PSYCH

CH. 14 Psychological Disorders

Defining Psychological/mental disorder
According to the APA (American Psychiatric Association) a pattern of behavior
can be considered a psychological disorder if and only if:
significant pain or distress, an inability to work or play, and increased
risk of death or a loss of freedom in important areas of life.
Is within the person, due to biological factors, learned habits, or mental
processes and is not simply a normal response to specific life events
The problem is not a deliberate reaction to conditions such as poverty,
prejudice, government policy or other conflicts with society.
Diagnosing Individuals
Diagnostic and Statistical Manual of Mental Disorders (DSM IV TR)
Brief Description
Diagnostic features
Associated features and Disorders
Specific Culture, Age and Gender Features
Prevalence
Course
Familial Pattern
Differential Diagnosis
Disorders usually first diagnosed in infancy, childhood or adolescence:
MR, ADD. ADHD, Developmental Disorders such as Autism, PDD, etc.
Delirium, dementia, amnestic and other cognitive disorders: degenerative
disorders like syphilis or Alzheimers or attributed to brain damage, drugs or other
toxic substances
Substance-Related Disorder: Addiction and Withdrawal, alcohol, cocaine,
nicotine, heroin, hallucinogens, etc.
Schizophrenia and other psychotic disorders: schizophrenia, schizoaffective,
schizophreniform, Delusional disorder, brief psychotic disorder
Mood disorder: depression, mania, bipolar
Anxiety Disorders: generalized anxiety disorder, phobias, PTSD, OCD

Somatoform Disorders: hypochondriasis, conversion disorder, pain disorder,

body dysmorphic disorder.
Factitious disorder: Munchausens and munchausens by proxy
Dissociative Disorders: Dissociative amnesia, Dissociative Identity Disorder (AKA
Multiple Personality Disorder), Fugue states
Sexual and gender identity disorders: Sexual dysfunctions (female arousal
disorder, male erectile disorder there is a category for orgasmic disorders),
Paraphilias which include exhibitionism, fetishism, frotteurism, pedophelia, sexual
masochism and sadism, transvestic fetishism, voyeurism, Gender Identity disorder
Eating disorder: anorexia, bulimia
Sleep disorders: insomnia, hypersomnia, narcolepsy, sleep apnea (parasomnias
include, nightmare disorder, sleep terror disorder, sleepwalking
Impulse Control Disorders: Intermittent explosive disorder (rage), kleptomania,
pyromania, pathological gambling, trichotillomania
Adjustment disorders

 Personality Disorders: Cluster A (these individuals often appear odd or

eccentric meaning you can often look at them and know something is
off): Paranoid PD, Schizoid PD, Schizotypal PD Cluster B (these individuals
often appear dramatic, emotional or erratic in behavior): Antisocial PD,
Borderline PD, Histrionic PD, Narcissistic PD Cluster C (these individuals often
appear fearful or anxious): Avoidant PD, Dependent PD, Obsessive- Compulsive
PD
Additional conditions that may be a focus of clinical attention: medication
induced problems, relationship problems, abuse, malingering (intentional
production of physical or psychological symptoms found in large numbers in
prison populations), etc.

Clients/patients are evaluated on 5 dimensions or Axes

Axis I: Primary Clinical Problem (Clinical Disorders EXCEPT for PDs and MR)
Axis II: PDs and MR
Axis III: General Medical Conditions
Axis IV: Psychosocial & Environmental Problems
Axis V: Global Assessment of Functioning
Causes
Medical model: disordered thoughts feelings and behaviors are caused by
physical disease (genetic links, damage to parts of the brain and nervous system,
hormone imbalances and neurotransmitter activity)
Psychological Model: psychological disorders are caused and then maintained by
a persons past and present life experiences negatively impacting events
include prolonged illness, natural disasters, war, physical and sexual abuse,
domestic violence, divorce, death of a loved one, problems with relationships, etc.
Psychodynamic for abnormal personality development and mental disorders
emphasizes that role of parental influences, unconscious conflicts, guilt,
frustration, etc mental disorders spring from inner conflicts that are so intense
that they overwhelm our normal defense mechanisms that usually keep us
mentally balanced.
Behavioral, Cognitive, Social-learning abnormal behavior is a learned
response to reward and punishment that is further influenced by our perceptions,
expectations, values and role models.
Humanistic mental disorders arise when we, ourselves, block our own
efforts to grow and achieve self-actualization.
Sociocultural Model our culture and society dictate many things related
to mental disorders like the stressors we encounter, the kinds of disorders we
are likely to have and the treatments that we are likely to receive. As we
have seen there are some disorders that are culture-specific as there are
disorders that are more broad across cultures but still more likely found in
some cultures than others or to take different forms in one culture over
another (adolescent behavior and therefore mental disorders or behavior
defined as dysfunctional varies from American teens to teens in Thailand) or
even in certain group members of one culture (while it is not exclusive, it is
more often than not that adolescent girls, not boys, develop anorexia or
bulimia
Childhood Disorders

 ADHD
Inattentive Type
Hyperactive Type
Combined Type
Age 7. 2+ Settings
Etiology, Prognosis
Childhood Bx Disorders
Oppositional Defiant Disorder (ODD)
Conduct Disorder
Childhood Onset
Adolescent Onset
Childhood Anxiety
Separation Anxiety Disorder
Excessive worry
Fearful or being away from parents
Stems from stressful situation
Impairs functioning
Pervasive Developmental Disorders
Autism
Language/Communication
Social Interactions
Stereotyped Behaviors
Etiology, Prognosis
Aspergers
Disintegrative Disorders
Retts
girls
Childhood Disintegrative Disorders
Develop normally, plateau or decrease
Mental Retardation
IQ <70
Adaptive Functioning Impairment
Mild
Moderate
Severe
Profound
Eating Disorders
Pica
Rumination
Anxiety Disorders
Panic attack not specific to anxiety disorders period of intense fear or
discomfort in the absence of real danger that also includes at least 4 of 13 somatic
(body or physiological) or cognitive symptoms: palpitations, sweating, trembling or
shaking, sensations of shortness of breath or smothering, feeling of choking, chest

pain or discomfort, nausea or abdominal distress, dizziness or lightheadedness,

derealization or depersonalization, fear of losing control, fear of dying, chills or hot
flashes. The onset is sudden and peaks rapidly and is accompanied by an
impending fear or sense of doom. They can be unexpected (uncued), situationally
bound (cued) and situationally predisposed (it may happen during that situation
however it doesnt ALWAYS happen or it doesnt happen right away).
Agoraphobia anxiety about being in places or situations from which escape
might be difficult or embarrassing or in which help might not be available in the
event of having a panic attack or panic-like symptoms usually leads to
avoidance of places or situations; being alone outside of the home, being in
crowds, traveling on buses, trains, planes, etc.
Specific or Simple Phobia marked and persistent fear of specific objects or
situations. Exposure to the stimulus almost always invokes anxiety. This fear is
typically unreasonable and/or excessive and it is usually recognized as this.
Subtypes: animal (usually childhood onset), natural environment (fear of heights,
water, etc childhood onset), blood-injection type (fear of seeing blood or injury),
Situations (bridges, tunnels , claustrophobia), Other
Phobias are common but are not always so severe that they are clinically
significant or cause significant distress lifetime prevalence rates can range from
about 7 to 11% these numbers are also dependent upon defining impairment or
distress of the individual. Many phobias begin in childhood there is a familial
pattern, but the root cause of that may be learning, not necessarily biological predispositioning.
Social Anxiety Disorder (Social Phobia) marked or persistent fear of social or
performance situations in which embarrassment may occur, exposure to these
situations almost always invokes anxiety or panic. Again, often recognized as
excessive or unreasonable.
Lifetime prevalence is about 3-13% again depends on defining impairment
and distress. Onset is typically in mid to late teens
Obsessive-Compulsive Disorder recurrent obsessions (persistent ideas,
thoughts, impulses or images experiences as intrusive and inappropriate and
cause anxiety or distress) or compulsions (repetitive behaviors or mental acts with
the goal is to prevent or reduce anxiety or distress, not to provide pleasure or
satisfaction) that are severe enough to be time consuming (taking more than 1
hour per day) or cause marked distress or impairment the individual at some
point recognizes these obsessions and compulsions are excessive and
unreasonable. Also, the thoughts are not simply worries about real-life problems
Lifetime prevalence is about 2.5% typical onset is in the teens or early
adulthood and typically earlier for males than females. Higher rates between first
degree relatives with the disorder than in the general population.
PTSD development of characteristic symptoms following exposure to an extreme
traumatic stressor involving direct personal experience of an event that involves
actual or threatened death or serious injury or witnessing such an event the
response must include intense fear, helplessness or horror, persistent reexperiencing of the event, persistent avoidance of stimuli associated with the
event, numbing of general responsiveness, increased arousal. Symptoms must be
present for more than 1 month.
Generalized Anxiety Disorder excessive anxiety and worry occurring more
days than not for a period of at least 6 months about a number of events or
activities. Difficult to control worry and there are at least 3 additional symptoms:

restlessness, being easily tired, difficulty concentrating, irritability, muscle tension,

disturbed sleep. The worry or anxiety is not confined to just one thing or one
situation. The individual does not always recognize the worry or fear as excessive
or unreasonable .. .
Lifetime prevalence is about 5% chronic but fluctuating
Anxiety, as a trait has a familial pattern the disorder also seems to have
genetic connections.
Dissociative amnesia (psychogenic amnesia) inability to recall important
personal information, like a traumatic event or that of a stressful nature ... it
presents as a gap in memory
It can happen at any age and can last from minutes to years.
Dissociative fugue (fugue state) sudden, unexpected travel away from home
or regular, routine places of daily activities with the inability to recall part ones
past or all of ones past confusion about personal identity and even the
assumption of a new identity.
Lifetime prevalence is about .2% and it increases in times of extremely
stressful events
Dissociative Identity Disorder (Multiple Personality Disorder) presence of
2 or more distinct identities or personality states that recurrently take control of
behavior, there is an inability to recall important personal info reflects a failure
to integrate various aspects of identity, memory and consciousness each
personality state may be experienced as if it has a distinct personal history, selfimage and identity, including a separate name.
The primary identity usually carries the individuals given name and is
passive, dependent, guilty and depressed . Identities can emerge in different
situations and can posses different names, primary characteristics, voice
tones and patterns, ages, general knowledge, etc. Not all the identities may
know about or know each other the weaker, more passive identities
usually know less or remember less than the more aggressive identities
First symptom presentation is usually between 6 and 7 chronic and
recurrent
Substance-Related Disorders
these disorders are related to the taking of a drug of abuse, to the side effects of a
medication and/or to exposure to toxins.
Substance Use Disorders (Dependence and Abuse), Substance Induced Disorders
(Intoxication, Withdrawal, Delirium, Persisting Amnestic Disorder, Psychotic
Disorder, mood disorder, anxiety disorder, sexual dysfunction and sleep disorder).
Dependence pattern of self-administration that results in tolerance, withdrawal
and compulsive drug-taking behavior
Abuse maladaptive pattern of substance use accompanied by recurrent and
adverse consequences related to the use
Intoxication development of a reversible substance-specific syndrome due to
taking or exposure to drugs or toxins
Withdrawal development of a substance specific maladaptive behavioral change
with physiological and cognitive components, that is due to stopping of or
reduction in heavy and prolonged substance use.
Mood Disorders

 Major Depressive Episode at least 2 weeks of a depressed mood, loss of interest

or pleasure in nearly all activities. May present as irritability rather than sadness.
The individual must also have at least 4 of the following: changes in appetite,
weight, sleep, and/or psychomotor activity; decreased energy, feelings of
worthlessness or guilt, difficulty thinking, concentrating and/or making decisions;
suicidal ideation. Symptoms must be present everyday, for most of the day for at
least 2 consecutive weeks.
o Hippocampus is smaller in people with depression
o Memory is impaired
o Cortisone steroid (stress hormone) released more
o Learned helplessness feeling as though you cant do anything and youre a
failure
o Attribute setbacks to yourself rather than the situation
o Those that ruminate tend to
Manic Episode period where there is an abnormally and persistently elevated,
expansive or irritable mood. Must last at least 1 week (everyday for most of the
day) and must also include at least 3 additional symptoms: inflated self- esteem or
grandiosity, decreased need for sleep, pressured speech, flight of ideas, increased
distractibility, excessive involvement in pleasurable activities (often risk taking
behavior) or psychomotor activity, sometimes delusions and hallucinations.
Mixed episode at least 1 week in which criteria for Major Depressive AND Manic
episodes are met nearly everyday rapidly alternating moods
Hypomanic Episode a distinct period in which there is an abnormally and
persistently elevated, expensive or irritable mood that lasts at least 4 days. Other
symptoms similar to Manic episode, but no delusions or hallucinations
Major Depressive Disorder one or more Major Depressive episodes diagnosed
by the number of episodes after the first episode is experienced, it is called
Recurrent. An episode is considered to be over when 2 months go by without any
signs or symptoms of a major depressive episode.
This has varied from 10-25% lifetime prevalence for women and 5-12% for men.
Can begin at any age but typically will begin in the mid-20s. and often times there
is a life stressor that will trigger the development of the episodes. People who
have had one episode have a 60% chance of a second, those with 2 have a 70%
chance of a third and those who have had 3 have a 90% of a fourth. About 2/3,
66%, of Major Depressive Episode sufferers completely recover and about 1/3,
33%, recover only partially or not at all. This disorder is 1.5 to 3 times more
common among first-degree relatives.
Bipolar I disorder occurrence of one or more manic or mixed episodes ... often the
individual has also experienced one or more major depressive episodes as well.
About 10-15% of teens who present with Major Depressive Episodes will develop
Bipolar I. It appears to be equally common among men and women although the
first episode is more likely to be manic in males and depressive in females.
Lifetime prevalence is about .4 to 1.6%. Average age of onset is about 20. 4-24%
chances of developing Bipolar I if a first degree relative has Bipolar I, 1-5% is they
have Bipolar II and 4-24% if they have Major Depressive Disorder.
Schizophrenia
Thermal regulation is off
Hard to treat not based in reality
Delusions fixed firm beliefs, even if theyre not realistic

 Hallucinations auditory, visual, olfactory, tactile (feeling) things that arent there
Paranoid & suspicious
mixture of positive and negative symptoms that are present more often than not
over at least a 1 month period with some other signs persisting for at least 6
months.
Positive symptoms reflect an excess of distortion of normal functions (delusions,
hallucinations, disorganized speech, disorganized or catatonic behavior).
Negative symptoms include restrictions in the range and intensity of emotions
(called affective flattening), loss of fluency and productivity of thought and speech
and the loss of goal-directed behavior.
More catatonic
Hard to reason
Types: Paranoid (prominent delusions & auditory hallucinations), Disorganized
(prominent disorganized speech, behavior and flat or inappropriate affect),
Catatonic (marked psychomotor disturbances like immobility or excessive motor
activity, extreme negativity, mutism, tics, echolalia), Undifferentiated (little bit of
everything)
Lifetime prevalences range from .5% to 1.5%. Annually about, .5 to 5 individuals
per every 10,000 are diagnosed.
First appears usually in the early 20s for men and late 20s for women. Has been
found to be more prevalent among urban born individuals vs. rural born
individuals. Course is persistent, with periods of remission if medicated. If you have
a parent with Schizophrenia, you have about 10 times greater a chance of also
developing the disorder than someone who doesnt have it in a first-degree
biological relative.
Schizophreniform disorder has the same diagnostic criteria of Schizophrenia BUT
the symptoms are present for at least 1 month, but do not last longer than 6
months.
Delusional Disorder presence of one or more non-bizarre delusions for at
least 1 month. There may be hallucinations but not prominent.
specific types: Erotomanic (the central theme is that another person is in
love with them), Grandiose (individual claims to have a great, but
unrecognized talent or insight, having invented something or having a
relationships with someone important, Jealous (believe that their spouse or
lover is unfaithful without prompting or past behavior), Persecutory ( they
believe that they are being conspired against, lied to, followed, etc),
Somatic (they believe that there is something physical wrong with them like
they emit foul odors from the mouth, body odor, they have a parasite, body
dysmorphy or that parts of their body are not functioning properly), mixed
and unspecified.
Brief Psychotic Disorder involves the onset of at least one positive psychotic
symptoms such as delusions, hallucinations, disorganized speech or behavior. This
lasts for at least 1 day but no more than 1 month.
Somatoform Disorders
physical symptoms that generally suggest the presence of a general medical
condition but are not fully explained by one, or the effects of a substance or
another mental disorder.
Conversion Disorder presence of symptoms or deficits affecting voluntary
motor or sensory function (blindness, paralysis) that suggest neurological or other

general medical condition, but psychological factors (reaction to stress or

psychological pain) are judged to be associated with the initiation or exacerbation
of the symptom or deficit. The symptoms are not intentional or made up.
Very rare but rates have ranged from 11 to 500 in every 100,000. Onset is
usually anywhere from late childhood to early adulthood rarely before 10
or after 35.
Hypochondriasis preoccupation with fears of having or the idea that one has a
serious disease based on misinterpretation of one or more bodily signs or
symptoms. A medical condition cannot fully account for the individuals concern.
Even if the person is assured they do not have the disease, etc, the fear still
persists.
Prevalence 1-5% in general population. Can begin at any age but typically
begins in early adulthood usually chronic with lulls.
Factitious Disorder the individual intentionally produces or makes up (feigns)
physical or psychological symptoms in order to assume the sick role. Complaints,
objective signs (manipulating a thermometer), self-inflicted conditions,
exaggeration or exacerbation of existing medical conditions .
More common in females than males, but the more severe cases are found in
men. Onset is usually early adulthood with intermittent episodes
Paraphilias
recurrent intense sexually arousing fantasies, sexual urges or behaviors generally
involving 1. nonhuman objects, 2. the suffering or humiliation of oneself or ones
partner or 3. children or other non consenting person, that occur over a period of
at least 6 months. (often they begin in late adolescence)
Eating Disorders
-appear disturbances & obsession with weight
-most die (anorexia)
Anorexia Nervosa
Individual refuses to maintain a normal body weight (less than 85% of
suggested/normal weight for age, height, etc).
Restricting vs. Binge-Eating/Purging
Body image dangerous measures to loose weight
Drastic change in weight
Most people dont understand that they have a problem
Rarely seek treatment on their own
Amenoria loss of menstrual cycles
Metabolic problems & cardiac arrest
14 y/o
obsessive, emotional restraint
Bulimia Nervosa
Maintaining a normal body weight, but binge-eating & recurrent,
inappropriate compensatory behavior
Purging vs. Non-Purging
Guilt
Usually normal weight
Cardiac arthmyas, metablic deficiencys, gastrointestintal
15-21 y/o
impulsivity, low self esteem, overly sensitive


Sleep Disorders
Dyssomnias
Insomnia, hypersomnia, narcolepsy, sleep apnea
Parasomnias
Nightmare Disorder, Sleep Terror Disorder, Sleep Walking Disorder
90-95% are women (western)
High genetic vulnerability

Personality Disorders
an enduring pattern of behavior and inner experience that deviates markedly from
the expectations of the individuals culture, its pervasive and inflexible, has an
onset in late adolescence or early adulthood, it is stable over time and leads to
distress and impairment.
Paranoid Cluster A - pattern of pervasive distrust and suspiciousness of
others leading to interpreting motives of others as bad, hurtful, harmful (all
intentionally) they assume that anyone and everyone will exploit them, harm
them , deceive them, even if there is no evidence to support this they do not
normally form close relationships out of fear and the distrust, they over- read
things and situations.
Lifetime prevalence about .5-2.5% of general public.
Antisocial Cluster B pattern of disregard for and violation of the rights of
others (psychopathy, sociopathy); deceit and manipulation are the central features
of this disorder. This individual must have a diagnosis of Conduct Disorder before
age 15 (aggression to people and animals, destruction of property, deceitfulness or
theft, serious violations of rules ) and must be at least 18 at time of Antisocial
diagnosis. These people never follow rules or lawful behavior, they are
irresponsible, lie, cheat, steal, have no empathy and feel no remorse.
Lifetime prevalence is about 3% in males and 1% in females by 40 the
signs seem to recede and criminal behavior stops or slows down, probably
due to a function of age rather than cure or treatment
Dependent - Cluster C pervasive and excessive need to be taken care of and it
leads to clingy and submissive behavior and fears of separation. They have
difficulty making everyday decisions without advice and reassurance of
others, they are passive and allow others to take control and
responsibility for most areas of their lives (adults will depend on their parents or
spouse) this need goes beyond age- appropriate and situationally -appropriate
requests for advice or help. Very rarely will they disagree with anyone, for fear of
losing the relationship, they lack self-confidence and motivation. Most of the time it
isnt diagnosed until early adulthood, this is the most reported PD in mental health
clinics.
Obsessive-Compulsive PD preoccupation with orderliness, perfectionism and
mental and interpersonal control at the expense of flexibility, openness and
efficiency.
Borderline personality emotional libility with intense personal relationships
-common in women
-involuntary commitment commiting someone that u believe is a harm to themselves
or others