Abnormal Psychology As A Field of Study PDF

Chapter 1: ABNORMAL PSYCHOLOGY AS A FIELD OF STUDY ▪ Either to self or to others The study of abnormal psychology as a discipline is concerned with enormous c. Atypical or Not Culturally Expected (Deviance) – deviates from the aver...

Chapter 1: ABNORMAL PSYCHOLOGY AS A FIELD OF STUDY ▪ Either to self or to others The study of abnormal psychology as a discipline is concerned with enormous c. Atypical or Not Culturally Expected (Deviance) – deviates from the average or the norm of challenge is keeping up with the literature and integrating the many important recent findings the culture that shape our present understanding of abnormal behavior patterns and their treatment. ▪ Not just to the society but deviation from the person’s usual behavior Today, new scientific investigations and findings are being reported, new assessment techniques are being devised, and innovative methods of treatment are emerging. d. Dangerousness – creates potential harm to self (suicidal gestures) and others (excessive ABNORMAL PSYCHOLOGY DEFINED aggression) A. Abnormal psychology is the branch of science of psychology that deals with the nature, e. Duration - is this change in mental state persistent and of sufficient and significant description, causes, treatment of abnormal behavior patterns. Duration? We know that our mood, thoughts and behaviors to fluctuate constantly, moment to B. Abnormal Psychology – branch of psychology that studies unusual patterns of behavior, moment. This is normal and to be expected. However, if the change in mood and behaviors is emotions, and thought which may or may not indicate an underlying condition. sustained, persistent and pervasive (present across all contexts and situations), it is more concerning. Abnormal behavior in which psychologists and other scholars view this condition are typified by anxiety or depression, but most of us become anxious or depressed from time to E. The duration cut-off is somewhat arbitrary, is decided by expert consensus backed by time, and our behavior is not considered abnormal. It is normal to become anxious or a bit scientific research, and varies among different mental illnesses. excited in anticipation of the final examination or of an important job interview. It is alright to feel depressed when you failed a board examination or when you have lost someone close to o Psychopathology – scientific study of mental disorders you. It is normal to feel down when one failed an examination, but not when one’s grades are excellent. o Clinical Psychology – applied branch of psychology that seeks to understand, assess, and treat psychological conditions in a clinical setting. A question may be asked. When our emotions like anxiety and depression judged abnormal? These feelings may be appraised abnormal when they are not appropriate to the o Normal Behavior – one behavior that is like other people in the society situation. ▪ Normality is social conformity – some behaviors are non-conforming but normal C. Abnormal behavior can become pathological in nature and so leads to the scientific study of psychological disorders, or psychopathology. ▪ Normality is personal comfort D. Mental disorders are characterized by psychological dysfunction which causes physical ▪ Normality is a process and/or psychological distress or impaired functioning and is not an expected behavior according to societal or cultural standards. o Criteria for determining Abnormal Behavior o Psychological Disorder – psychological dysfunction within an individual associated with ✓ Norm-violation distress or impairment in functioning and a response that is not typical or culturally expected ✓ Statistical rarity ✓ Personal Discomfort o 4 D’s of Psychological Disorder ✓ Deviation a. Psychological Dysfunction – refers to a breakdown on cognitive, emotional, or behavioral ✓ Maladaptiveness functioning o Clinical Assessment – the systematic evaluation and measurement of psychological, ▪ Interferes daily functioning biological, and social factors in an individual presenting with a possible psychological disorder b. Distress or Impairment – individual is extremely upset and cannot function properly o Diagnosis – process of determining whether the particular problem afflicting the individual they become prolonged and persisted long after the source of anguish or anxiety has meets all criteria for a psychological disorder been removed. MANIFESTATION OF ABNORMAL BEHAVIOR 5. Behavior is maladaptive or self-defeating. Behavior that leads to unhappiness rather than self-fulfillment can be considered abnormal. Behavior that blocks our Abnormal behavior may be manifested by the magnitude or extent of the problem. desire and ability to function in expected roles, or to adapt to our environments may Psychologists generally agree that behavior may be perceived abnormal when it has also be regarded abnormal. Persistent alcohol consumption that usually impairs one’s some combination of these criteria: health and social or occupational functioning may be considered as abnormal. F. Behavior is unusual. Behavior that is unusual is often considered abnormal. When one Agoraphobic behavior which is characterized by intense fear of going into claims of seeing or hearing things that do not really exist, are almost considered public places is abnormal because it is uncommon. People to have misconceptions of abnormal. Becoming overcome with the feelings of panic when standing in a crowded reality may also be unable to perform their daily responsibilities to the employers and elevator is also uncommon and considered abnormal. families. Hallucination or delusions may preoccupy or confuse people when they should be preoccupied with their responsibilities on their jobs. G. Behavior is socially unacceptable or violates social norms. A person standing on elevated sidewalk and repeatedly shouting “kill” to passerby would be labeled 6. Behavior is dangerous. Behavior that is dangerous to oneself and other people abnormal. Bur shouting “kill” while watching a volleyball game is usually within may be viewed as abnormal. During wartime, soldiers who sacrifice themselves to gain normal norms. freedom with little concern for their own welfare and safety may be characterized as courageous, heroic, nationalistic and patriotic. On the other hand, those who threaten One problem in basing the definition of abnormal behavior on social norms is that or attempt to commit suicide because of problems that seem insurmountable are norms reflect relative standards, not universal truths. What is normal in one culture may be viewed as abnormal. abnormal in another. This situation is illustrated of an American executive who went to Seoul, Korea, and decided to eat local meat for dinner. But he is stunned to learn that the specialty in Abnormal behavior has multiple definitions. In most cases, a combination of Seoul is dog meat because it is believed to improve sex activity. these criteria is use to define abnormality. Some criteria may be weighed more heavily than others. These depend on the existing situation. In Ongpin, in Chinatown in Manila, is not surprising to see stores selling meat of snakes displayed on counters. The Chinese believe that these kinds of food are rich in aphrodisiac that excite sexual desire among men. Chapter 2: Psychological Disorders and Specific Symptoms based on DSM-5 Thus, behavior that is deemed normal in one culture may be viewed as abnormal in H. Anxiety Disorders another. It is important that clinicians need to weigh cultural differences in determining what Differentiating Anxiety disorders is normal and abnormal. I. Separation Anxiety Disorder 3. Perception or interpretation of reality is faulty. Normally, our sensory systems and - concerns with real or imagined separating from attachment figures cognitive processes permit us to form accurate mental representations of the things - separation may lead to extreme anxiety and panic attacks we see in the environment. But seeing things and fearing voices or sounds that are not - not entirely responsible for school absences or school avoidance present are considered hallucinations, which are often signs of mental disorder. By the - do not attend school so they won’t be separated with their attachment figure same premise, holding unfounded ideas or delusions, such as ideas of persecution that - fear of possible separation is the central thought the MNLF are “out to attack” our barangay again may be regarded as signs of mental - concerned about the proximity and safety of key attachment figures disturbances. - at least 4 weeks (children) or 6 months or more (adults) J. Selective Mutism 4. The individual is in severe personal distress. Various states of personal distress - rare childhood disorder cause by troublesome emotions, e.g., anxiety, fear, and depression, may be considered - characterized by a lack of speech in one or more setting in which speaking is socially abnormal. Appropriate feelings of distress are not usually considered abnormal unless expected - restricted to a specific social situation - a child could speak in one setting but cannot/do not in another setting - history of severe social neglect - not better explained by communication disorder R. Disinhibited Social Engagement Disorder - only diagnosed when a child has established a capacity to speak in some social situations - actively approaches and interacts with unfamiliar adults - learn to perform avoidance and safety behaviors to avoid disasters - can be distinguished from ADHD by not showing difficulties in attention or hyperactivity - at least 1 month S. Posttraumatic Stress Disorder K. Specific Phobia - exposure to actual death, injury or sexual violence (direct experience, witness, learning - irrational fear of a specific object or situation that markedly interferes with an that the event happened to a close family, repeated exposure) individual’s ability to function - more than 1 month - acquired through direct experience, experiencing in false alarm, and observation - heightened activity in the HPA axis - it only fears one setting, unlike Agoraphobia (which requires 3 settings), then Specific - requires trauma exposure precede the onset of the symptoms Phobia-Situational can be diagnosed - too much use of dissociation - 6 months or more T. Acute Stress Disorder L. Social Anxiety Disorder - exposure to trauma (direct experience, witness, learning that event occurred to close fam, - fear or anxiety about possible embarrassment or scrutiny repeated exposure) - can have panic attacks but it is cued by social situations - 3 days to 1 month after trauma exposure - typically have adequate age-appropriate social relationships and social communication - if the symptoms persist for more than 1 month and meet the criteria for PTSD, then PTSD capacity will be diagnosed - 6 months or more U. Adjustment Disorder M. Panic Disorder - development of emotional or behavior symptoms in response to identifiable stressors - cannot be diagnosed unless full symptom panic attacks were experienced occurring within 3 months of the onset of the stressors - norepinephrine activities are irregular - If symptoms persist beyond 6 months after the stressor or its consequences have ceased, - abrupt surge of intense fear or discomfort out of nowhere, with no triggers the diagnosis will no longer apply - followed by persistent concerns about more attacks or the consequences of it or - May sometimes be diagnosed instead of bereavement if bereavement is judged to be out maladaptive change in behavior related to the attacks of proportion to what would be expected or significantly impairs self-care and N. Agoraphobia interpersonal relations - developed after a person has unexpected panic attacks V. Prolonged Grief Disorder - fear in two or more situations (public transportation, open spaces, enclosed spaces, - death, at least 12 months, of a person close to the bereaved individual (6 months for standing in line, being outside of the home alone) due to thoughts that escape might be children) difficult or no one will help them in case panic-like symptoms would manifest - focused on loss and separation from a loved one rather than reflecting generalized low - 6 months or more mood O. Generalized Anxiety Disorder - distress from a deceased person - difficulty to control worry - excessive anxiety and worry occurring more days than not for at least 6 months, about a W. OCD-Related Disorders number of events or activities X. Obsessive-Compulsive Disorder - “the world is a dangerous place” - Obsessions: intrusive and mostly nonsensical thoughts, images, or urges that the - intense cognitive processing in the frontal lobes, particularly in the left hemisphere individual tries to resist or eliminate - intense worrying may act as avoidance - Compulsions: thoughts or actions used to suppress the obsessions and provide relief - worry whether or not they are judged/evaluated - Tic Disorders is common to co-occur in patients with OCD - fear circuit is excessively active - obsessions usually do not involve real life concerns and can include one, irrational, or magical content P. Trauma-and-Stressor Related Disorders - In BDD and Tricho, the compulsive behavior is limited to hair pulling or distortions in Q. Reactive Attachment Disorder absence of obsessions - withdrawn toward adult caregivers - obsessions and compulsions are not limited to concerns about weight and food - evident before age 5 years - Compulsions are usually preceded by obsessions, tics are often preceded by premonitory - People who develop these disorders tend to have a disproportionate incidence of disease sensory urges in their family when they were children Y. Body Dysmorphic Disorder FF. Conversion Disorder (Functional Neurological Symptom Disorder) - preoccupation with some imagined defect - altered voluntary motor or sensory function - imagined ugliness - incompatibility between the symptom and recognized neurological or medical conditions - excessive appearance-related preoccupations and repetitive behaviors that are time- - unexpected neurological disease cause for the symptoms is rarely found at follow-up consuming - too much use of denial - can be co-morbid with eating disorders GG. Psychological Factors affecting other Medical Conditions Z. Hoarding - medical symptom is present - difficulty discarding or parting with possessions - psychological or behavioral factors affect medical condition - Prader-Willi Syndrome: characterized by severe hypotonia, poor appetite, and feeding - psychological or behavioral factors are judged to affect the course of medical condition difficulties in early infancy, followed in early childhood by excessive eating and gradual - Psychological factors affecting other medical conditions are diagnosed when the development of morbid obesity psychological traits or behaviors do not meet criteria for a mental diagnosis - not direct consequence of neurodevelopmental disorder, nor delusion, nor psychomotor HH. Factitious Disorder retardation, fatigue, or loss of energy - Imposed on Self: individual present himself or herself as ill AA. Trichotillomania - Imposed on Another: presents another individual as ill - should not be diagnosed when hair removal is performed solely for cosmetic reasons - absence of obvious rewards - diagnosis will be OCD, if there is obsession of symmetry - Malingering: false medical symptoms or exaggerating existing symptoms in hopes of - someone with ASD could have hair-pulling behaviors when frustrated or angry, so if it’s being rewarded impairing then it can be diagnosed as stereotypic movement disorder - note the delusion or hallucination, if then, psychotic disorder II. Dissociative Disorders BB. Excoriation JJ. Depersonalization-Derealization Disorder - note delusion or tactile hallucination - Depersonalization: your perception alters so that you temporarily lose the sense of your - In absence of deception, excoriation disorder can be diagnosed if there are repeated own reality, as if you are in a dream watching yourself attempts to decrease or stop skin picking - Derealization: your sense of external world is lost; thing may seem to change shape or size; people may seem dead or mechanical CC. Somatic Symptom and Related Disorders - characterized by the presence of constellation of typical depersonalization/derealization DD. Somatic Symptom Disorder symptoms and the absence of manifestations of illness anxiety disorder - one or more symptoms cause distress and disruption of daily life - must precede the onset of major depressive epi or clearly continues even after its - chronic, influenced by the number of symptoms, age, level of impairment, and any resolution comorbidity - when symptoms occur ONLY during panic attacks, it must not be diagnosed with D/DD - ineffectiveness of analgesics, history of mental disorders, unclear palliative factors, KK. Dissociative Amnesia persistence without cessation, and stress - inability to recall important autobiographical information, usually of traumatic or - must be accompanied by excessive or disproportionate thoughts, feelings, or behavior stressful nature, that is inconsistent with ordinary forgetting - focus is on the distress that particular symptoms cause - usually localized or selective amnesia for specific events, then generalized, if entire life - individual’s belief that somatic symptoms might reflect serious underlying physical history illness are not held with delusional intensity - Dissociative Fugue: memory loss revolves around specific incident, an unexpected trip; - with enhanced perceptual sensitivity to illness cues individuals just take off and later find themselves in a new place, unable to remember why EE. Illness Anxiety Disorder or how you got there - preoccupation with having or acquiring serious illness - If a person experiencing PTSD cannot recall part or all of specific trauma event and that - usually minimal to no symptoms, mild intensity extends to beyond the immediate time of the trauma, comorbid diagnosis of DA may be - interpret ambiguous stimuli as threatening warranted - develop in the context of a stressful life - there must be no true neurocognitive deficits - too much use of repression LL. Dissociative Identity Disorder QQ. Premenstrual Dysphoric Disorder - disruption of identity characterized by two or more distinct personality states - majority of menstrual cycles, at least 5 symptoms must be present - host personality: the person who becomes the patient and asks for treatment; developed o Seasonal Affective Disorder – episodes must have occurred for at least 2 yrs with no later evidence of nonseasonal MDE during that period of time - switch: transition from one personality to another - extreme subtype of PTSD ▪ Cabin fever - Hypnotic Trance: tend to be focused on one aspect of their world and they become o Integrated Grief – acute grief, the finality of death and its consequences are vulnerable to suggestions by the hypnotist acknowledged and the individual adjusts to the loss - does not have a classic bipolar sleep disturbance o Complicated Grief – this reaction can develop without preexisting depressed state - Individuals with schizophrenia have low hypnotic capacity, whilst, individuals with DID o bipolar disorder may simply be a more severe variant of mood disorders have highest hypnotic capacity among all clinical groups - appear to encapsulate a variety of severe personality disorder features RR. Bipolar Disorders - too much use of dissociation SS. Bipolar I - at least 1 manic episode MM. Unipolar Disorders - children should be judged according to his or her own baseline in determining whether a NN. Disruptive Mood Dysregulation Disorder particular behavior is normal or evidence of manic episode - recurrent temper outburst (verbally or behaviorally) that are grossly out of proportion - first ep usually MDE - 3 or more times/week - factors that should be considered: family history, onset, medical history, presence of - irritable or angry most of the day psychotic symptoms, history of lack of response to - 12 or more months, at least 2 settings antidepressant treatment or the emergence of manic episode during antidepressant - onset should be after 6 yrs-18yrs treatment - do not occur exclusively during MDE - The diagnosis is “Bipolar I disorder, with psychotic features” if the psychotic symptoms - bipolar = episodic, DMD = persistent have occurred EXCLUSIVELY during manic and major depressive episodes - diagnosis cannot be assigned to a child who has ever experienced full-duration - Symptoms of mania in BP1 occur in distinct episodes and typically begin in late hypomanic or manic episode (irritable or euphoric) or who has ever had a manic or adolescence or early adulthood hypomanic episode lasting more than 1 day - When any child is being assessed for Mania, it is essential that the symptoms represent - presence of severe and frequently recurrent outburst and persistent disruption in mood clear change from the child’s typical behavior between outburst - Symptoms of mood lability and impulsivity must represent a distinct episode of illness, or - severe in at least one setting and mild to moderate to second setting there must be a noticeable increase in these symptoms over the individual’s baseline in OO. Major Depressive Disorder order to justify an additional diagnosis of BP1 - at least 2 weeks of either anhedonia or depressed mood TT. Bipolar II - “other specified depressive disorder” can be made in addition to the diagnosis of - MDE + Hypomanic episodes psychotic disorder - often begins with depressive episodes - in schizoaffective, delusions or hallucinations occur exclusively for 2 weeks without MDE - highly recurrent - Seasonal, Catatonic, Melancholic - once hypomanic episode has occurred, it never reverts back to MDD PP. Persistent Depressive Disorder (Dysthymia) - BP2 is distinguished from cyclothymic disorder by the presence of one or more - depressed mood for at least 2 years hypomanic episodes and one or more MDE - if full criteria for a MDE have been met at some point during the period of illness, a UU. Cyclothymic Disorder diagnosis of MDD would apply. Otherwise, a diagnosis of “other - milder but more chronic version of bipolar disorder specified depressive disorder” or “unspecified depressive disorder” should be given - do not meet the complete criteria for depressive symptoms and hypomanic symptoms - a separate diagnosis of PDD is not made if the symptom occur only during the course of the psychotic disorder VV. Eating Disorders - Double Depression: suffer from both MDE and PDD with fewer symptoms WW. Pica - eating of non-nutritive, nonfood substances for at least 1 month - inappropriate to the developmental age XX. Rumination Disorder FFF. Sleeping Disorders - repeated regurgitation of food for at least 1 month GGG. Insomnia - re-chewed, re-swallowed, or spit-out - difficulty initiating and maintaining sleep - not attributable to gastrointestinal or other medical condition - early-morning awakening with inability to return to sleep - self-soothing or self-stimulating - at least 3 nights/week, for at least 3 months YY. Avoidant/Restrictive Food Intake Disorder - Rebound Insomnia: sleep problems re-appearing, but sometimes worst - eating or feeding disturbance - situational, persistent, or recurrent, episodic - lack of interest in eating food HHH. Hypersomnolence Disorder - dependence on enteral feeding or nutritional supplements - excessive sleepiness despite having at least 7 hours of main sleep - requires that the disturbance of intake is beyond that directly accounted for by physical - recurrent periods of sleep or lapses into sleep within the same day symptoms consistent with medical condition; the eating - take longer naps, have trouble waking from naps, and do not feel alert afterward disturbance may also persist after being triggered by medical condition and following - at least 3x/week, for at least 3 months resolution of the medical condition III. Narcolepsy - if eating problems is the focus, then A/RFID, if weight, then Anorexia Nervosa - recurrent episodes of irrepressible need to sleep, lapsing into sleep, or napping with - might precede the onset of Anorexia Nervosa cataplexy, hypocretin deficiency, and evidence from ZZ. Anorexia Nervosa polysomnography showing REM sleep latency less than or equal to 15 mins - fear of gaining weight - 3x/week, for at least 3 months - subtypes: binge-eating/purging type and restricting type JJJ. Obstructive Sleep Apnea Hypopnea - associated with stressful life event - at least 4 obstructive apneas or hypopneas per hour of sleep or evidence from - BDD may be considered if the distortion is unrelated to body shape and size polysomnography of 15 or more obstructive apneas and/or hypopneas per hour of sleep - amenorrhea and cardiovascular problems - Apnea: absence of airflow - very underweight - Hypopnea: reduction in airflow AAA. Bulimia Nervosa KKK. Central Sleep Apnea - recurrent episodes of binge-eating then purging to prevent weight gain - evidence by polysomnography of 5 or more central apneas per hour of sleep - binge-eating for at least once a week for 3 months - Cheyne-Stokes Breathing: an abnormal pattern of breathing characterized by - normal weight progressively deeper, and sometimes faster, breathing followed by a gradual decrease that - chronic purging can result to enlargement of salivary gland caused by repeated vomiting, results in a temporary stop in breathing called an apnea causing chubby face LLL. Sleep-Related Hypoventilation - electrolyte imbalance that may lead to arrythmia, seizures, and renal failure - Polysomnography demonstrates episodes of decreased respiration associated with BBB. Binge-Eating Disorder elevated CO2 levels - recurrent episodes of just binge eating MMM. Circadian Rhythm Sleep-Wake Disorders - do not show marked or sustained dietary restriction designed to influence body weight - persistent or recurrent pattern of sleep disruption due to alteration of the circadian and shape between binge-eating episodes system or misalignment between the endogenous circadian rhythm - usually overweight - leads to excessive sleepiness or insomnia, or both NNN. Non-REM Sleep Arousal Disorders CCC. Elimination Disorders - incomplete awakening from sleep: sleepwalking or sleep terrors DDD. Enuresis - cannot remember anything when they woke up - repeated voiding of urine in bed, voluntary or - occur mostly in childhood and non-rem sleeps intentional - produce rapid and complete awakening without confusion, amnesia, or motor activity EEE. Encopresis OOO. Nightmare Disorder - repeated passage of feces into inappropriate places - repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity - upon awakening, they become oriented and alert - appear in children exposed to acute or chronic psychosocial stressors - occur during REM Sleep ZZZ. Paraphilic Disorders PPP. REM Sleep Behavior Disorder AAAA. Voyeuristic Disorder - repeated episodes of arousal during sleep associated with vocalization and/or complex - intense arousal from observing an unsuspecting naked person for at least 6 months motor behaviors - nonconsensual - during REM sleep - at least 18 yrs old - upon awakening, the individual is completely awake, alert, and not confused QQQ. Restless Legs Disorder BBBB. Exhibitionistic Disorder - urge to move the legs, usually accompanied or in response to uncomfortable and - intense arousal from exposing genitals to an unsuspecting person for at least 6 months unpleasant sensations of the legs - nonconsensual - during rests CCCC. Frotteuristic Disorder - sense of relief during the movement - intense arousal from touching or rubbing genitals against nonconsenting person for at - worse in evening least 6 months - 3x/week, for at least 3 months - nonconsensual DDDD. Sexual Masochism RRR. Sexual Dysfunctions - intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise SSS.Delayed Ejaculation made to suffer for at least 6 months - delay or absence of ejaculation EEEE. Sexual Sadism - at least 6 months - intense sexual arousal from the physical suffering of another person for at least 6 months - either lifelong or acquired, generalized or situational FFFF. Pedophilic Disorder TTT. Erectile Disorder - intense sexually arousing fantasies, urges, or behaviors involving prepubescent child or - difficulty having, maintaining erection and decrease in erectile rigidity children for at least 6 months - at least 6 months - has ACTED on these urges UUU. Female Orgasmic Disorder - at least 16 yrs old and at least 5 yrs older than the child or children - delay or absence of orgasm and reduced intensity of orgasmic sensations GGGG. Fetishistic Disorder - at least 6 months - intense sexual arousal from either the use of nonliving objects or highly specific focus on - either lifelong or acquired, generalized or situational nongenital body parts for at least 6 months VVV. Female Sexual Interest/Arousal Disorder - not limited to cross-dressing or sex toys - absent/reduced interest in sexual activity HHHH. Transvestic Disorder - no sexual thoughts or fantasies, no initiation, no sexual excitement or pleasure during sex - intense arousal from cross-dressing for at least 6 months - at least 6 months WWW. Genito-Pelvic Pain/Penetration Disorder IIII. Disruptive, Impulse-Control disorders, and Conduct Disorder - difficulties in vaginal penetration during intercourse JJJJ. Oppositional Defiant Disorder - vaginal pain during intercourse or penetration attempts - angry irritable mood, argumentative/defiant behavior against authority figure for at least - anxiety about anticipating vulvovaginal or pelvic pain 6 months - at least 6 months - annoys others XXX. Male Hypoactive Sexual Disorder - blames others for his/her mistakes - persistently deficient or absent sexual/erotic thoughts or fantasies and desire for sexual - precedes the development of conduct disorder activity - conveys risk for the development of anxiety disorders and MDD - at least 6 months - increased risk for a number of problems in adjustment as adults YYY. Premature (Early) Ejaculation - less severe than CD and do not include aggression towards people, property (IED) - ejaculation approx. 1 min following vaginal penetration or even before the individual - co-morbid with ADHD wishes it - diagnosis should not be made if the symptoms occur exclusively during the course of a - at least 6 months and must be experienced on almost all or all occasions mood disorder - if criteria for DMDD are met, then DMM is given even if all criteria for ODD are met KKKK. Intermittent Explosive Disorder OOOO. Kleptomania - behavioral outburst, failure to control aggressive impulses - failure to resist impulses to steal objects that are not need for personal use - verbal aggression, physical aggression twice weekly for a period of 3 months - increase tension before committing the theft - at least 6 yrs of age - pleasure after committing the theft - quite common regardless of the presence of ADHD or other disruptive, impulse-control, and conduct disorders PPPP. Personality Disorders - Also should not be made in children and adolescents ages 6-18 years, when the impulsive Cluster A—Odd or Eccentric Disorders aggressive outbursts occur in the context of an adjustment disorder Three personality disorders—paranoid, schizoid, and schizotypal— - A diagnosis of DMDD can only be given when the onset of recurrent, problematic, share common features that resemble some of the psychotic symptoms seen in impulsive aggressive outburst is before age of 10 years schizophrenia. - A diagnosis of DMDD should be made for the first time after 18 years QQQQ. Paranoid - Aggression in ODD is typically characterized by temper tantrums and verbal arguments - excessively mistrustful and suspicious of others, without justification with authority figures, whereas IED are in response to a broader array of provocation and - more common among relatives who have schizophrenia include physical assault - maybe due to early mistreatment or traumatic childhood experiences LLLL. Conduct Disorder - associated with prior history of childhood mistreatment, externalizing symptoms, - repetitive and persistent pattern of behavior in which the basic rights of others or major bullying, and adult appearance of interpersonal aggression age-appropriate societal norms or rules are violated - “I cannot trust people” - often bullies, initiates fights, physically cruel, destroying properties, theft, serious - too much use of projection violation of rules RRRR. Schizoid - Onset may occur as early as the preschool years, but the first significant symptoms - detachment from social relationships and limited range of emotions usually emerge during the period from middle childhood through middle adolescence - tendency to turn inward and away from the outside world - ODD is the most common precursor to the childhood-onset type - childhood shyness is reported as a precursor to later personality disorder - Physically aggressive symptoms = childhood - “Relationships are messy and undesirable” - Nonaggressive symptoms = adolescence SSSS. Schizotypal - May be diagnosed in adults, though onset is rare after age 16 years - typically socially isolated and behave in ways that would seem unusual to many of us, and - Childhood-onset type predicts a worse prognosis and an increased risk of criminal they tend to be suspicious and to have odd beliefs behavior in adulthood - “ideas of reference” – false beliefs that random or irrelevant occurrences in the world - When criteria for both ODD and CD are met, both diagnoses can be given directly relate to oneself - When criteria for both ADHD and CD are met, both diagnoses can be given - have odd beliefs or engage in magical thinking - Individuals with conduct disorder will display substantial levels of aggressive or - associated with childhood mistreatment and could be resulted from PTSD symptoms nonaggressive conduct problems during periods in which there is no mood disturbance, - “It is better to be isolated from others” either historically or concurrently - If criteria for both IED and CD has been met, the diagnosis of IED should be given only Cluster B—Dramatic, Emotional, or Erratic Disorders when the recurrent impulsive aggressive outbursts warrant TTTT. Histrionic independent clinical attention - tend to be overly dramatic and almost to be acting - express emotions in an exaggerated - CD is diagnosed only when the conduct problems represent a repetitive and persistent manner pattern that is associated with impairment in social, academic, or occupational functioning - histrionic and antisocial co-occur more often MMMM. Pyromania - “ako ang bida” - purposeful fire setting on more than one occasion - arousal before the act - “People are there to serve or admire me” - fascination to fire and its situational context UUUU. Borderline - not done for monetary gain or etc. - moods and relationships are unstable, and usually they have poor self-image - separate diagnosis is not given when fire setting occurs as part of CD, manic episode, or - often feel empty and are great risk of dying by their own hands antisocial personality disorder - often engage to suicidal behaviors NNNN. - tend to have turbulent relationships, fearing abandonment but lacking control over their - feel uncomfortable or helpless when alone emotions - “I need people to survive and be happy” - often intense, going from anger to deep depression in a short time ZZZZ. Obsessive-Compulsive - prevalent in families with history of mood disorders - perfectionist - if co-occurs with mood disorders, both are diagnosed - fixation on things being done “the right way” - recovery is more difficult and less stable - this preoccupation with details prevents them from completing much of anything - “I deserve to be punished” - need to control VVVV. Narcissistic - when criteria for both OCD and OCPD are met, both can be given - they consider themselves different from others and deserve special treatment - “I am perfectionist, everything should be done under my control and liking” - unreasonable sense of self-importance and are so preoccupied with themselves that they - “People should do better, try harder.” lack sensitivity and compassion - grandiosity AAAAA. Schizophrenia Spectrum and Other Psychotic Disorders - “I am the greatest in the world” o John Haslam – superintendent of a British Hospital who outlined a description of the - “Since I am special, I deserve special rules.” symptoms of Schizophrenia in his book Observations on Madness and Melancholy WWWW. Antisocial o Philippe Pinel – French physician who described cases of schizophrenia - characterized as having history of failing to comply with social norms o Benedict Morel – used the term demence precoce meaning early or premature loss of - at least 18 years of age mind to describe schizophrenia - evidence of CD before 15 years old o Emil Kraepelin – unified the distinct categories of schizophrenia under the name - irresponsible, impulsive, and deceitful Dementia Praecox - lacking in conscience and empathy, selfishly take what they want and do as they please, ▪ Combined several symptoms of insanity that had usually been viewed as reflecting violating social norms and expectations separate and distinct disorders: - CD will be given if the criteria for Antisocial PD is not met a. Catatonia – alternating immobility and excited agitation - Underarousal Hypothesis: psychopaths have abnormally low levels of cortical arousal b. Hebephrenia – silly and immature emotionality - Fearlessness Hypothesis: psychopaths possess a higher threshold for experiencing fear c. Paranoia – delusions of grandeur or persecution than most other individuals ▪ Distinguished dementia praecox - “I am entitled to break rules” ▪ Also noted the numerous symptoms in people with dementia praecox, including hallucinations, delusions, negativism, and stereotyped behavior Cluster C—Anxious or Fearful Disorders o Eugen Bleuler – introduced the term schizophrenia (“splitting of mind”) People diagnosed with the next three personality disorders we ▪ Associative Splitting highlight—avoidant, dependent, and obsessive-compulsive— o Positive Symptoms: share common features with people who have anxiety disorders. 1. Delusions – misrepresentation of reality (disorder of thought content) XXXX. Avoidant ▪ Persecutory – belief that one is going to be harmed, harassed and so forth - extremely sensitive of the opinion of others and although they desire social relationship, their anxiety leads them to avoid ▪ Referential – certain gestures, comments, environmental cues, and so forth are directed - extremely low self-esteem cause them to be limited with friendships and dependent to at one-self) those they feel comfy with ▪ Grandiose – when an individual believes that he or she has exceptional abilities, wealth, - feel chronically rejected by others and pessimistic about their future or fame - negative self-concept ▪ Erotomanic – when an individual believes falsely that another person is in love with him - Social Anxiety Disorder – negative evaluations or her - “If they knew the real me, they would reject me” ▪ Nihilistic – conviction that a major catastrophe will occur YYYY. Dependent ▪ Somatic – focus on preoccupations regarding health and organ function - rely on others to make ordinary decisions and even important ones which result in an ▪ Thought Withdrawal – thoughts have been “removed” by outside force unreasonable fear of abandonment ▪ Thought Insertion – thoughts have been put into one’s mind - agree with other people’s opinion just to be not rejected ▪ Delusions of Control – one’s body or actions are being acted on or manipulated by some o More severe symptoms of schizophrenia first occur in late adolescence or early outside force adulthood ▪ Capgras Syndrome – person believes someone he or she knows has been replaced by a o Prodromal Stage – 1-2 year period before the serious symptoms occur but when less double severe yet unusual behaviors start to show themselves ▪ Cotard’s Syndrome – the person believes he or she is dead o Schizophrenia is partially the result of excessive stimulation of striatal dopamine d2 ▪ Clerambault Syndrome - characterized by the delusional idea, usually in a young receptors o It appears that several brain sites are implicated in the cognitive dysfunction observed woman, that a man whom she considers to be of higher social among people with schizophrenia, especially prefrontal cortex, various related cortical and/or professional standing is in love with her regions and subcortical circuits, ▪ Fregoli Syndrome – a person holds a delusional belief that different people are in fact a including thalamus and the striatum single person who changes his or her appearance or is in disguise o Schizophrenogenic Mother – used for a time to describe a mother whose cold, ▪ Motivational View of Delusions – look at these beliefs as attempts to deal with and dominant, and rejecting nature was thought to cause schizophrenia in her children relieve anxiety and stress o Double bind communication – used to portray communication style that produced ▪ Deficit View of Delusions – sees these beliefs as a resulting from brain dysfunction that conflicting messages, which cased schizophrenia to develop creates these disordered cognitions or perceptions o Families with high expressed emotion view the symptoms of schizophrenia as 2. Hallucinations – experience of sensory events without any input from the surrounding controllable and that the hostility arises when family members think that patients just do environment not want help themselves ▪ Auditory Hallucination – most common form experienced by people with Types: schizophrenia BBBBB. Delusional Disorder ▪ Most active part during Hallucination is Broca’s Area (speech production) - one or more delusions for at least 1 month - persistent belief that is contrary to the reality ▪ Autoscopic Hallucination – individual experiences, all or part of the person's own body in the absence of other characteristics of schizophrenia appeared within the external space, viewed from - tend not to have flat affect, anhedonia, or other negative symptoms his/her physical body - socially isolated due to being suspicious ▪ Hypnagogic Hallucination – happens during sleep - Shared Psychotic Disorder (Folie a Deux): condition in which an individual develops ▪ Ictal Hallucination – associated with temporal lobe foci delusions simply as a result of a close relationship with a delusional individual ▪ Hypnopompic Hallucinations – happens when waking up - Erotomanic, Grandiose, Jealous, Persecutory, Somatic, Mixed, Unspecified o Negative Symptoms – usually indicate absence or insufficiency of normal behavior - functioning is better than what is observed in Schizophrenia a. Avolition – inability to initiate and persist activities - eventually develop schizophrenia b. Anhedonia – lack of pleasure - absence of active phase of schizophrenia c. Asociality – lack of interest in social interactions CCCCC. Brief Psychotic Disorder d. Flat Affect/Affective Flattening – do not show emotions when you would normally - presence of one of the ff: delusions, hallucinations, disorganized speech, catatonic expect them to behavior for at least 1 day but less than 1 month, with eventual full return to premorbid o Disorganized Symptoms level of functioning 1. Disorganized Speech – individual may switch from one topic to another (derailment or - can experience relapse loose associations) or answers to questions may be related or completely unrelated - if psychotic symptoms persist for at least 1 day in PD, an additional diagnosis of Brief (tangentiality) Psychotic Disorder may be appropriate DDDDD. Schizophreniform Disorder ▪ Word Salad - two or more of the following, present during a 1-month period: delusions, hallucinations, ▪ Clang associations – are groups of words chosen because of the catchy way they sound, disorganized speech, catatonic behavior, negative symptoms not because of what they mean - at least 1 month BUT less than 6 months 2. Inappropriate Affect – laughing or crying at improper times - development similar to schizophrenia 3. Grossly Disorganized or abnormal motor behavior – childlike silliness to EEEEE. Schizophrenia unpredictable agitation - two or more of the following, present during 1-month period: delusions, hallucinations, o Neologisms – construction of new words in order to communicate with schizophrenics disorganized speech, catatonic behavior, negative symptoms thoughts - disturbance in one or more major areas - disturbances in normal fluency and time patterning of speech that are inappropriate for - at least 6 months the individual’s age and language skills - abrupt or insidious - can be insidious or more sudden - prognosis is influenced both by duration and by severity of illness and gender MMMMM. Social (Pragmatic) Communication Disorder - possible reduced psychotic experience during late life - difficulties in the social use of verbal and nonverbal communication - too much use of regression - deficits in using communication for social purposes in a manner that is appropriate for FFFFF. Schizoaffective Disorder the social context - major mood ep + delusions or hallucinations for 2 or more weeks - difficulties in following the rules of conversating and do not understand metaphors, etc. - some individuals tend to change diagnosis into mood disorder or to schizophrenia over - current symptoms or developmental history fails to reveal evidence that could meet the time restrictive/repetitive patterns of behavior, interests, or activities of ASD GGGGG. Neurodevelopmental Disorders NNNNN. Autism Spectrum Disorder HHHHH. Intellectual Developmental Disorder - deficient Communication, Restrictive/Repetitive Actions/Behaviors, Impaired Social - includes both intellectual and adaptive functioning deficits in conceptual, social, and Interaction practical domains - evident in early childhood - difficulties with day-to-day activities to an extent that reflects both severity of their - failure to develop age-appropriate social relationships, social reciprocity, nonverbal cognitive deficits and the type and amount of assistance their receive comms, and initiating and maintaining social relationships - difficulties in conceptual, social, and judgement - inability to engage in joint attention - causes: deprivation, abuse, neglect, exposure to disease or drugs during pre-natal, - maintenance of sameness difficulties during labor and delivery, infections, and head injury - The developmental course and absence of restrictive, repetitive behaviors and unusual - Phenylketonuria, Lesch-Nyhan Syndrome, Down Syndrome, Fragile X Syndrome interests in ADHD help in differentiating ASD and ADHD - generally nonprogressive, there are period of worsening, then stabilization, and in others - A concurrent diagnosis of ADHD should be considered when attentional difficulties or progressive of intellectual function in varying degrees hyperactivity exceeds that typically seen in individuals - lifelong of comparable mental age IIIII. Global Developmental Delay - ADHD is one of the most common comorbidities in ASD - for children under 5 years old when they fail to meet expected developmental milestone - A diagnosis of ASD in individual with IDD is appropriate when social communication and in several areas of functioning interaction are significantly impaired relative to the JJJJJ. Language Disorder developmental level of the individual’s nonverbal skills - difficulties in acquisition and use of language modalities due to DEFICITS in - IDD is appropriate diagnosis when there is no apparent discrepancy between the level of comprehension and production social communicative skills and other intellectual skills - reduced vocab, limited sentence structure, impairments in discourse - The diagnosis of ASD supersedes that of social communication disorder whenever the - regional, social, or cultural/ethnic variations must be considered when an individual is criteria for ASD are met, and care should be taken to enquire carefully regarding past or being assessed current restricted/repetitive behavior - declines in critical social communication behavior during the first two years of life are OOOOO. Rett Disorder evident in most children with ASD, thus, it must be not confused with LD - genetic condition that affects mostly females and is characterized by hand wringing and KKKKK. Speech Sound Disorder poor coordination - difficulty in speech sound production - Clear genetic component - children’s progression in mastering speech sound production should result in most - Evidence of brain damage combined with psychosocial influences intelligible speech by 3 years old PPPPP. Attention-Deficit/Hyperactivity Disorder - continuous use of immature phonological simplification processes when the child has - pattern of inattention and/or hyperactivity-impulsivity that interferes functioning for at already passed the age wherein most of them can now produce words clearly least 6 months - when LD is present, Speech Sound Disorder has poorer prognosis - dislikes organization, focused work - selective mutism may develop - often losses things, forgets daily activities, and easily distracted LLLLL. Childhood-Onset Fluency Disorder (stuttering) - fidgets a lot, stands up when seating is expected, always “on the go” - present in two or more settings o Dementia – describe a group of symptoms affecting memory, thinking, and social - difficulty sustaining their attention on task or activity abilities severely enough to interfere daily life - in pre-school, main manifestation is hyperactivity XXXXX. Alzheimer’s - Fidgetiness and restlessness in ADHD are typically generalized and not characterized by – most common type of neurocognitive disorder, usually occurring after the age 65, repetitive stereotypic movements marked most prominently by memory impairment - A diagnosis of ADHD in IDD requires that inattention or hyperactivity be excessive for - Usually begins with mild memory problems, lapses of attention, and difficulties in mental age Specific Learning Disorder language and communication - difficulties learning and using academic skills for at least 6 months, despite interventions - Excessive senile plaques (sphere-shaped deposits of beta-amyloid protein that form in - academic skills are substantially and quantifiably below those expected for the the spaces between certain neurons and in certain blood vessels of the brain as people individual’s chronological age, IQ, and education age) and neurofibrillary tangles (twisted QQQQQ. Developmental Coordination Disorder protein fibers that form within certain neurons) - acquisition and execution of coordinated motor skills are below expected given the - includes multiple cognitive deficits that develop gradually and steadily chronological age - inability to integrate new information results to failure to learn new association - clumsiness, slowness, and inaccuracy of performance of motor skills - Anomia, Apraxia, Agnosia, Amnesia, Aphasia RRRRR. Stereotypic Movement Disorder - cognitive deterioration is slow during the early and later stages but more rapid during - repetitive, seemingly driven, and apparently purposeless motor behavior middle stages - may result in self-injury YYYYY. Vascular Injury SSSSS. Tic Disorders - when the blood vessels in the brain are blocked or damaged and no longer carry oxygen - Tourette’s: both motor and one or more vocal tics for more than 1 year and other nutrients to certain areas of brain tissues, damage - Persistent: single or multiple motor or vocal tics, but NOT BOTH for more than 1 year results - Provisional: single or multiple more and/or vocal tics for less than 1 year since the first - declines in speed of information processing and executive functioning onset ZZZZZ. Frontotemporal Degeneration - Motor Stereotypies are defined as involuntary rhythmic, repetitive, predictable - categorize a variety of brain disorders that damage the frontal or temporal regions of the movements that appear purposeful but serve no obvious adaptive function; often self- brain – areas that affect personality, language, and behavior soothing or pleasurable and stop - declines in appropriate behavior or language with distraction - Pick’s Disease: rare neurological condition that produces symptoms similar to Alzheimer’s, usually occurring in relatively early in life (40s or 50s) TTTTT. Neurocognitive Disorders AAAAAA. Traumatic Brain Injury UUUUU. Delirium - symptoms must persist for at least a week following the trauma, including executive - characterized by impaired consciousness and cognition during the course of several dysfunction and problems with learning and memory hours or days BBBBBB. Lewy Body Disease - appear confused, disoriented, and out of touch with their surroundings - involves the buildup of clumps of protein deposits called Lewy Bodies, within many - effects may more lasting neurons - can be experienced by children who have high fevers or taking certain medication - Features significant movement difficulties, visual hallucinations, and sleep disturbances - reversible - Second most common neurocognitive disorder - gradual and include impairment in - occurs during the course of dementia alertness and attention, vivid visual hallucinations, and motor impairment - full recovery with or without treatment CCCCCC. Parkinson’s Disease VVVVV. Major Neurocognitive Disorder - slowly progressive neurological disorder marked by tremors, rigidity, and unsteadiness - gradual deterioration of brain functioning that affects memory, judgement, language, and - motor problems, tend to have stooped posture, slow body movements (bradykinesia), other advanced cognitive process tremors, and jerkiness WWWWW. Mild Neurocognitive Disorder - damage in dopamine pathways - early stages of cognitive declines DDDDDD. HIV Infection - most impairments in cognitive abilities but can, with some accommodations - HIV infection seems to be responsible for the neurological impairment - early symptoms: cognitive slowness, impaired attention, and forgetfulness - clumsy, repetitive movements, and become apathetic and socially withdrawn - Alcohol Dehydrogenase: metabolize alcohol - sometimes referred as Subcortical Dementia - Korsakoff syndrome: is a chronic memory disorder caused by severe deficiency of - more likely to experience depression and anxiety thiamine (vitamin B-1). EEEEEE. Substance-Use - Korsakoff syndrome is most caused by alcohol misuse, but certain other conditions also - use of different psychoactive substances + poor diet can cause the syndrome - include memory impairment, aphasia, apraxia, agnosia, or disturbance in executive Caffeine – most common psychoactive substance functioning - “gentle stimulant” FFFFFF. Huntington’s - found in tea, coffee, soda, and cocoa products - inherited progressive disease in which memory problems, along with personality changes Cannabis (Marijuana) – reactions include mood swings or even dream-like experiences and mood difficulties, worsen over time - chronic and heavy users report tolerance, especially to euphoric high: they are unable to - Have movement problems too, such as severe twitching and spasms reach the levels of pleasure they experienced earlier GGGGGG. Prion Disease Hallucinogens – most common, “LSD” produced synthetically in the laboratory - caused by prions (proteins that can reproduce and cause damage to brain cells leading to - others: psilocybin (mushroom), lysergic acid amide (seeds of morning glory plant), neurocognitive decline dimethyltryptamine (DMT), and mescaline - no treatment but not contagious - Phencyclidine (PCP) is snorted, smoked, or injected intravenously, and it causes - Creutzfeldt-Jakob Disease: symptoms include spasms of the body caused by slow acting impulsivity and aggressiveness virus that may live in the body for years before the disease develops Inhalant – solvents, aerosol sprays, gases, nitrites, usually found at home or workplace HHHHHH. Substance-Related and Addictive Disorder Opioid – natural chemicals in the opium poppy that have narcotic effect (relieves pain and o Substance – chemical compounds that are ingested to alter mood or behavior induce sleep) o Psychoactive substances – alter mood, behavior, or both - includes natural opiates, synthetic variation, and the comparable substances that occur o Substance Use – ingestion of psychoactive substances in moderate amounts that does naturally in the brain not significantly interfere with social, educational, or - also includes Heroin occupational functioning Sedative-, Hypnotic-, or Anxiolytic- - calming, sleep-inducing, and anxiety-reducing o Substance Intoxication – physiological reaction to ingested substances - includes barbiturates and benzodiazepines o Substance Use Disorders – how much of a substance is ingested is problematic - barbiturates and benzodiazepines relax the muscles and can produce mild feeling of well being o Physiological Dependence – meaning the use of increasingly greater amounts of the - combining alcohol with these substances can be fatal (Manilyn Monroe case) drug to experience the same effect (tolerance) and a negative physical response when the Stimulant – most commonly consumed psychoactive drugs in US substance is no longer ingested (withdrawal) - includes caffeine, nicotine, amphetamines, and cocaine Alcohol – produced when certain yeast reacts with sugar and water, then fermentation - Amphetamine: can induce feelings of elation and vigor and can reduce fatigue; prescribed takes place to people with narcolepsy and ADHD - depressant - another variants of Amphetamine are Methylenedioxymethamphetamine - inhibitions are reduced and we become more outgoing or ecstasy club drug (makes you feel euphoric) and methamphetamine (crystal meth) - with more drinking, alcohol depresses the brain which impedes the functioning - Cocaine: increases alertness, produces euphoria, increases blood pressure and pulse, and - Withdrawal Delirium (Delirium Tremens): condition that can produce frightening causes insomnia and loss of appetite hallucinations and body tremors - Intranasal use and oral use of substances result in more gradual progression occurring - Breathalyzer: measures levels of intoxication over months to years - GABA seems to be particularly sensitive to alcohol Tobacco – contains nicotine - The Glutamate system is involving why alcohol affects our cognitive abilities - linked with signs of negative affect such as depression, anxiety, and anger - Two types of organic brain syndromes may result from long-term alcohol use: Dementia - being depressed increases your risk of becoming dependent on nicotine and, at the same and Wernicke-Korsakoff Syndrome (Confusion, loss of muscle coordination, and time, being dependent will increase your risk of becoming unintelligible speech, believed to be cause by a deficiency of thiamine) depressed - Fetal Alcohol Syndrome o Acute alcohol withdrawal occurs as an episode usually lasting 4-5 days and only after extended periods of heavy drinking o Withdrawal is rare for individuals younger than 30 years o The symptoms of an alcohol-induced mental disorder are likely to remain clinically relevant as long as the individual continues to experience severe intoxication or withdrawal o Genetic factors may affect how people experience and metabolize certain drugs o Positive and Negative Reinforcement o Opponent-Process Theory – an increase in positive feelings will be followed shortly by an increase in negative feelings and vice versa o Expectancy Effect – expectancies develop before people actually use drugs, perhaps as a result of loved one’s use, advertising, etc. o Treatment: Nicotine replacement therapy, Bupropion, Naltrexone, Acamprosate, Disulfiram, Methadone, Buprenorphine, Aversion Therapy, Inpatient treatments, Aversion Therapy, etc. o Cross-Tolerance – tolerance for a substance has not taken before as a result of using another substance similar to it o Synergistic Effect – an increase of effects that occurs when more than one substance is acting on the body at the same time IIIIII. Gambling Disorder - persistent and recurring gambling behavior - at least 4-symptoms within 12 months - Onset can occur during adolescence or young adulthood but in other individuals it manifests during middle or even older adulthood - Progression appears to be more rapid in women than in men - An additional diagnosis of gambling disorder should be given only if the gambling behavior is not better explained by manic episodes