Abnormal Psychology PDF

# Abnormal Psychology ## **BLEPP2023** **Source:** Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR, Psych Pearls ## Normalcy and Abnormalcy (5) **Recognizing Normal and Abnormal manifestations of behavior** * **Psychological Disorder** - psychological dysfunction within a...

# Abnormal Psychology ## **BLEPP2023** **Source:** Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR, Psych Pearls ## Normalcy and Abnormalcy (5) **Recognizing Normal and Abnormal manifestations of behavior** * **Psychological Disorder** - psychological dysfunction within an individual associated with distress or impairment in functioning and a response that is not typical or culturally expected * **4 D's of Psychological Disorder** * **Psychological Dysfunction** - refers to a breakdown in cognitive, emotional, or behavioral functioning * Interferes daily functioning * **Distress or Impairment** - individual is extremely upset and cannot function properly * Either to self or to others * **Atypical or Not Culturally Expected (Deviance)** - deviates from the average or the norm of the culture * Not just to the society but deviation from the person's usual behavior * **Dangerousness** - creates potential harm to self (suicidal gestures) and others (excessive aggression) * **Psychopathology** - scientific study of mental disorders * **Clinical Psychology** - applied branch of psychology that seeks to understand, assess, and treat psychological conditions in a clinical setting * **Abnormal Psychology** – branch of psychology that studies unusual patterns of behavior, emotions, and thought which may or may not indicate an underlying condition **Normal Behavior** * people in the society - one behavior that is like other * **Normality is social conformity** - some behaviors are non-conforming but normal * **Normality is personal comfort** * **Normality is a process** **Criteria for determining Abnormal Behavior** * Norm-violation * Statistical rarity * Personal Discomfort * Deviation * Maladaptiveness **Clinical Assessment** - the systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder **Diagnosis** - process of determining whether the particular problem afflicting the individual meets all criteria for a psychological disorder ## Theoretical Approaches in Explaining the Etiology of Psychological Disorders (20) * **One-Dimensional** - looking for a single cause * **Multidimensional** - looking for a systemic cause ### Genetic contributions * **Genes** - long molecules of DNA at various locations on chromosomes, within cell nucleus * 46 Chromosomes, 23 Pairs, 22 Pairs of Autosomes, 1 pair Sex Chromosomes * XX - female, XY – male * **Dominant** and **Recessive** * **Phenotypes** - observable characteristics * **Genotypes** - unique genetic makeup * **Endophenotypes** - genetic mechanisms that ultimately contribute to the underlying problems causing the symptoms and difficulties experienced by people with psychological disorders * **Basic Genetic Epidemiology** - statistical analysis of family, twin, and adoption studies; if the disorder can be inherited and how much is attributable to genetics * **Advanced Genetic Epidemiology** studies the factors that influence the disorder * **Gene Finding** – what gene influences the behavior * **Molecular Genetics** biological analysis of individual DNA samples; biological processes genes affect to produce symptoms of the disorder * **Family Studies** - examine behavioral pattern or emotional trait in the context of the family * **Proband** - family member with the trait singled out for study * The first person in the family to be identified as possibly having genetic disorder and who may receive genetic counseling or testing * **Adoption Studies** - identify adoptees who have a particular behavioral pattern or psychological disorder and attempt to locate first-degree relatives who were raised in different family settings * **Twin Studies** - usually conducted to identical twins because they share genetic makeup' * Those people who reported more severe stressful life events and had at least one short allele of the 5-HTT gene were at greater risk of developing depression (Caspi et al., 2003) (serotonin-transporter gene) * **Epigenetics** - factors other than inherited DNA sequence, such as new learning or stress, that alter the phenotypic expression of genes ## Biological and Neurological Bases * **Neuroscience** - study of the nervous system, especially the brain to understand behavior, emotions, and cognitive processes | Neurotransmitter | High | Low | |-------------------|------|-----| | Dopamine | Schizophrenia | Parkinson's | | Acetylcholine | | Alzheimer's (Dementia) | | Norepinephrine | Mania | Mania | | GABA | Relaxation | Depression | | Serotonin | | Anxiety/OCD, Depression | | Epinephrine | Stress | Fatigue | | | Sleep Disorders | Eating Disorders | | Glutamate | Psychosis | Huntington's Disease | | Endorphin | | | * **Agonist** - effectively increase the activity of the neurotransmitters (Excitatory) * **Antagonist** - decrease or black neurotransmitter (Inhibitory) * **Inverse Agonists** - produces effects opposite to those produced by the neurotransmitters * **Reuptake** - neurotransmitter is released, quickly broken down and brought back to the synaptic cleft ### Neurotransmitter * **chemical messengers of the body** * **Glutamate (E)** [memory] - most abundant in the brain and plays a key role in thinking, learning, and memory * **GABA (I)** [calming] – most common inhibitory neurotransmitter in the brain and regulates mood, irritability, sleep, seizures * **Serotonin (I)** [mood] - regulates mood, sleep patterns, sexuality, appetite, and pain * **Dopamine** [pleasure] - body reward system, pleasures, achieving heightened arousal and learning * **Epinephrine** [fight-or-flight] – responsible for fight-or-flight response * **Norepinephrine** [concentration] - alertness, arousal, decision-making, attention, and focus * **Endorphins** [euphoria] - natural pain reliever, reduces pain * **Acetylcholine (E)** [learning] - regulates heart rate, blood pressure and gut motility, role in muscle contraction, memory, motivation, sexual desire, sleep, and learning ### Brain Stem * lower and more ancient part of the brain; essential for autonomic functioning such as breathing, heartbeat, etc. ### Hindbrain * contains the medulla, pons, and cerebellum; regulates many autonomic activities such as breathing, heartbeat, and digestion ### Cerebellum * controls motor coordination * abnormalities associated with autism ### Midbrain * coordinates movements with sensory input and contains parts of reticular activating system (contributes to sleep, arousal and tension) ### Thalamus and Hypothalamus * involves in regulating behavior, emotions, and hormones ### Limbic System * center of the brain located around the edge of the Hippocampus, Cingulate Gyrus, Septum, and Amygdala * **Amygdala** - emotions * **Hippocampus** - shrinks when a person have depression * **Regulate emotional experiences and expressions and, to some extent, our ability to learn and to control impulses** * **Basal Ganglia** - base of the forebrain, includes caudate nucleus * **Damage involved changing our posture or twitching or shaking** * **Related to Parkinson's Disease** * **Cerebral Cortex** - provides us with our distinctly human qualities, allowing us to look to the future and plan, to reason, and to create * **Left Hemisphere** - responsible for verbal and other cognitive processes * **Right Hemisphere** - perceiving the world around us and creating images * **Lobes:** Frontal, Parietal, Occipital, Temporal * **Prefrontal Cortex** - area responsible for higher cognitive functions * **HPA Axis** - Hypothalamus, Pituitary Gland, Adrenal Cortex * regulate cardiovascular system and endocrine system * **Somatic Nervous System** - controls the muscles * **Autonomic Nervous System** * **Sympathetic** - fight or flight responses * **Parasympathetic** - calms the sympathetic nervous system; rest and digest functions * **Endocrine System** - glands produce hormones that is released to the blood streams * **Pituitary** - master gland * **Thyroid** - controls metabolism and growth (thyroxine) * **Parathyroid** - controls the levels of calcium * **Adrenal** - controls metabolism, blood pressure, sex development, stress (epinephrine) * **Pineal** - releases melatonin * **Pancreas** - creates insulin * **Testes** - makes sperm and release testosterone * **Ovaries** - releases estrogen, progesterone, and testosterone * **Permissive Hypothesis** - when serotonin levels are low, other neurotransmitters are permitted to range more widely, become dysregulated, and contribute to mood irregularities ## Learning * **Classical Conditioning** - type of learning in which neutral stimulus is paired with response until it elicits that response * **Unconditioned Stimulus** - natural stimulus * **Unconditioned Response** – natural or unlearned response * **Conditioned Stimulus** - newly conditioned event introduced * **Conditioned Response** - response from the conditioned stimulus * **Extinction** - without CS showed long enough, the behavior could be eliminated * **Stimulus Generalization** - strength of the response to similar objects or people is usually a function of how similar these objects or people are * E.g., You are afraid of fury dogs because they once attacked you. Now, whenever you see something fury, your body trembles, you cannot breathe properly and wanted to go away. * **Introspection** - Edward Titchener; subjects report their inner thoughts and feelings after experiencing certain stimuli * **John B. Watson** - founder of behaviorism * **Little Albert** - patients were gradually introduced to the objects or situations they feared so that their fear could extinguish * **Operant Conditioning** - behavior changes as a function of what follows the behavior (rewards or punishment) * **B.F. Skinner** * **Edward Thorndike** - Law of effect (behavior can be strengthened or weakened) * **Reinforcement** - reward * **Shaping** - process of reinforcing successive approximations to a final behavior or set of behaviors * **Social Learning** - Albert Bandura * **Modeling/observational learning:** process of learning in which an individual acquires responses by observing and imitating others * **Observational learning** * **Social Cognitive Theory:** people observe models, learns chunks of behavior, and mentally put chunks together into complex new behavior patterns * **Albert Bandura** * **Hitting Doll experiment** * **Self-Efficacy** - person's confidence in their own abilities to accomplish their goals * **Learned Helplessness** – when rats or other animals encounter conditions over which they have no control, they give up attempting to cope and seem to develop the animal equivalent of depression * **Martin Seligman and colleagues ** * **People make an attribution that they have no control, and become depressed** * **Causes:** coercive, ineffective, inconsistent parents, media violence, peer rejection * **Internal:** negative effects due to internal failings * **Stable:** even after a particular negative events pass, additional bad things will "always be my fault" remains * **Global:** attributions extend across a variety of issues * **Learned Optimism** - if people faced with considerable stress and difficulty in their lives, nevertheless, display optimistic, upbeat attitude, they are likely to function better psychologically and physically * **Positive Psychology** * **Prepared Learning** - we have become highly prepared for learning about certain types of objects or situations over the course of evolution because this knowledge contributes to the survival of the species * **Learning from ancestors** * **Hopelessness Theory** - desirable outcomes will not occur, and that the person has no responses available to change this situation * **Cognitive theories with Psychoanalytic** * **Fear** - fight or flight response * **Evolutionary adaptation** * **White with fear, trembling, faster breathing, increase in glucose, pupil dilate, hearing become more acute, digestive system stops, pressure to urinate, defecate, vomit to reduce waste materials.** * **Introjection** - direct all their feelings for the loved one, including sadness and anger, toward themselves * **Symbolic or Imagined Loss** – person equates other kinds of events with the loss of a loved one ## Attributional Style * ways in which people explain the cause of events within their lives * **Internal-External** – who or what is responsible for the event * whether something unique about the person (internal) or something about the situation caused the event (external) * **Stable-Unstable** – perceived permanence of the cause * an event can be viewed as constant and likely to happen again (stable) or it only happens once (unstable) * **Global-Specific** - universal throughout your like (global) or specific to a part of your life (specific) * **Cognitive Theory of Depression** - persons susceptible to depression develop inaccurate/unhelpful core beliefs about themselves, others, and the world as a result of their learning histories * **Depressed people consistently think in illogical ways and keep arriving at self-defeating conclusions ** * **Tends to Overgeneralize** (draw broad negative conclusions on the basis of single insignificant event) [Cognitive Bias] * **Depressive Cognitive Triad:** depressed people make cognitive errors in thinking negatively about themselves, immediate world, and their future * **Beck Hopelessness Scale** * **Negative Schema:** an enduring negative cognitive system about some aspects of life * **Self-Blame Schema:** people feel personally responsible for every bad happenings * **Negative Self-Evaluation Schema:** "can never do anything correctly" * **False Consensus Effect/False Consensus Bias:** people tend to overestimate the extent to which their opinions, beliefs, preferences, values, and habits are normal and typical of the others (“Everyone shares the same opinion as me,”) * **Negative Cognitive Styles:** * **Dichotomous Thinking/Absolutist/Black and White Thinking** - seeing only of the extremes of things, never the middle * "either I ace this test or fail," * **Overgeneralization** - making generalizations about a negative aspect * "bagsak ako sa physics, hindi na ko makaka-graduate ng college," * **Personalization** - tendency for individuals to relate external events to themselves, even when there is no basis for making this connection * **egocentric thinking, everything is about him "kasalanan ko kung bakit umiyak yung bata"** * **Selective Abstraction** - focuses on the negative detail is taken out of context and believed whilst everything else in the context is ignored * /almost good feedback except for one /focused on that single feedback * **Arbitrary Inference** - evident when depressed individuals emphasize the negative rather than the positive aspects of a situation * **only accepts negative thoughts** * **no logical reasoning** * **interpreting a situation when there is no factual evidence** * /passed, “chamba”, /negative “kasalanan ko kasi" * **Labeling and Mislabeling** - portraying one's identity on the basis of imperfections and mistakes made in the past and allowing them to define one's true identity * /bullied for being dark-skinned, “I am ugly." * **Minimization** - downplaying the significance of an event or emotion * **common strategy in dealing with feelings of guilt "Parang nakakarami ka na ah," "Luh parang tanga, sampung bote pa lang"** * **Magnification** - effects of one's behaviors are magnified * /may konting mantsa sa damit, "Iniisip siguro nila hindi ako naglalaba," * **General Adaption to Stress Theory** - understanding the relationship between stressful events and the body's response to stress * **Alarm:** fight-or-flight response * **Resistance:** coping mechanisms * **Exhaustion:** body defenses resources are depleted * **Hans Selye** * **Stress-Appraisal/Cognitive Appraisal Theory** - stress is a two-way process, it involves a production of stressors and the response of an individual subjected to these stressors * **Primary Appraisal:** an individual tends to ask questions like, "What does this stressor and/or situation mean?", and "How can it influence me?" * **Understanding the stressor** * **Secondary Appraisal:** involves those feelings related to dealing with the stressor or the stress it produces * **Deals with the stressor ** * **Starts to assess internal and external resources available to solve the problem** * **Positive:** "I can do it if I do my best," * **Negative:** "I cannot do it.” ## Memory Disorders * **Anosognosia:** no memories of his own illness * **Confabulation:** filling in memory gaps with imaginary experiences * **Disorientation:** cannot identify or recognize time, places, and persons * **De Javu:** unfamiliar perceived as familiar * **Jamais Vu:** familiar perceived as unfamiliar * **Hypermnesia:** increased memory * **Paramnesia:** false or perverted memory * **Amnesia:** loss of memory ### Types of Amnesia: 1. **Biogenic** - caused by brain damage or disease * **Retrograde** - inability to retrieve information that was acquired before (remote memory loss) * **Anterograde** - inability to transfer new information from the short-term store to long-term store (recent memory loss) 2. **Psychogenic or Dissociative or Functional** - caused by psychological trauma, repressed memories * **Generalized** - origin is rare psychological disorder and spontaneous recovery from amnesia in a comparatively short period of time * **Localized** - no memory of specific events * **Selective** - can only recall only small parts of the events * **Situation-Specific** – result of severely stressful event, as part of PTSD * **Global** - cannot recall both past and present; total memory loss ### Memory * the process by which we encode, store, and retrieve information * **Declarative:** factual information * **Procedural:** skills and habits * **Semantic:** general knowledge and facts, logic * **Episodic:** events that occur in a particular time, place, or context ### Three-System Approach to Memory * information must travel if it is to be remembered * **Sensory:** initial storage of information, perceived by the senses * **Short-Term Memory:** holds info for 15 to 20 seconds * **Long-Term Memory** - stores on a relatively permanent basis, although, at times, it can be difficult to retrieve * **Chunks** - meaningful grouping of stimuli that can be stored as a unit in STM * **Rehearsal** - repetition of information that has entered the STM * **Repetitive:** as long as it is repeated, it states in the STM * **Elaborative:** transfers info to LTM * **Tip-Of-The-Tongue Phenomenon** - inability to recall information that one realizes one knows * **Retrieval Cue** – allow us to recall more easily * **Recall:** memory task in which specific information is retrieved * **Recognition:** individual is presented with a stimulus and asked whether they have been exposed to it in the past or to identify it from the list of alternatives * **Levels-Of-Processing Theory** - degree to which new materials is mentally analyzed * **Implicit Memory:** can be recalled automatically without thinking * **Explicit Memory:** requires conscious retrieval of information * **Constructive Processes** - memories are influenced by the meaning we give to them * **Autobiographical:** episodes from our own lives * **Flashbulb Memories:** specific or surprising events that are so vivid in memory it as if they represented a snapshot of the event * **Forgetting** – permits us to form general impressions and recollections * **Helps us avoid being burdened and distracted by trivial stores of meaningless data** * **Failure of Encoding:** failure to pay attention and place information in memory * **Decay:** loss of information due to non-use * **Cue-Dependent Forgetting:** insufficient retrieval cues * **Proactive Interference:** learned earlier disrupts the recall of newer material; you forget the new info * **Retroactive Interference:** difficulty in recalling info learned earlier because of later exposure to different material; you forget the old info * **Learned Helplessness (Martin Seligman)** – if they learn that nothing they do helps them avoid the shocks, they eventually become helpless, give up, and manifest an animal equivalent of depression * **Anxiety is the first response to a stressful situation** ## Diathesis-Stress Model * individuals inherit tendencies to express certain traits or behaviors, which may then be activated under conditions of stress (Eric Kandel) * **Diathesis** - a condition that makes someone susceptible to developing disorder (vulnerability) * The higher vulnerability, the lesser life stress needed to trigger traits * **Predisposing Factor:** cause of a disorder (i.e., situations that trigger the development of the disorder) * **Precipitating Factor:** factors that allow the disorders to develop (i.e., factors that could contribute to the development of a disorder) * **Protective Factor:** reduces the severity of the problems * **Perpetuating Factor:** factors that maintain the problem once established ### Gene-Environment Correlation Model * people might have genetically determined tendency to create the environment risk factors that trigger a genetic vulnerability ### Epigenetics * study how your behavior and environment can cause changes that affect your genes work ### Reciprocal Gene-Environment Model * claims that people with a genetic predisposition to a disorder may also have a genetic tendency to create environmental factors that promote the disorder ## Role of culture, social interactions, and interpersonal factors in the development ### Sociogenic Factors: * Unemployment * Poverty * Crime * Poor Educational Level * People who are isolated and lack social support or intimacy in their lives are more likely to become depressed when under stress and to remain depressed longer than people with supportive spouses or warm friendships. * People's online relationships tend to parallel their offline relationships ### Family Systems Theory * family is a system of interacting parts who interact with one another in consistent ways and follow rules unique to each family * Structure and communication patterns of some families actually force individual members to behave in a way that otherwise seems abnormal * An individual's behavior, whether normal or abnormal, is best understood in the light of the individual's unique cultural context. * Multicultural Perspective - each culture within large society has a particular set of values and beliefs, as well as special external pressures, that help account for the behavior and functioning of its members (Culturally Diverse Perspective) ## Suicide * self-inflicted death in which the person acts intentionally, directly, and consciously * **Death Seekers** – clearly intend to end their lives at the time they attempt suicide * May last only a short time * **Death Initiators** - clearly intent to end their lives, but they act out of a belief that the process is already under the way and that they are simply hastening the process * **Death Ignorers** - do not believe that their self-inflicted death will mean the end of their existence * **Death Darers** - experience mixed feelings, or ambivalence, about their intent to die, even at the moment of their attempt, and they show this ambivalence in the act itself * Their risk-taking behavior does not guarantee death * **Subintentional Death** a death in which the victim plays an indirect, hidden, partial, or unconscious role * **Suicidal Ideation** – thinking seriously about suicide * **Suicidal Plans** – formulation of a specific method for killing oneself * **Suicidal Attempts** - the person survives from attempts * **Emile Durkheim's Suicide Types:** * **Altruistic** - formalized suicides; dishonor to self, family, or society * **Egoistic** - loss of social supports as an important provocation for suicide * **Anomic** - result of marked disruptions, such as sudden loss of job * **Fatalistic**- loss of control over one's own destiny * Freud believed that suicide indicated unconscious hostility directed inward to the self rather than outward to the person or situation causing the anger * If a family member committed a suicide, there is an increased risk that someone else will also * **Low levels of serotonin is associated with suicide and with violent suicide attempts (low levels of serotonin is linked with impulsivity, instability, and the tendency to overreact to situation)** * **The stress of a friend's suicide or some other major stress may affect several individuals who are vulnerable because of existing psychological disorders** * **Hopelessness** – pessimistic belief that one's present circumstances, problems, or mood will not change * **Dichotomous Thinking** – viewing problems and solutions in rigid either/or terms * **Common triggering factors:** * Stressful events * Mood and thought changes * Alcohol and other drug use * Mental disorders * Modeling ## Psychological Disorders and Specific Symptoms based on DSM-5 (50) ### Differentiating Anxiety disorders * **Separation Anxiety Disorder** * concerns with real or imagined separating from attachment figures * separation may lead to extreme anxiety and panic attacks * not entirely responsible for school absences or school avoidance * do not attend school so they won't be separated with their attachment figure * fear of possible separation is the central thought * concerned about the proximity and safety of key figures * attachment * at least 4 weeks (children) or 6 months or more (adults) * **Selective Mutism** * rare childhood disorder characterized by a lack of speech in one or more setting in which speaking is socially expected * restricted to a specific social situation * a child could speak in one setting but cannot/do not in another setting * not better explained by communication disorder * only diagnosed when a child has established a capacity to speak in some social situations * learn to perform avoidance and safety behaviors to avoid disasters * at least 1 month * **Specific Phobia** * irrational fear of a specific object or situation that markedly interferes with an individual's ability to function * false alarm, and observation acquired through direct experience, experiencing in * it only fears one setting, unlike Agoraphobia (which requires 3 settings), then Specific Phobia-Situational can be diagnosed * 6 months or more * **Social Anxiety Disorder** * fear or anxiety about possible embarrassment or scrutiny * can have panic attacks but it is cued by social situations * typically have adequate age-appropriate social relationships and social communication capacity * 6 months or more * **Panic Disorder** * cannot be diagnosed unless full symptom panic attacks were experienced * norepinephrine activities are irregular * abrupt surge of intense fear or discomfort out of nowhere, with no triggers * followed by persistent concerns about more attacks or the consequences of it or maladaptive change in behavior related to the attacks * **Agoraphobia** * developed after a person has unexpected panic attacks * fear in two or more situations (public transpo, open spaces, enclosed spaces, standing in line, being outside of the home alone) due to thoughts that escape might be difficult or no one will help them in case panic-like symptoms would manifest * 6 months or more * **Generalized Anxiety Disorder** * difficulty to control worry * excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities * "the world is a dangerous place" * intense cognitive processing in the frontal lobes, particularly in the left hemisphere * intense worrying may act as avoidance * worry whether or not they are judged/evaluated * fear circuit is excessively active ### Differentiating Trauma-and-Stressor Related Disorders * **Reactive Attachment Disorder** * withdrawn toward adult caregivers * evident before age 5 years * history of severe social neglect * **Disinhibited Social Engagement Disorder** * actively approaches and interacts with unfamiliar adults * can be distinguished from ADHD by not showing difficulties in attention or hyperactivity * **Posttraumatic Stress Disorder** * exposure to actual death, injury or sexual violence (direct experience, witness, learning that the event happened to a close family, repeated exposure) * more than 1 month * heightened activity in the HPA axis * requires trauma exposure precede the onset of the symptoms * too much use of dissociation * **Acute Stress Disorder** * exposure to trauma (direct experience, witness, learning that event occurred to close fam, repeated exposure) * 3 days to 1 month after trauma exposure * if the symptoms persists for more than 1 month and meet the criteria for PTSD, then PTSD will be diagnosed * **Adjustment Disorder** * development of emotional or behavior symptoms in response to identifiable stressors occurring within 3 months of the onset of the stressors * If symptoms persist beyond 6 months after the stressor or its consequences have ceased, the diagnosis will no longer apply * May sometimes be diagnosed instead of bereavement if bereavement is judged to be out of proportion to what would be expected or significantly impairs self-care and interpersonal relations * **Prolonged Grief Disorder** * death, at least 12 months, of a person close to the bereaved individual (6 months for children) * focused on loss and separation from a loved one rather than reflecting generalized low mood distress from a deceased person ### Differentiating OCD-Related Disorders * **Obsessive-Compulsive Disorder** * **Obsessions:** intrusive and mostly nonsensical thoughts, images, or urges that the individual tries to resist * eliminate thought or actions used to suppress the obsessions and provide relief * **Compulsions:** * Tic Disorders is common to co-occur in patients with OCD * obsessions usually do not involve real life concerns and can include one, irrational, or magical content * In BDD and Tricho, the compulsive behavior is limited to hair pulling or distortions in absence of obsessions * concerns about weight and food * obsessions and compulsions are not limited to about weight and food * Compulsions are usually preceded by obsessions, tics are often preceded by premonitory sensory urges * **Body Dysmorphic Disorder** * preoccupation with some imagined defect * imagined ugliness * excessive appearance-related preoccupations and repetitive behaviors that are time-consuming * can be co-morbid with eating disorders * **Hoarding** * difficulty discarding or parting with possessions * **Prader-Willi Syndrome:** characterized by severe hypotonia, poor appetite, and feeding difficulties in early infancy, followed in early childhood by excessive eating and gradual development of morbid obesity * not direct consequence of neurodevelopmental disorder, nor delusion, nor psychomotor retardation, fatigue, or loss of energy * **Trichotillomania** * should not be diagnosed when hair removal is performed solely for cosmetic reasons * diagnosis will be OCD, if there is obsession of symmetry * someone with ASD could have hair-pulling behaviors when frustrated or angry, so if it's impairing then it can be diagnosed as stereotypic movement disorder * note the delusion or hallucination, if then, psychotic disorder * **Excoriation** * note delusion or tactile hallucination * In absence of deception, excoriation disorder can be diagnosed if there are repeated attempts to decrease or stop skin picking ## Explaining Somatic Symptom Disorders ### Somatic Symptom Disorder * one or more symptoms cause distress and disruption of daily life * chronic, influenced by the number of symptoms, age, level of impairment, and any comorbidity * ineffectiveness of analgesics, history of mental disorders, unclear palliative factors, persistence without cessation, and stress * must be accompanied by excessive or disproportionate thoughts, feelings, or behavior * focus is on the distress that particular symptoms cause * individual's belief that somatic symptoms might reflect serious underlying physical illness are not held with intensity * delusional with enhanced perceptual sensitivity to illness cues * **Illness Anxiety Disorder** * preoccupation with having or acquiring serious illness * usually minimal to no symptoms, mild intensity * interpret ambiguous stimuli as threatening * develop in the context of a stressful life * People who develop these disorders tend to have a disproportionate incidence of disease in their family when they were children * **Conversion Disorder (Functional Neurological Symptom Disorder)** * altered voluntary motor or sensory function * incompatibility between the symptom and recognized neurological or medical conditions or unexpected neurological disease cause for the symptoms is rarely found at follow-up * too much use of denial * **Psychological Factors affecting other Medical Conditions** * medical symptom is present * psychological or behavioral factors affect medical condition * psychological or behavioral factors are judged to affect the course of medical condition * Psychological factors affecting other medical conditions is diagnosed when the psychological traits or behaviors do not meet criteria for a mental diagnosis * **Factitious Disorder** * **Imposed on Self:** individual present himself or herself as ill * **Imposed on Another:** presents another individual as ill in absence of obvious rewards * **Malingering:** false medical symptoms or exaggerating existing symptoms in hopes of being rewarded ## Evaluating DID from other Disorders ### Depersonalization-Derealization Disorder * **Depersonalization:** your perception alters so that you temporarily lose the sense of your own reality, as if you are in a dream watching yourself * **Derealization:** your sense of external world is lost; thing may seem to change shape or size, people may seem mechanical or dead * **Characterized by the presence of constellation of typical depersonalization/derealization symptoms and the absence of manifestations of illness anxiety disorder** * **must precede the onset of major depressive epi or clearly continues even after its resolution** * **when symptoms occur ONLY during panic attacks, it must not be diagnosed with D/DD** ### Dissociative Amnesia * **inability to recall important autobiographical information, usually of traumatic or stressful nature, that is inconsistent with ordinary forgetting** * **usually localized or selective amnesia for specific events, then generalized, if entire life history** * **Dissociative Fugue:** memory loss revolves around specific incident, an unexpected trip; individuals just take off and later find themselves in a new place, unable to remember why or how you got there * **If a person experiencing PTSD cannot recall part or all of specific trauma event and that extends to beyond the immediate time of the trauma, comorbid diagnosis of DA may be warranted** * **there must be no true neurocognitive deficits** * **too much use of repression** ### Dissociative Identity Disorder * **disruption of identity characterized by two or more distinct states of personality** * **extreme of PTSD** * **host personality:** the person who becomes the patient and asks for treatment; developed later * **switch:** transition from one personality to another * **subtype** -Hypnotic Trance: tend to be focused on one aspect of their world and they become vulnerable to suggestions by the hypnotist * does not have a classic bipolar sleep disturbance * Individuals with schizophrenia have low hypnotic capacity, whilst, individuals with DID have highest hypnotic capacity among all clinical groups * appear to encapsulate a variety of severe personality disorder features * **too much use of dissociation** ## Illustrating Depressive Disorders ### Unipolar Disorders * **Disruptive Mood Dysregulation Disorder** - recurrent temper outburst (verbally or behaviorally) that are grossly out of proportion * 3 or more times/week * irritable or angry most of the day * 12 or more months, at least 2 settings * onset should be after 6 yrs-18yrs * do not occur exclusively during MDE * bipolar = episodic, DMD = persistent * diagnosis cannot be assigned to a child who has ever experienced full-duration hypomanic or manic episode (irritable or euphoric) or who has ever had a manic or hypomanic episode lasting more than 1 day * presence of severe and frequently recurrent outburst and persistent disruption in mood between outburst * severe in at least one setting and mild to moderate to second setting * **Major Depressive Disorder** * at least 2 weeks of either anhedonia or depressed mood * "other specified depressive disorder" can be made in addition to the diagnosis of psychotic disorder * in schizoaffective, delusions or hallucinations occur exclusively for 2 weeks without MDE * **Seasonal, Catatonic, Melancholic** * **Persistent Depressive Disorder (Dysthymia)** - depressed mood for at least 2 years * if full criteria for a MDE has been met at some point during the period of illness