Abnormal Psychology PDF

Module 1 Definitions of normality vary widely by 3. Normality is personal comfort person, time, place, culture, and situation. - If a person feels/experiences pleasure or "Normal" is, after all, a subjective comfort, then the behavior is considered normal. perception, an...

Module 1 Definitions of normality vary widely by 3. Normality is personal comfort person, time, place, culture, and situation. - If a person feels/experiences pleasure or "Normal" is, after all, a subjective comfort, then the behavior is considered normal. perception, and also a vague one-it is Likewise, if a person feels/experiences often easier to describe what is not displeasure or discomfort, then that is normal than what is normal. considered abnormal. Issues with this definition include the Problem of Individual In simple terms, however, society at large Reactions to Discomfort and the Problem of often perceives or labels "normal" as Social Consequences. "good," and "abnormal" as "bad." Defining Abnormal Psychology Being labeled as "normal" or "abnormal" Abnormal psychology is a branch of can therefore have profound ramifications psychology that deals with psychopathology for an individual, such as exclusion or and abnormal behavior, or the patterns of stigmatization by society. emotion, thought, and behavior that can be Although it is difficult to define "normal," it signs of a mental health condition. is still important to establish guidelines in order to be able to identify and help It seeks to understand, classify, diagnose, and people who are suffering. treat psychological disorders, as well as to explore the various factors that contribute to Normal Behavior these mental health disorders. The definitions of what is considered normal Abnormal Psychology behavior describe it as behavior that is refers to the scientific study of people who are socially acceptable to the standards of the atypical or unusual, with the intent to be able society. to reliably predict, explain, diagnose, identify the causes of, and treat maladaptive behavior In short, if behavior is socially acceptable or conforming to the standards of society, then that behavior is normal. Abnormal Behavior Criteria for Normality is a combination of personal distress, psychological dysfunction, deviance from 1. Normality is average social norms, dangerousness to self and - what is accepted by the majority others, and costliness to society. is considered normal. A problem in this The study of psychological disorders is called definition that not everything that is psychopathology. accepted by the majority can be considered normal. Mental Disorders 2. Normality is social conformity - Anyone who conforms to the standards of are characterized by psychological the society is considered normal. dysfunction, which causes physical and/or Two main problems in this definition put psychological distress or impaired functioning consideration to the Problem of Criminality and is not an expected behavior according to and the Problem of Social Standards. societal or cultural standards. '  The 4D’s of Abnormal Psychology 1. Dysfunction 2. Psychodynamic Perspective - Includes "clinically significant disturbance in - Developed by Sigmund Freud, an individual's cognition, emotion regulation, this perspective focuses on unconscious or behavior that reflects a dysfunction in the conflicts and early childhood experiences as psychological, biological, or developmental the root causes of psychological disorders. It processes underlying mental functioning.” suggests unresolved conflicts can lead to psychological distress and abnormal behavior. 2. Distress Therapy based on this perspective aims to - When the person experiences a disabling bring these unconscious conflicts to condition "in social, occupational, or other consciousness and resolve them through important activities". Distress can take the techniques like free association and form of psychological or physical pain, or both interpretation. concurrently. 3. The Behavioral Perspective 3. Deviance - The behavioral perspective emphasizes - Closer examination of the word abnormal observable behaviors and how they're learned indicates a move away from what is normal, or through interactions with the environment. It the mean (i.e., what would be considered suggests that abnormal behaviors are a result average and in this case in relation to of maladaptive behaviors learning, often behavior), and so is behavior that infrequently influenced reinforcement, punishment, by and occurs (sort of an outlier in our data). conditioning. Therapies based on this perspective, such as behavior therapy, focus 4. Dangerousness on modifying behaviors through techniques - behavior represents a threat to the safety of like exposure therapy, operant conditioning, the person or others. It is important to note and systematic desensitization. that having a mental disorder does not imply a person is automatically dangerous. 4. The Cognitive Perspective - The cognitive perspective focuses on the The depressed or anxious individual is often role of distorted or dysfunctional patterns in no more a threat than someone who is not the development thought psychological depressed, and as Hiday and Burns 2010) disorders. It suggests that how of individuals showed, dangerousness is more the interpret situations and events can lead to exception than the rule. negative emotions and behaviors. Cognitive therapies aim to identify and modify these Different Perspectives negative thought patterns to promote healthier thinking and emotional well-being. 1. The Medical Perspective 5. The Socio-Cultural Perspective - The medical perspective views psychological - The socio-cultural perspective emphasizes disorders as similar to physical diseases, with the influence of cultural, societal, and underlying biological causes. It emphasizes environmental factors on the development and factors like genetics, brain chemistry, and expression of psychological disorders. It neurobiology in explaining the development recognizes that norms, values, and social and manifestation of disorders. Treatment expectations vary across cultures and can often involves interventions such as impact the way disorders are perceived and medication and medical issuesures to address therefore experienced. This perspective also these underlying biological issues. considers how social support systems and cultural beliefs influence the course of treatment and recovery. MODULE 2 The Sociocultural Contributions Sociocultural contributions looks at the various The Causative Nature of circles of influence in the individual, ranging from Abnormal Behavior close friends and family, to institutions and policies of a country or the whole world as whole. Biological Contributions 1 Social policies The biological contributions are factors within the 2 Discrimination body that can contribute to abnormal behavior. 3 Stigma 1. Genetics 2. Physical changes that occur as part Stigma of normal aging Stigma is when someone sees you in a negative 3. Illnesses and injuries way because of a particular characteristic or attribute (such as skin color, cultural background, It runs in the genes a disability, or a mental illness). When someone Scientists have long recognized that many treats you in a negative way because of your psychiatric disorders tend to run in families, mental illness, this is discrimination. suggesting potential genetic roots. Such Stigma happens when a person defines someone disorders include autism, attention deficit by their illness rather than who they are as an hyperactivity disorder (ADHD), bipolar disorder, individual. For example, they might be labelled major depression and schizophrenia. ‘psychotic’ rather than ‘a person experiencing psychosis). The chance of an individual having a specific mental disorder is higher if the family members For people with mental health issues, the social have the same mental disorder. Even though a stigma and discrimination the experience can mental disorder may run in a family, there may be make their problems worse, making it harder to considerable symptoms among family members. recover. It may cause the person to avoid getting This means that one person in the family may the help they need because of the fear of being have a mild case, while someone else has a stigmatized. more severe case of the mental disorder. Mental disorders, however, do not follow typical patterns How do people with mental of inheritance. illness treated? The Psychological Contributions Stereotypes are special types of schemas that The psychological contribution is a constellation are very simplistic, very strongly held, and not of factors influenced by alterations with exposure based on firsthand experience. to a certain environment. 1 Past learning experiences Social identity theory states that people 2 Maladaptive thought patterns categorize their social world into meaningfully 3 Difficulties coping with stress simplistic representations of groups of people. These representations are then organized as Maladaptive thought patterns prototypes, or “fuzzy sets of a relatively limited Maladaptive thinking may refer to a belief that is number of category-defining features that only false and rationally unsupported-what Ellis called define one category but serve to distinguish it an “irrational belief”. An example of such belief is from other categories” Out-group homogeneity that one must be loved and approved by occurs when we see all members of an outside everyone in order to be happy or to have a sense group as the same. This leads to a tendency to of self-worth. show favoritism to, and exclude or hold a negative view of, members outside of one's This is irrational first because it cannot possibly immediate group, called the in-group/out-group be achieved-no one is loved or approved of by bias. The negative view or set of beliefs about a everyone-and second because believing it group of people is what we call prejudice, and removes the conditions of happiness and self- this can result in acting in a way that is negative worth from the individual’s control, placing them against a group of people, called discrimination. instead in the control of other people. Stigma Takes on Three Forms Classifying Mental Disorders Disease Occurrence Public Stigma- when members of a society endorse negative stereotypes of people with Occurrence can be investigated in several ways. mental disorders and discriminate against them. First, prevalence is the percentage of people in a They might avoid them altogether, resulting in population that has a mental disorder or can be social isolation. An example is when an employer viewed as the number of cases divided by the intentionally does not hire a person because their total number of people in the sample. mental illness is discovered. Point prevalence indicates the proportion of a Label avoidance- to avoid being labeled as population that has the characteristics at a “crazy” or “nuts” people needing care may avoid specific point in time. In other words, it is the seeking it altogether or stop care once started. number of active cases. Due to these labels, funding for mental health services could be restricted and instead, physical Period prevalence indicates the proportion of a health services funded. population that has the characteristic at any point during a given period of time, typically the past Self-stigma- when people with mental illnesses year. internalize the negative stereotypes and prejudice, and in turn, discriminate against Lifetime prevalence indicates the proportion of a themselves. They may experience shame, population that has had the characteristic at any reduced self-esteem, hopelessness, low self- time during their lives. efficacy, and reduction in coping mechanisms. Experience of stigma or self-stigma can also lead Incidence indicates the number of new cases in a to the following: population over a specific period. 1 Refusal to receive treatment 2 Social isolation Comorbidity describes when two or more mental 3 Distorted perception of the disorders are occurring at the same time and in incidence of mental illness the same person. Understanding Classification Etiology, Course of the Classification is how we organize or categorize Disorder, Prognosis things. It is useful for us to do the same with The etiology is the cause of the disorder. There abnormal behavior, and classification provides us may be social, biological, or psychological with a nomenclature, or naming system, to explanations for the disorder which need to be structure our understanding of mental disorders understood to identify the appropriate treatment. in a meaningful way. The course of the disorder is its particular Epidemiology is the scientific study of frequency pattern. A disorder may be acute, meaning it and causes of diseases and other health-related lasts a short time, or chronic, meaning it persists states in specific populations such as school, for a long time. It can also be classified as time- neighborhood, a city, a country, and the world. limited, meaning that recovery will occur after some time regardless of whether any treatment Psychiatric or mental health epidemiology refers occurs. to the occurrence of mental disorders in a population. In mental health facilities, we say that Prognosis is the anticipated course the mental a patient presents with a specific problem, or the disorder will take. A key factor in determining the presenting problem, and we give a clinical course is age, with some disorders presenting description of it, which includes information about differently in childhood than adulthood. the thoughts, feelings, and behavior that constitute that mental disorder. We also seek to gain information about the occurrence of the disorder, its cause, course, and treatment possibilities.  Risk Assessment Facts About Anxiety Risk factors for mental illness include both -The various forms of anxiety disorders —including genetic and environmental influences. phobias, obsessions, compulsions, and extreme worry Environmental influences include early childhood —represent the most common type of abnormal behavior. relationships and experiences (such as abuse or - Anxiety disorders lead to significant social and neglect), poverty, the effects of race and racism, occupational impairment and a reduced quality of life. and major life stressors (such as a breakup, the - Anxiety disorders share several important similarities loss of a job, or the death of a loved one). Other with mood disorders. From a descriptive point of view, risk factors may include family history of mental both categories are defined in terms of negative illness (such as depression or anxiety), emotional responses. Feelings such as guilt, worry, temperament, and attitudes (e.g., pessimism). and anger frequently accompany anxiety and depression. Some mental disorders have a genetic - The close relationship between symptoms of anxiety link.Usually this link is a predisposition to and those for depression suggests that these developing the disorder, which means that while disorders may share common causal features. an individual may be more likely than other - From a biological point of view, certain brain regions individuals to develop it, there is no guarantee and a number of neurotransmitters are involved in the that they will. etiology of anxiety disorders as well as mood disorders. MODULE 3 Causes of Anxiety Defining Anxiety SOCIAL FACTORS Stressful Life Events Anxiety is a normal and often healthy emotion Childhood Adversity and It's normal to feel anxious occasionally. Attachment Relationships and Separation Anxiety When faced with potentially harmful situations or worrying triggers, our "nerves" become the PSYCHOLOGICAL FACTORS warning signs we need to navigate the dangers Learning Processes (conditioning) Cognitive around us. A faster heartbeat, sweating, and Factors (perception, memory, attention) increased sensitivity are just a few ways our Perception of Control body responds to the increased adrenaline rush Catastrophic Misinterpretation in our minds, triggering our need to "fight or Attention to Threat and Biased Information flee" from our immediate threat. Processing However, when a person regularly feels disproportionate levels of anxiety, it might become a medical disorder. Types of Anxiety Disorders Fight or Flight Response 1. Generalized anxiety disorder (GAD) is characterized by uncontrollable worry and anxiety about a The fight or flight response is an automatic number of events or activities. The worry and physiological reaction to an event that is anxiety among individuals suffering from GAD perceived as stressful or frightening. The primarily focus on family, finances, work, and perception of threat activates the sympathetic illness. In contrast to most people, people with nervous system and triggers an acute stress GAD worry even when things are going well. response that prepares the body to fight or flee. Moreover, their worries intrude into their awareness when they are trying to focus on their thoughts— The fight-or-flight response arises when people and they cannot stop worrying. perceive a threat; when the arousal feels out of control-either because the individual has an Symptoms are present for at least half the days overactive stress response or because he or during a 6-month period. People with GAD feel a she misinterprets the arousal-the person may chronic, low level of anxiety or worry about many experience panic. In response to the panic, things. Moreover, the fact that they constantly some people develop a phobia of stimuli worry in itself causes them distress. related to their panic and anxiety symptoms. DSMV Diagnostic Criteria for Gender Differences Generalized Anxiety Disorder Twice as many women as men are diagnosed with GAD (GAD) Cultural Differences The content of the worries of people with 1. Excessive anxiety and worry (apprehensive GAD is shaped by their culture, their personal expectation), occurring more days than not at least experiences, and the environment in which they 6 months, about a number of events or activities live. Some people worry about catastrophic events, (such as work or school performance). such as natural disasters; others worry about 2. The person finds it difficult to control the worry. human-caused calamities, such as nuclear war or 3. The anxiety and worry are associated with three terrorist acts. ( or more) of the following six symptoms (with at least some symptoms present for more days than 2. A Panic Attack is a sudden, overwhelming not for the past 6 months). Note: Only one item is experience of terror or fright. Whereas anxiety required in children. involves a blend of several negative emotions, (1) restlessness or feeling keyed up or panic is more focused. Some clinicians think of on edge panic as a normal fear response that is triggered at (2) being easily fatigued an inappropriate time. (3) difficulty concentrating or mind Panic attacks are defined largely in terms of a list going blank of somatic or physical sensations, ranging from a (4) irritability heart palpitations, sweating, and trembling to (5) muscle tension nausea, dizziness, and chills. Panic attacks are (6) sleep disturbance (difficulty falling or further described in terms of the situations in which staying asleep, or restless unsatisfying sleep) they occur, as well as the person’s expectations about their occurrence. An attack is said to be Generalized Anxiety Disorder expected, or cued, if it occurs only in the presence of a particular stimulus. Facts at a Glance Diagnostic Criteria for Panic Prevalence Attack in DSM-IV-TR Approximately 5% of people will develop GAD in their lifetime, with women over age 40 at A discrete period of intense fear or discomfort, in highest risk (approximately 10% of this group will which for (or more) of the following symptoms develop the disorder) developed abruptly and reached a peak within 10 Primary care physicians report that their minutes: patients suffer from GAD more frequently than 1. Palpitations, pounding heart, or other anxiety disorders. accelerated heart rate. 2. Sweating Comorbidity 3. Trembling or shaking GAD occurs very frequently with 4. Sensations of shortness of breath depression, with up to 80% of those having GAD or smothering during their lives also experiencing depression at 5. Feeling of choking some point. 6. Chest pain or discomfort Approximately half of the people who have 7. Nausea or abdominal distress both GAD and depression during their lifetimes 8. Feeling dizzy, unsteady, lightheaded, have both disorders at the same time. or faint 9. Derealization (feelings of unreality) or Onset depersonalization (being detached from oneself) Approximately half the people with GAD 10. Fear of losing control or going crazy develop the disorder between the ages of 10 and 11. Fear of dying 19, whereas most others, particularly women, 12. Paresthesias (numbness or tingling develop it sometime after turning 40. sensations) 13. Chills or hot flushes  3. Panic disorder is a type of anxiety disorder. It Comorbidity causes panic attacks, which are caused by sudden, Approximately 15-30% of those with panic brief feelings of fear and strong physical reactions disorder also have social phobia or GAD, and in response to ordinary, non threatening situations. 2-20% have some other type of anxiety disorder. When you’re having a panic attack, you may sweat Over a third of those with panic disorder a lot, have difficulty breathing and feel like your also have a personality disorder. heart is racing. You may feel as if you are losing control. You may also have physical symptoms, Onset such as: Panic disorder is most likely to arise during Fast heartbeat two phases of life: the teenage years or the Chest or stomach pain mid-30s Breathing difficulty Weakness or dizziness Gender Differences Sweating Women are two to three times more likely Feeling hot or cold chill than men to be diagnosed with panic disorder. Tingly or numb hands Panic disorder is marked by frequent, unexpected Fear panic attacks, along with fear of further attacks and possible restrictions of behavior in order to prevent the physical and emotional response to real or such attacks. perceived imminent threat. Anxiety Diagnostic Criteria for Panic the anticipation of future threat. Disorder in DSM-IV-TR Phobia (without Agoraphobia) excessive fear or anxiety about or avoidance of A. Both (1) and (2): objects or situations. 1.Recurrent unexpected Panic Attacks 2.At least one of the attacks has been followed fear or anxiety that is PERSISTENT EXCESSIVE by 1 month (or more) of one (or more) of the and OUT OF PROPORTION to the actual danger following: posed by the object of the phobia. 1.Persistent concern about having additional attacks NOT ALL FEARS CAN BECOME PHOBIAS 2.Worry about the implications of the attack or its consequences (e.g., losing control, having a Etiology of Phobia heart attack, “going crazy”) 3.A significant change related to the attacks. B. Absence of Agoraphobia C. The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug abuse, a medication) or a general medical condition (e.g., hyperthyroidism). Panic Disorder Facts at a Glance Prevalence Up to 3% of people worldwide will experience panic disorder at some point of their lives. However, 30% of people will experience at least one panic attack in their lives. Up to 60% of people seen by cardiologists have panic disorder  Societal Expectations Neurobiological Societal factors that can influence the development of phobia, especially social phobia. Symptoms of Phobia Chemical Imbalances Types of Phobias Specific Phobia- Characterized by intense, persisting fear of an object or situation, which is considered dangerous. Social Phobia- AKA Social anxiety disorder. Involves the fear of social situations, including situations that involve scrutiny or contact with strangers. Agoraphobia- refers to a fear of or anxiety regarding places from which escape might be difficult. Genetic Factors People with a close family member with a phobia or another anxiety disorder also have a greater risk of a phobia. Childhood Trauma Going through an early traumatic event may have an impact on the development of phobia, sometimes years later. Observational Learning Phobia by the Numbers If you did not experience a traumatic event Specific Phobia- 12% (more common in women; yourself, did you see someone else in a traumatic onset is below age 10 years. social situation? Social Phobia- 7% (more common in women; onset Parenting Style is below 8-15 years. One or both of your parents was rejecting, Agoraphobia- 1% (more common in women) controlling, critical, or overprotective. Isolation and Inhibition As a child, you were not exposed to enough social situations and were not allowed to develop appropriate social skills. Diagnostic Criteria of The Psyche of Depression Phobic Disorders What is depression? Depression can refer either to a mood or to a clinical syndrome, a combination of emotional, cognitive, and behavioral symptoms. The feelings associated with a depressed mood often include disappointment and despair. Although sadness is a universal experience, profound depression is not. No one has been able to identify the exact point at which “the feeling down or blue” crosses a line and becomes depression. One experience shades gradually into the next. People who are in a severely depressed mood describing the feeling as overwhelming, suffocating, or numbing. In the syndrome of depression, which is also called clinical depression, a depressed mood is accompanied by several other symptoms, such as fatigue, loss of energy, difficulty in sleeping, and changes in appetite. Clinical depression also involves a variety of changes in thinking and overt behavior. The person may experience cognitive symptoms, such as extreme guilt, feelings of worthlessness, concentration problems, and thoughts of suicide. Behavioral symptomes may range from constant Treatment Options for pacing and fidgeting to extreme inactivity. Phobic Disorders CBT- involves learning to identify underlying DSM-5-TR Diagnostic Criteria negative thoughts that contribute to fear or anxiety. for a Major Depressive Systematic Desensitization- gradually exposing you Episode to parts of triggers slowly. A. Five (or more) of the following symptoms have been present during the same two-week Flooding- involves exposing you to the phobia period and represent a change from triggers themselves. previous functioning; at least one of the symptoms is either (1) depressed mood (2) Medications- may be prescribed in some cases to loss of interest or pleasure. help manage phobia symptoms. Note: Do not include symptoms that are clearly attributable to another medical condition. 1. Depressed mood most of the day, nearly everyday, as indicated by either subjective report (eg, feels sad, empty, hopeless) or observations made by others (eg, appears tearful). (NOTE: In children and adolescents, can be irritable mood.)  2. Markedly diminished interest or pleasure in all, D. The occurrence of the major depressive episode or almost all, activities most of the day, is not better explained by schizoaffective disorder, nearly every day (as indicated by either schizophrenia, schizophreniform disorder, subjective account or observation.) delusional disorder, or other specified and other 3. Significant weight loss when not dieting or unspecified schizophrenia spectrum and other weight gain (eg, a change of more than 5% psychotic disorders. of body weight in a month), or decrease or E. There has never been a manic or increase in appetite nearly every day. hypomanic episode. (NOTE: In children, consider failure to make expected weight gain.) NOTE: This exclusion does not apply if all of the 4. Insomnia or hypersomnia nearly every day. manic-like or hypomanic-like episodes are 5. Psychomotor agitation or retardation nearly substance-induced or are attributable to every day (observable by others, not merely psychological effects of another medical condition. subjective feelings of restlessness or being slowed down). 6. Fatigue or loss of energy nearly every day. 7. Feelings of worthlessness or excessive or inappropriate guilt ( which may be delusional) nearly every day (not merely self-approach or guilt about being sick). 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by their subjective account or observed by others). 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideatiob without specific plan, or suicide attempt or a specific plan for committing suicide. B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The episode is not attributable to the direct physiological effects of a substance or to another medical condition. NOTE: Criteria A through C represent a major depressive episode. NOTE: Responses to a significant loss (eg, Forms of Depression bereavement, financial ruin, losses from a Persistent depression national disaster, a serious medical illness Persistent depressive disorder is depression that or disability) may include the feelings of lasts for 2 years or more. People may also refer to intense sadness rumination about the loss, this as dysthymia or chronic depression. Persistent insomnia, poor appetite,and weight loss depression might not feel as intense as major noted in Criteria A, which may resemble a depression, but it can still strain relationships and depressive episode. Although such make daily tasks difficult. symptoms may be understandable or considered appropriate to the loss, the Manic Depression or Bipolar Disorder presence of a major depressive episode in Manic depression involves periods of mania or addition to the normal response to a hypomania, where you feel very happy. These significant loss should also be carefully periods alternate with episodes of depression. considered. This decision inevitably requires Manic depression is an outdated name for bipolar the exercise of clinical judgment based on disorder. Hypomania is a less severe form of the individual’s history and the cultural mania. norms for the expression of distress in the context of loss. Premenstrual dysphoric disorder Suicidal ideation refers to thinking about, considering, Premenstrual dysphoric disorder (PMDD) is a or planning suicide. severe form of premenstrual syndrome (PMS). While PMS symptoms can be both physical and psychological, PMDD symptoms tend to be mostly DSM-5 Suicidal Behavior Disorder psychological. According to the DSM-5, there are five proposed criterion Suicidal Behavior Disorder, with two Situational depression specifiers; Situational depression, or adjustment disorder with 1. The Individual has made a sulcide attempt within depressed mood, looks like major depression in the past two years. many ways. However, situational depression is 2. The criterion for non-suicidal self-injurlous brought on by specific events or situations, such behavior Is not met during the aforementloned as: the death of a loved one, a serious illness or sulcide attempts. other life threatening event, going through divorce 3. The diagnosis is not applied to preparation for a or child custody Issues, being in emotionally or suicide attempt, or suicidal ideation. physically abusive relationships, being unemployed 4. the act was not attempted during an altered or facing serious financial difficulties, facing mental state, such as delirium or " confusion". extensive legal troubles. 5. The act was not ideologically motivated e.g. - religious or political. Atypical depression Atypical depression refers to depression that Other specifiers are: temporarily goes away in response to positive Current- Not more than 12-24 months since events. Despite its name, atypical depression is not last attempt. unusual or rare. It also does not mean that it's In Remission- more than 24 months since last more or less serious than other types of attempt. (American Psychiatric Association, 2013). depression. Risk Factors for Depression Onset Biochemistry: Differences In certain chemicals in The DSM-5 notes that Suicidal Behavior Disorder the brain may contribute to symptoms of could occur at any point in the lifespan, very rarely depression. under age 5. (American Psychiatric Association, Genetics: Depression can run in families. For 2013). example, if one identical twin has depression, the other has a 70 percent chance of having the illness Prevalence sometime in life. The DSM -5 does not indicate the prevalence of Personality: People with low self-esteem, who are Suicidal Behavior Disorder (American Psychiatric easily overwhelmed by stress, or who are generally Association, 2013). About 5-8% of teens attempt pessimistic appear to be more likely to experience suicide each year according to some studies depression. (Blaszczak-Boxe, 2014 ).The actual numbers are Environmental factors: Continuous exposure to unknown of course, as attempts may be hidden or violence, neglect, abuse or poverty may make denied, and this is not including suicidal ideation some people more vulnerable to depression. which is not acted out behaviorally. Understanding Suicide Risk Factors Suicide is an extremely personal, private, and The DSM-5 indicates that risk factors for Suicidal complicated act. Escape from psychological suffering Behavior Disorder are mental illnesses such as is often a significant motive in suicide. Suicide is bipolar disorder, major depressive disorder, often defined as death caused by self-directed schizophrenia, schizoaffective disorder, anxiety injuries behavior with intent to die as a result of the disorders panic disorder and PTSD, substance use behavior. disorders (especially alcohol use disorder), borderline personality disorder, antisocial A suicide attempt is a non-fatal, self-directed, personality disorder, eating disorders, and potentially injurious behavior with intent to die as a adjustment disorders (American Psychiatric result of the behavior. A suicide attempt might not Association, 2013). result in injury. Chronic pain and terminal or chronic illnesses, Non Suicidal Self-Injury which cause impairment and loss of physical ability, may be co-morbid with Suicidal Behavior Disorder. Some people deliberately harm themselves without In recent years, there has been increasing trying to end their own lives. The most frequent attention to children and teens contemplating or forms of nonsuicidal self injurious behaviors involve carrying out suicide in response to bullying. It has cutting, burning, or scratching the skin, usually in a been found that there is an especially robust place where the wounds and resulting scars can correlation between cyber bullying and suicidality. easily be concealed from others. Why Do People Commit Suicide? People who engage in nonsuicidal self-injury do it because the pain serves a useful purpose for them - Mental Illness regardless of its impact on their appearance. - Traumatic Stress - Substance Use and Impulsivity Symptoms of Non Suicidal Self-Injury - Loss or Fear of Loss According to DSM-5, NSSI diagnostic criteria are - Hopelessness as follows (American Psychiatric Association, - Chronic Pain and Illness 2013): - Feeling Like a Burden to Others Over the past year, the person has for at least 5 - Cry for Help days engaged in self-injury, with the anticipation Classification of Suicide that the injury will result in some bodily harm. No suicidal intent. Anomic suicide (diminished regulation) occurs -The act is not socially acceptable. following a sudden breakdown in social order or a disruption of the norms that govern people -The act or its consequence can cause significant behavior. Anomic suicide explains increased distress to the individual's daily life. suicide rates that occur following an economic or -The act is not taking place during psychotic political crisis or among people who are adjusting eplsodes, delirium, substance intoxication, or to the unexpected loss of a social or occupational substance withdrawal. It also cannot be explained role. The typical feelings associated with anomic (a by another medical condition. term coined by Durkheim, which literally means -The Individual engages In self-Injury expecting to “without a name”) are anger, disappointment, and get relief from a negative emotion; to deal with a exasperation. personal Issue, to create a positive feeling. Fatalistic suicide (excessive regulation) occurs The self-injury is associated with one of when the circumstances under which a person the following: lives become unbearable. A slave, for example, -The individual experienced negative feelings right might choose to commit suicide in order to escape before committing the act. from the horrible nature of his or her existence. -Right before self-injury, the individual was This type of suicide was mentioned only briefly by preoccupied with the planned act Durkheim, who thought that it was extremely -The individual thinks a lot about self injury even if common. act does not take place. Egoistic suicide (diminished integration) occurs Epidemiology when people become relatively detached from -NSSI has a prevalence rate of about 1 to 4 society and when they feel that their existence is percent in the adult population in the United States. meaningless. Egoistic suicide is presumably more Furthermore the extremely severe form of self- common among groups such as people who are injury is seen in about 1 percent of the population. suffering from mental disorders. The predominant Though some research has indicated a lifetime emotions associated with egoistic suicide are prevalence of NSSI being as high as 5.9 percent depression and apathy. and an increased 2.7 percent that have self injured greater than five times. Altruistic suicide (excessive integration) occurs when the rules of the social group dictate that the NSSI is more common among teenagers, with a person must sacrifice his or her own life for the reported 15 percent admitting to some type of self- sake of others. One example is the former practice injury. Furthermore, there is a greater risk for NSSI in some Native American tribes of elderly persons among college students when compared to the voluntarily going off themselves to die after they felt general population, where rates range from 17 to they had become a burden to others. 35 percent. Males and females have comparable NSSI rates, Many NSSI patients use at least 2 different ways to even though men more often report using burning perform self-injury, as high as 69 percent. One and hitting methods, while women report using should also pay close attention regarding when cutting and burning methods. Cutting is the most NSSI greatly increases the risk for suicide. While common form of NSSI, where as much as 70 much concrete data has not been performed percent of NSSI patients, state that they have used concerning this, it is important to gauge how the the cutting form in the past. patient perceives suicide, and life, since this can indicate when self injury increases the risk for Psychiatric Disorders suicidality (Kerr, Muehlenkamp, & Turner, 2010). There is an increased rate of self-injury among the psychiatric populations, where about 2 to 20 Course and Outcome percent reportedly engaged in NSSI (Kerr, Research shows that the normal age of onset for Muehlenkamp, & Turner, 2010). This is especially NSSI is 14 and 24 years of age, with an increase seen among teen psychiatric patients, with high among those between 12 to 14 and those who are prevalence rates of about 40 to 80 percent. Certain 18 to 19 years of age. Over a long period of time, psychiatric disorders are noted for having greater BPD patients tend to have decreased prevalence rates of self-injury. These include Borderline rates of NSSi, from 80 percent to 28 percent, over personality disorder (BPD), dissociative disorders, a 6 year time span. This was also seen with other eating disorders and major depressive disorders. personality disorders, where incidence rates decreased from 16.7 to 1.6 percent. BPD highlights a very high prevalence rate of individuals who commit self-injury, ranging from Defining the changes in about 70 to 75 percent (Kerr, Muehlenkamp, & Turner, 2010). Self-injury is noted to be one of the categorization criteria for establishing a diagnosis of BPD. Much -There have been six revisions since it was first evidence tom research indicates that it is used by published in 1952, the last major revision was BPD patients to experience great relief from ‘DSM-5', published in May 2013, superseding horrible emotions. NSSI is also seen highly in DSM-IV, which was published in 1994 and revised dissociative disorders where as much as 69 in 2000. percent are indicated to have exhibited some self- -Significantly, in DSM-5 there was a significant and injury. controversial change to where OCD was listed. The previous edition of the DSM (DSM-IV) categorized Individuals with eating disorders tend to engage in Obsessive-Compulsive-Disorder (OCD) under NSSI. Research reports prevalence rates of about 'Anxiety Disorders’. However, some experts 26 to 55 percent for individuals that are diagnoses controversially suggested that the revised edition of with bulimia nervosa, while much higher for those the DSM remove OCD from this category and with anoxeria nervosa binge-purge type, about 27 group it with loosely related conditions under the to 61 percent (Kerr, Muehlenkamp, & Turner, heading of 'Obsessive-Compulsive and Related 2010). Disorders', which is what they did indeed do for There appears to be some association between DSM-5 individuals who commit NSSI and major depressive disorder. While data in this area is lacking, Defining Obsessive research has shown that 42 percent of a particular self-injuring sample met the criteria for major Compulsive Disorder depressive disorder (Kerr, Muehlenkamp, & Turner, Obsessive-compulsive disorder (OCD) is a long- 2010). lasting disorder in which a person experiences Suicidal Behavior uncontrollable and recurring thoughts (obsessions), Evidence indicates a strong association that exists engages in repetitive behaviors (compulsions), or between suicidality and self injury. Research states both. that as high as 40 percent of those NSSI patients have dealt with suicidal thoughts while inflicting the injury. Additionally as high as about 50 to 85 percent of NSSI patients have a previous history of at least one suicidal attempt. The association also indicates that as the type of self-injury increases, the severity of suicide also increases. Obsession When confronted with the possibility (or even sometimes the thought) of contamination, people 1. Recurrent and persistent thoughts, urges, or with contamination obsessions often feel impulses that are experienced, at some time during overwhelmed. the disturbance, as intrusive and unwanted, and To feel "pure" or "clean" again, people with that in most individuals cause marked anxiety or contamination-related obsessions may: distress. -Engage in excessive and sometimes ritualized 2. The individual attempts to ignore or suppress hand-washing such thoughts, urges, or images, or to neutralize -Disinfect or sterilize things them with some other thought or action (i.e., by -Throw things away performing a compulsion). -Change clothes frequently -Create clean areas off-limits to others Common Obsession -Avoid certain places or touching things Perfectionism People with perfectionistic obsessions are Causing Harm overwhelmed by fear of making mistakes, Some people with OCD experience obsessions doing something wrong, or leaving things out related to causing harm to themselves or others. of place. Common examples of obsessive fears related to Perfectionistic OCD may involve obsessions with: causing harm include: -Order, symmetry, and organization -Forgetting to turn off household appliances -Neatness -Getting into a car accident -Following specific rules, directions, and routines -Getting someone sick -Feeling that things are "in their place" or "just right -Accidentally dropping a baby -Completing tasks at work or school perfectly Many people with OCD feel an "over-responsibility Relational for harm," meaning that they feel their everyday Relationship-focused obsessions involve actions can cause bad things to happen even when overwhelming doubts and worries about the it's unlikely or impossible. "rightness" of a romantic relationship or partner. People who have obsessive thoughts or worries Discerning Compulsion about a particular romantic partner often have an What is compulsion? intense fear of abandonment. Repetitive behaviors (e.g., hand washing, ordering, People with ROCD may experience symptoms checking) or mental acts (eg , praying, counting, such as: repeating words silently) that the individual feels -Constantly questioning their feelings or their driven to perform in response to an obsession or partner's feelings according to rules that must be applied rigidly. -Wondering if their partner is their soulmate or "the one" The behaviors or mental acts are aimed at -Frequently comparing their current partner to preventing or reducing anxiety or distress, or previous partners preventing some dreaded event or situation; -Preoccupation with their partner's perceived however, these behaviors or mental acts are not moral, emotional, or physical flaws connected in a realistic way with what they are -Worrying that their partner will cheat or leave the designed to neutralize or prevent, are clearly relationship excessive. Contamination Note: Contamination obsessions may involve fears of A.Young children may not be abe to articulate the physical contamination (such as with dirt, bacteria, aims of these behaviors or mental acts. germs, chemicals, or illness) or moral B.The obsessions or compulsions are time- contamination (such as with a person, place, or consuming (e.g., take ore than one hour per day) idea that is perceived as "bad" or distasteful). or cause clinically significant distress or impairment in social, occupational or other areas of functioning. C. The obsessive compulsions symptoms are not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication) or other medical condition.  D. The disturbance is not better explained by the Development and Course symptoms of another mental disorder (e.g., In the United States, the mean age at onset of excessive worries, as in generalized anxiety OCD is 19.5 years, and 25% of cases start by age disorder; preoccupation with appearance, as in 14 years. Onset after age 35 years is unusual but body dysmorphic disorder, difficulty discarding or does occur. Males have an earlier age at onset parting with possessions, as in hoarding disorder; than females: neary 25% of males have onset hair pulling, as in trichotillomania [hair-pulling before age 10 years. The onset of symptoms is disorder]; skin picking, as in excoriation [skin- typically gradual; however, acute onset has also picking] disorder; stereotypies, as in stereotypic beon reported. movement [skin-picking] preoccupation with substances or gambling as in substance-related If OCD is untreated, the course is usually chronic, and addictive disorders; preoccupation with having often with waxing and waning symptoms. Some an illness, as in illness anxiety disorder, sexual individuals have an episodic course, and a minority urges or fantasies, as in paraphilic disorders; have a deteriorating course. Without treatment, impulses, as in disruptive, impulse-control, and remission rates in adults are low 20% for those conduct disorders; guilty ruminations, as in major reevaluated 40 years later). Onset in childhood or depressive disorder; thought insertion or delusional adolescence can lead to a lifetime of OCD. preoccupations, as in schizophrenia spectrum and However, 40% of individuals with onset of OCD in other psychotic disorders; or repetitive patterns of childhood or adolescence may experience behavior, as in autism spectrum disorder). remission by early adulthood, Th course of OCD is often complicated by the co-occurrence of other Specify if: disorders. With good or fair insight: The Individual recognizes that obsessive-compulsive disorder Compulsions are more easily diagnosed in children beliefs are definitely or probably not true or that than obsessions are because compulsions are they may or may not be true. observable. However, most children have both obsessions and compulsions (as do most adults). With poor insight: The individual thinks The pattern of symptoms in adults can be stable obsessive-compulsive disorder beliefs are probably over time, but it is more variable in children. Some true. differences in the content of obsessions and compulsions have been reported when children With absent insight/delusional beliefs: The and adolescent samples have been compared with individual is completely convinced that obsessive- adult samples. These differences likely reflect compulsive disorder beliefs are true. content appropriate to different develop mental stages (e.g., higher rates of sexual and religious Specify further If: obsessions in adolescents than in children; higher Tic-related: The individual has a current or past rates of harm obsessions [e.g., fears of history of a tic disorder. catastrophic events, such as death or illness to self or loved ones] in children and adolescents than in Specifiers adults). Individuals with OCD vary in the degree of insight they have about the accuracy of the beliefs that Risk and Prognostic Factors underlie their obsessive-compulsive symptoms. Temperamental. Greater internalizing symptoms, Many individuals have good or fair insight (e.g., the higher negative emotionality, and behavioral individual believes that the house definitely will not, inhibition in childhood are possible temperamental probably will not, or may or may not burn down if risk factors. the stove is not checked 30 times. Environmental. Physical and sexual abuse in Some have poor insight (e.g, the individual childhood and other stressful or traumatic events believes that the house will probably burn down if have been associated with an increased risk for the stove is not checked 30 times), and a few (4% developine OCD. Some children may develop the or absent insight/delusional beliefs (e.g., the sudden onset of obsessive-compulsive symptoms, individual is convinced that the house will burn which has been associated with different down if the stove is not checked 30 times). Insight environmental factors including various infectious can vary within an individual over the course of the agents and a post-infectious autoimmune illness. Poorer insight has been linker to worse syndrome. long-term outcome. Genetic and physiological. The rate of OCD Defining Schizophrenia among first-degree relatives of adults with OCD is Schizophrenia is a severe form of abnormal approximately two times that among first-degree behavior that encompasses what most of us have relatives of those without the disorder; however, come to know as "madness." among first-degree relatives, individuals with onset People with schizophrenia exhibit many different of OCD in childhood or adolescence, the rate kinds of psychotic symptoms, indicating that they increased 10-fold. Familial transmission is due in have lost touch with reality. They may hear voices part to genetic factors (e.g., concordance rate of that aren't there or make comments that are 0.57 for monozygotic vs. 0.22 for dizygotic twins). difficult, if not impossible, to understand. The Dysfunction in the orbitofrontal cortex, anterior behavior may be guided by absurd ideas and cingulate cortex, and striatum have been most beliefs. strongly implicated. A. Two (or more) of the following, each present for Comorbidity a significant portion of time during a 1-month period Individuals with OCD often have other (or less if successfully treated). At least one of psychopathology. Many adults with the disorder these must be (1), (2), or (3): have a lifetime diagnosis of an anxiety disorder 1. delusions (76%; e.g., panic disorder, social anxiety disorder, 2.hallucinations generalized anxiety-disorder, specific phobia) or a 3.disorganized speech (e.g., frequent derailment or depressive or bipolar disorder (63% for any incoherence) depressive or bipolar disorder, with the most 4.grossly disorganized or catatonic behavior common being major depressive disorder [41%). 5.Negative symptoms (i.e., diminished emotional Onset of OCD is usually later than for most expression or avolition). comorbid anxiety disorders (with the exception of separation anxiety disorder) and PTSD but often Delusions precedes that of depressive disorders. Comorbid People with schizophrenia may also experience obsessive-compulsive personality disorder is also delusions-incorrect beliefs that persist, despite common in individuals with OCD (eg., ranging, evidence to the contrary. Delusions often focus on from 23% to 32%). a particular theme, and several types of themes are common among these patients. Up to 30% of individuals with OCD also have a -paranoid delusions involve the theme of being lifetime tic disorder. A comorbid tic disorder is most persecuted by others. common in males with onset of OCD in childhood. -delusions of control revolve around the belief that These individuals tend to differ from those without the person is being controlled by other people (or a history of tic disorders in the themes of their OCD aliens) symptoms, comorbidity, course, and patter of -delusions of grandeur is believing oneself to be familial transmission. A triad of OCD, tic disorder, significantly more powerful, knowledgeable, or and attention-deficit/hyperactivity disorder can also capable than is actually the case, referred to as seen in children. -delusions of reference: the belief that external events have special meaning for the individual. Disorders that occur more frequently in individuals with OCD than in those without the disolder include several obsessive-compulsive and related Hallucinations disorders such as body dysmorphic disorder, hallucinations are sensations so vivid that the trichotillomania (hair-pulling disorder), and perceived objects or events seem real even though excoriation (skin-picking) disorder. Finally, an they are not. Any of the five senses can be association between OCD and some disorders involved in a hallucination, although auditory characterized by impulsivity, such as oppositional hallucinations-specifically, hearing voices-are the defiant disorder has been reported. most common type experienced by people with schizophrenia. Disorganized Thinking (Speech) B. For a significant portion of the time since the onset of the disturbance, level of functioning in one People with schizophrenia can sometimes speak or more major areas, such as work, interpersonal incoherently, although they may not necessarily be relations, or self-care, is markedly below the level aware that other people cannot understand what achieved prior to the onset (of when the onset is in they are saying. childhood or adolescence, there is failure to Effective communication can be impaired, and achieve expected level of interpersonal, academic, answers to questions may be partially or or occupational functioning). completely unrelated. Rarely, speech may include putting together meaningless words that can't be C. Duration: Continuous signs of the disturbance understood, sometimes known as word salad. persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less Disorganized Behavior if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods -Disorganized, behavior, behavior that is so of prodromal or residual symptoms. unfocused and disconnected from a goal that the During these prodromal or residual periods, the person cannot successfully accomplish a basic signs of the disturbance may be manifested by only task, or the behavior is inappropriate in the negative symptoms or two or more symptoms listed situation. in Criterion A present in an attenuated for (e.g., odd -Disorganized behavior can range from laughing beliefs, unusual perceptual experiences). inappropriately in response to a serious matter or masturbating in front of others, to being unable to D. Schizoaffective disorder and depressive or perform normal daily tasks such as washing bipolar disorder with psychotic features have been oneself, putting together a simple meal, or even ruled out because either (1) no major depressive or selecting appropriate clothes to wear. manic episodes have occurred concurrently with the active-phase symptoms, or (2) if mood Negative Symptoms episodes have occurred during active-phase symptoms, they have been present for a minority of Flat Affect: Muted Expression the total duration of the active and residual periods Some people with schizophrenia exhibit flat affect, of the illness. which accurs when a person does not display a great range of emotion and hence often seems E. The disturbance is not attributable to the emotionally neutral. physiological effects of a substance (e.g., a drug of Such people may not express or convey much abuse, a medication) or another medical condition. information through their facial expressions or body language, and they tend to refrain from making eye contact (although they may smile somewhat and do Personality Disorder not necessarily come off as "Cold". Personality disorders in general are pervasive, enduring patterns of thinking, perceiving, reacting, Alogia: Poverty of Speech and relating that cause significant distress or People with schizophrenia who have alogia, or functional impairment. Personality disorders vary poverty of speech, may respond slowly or significantly in their manifestations, but all are minimally to questions and generally speak less believed to be caused by a combination of genetic than do most other people. and environmental factors. Many gradually become A person with alogia will take a while to muster the less severe with age, but certain traits may persist mental effort necessary to respond to a question. to some degree after the acute symptoms that Even choosing among words can be challenging. prompted the diagnosis of a disorder abate. Diagnosis is based on clinical criteria. Treatment is Avolition: Difficully initiating or with psychosocial therapies and sometimes with following through medications. Avolition, the term for difficulty in initiating or following through with activities, hospitalized patients are often shown sitting in chairs apparently doing nothing all day, not even talking to others. Personality disorders exist when these traits D. The impairments in personality functioning and become so pronounced, rigid, and maladaptive that the individuals personality trait expression are not they impair work and/or interpersonal functioning. better understood as normative for the individual's These social maladaptations can cause significant developmental stage or sociocultural environment. distress in people with personality disorders and in E. The impairments in personality functioning and those around them. the individuals personality trait expression are not solely due to the direct physiological effects of a Personality disorders usually start to become substance (eg., a drug.of abuse, medication) or a evident during late adolescence or early adulthood, general medical condition (e.g., severe head although sometimes signs are apparent earlier trauma). (during childhood). Traits and symptoms vary Types of Personality Disorders considerably in how long they persist; many resolve with time. Antisocial Personality Disorder The Diagnostic and Statistical Manual of Mental The essential features of a personality disorder are Disorders, 5th ed, Text Revision (DSM-5-TR) lists impairments in personality (self and interpersonal) 10 types of personality disorders, although most functioning and the presence of pathological patients who meet criteria for one type also meet personality traits. To diagnose antisocial personality criteria for one or more others. Some types (eg, disorder, the following criteria must be met: antisocial, borderline) tend to lessen or resolve as Significant impairments in personality functioning people age; others (eg, obsessive-compulsive, manifest by: schizotypal) are less likely to do so. 1. Impairments in self functioning (a or b): a. Identity: Ego-centrism; self-esteem derived from About 9% of the general population (1) and up to personal gain, power, or pleasure. half of psychiatric patients in hospital units and b. Self-direction: Goal-setting based on personal clinics have a personality disorder (2). gratification; absence of prosocial internal Overall, there are no clear distinctions in terms of standards associated with failure to conform to sex, socioeconomic class, and race. However, for lawful or culturally normative ethical behavior. antisocial personality disorder, males outnumber females 3:1 (3). In borderline personality disorder, and females outnumber males 3:1 (but only in clinical settings, not in the general population) (4). 2. Impairments in interpersonal functioning (a or b): a. Empathy: Lack of concern for feelings, needs, or For most personality disorders, levels of heritability suffering of others; lack of remorse after hurting or are about 50%, which is similar to or higher than mistreating another. that of many other major psychiatric disorders. b. Intimacy: Incapacity for mutually intimate This degree of heritability argues against the relationships, as exploitation is a primary means of common assumption that personality disorders are relating to others, including by deceit and coercion; character flaws primarily shaped by an adverse use of dominance or intimidation to control others. environment. General Criteria for B. Pathological personality traits in the following domains: Personality Disorder 1. Antagonism, characterized by: The essential features of a personality disorder are Manipulativeness: Frequent use of subterfuge to impairments in personality (self and interpersonal) influence or control others; use of seduction, functioning and the presence of pathological charm, glibness, or ingratiation to achieve one's personality traits. To diagnose a personality ends. disorder, the following criteria must be met: Deceitfulness: Dishonesty and fraudulence; a. Significant impairments in self (identity or self- misrepresentation of self; embellishment or direction) and interpersonal (empathy or intimacy) fabrication when relating events. functioning. Callousness: Lack of concern for feelings or b. One or more pathological personality trait problems of others; lack of guilt or remorse about domains or trait facets. the negative or harmful effects of one's actions on C. The impairments in personality functioning and others; aggression; sadism. the individual's personality trait expression are Hostility: Persistent or frequent angry feelings; relatively stable across time and consistent across anger or irritability in response to minor slights and situations. - insults; mean, nasty, or vengeful behavior. 2. Disinhibition, characterized by: 2. Impairments in interpersonal functioning (a or b): Irresponsibility: Disregard for - and failure to honor Empathy: Preoccupation with, and sensitivity to, - financial and other obligations or commitments; criticism or rejection, associated with distorted lack of respect for - and lack of follow through on - inference of others' perspectives as negative. agreements and promises. Intimacy: Reluctance to get involved with people Impulsivity: Acting on the spur of the moment in unless being certain of being liked; diminished response to immediate stimuli; acting on a mutuality within intimate relationships because of momentary basis without a plan or consideration of fear of being shamed or ridiculed outcomes; difficulty establishing and following plans. B. Pathological personality traits in the Risk taking: Engagement in dangerous, risky, and following domains: potentially self-damaging activities, unnecessarily 1. Detachment, characterized by: and without regard for consequences; boredom Withdrawal: Reticence in social situations; proneness and thoughtless initiation of activities to avoidance of social contacts and activity; lack of counter boredom; lack of concern for one's initiation of social contact. limitations and denial of the reality of personal Intimacy avoidance: Avoidance of close or romantic danger relationships, interpersonal attachments, and intimate sexual relationships. c. The impairments in personality functioning and Anhedonia: Lack of enjoyment from, engagement the individuals personality trait expression are in, or energy for life's experiences; deficits in the relatively stable across time and consistent across capacity to feel pleasure or take interest in things. situations. 2. Negative Affectivity, characterized by: d. The impairments in personality functioning and a. Anxiousness: Intense feelings of nervousness, the individual's personality trait expression are not tenseness, or panic, often in reaction to social better understood as normative for the individual's situations; worry about the negative effects of past developmental stage or sociocultural environment. unpleasant experiences and future negative E. The impairments in personality functioning and possibilities; feeling fearful, apprehensive, or the individuals personality trait expression are not threatened by uncertainty; fears of embarrassment. solely due to the direct physiological effects of a c. The impairments in personality functioning and substance (e.g., a drug of abuse, medication) or a the individual's personality trait expression are general medical condition (eg., severe head relatively stable across time and consistent across trauma). situations. F. The individual is at least age 18 years. D. The impairments in personality functioning and the individual's personality trait expression are not Avoidant Personality Disorder better understood as normative for the individual's developmental stage or socio-cultural environment. The essential features of a personality disorder are E. The impairments in personality functioning and impairments in personality (self and interpersonal) the individual's personality trait expression are not functioning and the presence of pathological solely due to the direct physiological effects of a personality traits. To diagnose avoidant personality substance (e.g., a drug of abuse, medication) or a disorder, the following criteria must be met: general medical condition (e.g., severe head A. Significant impairments in personality trauma). functioning manifest by: 1. Impairments in self functioning (a or b): Borderline Personality Disorder Identity: Low self-esteem associated with self- appraisal socially inept, personally unappealing, or The essential features of a personality disorder are inferior, excessive feelings of shame or impairments in personality (self and interpersonal) inadequacy. functioning and the presence of pathological Self direction: Unrealistic standards for behavior personality traits. To diagnose borderline associated with reluctance to pursue goals, take personality disorder, the following criteria must be personal risks, or engage in new activities involving met: interpersonal contact. Z And A. Significant impairments in personality 2. Disinhibition, characterized by: functioning manifest by: Impulsivity: Acting on the spur of the moment in 1. Impairments in self functioning (a or b): response to immediate stimuli; acting on a Identity: Markedly impoverished, poorly developed, momentary basis without a plan or consideration of or unstable self-image, often associated with outcomes; difficulty establishing or following plans; excessive self-critcism; chronic feelings of a sense of urgency and self-harming behavior emptiness; dissociative states under stress. under emotional distress. Self-direction: Instability in goals, aspirations, Risk taking: Engagement in dangerous, risky, and values, or career plans. potentially self-damaging activities, unnecessarily and without regard to consequences; lack of and concern for one's limitations and denial of the reality of personal danger. 2. Impairments in interpersonal functioning (a or b): 3. Antagonism, characterized by: Empathy: Compromised ability to recognize the a. Hostility: Persistent or frequent angry feelings; feelings and needs of others associated with anger or irritability in response to minor slights and interpersonal hypersensitivity (i.e., prone to feel insults. slighted or insulted); perceptions of others selectively biased toward negative attributes or Narcissistic Personality Disorder vulnerabilities. Intimacy: Intense, unstable, and conflicted close The essential features of a personality disorder are relationships, marked by mistrust, neediness, and impairments in personality (self and interpersonal) anxious preoccupation with real or imagined functioning and the presence of pathological abandonment; close relationships often viewed in personality traits. extremes of idealization and devaluation and To diagnose narcissistic personality disorder, the alternating between over involvement and following criteria must be met. withdrawal. Significant impairments in personality functioning manifest by: B. Pathological personality traits in the 1. Impairments in self functioning (a or b): following domains: Identity: Excessive reference to others for self- 1. Negative Affectivity, characterized by: definition and self-esteem regulation; exaggerated a. Emotional liability:Unstable emotional self-appraisal may be inflated or deflated, or experiences and frequent mood changes; emotions vacillate between extremes; emotional regulation that are easily aroused, intense, and/or out of mirrors fluctuations in self-esteem. proportion to events and circumstances. Anxiousness: Intense feelings of nervousness, Self direction: Goal-setting is based on gaining tenseness, or panic, often in reaction to approval from others; personal standards are interpersonal stresses; worry about the negative unreasonably high in order to see oneself as effects of past unpleasant experiences and future exceptional, or too low based on a sense of negative possibilities; feeling fearful, apprehensive, entitlement; often unaware of own motivations. or threatened by uncertainty; fears of falling apart or losing control. 2. Impairments in interpersonal functioning (a or b): Separation insecurity: Fears of rejection by - and/or Empathy: Impaired ability to recognize or identify separation from - significant others, associated with with the feelings and needs of others; excessively fears of excessive dependency and complete loss attuned to reactions of others, but only if perceived of autonomy. as relevant to self; over- or underestimate of own Depressivity: Frequent feelings of being down, effect on others. miserable, and/or hopeless; difficulty recovering from such moods: pessimism about the tuture; Intimacy: Relationships largely superficial and exist pervasive shame; reeling of inferior sell-worth; to serve self-esteem regulation; mutuality thoughts of suicide and suicidal behavior. constrained by little genuine interest in others" experiences and predominance of a need for personal gain B. Pathological personality traits in the B. Cognitive and perceptual dysregulation: Odd or following domain: unusual thought vague, circumstantial, 1. Antagonism, characterized by: metaphorical, over-elaborate, or stereotyped Grandiosity: Feelings of entitlement, either overt or thought or speech; odd sensations in various covert; self-centeredness; firmly holding to the sensory modalities. belief that one is better than others; condescending c. Unusual beliefs and experiences: toward others. Thought content and views of reality that are Attention seeking: Excessive attempts to attract viewed by others as bizarre or idiosyncratic; and be the focus of the attention of others; unusual experiences of reality admiration seeking. C. The impairments in personality functioning and 2. Detachment, characterized by: the individual's personality trait expression are Restricted affectivity: Little reaction to emotionally relatively stable across time and consistent across arousing situations; constricted emotional situations. experience and expression; indifference or D. The impairments in personality functioning and coldness. the individual's personality trait expression are not Withdrawal: Preference for being alone to being better understood as normative for the individual's with others; reticence in social situations; developmental stage or sociocultural environment. avoidance of social contacts and activity; lack of E. The impairments in personality functioning and initiation of social contact. the individual's personality trait expression are not Negative Affectivity, characterized by: solely due to the direct physiological effects of a a. Suspiciousness: Expectations of - and substance (e.g., a drug of abuse, medication) or a heightened sensitivity to - signs of interpersonal ill- general medical condition (e.g, severe head intent or harm; doubts about loyalty and fidelity of trauma). others; feelings of persecution. Schizotypal Personality Disorder Personality Disorder Trait Specified The essential features of a personality disorder are The essential features of a personality disorder are impairments in personality self and interpersonal) impairments in personality (self and interpersonal) functioning and the presence of pathological functioning and the presence of pathological personality traits. personality traits. To diagnose a personality disorder, the following To diagnose schizotypal personality disorder, the criteria met: following criteria must be met A. Significant impairments (ie., mild impairment or Significant impairments in personality functioning greater) in self (identity or self-direction) and manifest by: interpersonal (empathy or intimacy) functioning. 1. Impairments in self functioning: Identity: Confused boundaries between self and B. One or more pathological personality trait others; distorted sell-concept; emotional expression domains OR specific trait facets within domains, often not congruent with context or internal