by a combination of temporally predict another series of events. psychiatric symptoms and neurological deficits. MIND - Soul or psyche and is considered separate from INSULIN SHOCK THERAPY - Involves the body. administering large doses of insulin to induce a state of Supernatural Model hypoglycemia (low blood sugar) as a therapeutic intervention. Biological Model ELECTROCONVULSIVE THERAPY - Involves Psychological Model inducing controlled seizures with electrical stimulation EXORCISM - Various religious rituals were performed to alleviate symptoms of conditions such as major in an effort to rid the victim of evil spirits. depression, bipolar disorder, and schizophrenia. MASS HYSTERIA - Phenomenon where a group of RAUWOLFIA SERPENTINE - Now called as people exhibits similar symptoms or behaviors, often in reserpine or Indian snakeroot is a plant traditionally response to a shared stressor or belief, without an used in herbal medicine. identifiable physical cause. NEUROLEPTICS - Also called antipsychotics, a EMOTION CONTAGION - In which the experience class of medication used to manage symptoms of of an emotion seems to spread to those around us. psychosis. MOB PSYCHOLOGY - The study of how individuals’ BENZODIAZEPINES - Class of medications behavior and attitudes change when they are part of a commonly prescribed for their sedative, anxiolytic group or crowd. (anti-anxiety), muscle relaxant, and anticonvulsant properties. MELANCHOLER - Also called black bile is still used today in its derivative form melancholy to refer to MORAL THERAPY - An early form of psychiatric aspects of depression. treatment that was a significant departure from the harsh and often inhumane treatments that were common in SANGUINE (red, like blood) - Describes someone psychiatric care at the time. who is ruddy in complexion, presumably from copious blood flowing through the body, and cheerful and MENTAL HYGIENE MOVEMENT - A significant RATIONALIZATION - Conceals the true motivations reform effort aimed at improving mental health care and for actions, thoughts, or feelings through elaborate reducing the stigma associated with mental illness. reassuring or self-serving but incorrect explanations. PSYCHOANALYSIS - The study of structure of the REACTION FORMATION - Substitutes behavior, mind and the role of unconscious processes in thoughts, or feelings that are the direct opposite of determining behavior. unacceptable ones. BEHAVIORISM - Focuses on how learning and REPRESSION - Blocks disturbing wishes, thoughts, adaptation affect the development of psychopathology. or experiences from conscious awareness. PSYCHOANALYTIC THEORY - It explores the SUBLIMATION - Directs potentially maladaptive influence of the unconscious mind on behavior and feelings or impulses into socially acceptable behavior. emotions, and it emphasizes the role of early childhood PSYCHOSEXUAL STAGES OF DEVELOPMENT experiences in shaping personality and mental health. - The stages: oral, anal, phallic, latency, and genital— CATHARSIS - Refers to the process of releasing and represent distinctive patterns of gratifying our basic thereby providing relief from strong or repressed needs and satisfying our drive for physical pleasure. emotions. FIXATION - Refers to a psychological phenomenon ID - The source of our strong sexual and aggressive where an individual becomes stuck at a particular stage feelings or energies. of psychosexual development due to unresolved conflicts or unmet needs. LIBIDO - The energy or drive within the id. CASTRATION ANXIETY - Fear of removing one’s PLEASURE PRINCIPLE - An overriding goal of penis. maximizing pleasure and eliminating any associated tension or conflicts. OEDIPUS COMPLEX - Describes a child’s feelings of desire for their opposite-sex parent and jealousy and PRIMARY PROCESS - The id has its own rivalry with their same-sex parent. characteristic way of processing information. ELECTRA COMPLEX - It describes a girl’s feelings EGO - The part of our mind that ensures that we act of desire for her father and jealousy and rivalry with her realistically and operates reality principle. mother during the phallic stage of psychosexual SECONDARY PROCESS - The cognitive operations development. or thinking styles of the ego are characterized by logic PENIS ENVY - Girl’s desire for having a penis. and reason. NEUROSIS/NEUROTIC DISORDER - A range of SUPEREGO - Also called conscience, represents the mental health conditions characterized by chronic moral principles instilled in us by our parents and our emotional distress and dysfunction, but without a loss culture. of contact with reality. INTRAPSYCHIC CONFLICTS - Internal struggles OBJECT RELATIONS - The study of how children within an individual’s mind that arise from competing incorporate the images, the memories, and sometimes desires, emotions, or aspects of personality. the values of a person who was important to them and DEFENSE MECHANISMS - Unconscious protective to whom they were (or are) emotionally attached. processes that keep primitive emotions associated with COLLECTIVE UNCONSCIOUS - A wisdom conflicts in check so that the ego can continue its accumulated by society and culture that is stored deep coordinating function. in individual memories and passed down from DENIAL - Refuses to acknowledge some aspect of generation to generation. objective reality or subjective experience that is FREE ASSOCIATION - In which patients are apparent to others. instructed to say whatever comes to mind without the DISPLACEMENT - Transfers a feeling about or a usual socially required censoring. response to an object that causes discomfort onto DREAM ANALYSIS - In which the therapist interprets another, usually less threatening, object or person. the content of dreams, supposedly reflecting the PROJECTION - Falsely attributes own unacceptable primary-process thinking of the id, and systematically feelings, impulses, or thoughts to another individual or relates the dreams to symbolic aspects of unconscious object. conflicts. PSYCHOANALYST - The relationship between the 1825–1875: Syphilis is differentiated from other types therapist and the patient. of psychosis in that it is caused by a specific bacterium; ultimately, penicillin is found to cure syphilis. TRANSFERENCE - Patients come to relate to the therapist much as they did to important figures in their 1848: Dorothea Dix successfully campaigns for more childhood, particularly their parents. humane treatment in U.S. mental institutions. PSYCHODYNAMIC PSYCHOTHERAPY - A 1854: John P. Grey, head of New York’s Utica Hospital, therapeutic approach rooted in psychoanalytic theory believes that insanity is the result of physical causes, that focuses on exploring and understanding the thus de-emphasizing psychological treatments. unconscious processes and emotional conflicts that 1870: Louis Pasteur develops his germ theory of shape an individual’s thoughts, feelings, and behaviors. disease, which helps identify the bacterium that causes SELF-ACTUALIZATION - Refers to the realization syphilis. or fulfillment of one’s talents, potential, and abilities. 1895: Josef Breuer treats the “hysterical” Anna O., PERSON-CENTERED THERAPY - leading to Freud’s development of psychoanalytic theory. UNCONDITIONAL POSITIVE REGARD - 1930: Insulin shock therapy, electric shock treatments, COGNITIVE-BEHAVIORAL MODE - and brain surgery begin to be used to treat CLASSICAL CONDITIONING - psychopathology. SYSTEMATIC DESENSITIZATION - 1938: 1968: DSM-II is published. B. F. Skinner publishes The Behavior of Organisms, which describes BEHAVIOR THERAPY - the principles of operant conditioning. OPERANT CONDITIONING - 1943: The Minnesota Multiphasic Personality REINFORCEMENT - Inventory is published. SHAPING - 1946: Anna Freud publishes Ego and the Mechanisms of Defense. 1950: The first effective drugs for severe psychotic TIMELINE OF SIGNIFICANT EVENTS disorders are developed. Humanistic psychology (based on ideas of Carl Jung, Alfred Adler, and Carl Rogers) 400 B.C.: Hippocrates suggests that psychological gains some acceptance. disorders have both biological and psychological causes. 1952: The first edition of the Diagnostic and Statistical Manual (DSM-I) is published. 200 C.E.: Galen suggests that normal and abnormal behaviors are related to four bodily fluids, or humors. 1958: Joseph Wolpe effectively treats patients with phobias using systematic desensitization based on 1300s: Superstition runs rampant, and mental disorders principles of behavioral science. are blamed on demons and witches; exorcisms are performed to rid victims of evil spirits. 1968: DSM-II is published. 1400s: Enlightened view that insanity is caused by 1900: Sigmund Freud publishes The Interpretation of mental or emotional stress gains momentum, and Dreams. depression and anxiety are again regarded by some as disorders. 1990s: Increasingly sophisticated; no one influence— biological or environmental—is found to cause 1400–1800: Bloodletting and leeches are used to rid the psychological disorders in isolation from the other. body of unhealthy fluids and restore chemical balance. 1904: Ivan Pavlov receives the Nobel Prize for his work 1500s: Paracelsus suggests that the moon and the stars, on the physiology of digestion, which leads him to not possession by the devil, affect people’s identify conditioned reflexes in dogs. psychological functioning. 1913: Emil Kraepelin classifies various psychological 1793: Philippe Pinel introduces moral therapy and disorders from a biological point of view and publishes makes French mental institutions more humane. work on diagnosis. 1920: John B. Watson experiments with conditioned BEHAVIORAL INHIBITION SYSTEM (BIS) fear in Little Albert, using a white rat. Activated by signals from the brain stem of 1980: DSM-III is published. unexpected events, such as major changes in body functioning that might signal danger. When the BIS 1987: DSM-III-R is published. is activated by signals that arise from the brain stem 1994: DSM-IV is published. or descend from the cortex, our tendency is to freeze, experience anxiety, and apprehensively 2000: DSM-IV-TR is published. evaluate the situation to confirm that danger is 2013: DSM-5 is published. present. 2021: DSM-5 TR is published. FIGHT/FLIGHT SYSTEM (FFS) This circuit originates in the brain stem and travels through several midbrain structures, including the CHAPTER 5: ANXIETY, TRAUMA- amygdala, the ventromedial nucleus of the AND STRESSOR-RELATED, AND hypothalamus, and the central gray matter. OBSESSIVE-COMPULSIVE AND ANXIETY SENSITIVITY RELATED DISORDERS It appears to be an important personality trait that determines who will and who will not experience problems with anxiety under certain stressful ANXIETY conditions. A future-oriented negative mood state characterized TRIPLE VULNERABILITY THEORY by bodily symptoms of physical tension and by apprehension about the future. In humans, it can be The first vulnerability (or diathesis) is a a subjective sense of unease, a set of behaviors generalized biological vulnerability. We can see (looking worried and anxious or fidgeting), or a that a tendency to be uptight or high-strung might physiological response originating in the brain and be inherited. But a generalized biological reflected in elevated heart rate and muscle tension. vulnerability to develop anxiety is not sufficient to produce anxiety itself. FEAR The second vulnerability is a generalized psychological vulnerability. That is, you might An immediate alarm reaction to danger. Like also grow up believing the world is dangerous and anxiety, fear can be good for us. It protects us by out of control, and you might not be able to cope activating a massive response from the autonomic when things go wrong based on your early nervous system, which, along with our subjective experiences. If this perception is strong, you have a sense of terror, motivates us to escape (flee) or, generalized psychological vulnerability to anxiety. possibly, to attack (fight). As such, this emergency reaction is often called the flight or fight response. The third vulnerability is a specific psychological vulnerability in which you learn from early An immediate emotional reaction to current danger experience, such as being taught by your parents, characterized by strong escapist action tendencies that some situations or objects are fraught with and, often, a surge in the sympathetic branch of the danger. autonomic nervous system. COMORDIBITY PANIC ATTACK The co-occurrence of two or more disorders in a An abrupt experience of intense fear or acute single individual. discom fort, accompanied by physical symptoms that usually include heart palpitations, chest pain, GENERALIZED ANXIETY DISORDER (GAD) shortness of breath, and, possibly, dizziness. A panic attack represents the alarm response of real It is characterized by muscle tension, mental fear, but there is no actual danger. agitation, susceptibility to fatigue (probably the Two basic types of panic attacks: expected result of chronic excessive muscle tension), some (cued/always occurring) panic attack and irritability, and difficulty sleeping. unexpected (uncued/without warning) panic Anxiety focuses on minor, everyday events and not attack. on one major worry or concern.  Both genetic and psychological vulnerabilities The symptoms of an ataque seem quite similar to seem to contribute to the development of GAD. those of a panic attack, although such Although drug and psychological treatments may manifestations as shouting uncontrollably or be effective in the short term, drug treatments are no bursting into tears may be associated more often more effective in the long term than placebo with ataque than with panic. treatments. Successful treatment may help KYOL GOEU individuals with GAD focus on what is really threatening to them in their lives. What Hinton’s group discovered is that the Khmer concept of kyol goeu or “wind overload” (too ANXIETY SENSITIVITY much wind or gas in the body, which may cause The tendency to become distressed in response to blood vessels to burst) becomes the focus of arousal-related sensations, arising from beliefs that catastrophic thinking during panic attacks. these anxiety-related sensations have harmful NOCTURNAL PANIC consequences. Panic attacks occur more often between 1:30 a.m. PANIC DISORDER (PD) AND AGORAPHOBIA and 3:30 a.m. than any other time. In some cases, In panic disorder, which may or may not be people are afraid to go to sleep at night. accompanied by agoraphobia (a fear and avoidance Usually occur during delta wave or slow-wave of situations considered to be “unsafe”), anxiety is sleep, which typically occurs several hours after we focused on the next panic attack. For some people, fall asleep and is the deepest stage of sleep. People agoraphobia develops in the absence of panic with panic disorder often begin to panic when they attacks or panic-like symptoms. start sinking into delta sleep, and then they awaken An experience severe, unexpected panic attacks; amid an attack. Because there is no obvious reason they may think they’re dying or otherwise losing for them to be anxious or panicky when they are control. In many but not all cases. sound asleep, most of these individuals think they The fear and avoidance of situations in which a are dying. person feels unsafe or unable to escape to get home SLEEP TERRORS or to a hospital in the event of a developing panic, panic-like symptoms, or other physical symptoms, Children awaken imagining that something is such as loss of bladder control. chasing them around the room. It is common for The term agoraphobia was coined in 1871 by Karl them to scream and get out of bed as if something Westphal, a German physician, and, in the original were after them. However, they do not wake up and Greek, refers to fear of the marketplace. This is an have no memory of the event in the morning. appropriate term because the agora was the Greek marketplace—a busy, bustling area. One of the most ISOLATED SLEEP PARALYSIS stressful places for individuals with agoraphobia Occurs during the transitional state between sleep today is the shopping mall, the modern-day agora. and waking, when a person is either falling asleep INTEROCEPTIVE AVOIDANCE or waking up, but mostly when waking up. During this period, the individual is unable to move and The avoidance of internal physical sensations. experiences a surge of terror that resembles a panic These behaviors involve removing oneself from attack; occasionally, there are also vivid situations or activities that might produce the hallucinations. physiological arousal that somehow resembles the beginnings of a panic attack. LEARNED ALARMS SUSTO Cues become associated with a number of different internal and external stimuli through a learning A disorder that is characterized by sweating, process. increased heart rate, and insomnia but not by reports of anxiety or fear, even though a severe fright is the PANIC CONTROL TREATMENT (PCT) cause. Developed at one of our clinics concentrates on ATAQUES DE NERVIOS exposing patients with panic disorder to the cluster of interoceptive (physical) sensations that remind An anxiety-related, culturally defined syndrome them of their panic attacks. prominent among Hispanic Americans, particularly those from the Caribbean. SPECIFIC PHOBIA  An irrational fear of a specific object or situation Although the causes of social anxiety disorder are that markedly interferes with an individual’s ability similar to those of specific phobias, treatment has a to function. different focus that includes rehearsing or role- Phobias can be acquired by experiencing some playing socially phobic situations. In addition, drug traumatic event; they can also be learned treatments have been effective. vicariously or even be taught. Several disorders are also grouped under the Treatment of phobias is rather straightforward, with heading trauma- and stressor-related disorders a focus on structured and consistent exposure-based SELECTIVE MUTISM (SM) exercises. A rare childhood disorder characterized by a lack of BLOOD-INJECTION-INJURY PHOBIA speech in one or more settings in which speaking is Patients with blood phobia probably also inherit a socially expected. As such, it seems clearly driven strong vasovagal response that makes them by social anxiety, since the behavior does not occur susceptible to fainting. This alone would not be due to a lack of knowledge of speech or any sufficient to ensure their becoming phobic, but it physical difficulties, nor is it due to another disorder combines with anxiety to produce strong in which speaking is rare or can be impaired such as vulnerability. autism spectrum disorder. In fact, speech in selective mutism commonly occurs in some SITUATIONAL PHOBIA settings, such as home, but not others, such as Phobias characterized by fear of public school, hence the word selective. transportation or enclosed places. POSTTRAUMATIC STRESS DISORDER (PTSD) NATURAL ENVIRONMENT PHOBIA Emotional disorders occurred after physical assault Sometimes very young people develop fears of (particularly rape), car accidents, natural situations or events occurring in nature. The major catastrophes, or the sudden death of a loved one. examples are heights, storms, and water. These Posttraumatic stress disorder (PTSD) focuses on fears also seem to cluster together: If you fear one avoiding thoughts or images of past traumatic situation or event, such as deep water, you are likely experiences. to fear another, such as storms. Many of these The precipitating cause of PTSD is obvious—a situations have some danger associated with them, traumatic experience. But mere exposure to trauma and, therefore, mild to moderate fear can be is not enough. The intensity of the experience seems adaptive. to be a factor in whether an individual devel ops PTSD; biological vulnerabilities, as well as social ANIMAL PHOBIA and cultural factors, appear to play a role as well. Fears of animals and insects. Treatment involves reexposing the victim to the trauma and reestablishing a sense of safety to INFORMATION TRANSMISSION overcome the debilitating effects of PTSD. Sometimes just being warned repeatedly about a FLASHBACK potential danger is sufficient for someone to develop a phobia. When memories occur suddenly, accompanied by strong emotion, and the victims find themselves SEPARATION ANXIETY DISORDER reliving the event. Reliving emotional trauma to relieve emotional Characterized by children’s unrealistic and suffering is called catharsis. persistent worry that something will happen to their parents or other important people in their life or that ACUTE STRESS DISORDER something will happen to the children themselves that will separate them from their parents. This is similar to PTSD, occurring within the first month after the trauma, but the different name SOCIAL ANXIETY DISORDER (SAD) emphasizes the severe reaction that some people have immediately. Formerly known as social phobia. Social anxiety disorder is a fear of being around IMAGINAL EXPOSURE others, particularly in situations that call for some kind of “performance” in front of other people. In which the content of the trauma and the emotions associated with it are worked through  systematically, has been used for decades under a Drug treatment seems to be only modestly variety of names. successful in treating OCD. The most effective treatment approach is a psychological treatment FEAR MEMORY RECONSOLIDATION called exposure and ritual prevention (ERP). Refers to the process when fear memory is TIC DISORDER AND OCD reactivated and stored back into long-term memory again. This can make “good” exposures better but It is also common for tic disorder, characterized by also “bad” exposures worse. involuntary movement (sudden jerking of limbs, for example), to co-occur in patients with OCD ( PROLONGED GRIEF DISORDER (PGD) particularly children) or in their families. More This disorder is estimated to occur in from 9.8% to complex tics with involuntary vocalizations are 11% of all adults experiencing grief. The referred to as Tourette’s disorder. experience of grief for these individuals includes Observations among one small group of children intense longing for and preoccupation with the presenting with OCD and tics suggest that these deceased and a range of other symptoms that make problems occurred after a bout of strep throat. This it difficult to move on with life even after a year or syndrome is referred to as pediatric autoimmune more has passed (6 months or more for children). disorder associated with streptococcus infection (PANDAS). ADJUSTMENT DISORDERS When clients with OCD equate thoughts with the It describes anxious or depressive reactions to life specific actions or activity represented by the stress that are generally milder than would be seen thoughts, this is called thought–action fusion. in acute stress disorder or PTSD but are EXPOSURE AND RITUAL PREVENTION (ERP) nevertheless impairing in terms of interfering with work or school performance, interpersonal A process whereby the rituals are actively prevented relationships, or other areas of living. and the patient is systematically and gradually Adjustment disorder is the development of anxiety exposed to the feared thoughts or situations. or depression in response to stressful, but not BODY DYSMORPHIC DISORDER traumatic, life events. Individuals prone to anxiety or depression generally Dysmorphophobia (literally, fear of ugliness), was may experience increases during stressful life thought to represent a psychotic delusional state events. because the affected individuals were unable to realize, even for a fleeting moment, that their ideas ATTACHMENT DISORDERS were irrational. It refers to disturbed and developmentally A person who looks normal is obsessively inappropriate behaviors in children, emerging preoccupied with some imagined defect in before 5 years of age, in which the child is unable appearance (imagined ugliness). These patients or unwilling to form normal attachment typically have more insight into their problem and relationships with caregiving adults. may seek out plastic surgery as a remedy. Reactive attachment disorder describes children Psychological treatment approaches are also similar who are inhibited and emotionally withdrawn and to those for OCD and are approximately equally unable to form attachment with caregivers. successful. Disinhibited social engagement disorder HOARDING DISORDER describes children who inappropriately approach all strangers, behaving as if they had always had strong Hoarding disorder is characterized by excessive loving relationships with them. acquisition of things, difficulty discarding anything, and living with excessive clutter under conditions OBSESSIVE COMPULSIVE DISORDER (OCD) best characterized as gross disorganization. Focuses on avoiding frightening or repulsive The three major characteristics of this problem are intrusive thoughts (obsessions) or neutralizing excessive acquisition of things, difficulty these thoughts through the use of ritualistic discarding anything, and living with excessive behavior (compulsions). clutter under conditions best characterized as gross As with all anxiety disorders, biological and disorganization. psychological vulnerabilities seem to be involved in the development of OCD. TRICHOTILLOMANIA (HAIR PULLING 1. Agoraphobia. Fear and avoidance of situations, DISORDER) AND EXCORIATION (SKIN people, or places where it would be unsafe to PICKING DISORDER) have a panic attack. 2. Specific Phobia. Fear of specific object or The urge to pull out one’s own hair from anywhere situation that triggers attack. on the body, including the scalp, eyebrows, and 3. Social Anxiety Disorder (social phobia). Fear arms, is referred to as trichotillomania. of being called for some kind of “performance” Excoriation (skin picking disorder) is that may be judged. characterized, as the label implies, by repetitive and compulsive picking of the skin, leading to tissue damage. OTHER TYPES GENERALIZED ANXIETY CHAPTER SUMMARY: Uncontrollable unproductive worrying about everyday events Feeling impending catastrophe even after TREATMENT FOR ANXIETY DISORDERS successes Cognitive-Behavioral Therapy Inability to stop the worry-anxiety cycle Physical symptoms of muscle tension Systematic exposure to anxiety-provoking situations or thoughts POSTTRAUMATIC STRESS Learning to substitute positive behaviors and Fear of reexperiencing a traumatic event thoughts for negative ones Nightmares of flashbacks Learning new coping skills: relaxation Avoidance of the intense feelings of the event exercises, controlled breathing, etc. through emotional numbing Drug Treatment OBSESSIVE-COMPULSIVE Reduces the symptoms of anxiety disorders by Fear of unwanted and intrusive thoughts influencing brain chemistry Repeated ritualistic actions or thoughts antidepressants (Tofranil, Paxil, Effexor) designed to neutralize the unwanted thoughts benzodiazepines (Xanax, Klonopin) Other Treatments Managing stress through a healthy lifestyle: CHAPTER 6: SOMATIC SYMPTOM rest, exercise, nutrition, social support, and AND RELATED DISORDERS AND moderate alcohol or other drug intake DISSOCIATIVE DISORDERS TYPES OF DISORDERS DISSOCIATION/DISSOCIATIVE EXPERIENCES PANIC - People with panic disorders have had one or Some people feel as if they are dreaming. These more panic attacks and are anxious and fearful about mild sensations that most people experience having future attacks. occasionally are slight alterations, or detachments, Apprehension leading to intense fear in consciousness or identity. Sensation of “going crazy” or of losing control For a few people, these experiences are so intense Physical signs of distress: racing heartbeat, and extreme that they lose their identity entirely and rapid breathing. Dizziness, nausea, or assume a new one, or they lose their memory or sensation of heart attack or imminent death sense of reality and are unable to function. Conversion hysteria, unexplained physical Panic attacks can be expected (always occurring), and symptoms indicated the conversion of unconscious unexpected (occurring without warning). emotional conflicts into a more acceptable form. The term neurosis, as defined in psychoanalytic PHOBIAS - People with phobias avoid situations that theory, suggested a specific cause for certain produce severe anxiety and/or panic. There are three disorders. Specifically, neurotic disorders resulted main types: from underlying unconscious conflicts, anxiety that  resulted from those conflicts, and the In conversion disorder, there is physical implementation of ego defense mechanisms. malfunctioning, such as paralysis, without any apparent physical problems. Distinguishing among SOMATIC SYMPTOM DISORDER conversion reactions, real physical disorders, and Also known as Briquet’s syndrome, named after outright malingering (faking), is sometimes by Pierre Briquet, a French physician that first difficult. described somatic symptoms on his patients in FACTITIOUS DISORDER 1859. Somatic symptom disorder is characterized by a Also known as Munchausen syndrome. The focus on one or more physical symptoms condition was named for a German nobleman called accompanied by marked distress focused on the Baron von Münchhausen, who was known as the symptom that is disproportionate to the nature or Lügenbaron or Baron of Lies for exaggerating his severity of the physical symptoms. This condition war stories. He is the basis for a fictional character may dominate the individual’s life and interpersonal in Rudolf Erich Raspe’s Baron Munchausen’s relationships. Narrative of His Marvellous Travels and Campaigns in Russia, published in English in ILLNESS ANXIETY DISORDER Oxford, England, in 1786, where the character has Also known as hypochondriasis. Although the impossible adventures, such as visiting the moon terms hypochondriasis and hypochondriac are and sitting on a cannon ball flying through the air. still widely used among the public, they are no A diagnosis of Munchausen syndrome suggests that longer part of the DSM-5. the person is faking an illness, just as the original Illness anxiety disorder is a condition in which Münchhausen lied about his adventures. The individuals believe they are seriously ill and symptoms in factitious disorder are under become anxious over this possibility, even though voluntary control, as with malingering, but there is they are not experiencing any notable physical no obvious reason for voluntarily producing the symptoms at the time. symptoms except, possibly, to assume the sick role It is characterized by anxiety or fear that one has a and receive increased attention. serious disease. Therefore, the essential problem is An adult, almost always a mother, may purposely anxiety, but its expression is different from that of make her child sick, evidently for the attention and the other anxiety disorders. The individual is pity given to her as the mother of a sick child. When preoccupied with bodily symptoms, misinterpreting an individual deliberately makes someone else sick, them as indicative of illness or disease. the condition is called factitious disorder imposed on another. It was also known previously as PSYCHOLOGICAL FACTORS AFFECTING Munchausen syndrome by proxy. MEDICAL CONDITION DEPERSONALIZATION-DEREALIZATION The essential feature of this disorder is the DISORDER presence of a diagnosed medical condition (such as asthma, diabetes, or severe pain) clearly caused by Dissociative disorders are characterized by a known medical condition (such as cancer) that is alterations in perceptions: a sense of detachment adversely affected (increased in frequency or from one’s own self, from the world, or from severity) by one or more psychological or memories. behavioral factors. Depersonalization refers to your perception that alters so that you temporarily lose the sense of your CONVERSION DISORDER (FUNCTIONAL own reality, as if you were in a dream and you were NEUROLOGICAL SYMPTOM DISORDER) watching yourself. Depersonalization is often part The term conversion has been used off and on of a serious set of conditions in which reality, since the Middle Ages (Mace, 1992) but was experience, and even identity seem to disintegrate. popularized by Freud, who believed the anxiety Derealization refers to your sense of the reality of resulting from unconscious conflicts somehow the external world is lost. Things may seem to was “converted” into physical symptoms to find change shape or size; people may seem dead or expression. This allowed the individual to mechanical. These sensations of unreality are discharge some anxiety without actually characteristic of the dissociative disorders because, experiencing it. in a sense, they are a psychological mechanism Functional refers to a symptom without an organic whereby one “dissociates” from reality. cause.  When feelings of unreality are so severe and patterns of facial wrinkling, and even physical frightening that they dominate an individual’s life disabilities may emerge. and prevent normal functioning, clinicians may diagnose the rare depersonalization-derealization disorder. CHAPTER 7: MOOD DISORDERS DISSOCIATIVE AMNESIA AND SUICIDE Refers to people who are unable to remember anything, including who they are, are said to suffer from generalized amnesia. Generalized amnesia MOOD DISORDERS - Characterized by gross may be lifelong or may extend from a period in the deviations in mood that lasts for 2 weeks. more recent past, such as 6 months or a year MAJOR DEPRESSIVE EPISODE - An extremely previously. depressed mood state that lasts at least 2 weeks and Far more common than general amnesia is localized includes cognitive symptoms and disturbed physical or selective amnesia, a failure to recall specific functions to the point that even the slightest activity or events, usually traumatic, that occur during a movement requires an over whelming effort. specific period. A subtype of dissociative amnesia is referred to as ANHEDONIA - Loss of energy and inability to engage dissociative fugue with fugue literally meaning in pleasurable activities or have any “fun”. “flight” (fugitive is from the same root). In these MANIA - Individuals find extreme pleasure in every curious cases, memory loss revolves around a activity; some patients compare their daily experience specific incident—an unexpected trip (or trips). of mania with a continuous sexual orgasm. They Mostly, individuals just take off and later find become extraordinarily active (hyperactive), require themselves in a new place, unable to remember why little sleep, and may develop grandiose plans, believing or how they got there. Usually, they have left behind they can accomplish anything they desire. Duration is an intolerable situation. During these trips, a person required 1 week. sometimes assumes a new identity or at least becomes confused about the old identity. HYPOMANIC EPISODE - A less severe version of a An apparently distinct dissociative state not found manic episode that does not cause marked impairment in Western cultures is called amok (as in “running in social or occupational functioning and need last only amok”). Most people with this disorder are men. 4 days rather than a full week. Amok has attracted attention because individuals in MAJOR DEPRESSIVE DISORDER - Defined by the this trancelike state often brutally assault and presence of depression and the absence of manic, or sometimes kill people or animals. If the person is hypomanic episodes, before or during the disorder. not killed himself, he probably will not remember Lasts for 2 years (recurrent). the episode. Running amok is only one of a number of “running” syndromes in which an individual DEPRESSION - A devastating “low” with extreme enters a trancelike state and suddenly, imbued with lack of energy, interest, confidence, and enjoyment of a mysterious source of energy, runs or flees for a life. long time. PERSISTENT DEPRESSIVE DISORDER DISSOCIATIVE IDENTITY DISORDER (DYSTHYMIA) - Defined as depressed mood that continues at least 2 years, during which the patient People with dissociative identity disorder (DID) cannot be symptom free for more than 2 months at a may adopt as many as 100 new identities, all time even though they may not experience all of the simultaneously coexisting, although the average symptoms of a major depressive episode. More chronic number is closer to 15. In some cases, the identities than MDD. are complete, each with its own behavior, tone of voice, and physical gestures. DOUBLE DEPRESSION - Individuals who have Alters refers to the different distinct personalities of major depressive episodes and persistent depression the host (owner) itself. with fewer symptoms. The transition from one personality to another is called a switch. Usually, the switch is instantaneous. Physical transformations may occur 8 Basic Specifiers To Describe Depressive Disorders: during switches. Posture, facial expressions, 1. Psychotic Features (Mood-Congruent Or Mood- Incongruent) 2. Anxious Distress (Mild To Severe) MIXED FEATURES - When a person experience manic symptoms but feel somewhat depressed or 3. Mixed Features anxious at the same time or be depressed with a few 4. Melancholic Features symptoms of mania. 5. Atypical Features CYCLOTHYMIC DISORDER - A milder but more chronic version of bipolar disorder. Occurs for 2 years 6. With Catatonic Features in adults and 1 year in children. 7. Peripartum Onset RAPID-CYCLING SPECIFIER - An individual with 8. Seasonal Pattern bipolar disorder who experiences at least four manic or depressive episodes within a year is considered to have a rapid-cycling pattern, which appears to be a severe variety of bipolar disorder that does not respond well to HALLUCINATIONS - Seeing or hearing things that standard treatments. aren’t there. RAPID SWITCHING/RAPID MOOD DELUSIONS - Strongly held but inaccurate beliefs. SWITCHING - When direct transition from one mood CATALEPSY - In which the muscles are waxy and state to another happens and is a particularly treatment- semirigid, so a patient’s arms or legs remain in any resistant form of the disorder. position in which they are placed. ULTRA-RAPID CYCLE - Lengths that only last for SEASONAL AFFECTIVE DISORDER (SAD) - It is days to weeks. a type of depression that occurs at specific times of the ULTRA-ULTRA-RAPID CYCLING - In cases where year, most commonly during the fall and winter months cycle lengths are less than 24 hours. when daylight hours are shorter. LEARNED HELPLESSNESS THEORY OF ACUTE GRIEF - Prolonged grief disorder where DEPRESSION - Proposed by Seligman, stating that, individuals experience intense grief that lasts a year or people become anxious and depressed when they decide more. Includes feelings of longing, yearning and that they have no control over the stress in their lives. sadness as well as anxiety, anger or guilt. DEPRESSIVE COGNITIVE TRIAD - People make INTEGRATED GRIEF - In which the finality of death cognitive errors in thinking negatively about and its consequences are acknowledged and the themselves, their immediate world, and their future. individual adjusts to the loss. SUICIDE - Associated with mood disorders but can PREMENSTRUAL DYSPHORIC DISORDER occur in their absence or in the presence of other (PMDD) - Clinically significant emotional problems disorders. It often results from intense feelings of that can occur during the premenstrual phase of the hopelessness, despair, or emotional pain, frequently reproductive cycle of a woman. linked to mental health conditions like depression, DISRUPTIVE MOOD DYSREGULATION anxiety, or trauma. DISORDER - Condition in which a child has chronic negative moods such as anger and irritability without any accompanying mania. COMMON TYPES OF ANTIDEPRESSANTS BIPOLAR DISORDERS - The tendency of manic Tricyclics (Tofranil, Elavil) episodes to alternate with major depressive episodes in Monoamine Oxidase (MAO) Inhibitors an unending roller-coaster ride from the peaks of elation Selective Serotonin Reuptake Inhibitors or to the depths of despair. Also known as manic- SSRIs (Provac, Zoloft) depressive illness. Lithium UNIPOLAR MOOD DISORDER - Experience either depression or mania (mood remains at one pole). Typically, depression. THERAPIES FOR MOOD DISORDER BIPOLAR MOOD DISORDER - Experience Cognitive Behavioral Therapy alternation between depression and mania (mood travels Interpersonal Psychotherapy from one pole to another). Mixed episodes. Electroconvulsive Therapy (ECT) Light Therapy  Cognitive Behavioral Group Therapy have trouble concentrating lose or gain weight without trying PSYCHOLOGICAL TREATMENT FOR have trouble sleeping or sleep more than usual BIPOLAR DISORDER feel tired all the time Interpersonal And Social Rhythm Therapy (IPSRT) feel physical aches and pains that have no medical cause think about death or attempt suicide CHAPTER SUMMARY: During the Manic Phase, the person may: feel extreme pleasure and joy from every TYPES OF MOOD DISORDERS activity DEPRESSIVE be extraordinarily active, planning excessive Major Depressive Disorder Symptoms daily activities Symptoms of major depressive disorder: sleep little without getting tired begin suddenly, often triggered by a crisis, develop grandiose plans leading to reckless change, or loss behavior: unrestrained buying sprees, sexual indiscretions, foolish business investments, and are extremely severe, interfering with normal so on functioning have “racing thoughts” and talk on and on can be long term, lasting months or years if untreated be easily irritated and distracted Some people have only one episode, but the pattern usually involves repeated episodes or lasting symptoms. CHAPTER 8: EATING AND SLEEP- Persistent Depressive Disorder (Dysthymia) WAKE DISORDERS Long-term unchanging symptoms of mild depression, sometimes lasting 20 to 30 years if untreated. Daily functioning not as severely affected, but over time BULIMIA NERVOSA - Out-of-control eating impairment is cumulative. episodes, or binges, followed by self-induced vomiting, Double Depression excessive use of laxatives, or other attempts to purge (get rid of) the food. Alternating periods of major depression and dysthymia. ANOREXIA NERVOSA - The person eats only minimal amounts of food or exercises vigorously to offset food intake so body weight sometimes drops BIPOLAR - People who have a bipolar disorder live on dangerously. an unending emotional roller coaster. BINGE-EATING DISORDER (BED) - Individuals TYPES OF BIPOLAR DISORDERS may binge repeatedly and find it distressing, but they do Bipolar I - major depression and full mania not attempt to purge the food. Bipolar II - major depression and mild mania AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER (ARFID) - People with this problem limit Cyclothymia - mild depression with mild mania, their food intake not because they are concerned about chronic and long term weight or body shape but because they are simply not During the Depressive Phase, the person may: interested in eating or food or because they avoid certain sensory characteristics or consequences of food or lose all interest in pleasurable activities and eating. friends PURGING TECHNIQUES - Individual attempts to feel worthless, helpless, and hopeless compensate for the binge eating and potential weight gain. Techniques include self-induced vomiting ACTIGRAPH - One alternative to the comprehensive immediately after eating. assessment of sleep is to use a wristwatch-size device. Purging Type (vomiting, laxatives, or diuretics) DAYTIME SEQUELAE - Their behavior while awake. Non-purging Type (exercise and/or fasting) SLEEP EFFICIENCY (SE) - The percentage of time actually spent asleep, not just lying in bed trying to TREATMENT FOR EATING DISORDERS sleep. SE is calculated by dividing the amount of time sleeping by the amount of time in bed. For bulimia nervosa, medications like Fluoxetine (Prozac) can help by: modulating serotonin levels, improving mood, reducing compulsions, and alleviating INSOMNIA DISORDER - Involves not getting anxiety/depression. enough sleep (the prefix in means “lacking” or For anorexia nervosa, no medication has been found “without”). effective in promoting weight gain or addressing the FATAL FAMILIAL INSOMNIA - A degenerative root psychological causes. However, CBT (Cognitive brain disorder Behavioral Therapy) and family therapy are effective. PERIODIC LIMB MOVEMENT DISORDER - Psychological Treatments: Cognitive Behavioral Excessive jerky leg movement Therapy (CBT) PRIMARY INSOMNIA - Sleep problems were not related to other medical or psychiatric problem. SLEEP DISORDERS - Conditions that affect the SLEEP APNEA - People with this problem have quality, amount and timing of sleep you’re able to get at difficulty breathing at night. They often snore loudly, night. pause between breaths, and wake in the morning with a RAPID EYE MOVEMENT (REM) SLEEP - How a dry mouth and headache. brain circuit in the limbic system might be involved REBOUND INSOMNIA - Where sleep problems with anxiety. This region of the brain is also involved reappear, sometimes worse—may occur when the with our dream sleep. medication is withdrawn. CHRONOTYPE - Whether you are a morning or HYPERSOMNOLENCE DISORDERS - Involve evening type. sleeping too much (hyper means “in great amount” or SOCIAL JETLAG - Switching your schedule because “abnormal excess”). of social factors is similar to changing time zones when NARCOLEPSY - A chronic disorder where individuals you travel. experience overwhelming daytime sleepiness and DYSSOMNIA - Difficulties in getting enough sleep, sudden bouts of sleep. problems with sleeping when you want to, and CATAPLEXY - Sudden muscle weakness triggered by complaints about the quality of sleep, such as not feeling strong emotions. refreshed even though you have slept the whole night. SLEEP PARALYSIS - Brief periods of inability to PARASOMNIA - Characterized by abnormal move upon waking. behavioral or physiological events that occur during sleep, such as nightmares and sleepwalking. BREATHING-RELATED SLEEP DISORDER - People whose breathing is interrupted during their sleep POLYSOMNOGRAPHIC (PSG) EVALUATION - often experience numerous brief arousals throughout The patient spends one or more nights sleeping in a the night and do not feel rested even after 8 or 9 hours sleep laboratory and being monitored on a number of asleep. measures, including respiration and oxygen desaturation; leg movements; brain wave activity, CIRCADIAN RHYTHM SLEEP DISORDER - This measured by an electroencephalogram; eye disorder is characterized by disturbed sleep brought on movements, measured by an electrooculogram; muscle by the brain’s inability to synchronize its sleep patterns movements, measured by an electromyogram; and with the current patterns of day and night. heart activity, measured by an electrocardiogram. CHAPTER SUMMARY:  outpatient treatment to restore weight and correct dysfunctional attitudes on eating and EATING DISORDERS body shape Bulimia Nervosa family therapy out-of-control consumption of excessive tends to be chronic if left untreated; more amounts of mostly non-nutritious food within a resistant to treatment than bulimia short time Binge Eating elimination of food through self-induced vomiting and/or abuse of laxatives or diuretics similar to bulimia with out-of-control food binges, but no attempt to purge the food to compensate for binges, some bulimics (vomiting, laxatives, diuretics) or compensate exercise excessively or fast between binges for excessive intake vomiting may enlarge salivary glands (causing marked physical and emotional stress; some a chubby face), erode dental enamel, and cause sufferers binge to alleviate bad moods electrolyte imbalance resulting in cardiac failure or kidney problems binge eaters share some concerns about weight and body shape as individuals with anorexia weight usually within 10% of normal and bulimia age of onset is typically 18 to 21 years of age, tends to affect more older people than either although it can be as early as 10 bulimia or anorexia TREATMENT: TREATMENT: Drug treatment, such as antidepressants. short-term CBT to address behavior and Short-term cognitive-behavioral therapy (CBT) attitudes on eating and body shape to address behavior and attitudes on eating and IPT to improve interpersonal body shape. drug treatments that reduce feelings of hunger Interpersonal psychotherapy (IPT) to improve interpersonal functioning. self-help approaches Tends to be chronic if left untreated. Anorexia Nervosa SLEEP-WAKE DISORDERS intense fear of obesity and persistent pursuit of Characterized by extreme disruption in the everyday thinness; perpetual dissatisfaction with weight lives of affected individuals, and are an important factor loss in many psychological disorders. severe caloric restriction, often with excessive exercise and sometimes with purging, to the DYSSOMNIAS - Disturbances in the timing, amount, point of semi-starvation or quality of sleep. severely limiting caloric intake may cause Insomnia Disorder cessation of menstruation, downy hair on limbs and cheeks, dry skin, brittle hair or nails, Characteristics include difficulty initiating sensitivity to cold, and danger of acute cardiac sleep, difficulty maintaining sleep, or or kidney failure nonrestorative sleep. weight at least 15% below normal TREATMENT: Treatment may be medical (benzodiazepines) or psychological (anxiety reduction, average age of onset is between 18 and 21 years improved sleep hygiene); combined approach is usually of age, with younger cases tending to begin at most effective. 15 Narcolepsy TREATMENT: hospitalization (at 75% below normal weight)  Characteristics include sudden daytime onset of Occurs at least once during non-REM sleep in REM sleep combined with cataplexy, a rapid 15% to 30% of children under age 15. Causes loss of muscle tone that can be quite mild or may include extreme fatigue, sleep deprivation, result in complete collapse. Often accompanied sedative or hypnotic drugs, and stress. Adult by sleep paralysis and/or hypnagogic sleepwalking is usually associated with other hallucinations. psychological disorders. May have a genetic link. TREATMENT: Treatment is medical (stimulant drugs). Hypersomnolence Disorder Characteristics include abnormally excessive sleep and involuntary daytime sleeping. Classified as a disorder only when it’s subjectively perceived as disruptive. TREATMENT: Treatment is usually medical (stimulant drugs). Breathing-Related Sleep Disorders Characteristics include disturbed sleep and daytime fatigue resulting from hypoventilation (labored breathing) or sleep apnea (suspended breathing). TREATMENT: Treatment using continuous positive air pressure (CPAP) machines is the gold standard; weight loss is also often prescribed. Circadian Rhythm Sleep-Wake Disorders Characteristics include sleepiness or insomnia. TREATMENT: Treatment includes phase delays to adjust bedtime and bright light to readjust biological clock. PARASOMNIAS - Abnormal behaviors that occur during sleep. Nightmares Frightening REM dreams that awaken the sleeper. Nightmares qualify as nightmare disorder when they are stressful enough to impair normal functioning. Causes are unknown, but they tend to decrease with age. Sleep Terrors Occur during non-REM (nondreaming) sleep and most commonly afflict children. Sleeping child screams, cries, sweats, sometimes walks, has rapid heartbeat, and cannot easily be awakened or comforted. More common in boys than girls, and possible genetic link since they tend to run in families. May subside with time. Sleepwalking