Abnormal Psychology Reviewer

ABNORMAL PSYCHOLOGY REVIEWER
ASSESSING PSYCHOLOGICAL DISORDERS ɵ Ideas of reference – everything everyone else does somehow
relates back to the individual.
• Clinical assessment is the systematic evaluation and measurement of  Hallucinations – things a person sees/hears when those things
psychological, biological, and social factors in an individual presenting with a aren’t really there.
possible psychological disorder. 3. Mood and affect
• Diagnosis is the process of determining whether the particular problem  Mood – the predominant feeling state of the individual
afflicting the individual meets all criteria for a psychological disorder, as set  Affect – the feeling state that accompanies what we say at a given
forth in the fifth edition of the Diagnostic and Statistical Manual of Mental point
Disorders, or DSM-5. o Appropriate – ex. we laugh when we say something funny
KEY CONCEPTS IN ASSESSMENT o Inappropriate – ex. crying when one won a lottery, etc.
o Blunted/flat – no affect whatsoever.
The clinician begins by collecting a lot of information across a broad range of the 4. Intellectual functioning – a rough estimate of intellectual functioning
individual’s functioning to determine where the source of the problem may lie. Then,  Reasonable vocabulary, understand metaphors/abstract, memory
the clinician narrows the focus by ruling out problems in some areas and concentrating 5. Sensorium – refers to our general awareness of our surroundings.
on areas that seem most relevant.  Awareness of time/date/location
 “Clear” / “Oriented x3”
1. THREE BASIC CONCEPTS
o Reliability
o Validity
o Standardization
CLINICAL INTERVIEW
1. Core of most clinical work

2. Gathers information on:
o current and past behavior
o attitudes, and emotions
o detailed history of the individual’s
life in general and of the presenting problem.
MENTAL STATUS EXAM
 Involves the systematic observation of an individual’s behavior.
 Mental status exams can be structured and detailed but mostly are performed
relatively quickly by experienced clinicians in the course of interviewing or
observing a patient. BEHAVIORAL ASSESSMENT
 Covers FIVE CATEGORIES:  Behavioral assessment takes this process one
1. Appearance and behavior – notes any overt physical behaviors, general step further by using direct observation to formally
appearance, posture, and facial expression. assess an individual’s thoughts, feelings, and
2. Thought process – rate or flow, continuity, and content of speech behavior in specific situations or contexts.
 Loose association/ Derailment – disorganized speech pattern  In behavioral assessment, target behaviors are
noticeable on patients with schizophrenia. identified and observed with the goal of
 Delusions – distorted views of reality determining the factors that seem to influence
ɵ Delusions of persecution – an individual thinks people are after them.
him/her.  Analogue – similar settings, used by clinicians to assess behavior when
ɵ Delusions of grandeur – an individual thinks he/she is all- naturalistic observation is impractical or impossible.
powerful in some way.
ABNORMAL BEHAVIOR VS NORMAL BEHAVIOR • Behavior is any action or response made by an organism (APA). Anything that
an individual/organism do or does. Behavior in Filipino is “kilos”, “galaw”
• Two types of behavior: Overt and Covert. o Average IQ of a person: 90-110; higher than average called “gifted”/
o Overt: Directly observable. Example: Running, walking, raising hands, lower than average “learning disabilities.”
clapping, etc. o Those who have IQ that is below average are infrequent, they might have
o Covert: Not visible behavior, unobservable; higher intellectual activities; mental disorders, or they might be considered as slow learners, etc.
dreaming, thinking, remembering, etc. (mental processes) • Statistical Frequency - normal curve - not always a count of abnormal psychology
o Subtypes of behavior: o Hallucinations - Visual/Auditory, perceiving things that are not present.
 Voluntary: Behavior is controllable  no sensation, no perception
 Involuntary: Uncontrollable
B. Violation of Norms (Standard of Society): behavior is shaped by norms – cultural
 Conscious: Awareness
expectations about the right and wrong way to do things.
 Unconscious: Unaware
• Norms are relative; not
 Rational: Reason. absolute; Norms vary from
 Irrational: Unreasonable. Nonsensical. Has no basis. culture to culture. (Example:
Japan eating noodles)
 Simple: Uses only a few neurons. • Repetitive rituals
 Complex: Uses lots of neurons. Ex. Playing basketball — you performed by people with
use your hands, feet, even your whole body obsessive compulsive
disorder and the conversation
 Normal with imaginary voices that some people w/ schizophrenias are engaged in are
 Abnormal violation of social norms. Yet this way of defining mental disorder is both too broad
and too narrow.
• Abnormal behavior could develop from cultural, social forces, etc.
C. Maladaptiveness – often an indicator of abnormality; cannot adapt to environment;
• Psychopathology – Abnormality
withdrawing from old habits, rituals etc.
 The field concerned with the nature and development of abnormal behavior,
thoughts and feelings; 1. Adjustment: art of blending
 The scientific study of mental disorders. A term which refers to either the 2. Adaptation: process of mastery in the environment
study of mental illness or mental distress
• Mental Disorder - a clinically significant behavioral or psychological syndrome or D. Disability – impairment in some important area of life (e.g. work or personal
pattern that occurs in an individual and that is associated with present distress or relationships)
disability or with significantly increased risk of suffering, death, pain disability, or
an important loss of freedom. E. Suffering or Personal Distress – behavior is abnormal if it creates a great distress
or torment in the person experiencing it.
Components of Abnormal Behavior/ Criteria:
NOTE: If people suffer or experience psychological pain, we are inclined to
A. Statistical Deviancy / Statistical Rarity: abnormal behavior is infrequent, ex. consider this as indicative of abnormality. If the person is content with his/her
mania/ depression (do not use terms unless diagnosed by clinical life, then he/she is of no concern to the mental health field.
psychologist/psychiatrist); a person is normal if they do not deviate much from the
average in particular trait or behavior patter. F. Social Discomfort – when someone violates a social rule, those around him may
experience a sense of discomfort or unease.
(Trait – katangian/ characteristic of a person that is relatively stable)
NOTE: something abnormal in the behavior is not equal to the person.
• Statistical Infrequency – those who are below or above average from the normal
curve. If a behavior is uncommon, it deviates to statistical rules.
G. Irrationality and Unpredictability  Psychologists have known for over a century that we perform better when we are
a little anxious or have moderate amounts of anxiety. In short, social, physical, and
• Dangerousness - therapists are required to institutionalize clients who are a danger intellectual performances are driven and enhanced by anxiety.
to themselves and/or society if they make an explicit threat to harm themselves or
another person. CAUSES of ANXIETY:
NOTE: No one definition is "the best"/ "exactly correct". To a certain extent,  Biological Contributions:
each one captures a different aspect of the meaning of abnormality. When we o Genetics – we inherit a tendency to be tense, uptight, and anxious.
talk about abnormality, or when we study it, or treat those suffering from it, we Contributions from collections of genes in several areas on
inevitable invoke one or more of these definitions either explicitly or implicitly. chromosomes make us vulnerable when the right psychological and
social factors are in place.
o Associated with specific brain circuits and neurotransmitter systems
ANXIETY AND RELATED DISORDERS (GABA; Limbic System)
ANXIETY ▪ Behavioral inhibition system (BIS) – is activated by signals
 An emotion implicated so heavily across the full range of psychopathology. from the brain stem of unexpected events, such as major
 A negative mood state characterized by bodily symptoms of physical tension changes in body functioning that might signal danger. When the
and by apprehension about the future. BIS is activated by signals that arise from the brain stem or
 A subjective sense of unease, a set of behaviors (looking worried or fidgeting), descend from the cortex, our tendency is to freeze, experience
or a physiological response originating in the brain and reflected in elevated anxiety, and apprehensively evaluate the situation to confirm
heart rate and muscle tension. that danger is present.
 Anxiety is a future-oriented mood state.  Psychological Contributions:
o A sense of control that develops from early experiences is the
 Somewhat related to FEAR - an immediate alarm reaction to danger.
psychological factor that makes us less vulnerable to anxiety in later
 Fear is the emotional response to real or perceived imminent threat, whereas
life.
anxiety is anticipation of future threat.
▪ Anxiety Sensitivity – a general tendency to respond fearfully to
 Fear is more often associated with surges of autonomic arousal necessary for
anxiety symptoms and appears to be an important personality
fight or flight, thoughts of immediate danger, and escape behaviors.
trait that determines who will and who will not experience
 Anxiety more often associated problems with anxiety under certain stressful conditions.
with muscle tension and vigilance in
 Social Contributions:
preparation for future danger and
o Stressful life events trigger our biological and psychological
cautious or avoidant behaviors.
vulnerabilities to anxiety.
PANIC ATTACK: Fear that occurs o Theory of the Development of Anxiety
when there is nothing to be afraid of
and, therefore, at an inappropriate
time.
EXPECTED (Cued): Have a sensible

reason or cause for an attack to
occur. Expected attacks are more
common in specific phobias or social
anxiety disorder.
UNEXPECTED (Uncued): Have no

clue when or where the next attack
may occur. Unexpected attacks are
important in a panic disorder.
“TRIPLE VULNERABILITY THEORY”
Disorders arranged from age of onset: SELECTIVE MUTISM
 Characterized by a consistent failure to speak in social situations in which there is
SEPARATION ANXIETY DISORDER an expectation to speak (e.g., school) even though the individual speaks in other
 The individual with separation anxiety disorder is fearful or anxious about situations.
separation from attachment figures to a degree that is developmentally  The failure to speak has significant consequences on achievement in academic or
inappropriate. occupational settings or otherwise interferes with normal social communication.
 There is persistent fear or anxiety about harm coming to attachment figures and
events that could lead to loss of or separation from attachment figures and SELECTIVE MUTISM – DIAGNOSTIC CRITERIA
reluctance to go away from attachment figures, as well as nightmares and physical
symptoms of distress. A. Consistent failure to speak in specific social situations in which there is an
 Children with this disorder may be described as demanding, intrusive, and in need expectation for speaking (e. g., at school) despite speaking in other situations.
of constant attention, and, as adults, may appear dependent and overprotective.
B. The disturbance interferes with educational or occupational achievement or
SEPARATION ANXIETY DISORDER – DIAGNOSTIC CRITERIA with social communication.
A. Developmentally inappropriate and excessive fear or anxiety concerning C. The duration of the disturbance is at least 1 month (not limited to the first
separation from those to whom the individual is attached, as evidenced by month of school).
at least three of the following: D. The failure to speak is not attributable to a lack of knowledge of, or comfort
1. Recurrent excessive distress when anticipating or experiencing separation with, the spoken language required in the social situation.
from home or from major attachment figures.
2. Persistent and excessive worry about losing major attachment figures or E. The disturbance is not better explained by a communication disorder (e.g.,
about possible harm to them, such as illness, injury, disasters, or death. childhood onset fluency disorder) and does not occur exclusively during the
3. Persistent and excessive worry about experiencing an untoward event (e.g., course of autism spectrum disorder, schizophrenia, or another psychotic
getting lost, being kidnapped, having an accident, becoming ill) that causes disorder.
separation from a major attachment figure.
4. Persistent reluctance or refusal to go out, away from home, to school, to
work, or elsewhere because of fear of separation.
SPECIFIC PHOBIA
5. Persistent and excessive fear of or reluctance about being alone or without  Individuals with specific phobia are fearful or anxious about or avoidant of
major attachment figures at home or in other settings. circumscribed objects or situations.
6. Persistent reluctance or refusal to sleep away from home or to go to sleep  The fear, anxiety, or avoidance is almost always immediately induced by the
without being near a major attachment figure.
7. Repeated nightmares involving the theme of separation.
phobic situation, to a degree that is persistent and out of proportion to the
8. Repeated complaints of physical symptoms (e. g., headaches, actual risk posed.
stomachaches, nausea, vomiting) when separation from major attachment  There are various types of specific phobias:
figures occurs or is anticipated. o Animal o Situational and Others
o Natural environment
B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in o Blood-injection-injury
children and adolescents and typically 6 months or more in adults.
C. The disturbance causes clinically significant distress or impairment in SPECIFIC PHOBIA – DIAGNOSTIC CRITERIA
social, academic, occupational, or other important areas of functioning.
A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights,
D. The disturbance is not better explained by another mental disorder, such animals, receiving an injection, seeing blood).
as refusing to leave home because of excessive resistance to change in
autism spectrum disorder; delusions or hallucinations concerning separation Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or
in psychotic disorders; refusal to go outside without a trusted companion in clinging.
agoraphobia, worries about ill health or other harm befalling significant B. The phobic object or situation almost always provokes immediate fear or
others in generalized anxiety disorder; or concerns about having an illness anxiety.
in illness anxiety disorder.
SPECIFIC PHOBIA – DIAGNOSTIC CRITERIA SOCIAL ANXIETY DISORDER – DIAGNOSTIC CRITERIA
C. The phobic object or situation is actively avoided or endured with intense fear or C. The social situations almost always provoke fear or anxiety.
anxiety. Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging,
shrinking, or failing to speak in social situations.
D. The fear or anxiety is out of proportion to the actual danger posed by the specific
object or situation and to the sociocultural context. D. The social situations are avoided or endured with intense fear or anxiety.
E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. E. The fear or anxiety is out of proportion to the actual threat posed by the social
situation and to the sociocultural context.
F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning. F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or
more.
G. The disturbance is not better explained by the symptoms of another mental disorder, G. The fear, anxiety, or avoidance causes clinically significant distress or impairment
including fear, anxiety, and avoidance of situations associated with panic-like in social, occupational, or other important areas of functioning.
symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations
related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a
events (as in posttraumatic stress disorder); separation from home or attachment substance (e.g., a drug of abuse, a medication) or another medical condition.
figures (as in separation anxiety disorder) ; or social situations (as in social anxiety
disorder) . I. The fear, anxiety, or avoidance is not better explained by the symptoms of another
mental disorder, such as panic disorder, body dysmorphic disorder, or autism
spectrum disorder.
SOCIAL ANXIETY DISORDER
J. If another medical condition (e.g., Parkinson's disease, obesity, disfigurement
 The individual is fearful or anxious about or avoidant of social interactions and from bums or injury) is present, the fear, anxiety, or avoidance is clearly unrelated
situations that involve the possibility of being scrutinized. or is excessive.
 These include social interactions such as meeting unfamiliar people, situations in
which the individual may be observed eating or drinking, and situations in which Specify
FIGURE: if: How an individual may develop SAD
the individual performs in front of others.
Performance only: If the fear is restricted to speaking or performing in public.
 The cognitive ideation is of being negatively evaluated by others, by being
embarrassed, humiliated, or rejected, or offending others.
SOCIAL ANXIETY DISORDER – DIAGNOSTIC CRITERIA
A. Marked fear or anxiety about one or more social situations in which the individual
is exposed to possible scrutiny by others. Examples include social interactions (e.g.,
having a conversation, meeting unfamiliar people), being observed (e.g., eating or
drinking), and performing in front of others (e.g., giving a speech).
Note: In children, the anxiety must occur in peer settings and not just during
interactions with adults.
B. The individual fears that he or she will act in a way or show anxiety symptoms that
will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to
rejection or offend others).
PANIC DISORDER PANIC DISORDER – DIAGNOSTIC CRITERIA
 The individual experiences recurrent unexpected panic attacks and is
persistently concerned or worried about having more panic attacks or changes C. The disturbance is not attributable to the physiological effects of a substance (e.g.,
his or her behavior in maladaptive ways because of the panic attacks. a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism,
 Panic attacks are abrupt surges of intense fear or intense discomfort that Cardiopulmonary disorders).
reach a peak within minutes, accompanied by physical and / or cognitive
symptoms. D. The disturbance is not better explained by another mental disorder (e.g., the panic
 Two types: EXPECTED or UNEXPECTED | Onset occurs in early adult life. attacks do not occur only in response to feared social situations, as in social anxiety
 Panic attack may therefore be used as a descriptive specifier for any anxiety disorder: in response to circumscribed phobic objects or situations, as in specific
phobia; in response to obsessions, as in obsessive-compulsive disorder; in response
disorder as well as other mental disorders.
to reminders of traumatic events, as in posttraumatic stress disorder: or in response
to separation from attachment figures, as in separation anxiety disorder).
PANIC DISORDER – DIAGNOSTIC CRITERIA
A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense

fear or intense discomfort that reaches a peak within minutes, and during which
time four (or more) of the following symptoms occur:
Note: The abrupt surge can occur from a calm state or an anxious state.
1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating.
3. Trembling or shaking.
4. Sensations of shortness of breath or smothering.
5. Feelings of choking.
6. Chest pain or discomfort.
7. Nausea or abdominal distress.
8. Feeling dizzy, unsteady, light-headed, or faint.
9. Chills or heat sensations.
10. Paresthesias (numbness or tingling sensations).
11. Derealization (feelings of unreality) or depersonalization (being detached from
oneself)
12. Fear of losing control or "going crazy."
13. Fear of dying.
Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache,

uncontrollable screaming or crying) may be seen. Such symptoms should not count
as one of the four required symptoms.
B. At least one of the attacks has been followed by 1 month (or more) of one or
both of the following: CAUSES OF PANIC DISORDER
1. Persistent concern or worry about additional panic attacks or their consequences  Factors involving biological, psychological, and social.
(e. g., losing control, having a heart attack, "going crazy'').  articular situations quickly become associated in an individual’s mind with
2. A significant maladaptive change in behavior related to the attacks (e.g., behaviors
external and internal cues that were present during the panic attack
designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar
situations). (conditioning).
 Cues become associated with a number of different internal and external
stimuli through a learned alarm.
AGORAPHOBIA AGORAPHOBIA – DIAGNOSTIC CRITERIA
 Fear and avoidance of situations in which a person feels unsafe or unable to
escape. The individual fears these situations because of thoughts that escape I. The fear, anxiety, or avoidance is not better explained by the symptoms of another
might be difficult or help might not be available in the event of developing panic- mental disorder-for example, the symptoms are not confined to specific phobia,
like symptoms or other incapacitating or embarrassing symptoms. These situations situational type; do not involve only social situations (as in social anxiety disorder);
almost always induce fear or anxiety and are often avoided and require the and are not related exclusively to obsessions (as in obsessive-compulsive disorder),
presence of a companion. perceived defects or flaws in physical appearance (as in body dysmorphic disorder,
 Agoraphobia can cause individuals to become completely homebound, unable to reminders of traumatic events (as in posttraumatic stress disorder) , or fear of
leave their home and dependent on others for services or assistance to provide separation (as in separation anxiety disorder) .
even for basic needs.
Note: Agoraphobia is diagnosed irrespective of the presence of panic disorder. If an individual's
 Demoralization and depressive symptoms, as well as abuse of alcohol and presentation meets criteria for panic disorder and agoraphobia, both diagnoses should be
sedative medication as inappropriate self-medication strategies, are common. assigned.
AGORAPHOBIA – DIAGNOSTIC CRITERIA GENERALIZED ANXIETY DISORDER (GAD)
A. Marked fear or anxiety about two (or more) of the following five situations:  Refers to the excessive anxiety and worry (apprehensive expectation) about
1. Using public transportation (e.g., automobiles, buses, trains, ships, planes) several events or activities. The intensity, duration, or frequency of the anxiety
2. Being in open spaces (e.g., parking lots, marketplaces, bridges) and worry is out of proportion to the actual likelihood or impact of the
3. Being in enclosed places (e.g., shops, theaters, cinemas)
4. Standing in line or being in a crowd
anticipated event. The individual finds it difficult to control the worry and to
5. Being outside of the home alone. keep worrisome thoughts from interfering with attention to tasks at hand.
 GAD is characterized by muscle tension, mental agitation, susceptibility to
B. The individual fears or avoids these situations because of thoughts that escape might fatigue (probably the result of chronic excessive muscle tension), some
be difficult or help might not be available in the event of developing panic-like symptoms irritability, and difficulty sleeping.
or other incapacitating or embarrassing symptoms (e. g., fear of falling in the elderly; fear  Adults with generalized anxiety disorder often worry about everyday routine
of incontinence) life circumstances, such as possible job responsibilities, health and finances,
the health of family members, misfortune to their children, or minor matters
C. The agoraphobic situations almost always provoke fear or anxiety.
(e.g., doing household chores or being late for appointments).
D. The agoraphobic situations are actively avoided, require the presence of a companion,  Children with generalized anxiety disorder tend to worry excessively about
or are endured with intense fear or anxiety. their competence or the quality of their performance.
E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic GENERALIZED ANXIETY DISORDER – DIAGNOSTIC CRITERIA
situations and to the sociocultural context.
A. Excessive anxiety and worry (apprehensive expectation), occurring more days
F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. than not for at least 6 months, about a number of events or activities (such as
work or school performance)
G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning. B. The individual finds it difficult to control the worry.
H. If another medical condition (e.g., inflammatory bowel disease, Parkinson's disease) is C. The anxiety and worry are associated with three (or more) of the following six
present, the fear, anxiety, or avoidance is clearly excessive. symptoms (with at least some symptoms having been present for more days
than not for the past 6 months)
NOTE: Only one item is required in children.

1. Restlessness or feeling keyed up or on edge. SUBSTANCE / MEDICATION-INDUCED ANXIETY DISORDER

2. Being easily fatigued  Substance /medication-induced anxiety disorder involves anxiety due to substance
3. Difficulty concentrating or mind going blank. intoxication or withdrawal or to a medication treatment.
4. Irritability.
5. Muscle tension SUBSTANCE/ MEDICATION-INDUCED ANXIETY DISORDER
6. Sleep disturbance (difficulty falling or staying asleep, or restless,
– DIAGNOSTIC CRITERIA
unsatisfying sleep).
A. Panic attacks or anxiety is predominant in the clinical picture.
D. The anxiety, worry, or physical symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning. B. There is evidence from the history, physical examination, or laboratory findings
of both (1) and (2):
E. The disturbance is not attributable to the physiological effects of a substance 1. The symptoms in Criterion A developed during or soon after substance intoxication
(e.g., a drug of abuse, a medication) or another medical condition (e.g., or withdrawal or after exposure to a medication.
hyperthyroidism). 2. The involved substance/medication is capable of producing the symptoms in
Criterion A.
F. The disturbance is not better explained by another mental disorder (e.g., anxiety
or worry about having panic attacks in panic disorder, negative evaluation in C. The disturbance is not better explained by an anxiety disorder that is not
social anxiety disorder [social phobia], contamination or other obsessions in substance/ medication-induced. Such evidence of an independent anxiety
obsessive-compulsive disorder, separation from attachment figures in disorder could include the following:
separation anxiety disorder, reminders of traumatic events in posttraumatic 1. The symptoms precede the onset of the substance/medication use;
stress disorder, gaining weight in anorexia nervosa, physical complaints in 2. The symptoms persist for a substantial period of time (e.g., about 1 month) after
somatic symptom disorder, perceived appearance flaws in body dysmorphic the cessation of acute withdrawal or severe intoxication;
disorder, having a serious illness in illness anxiety disorder, or the content of 3. Or there is other evidence suggesting the existence of an independent non-
delusional beliefs in schizophrenia or delusional disorder). substance/medication-induced anxiety disorder (e.g., a history of recurrent non-
substance/medication-related episodes).
CAUSES OF GAD: D. The disturbance does not occur exclusively during the course of a delirium.
 Generalized biological vulnerability
– the tendency to be anxious is more likely to E. The disturbance causes clinically significant distress or impairment in social,
be heritable than GAD itself occupational, or other important areas of functioning.
 Generalized psychological vulnerability NOTE: This diagnosis should be made instead of a diagnosis of substance
– people with GAD are highly sensitive to threat. intoxication or substance withdrawal only when the symptoms in Criterion A
predominate in the clinical picture and they are sufficiently severe to warrant clinical
attention.
In summary, some people inherit a tendency to be
tense (generalized biological vulnerability), and
they develop a sense early on that important
events in their lives may be uncontrollable
and potentially dangerous (generalized
psychological vulnerability).
Significant stress makes them apprehensive

and vigilant. This sets off intense worry with
resulting physiological changes, leading to
GAD.
TRAUMA-RELATED DISORDERS POST-TRAUMATIC STRESS DISORDER
• All develop after a relatively stressful life event, often an extremely stressful or – DIAGNOSTIC CRITERIA
Note: The following criteria apply to adults, adolescents, and children older than 6 years. For
traumatic life event.
children 6 years and younger, see corresponding criteria below.
• Investigators working in this area concluded that these disorders did not fit as
neatly with other classes of disorders, because trauma and stress-related A. Exposure to actual or threatened death, serious injury, or sexual violence in one
disorders all share a proximal instigating stressful event followed by intense (or more) of the following ways:
emotional responses. 1. Directly experiencing the traumatic event(s).
• Include disorders in which exposure to a traumatic or stressful event is listed 2. Witnessing, in person, the event(s) as it occurred to others.
explicitly as a diagnostic criterion 3. Learning that the traumatic event(s) occurred to a close family member or close
• TRAUMA – an emotional response to a terrible event like an accident, rape, or friend. In cases of actual or threatened death of a family member or friend, the
event(s) must have been violent or accidental.
natural disaster. Immediately after the event, shock and denial are typical. Longer
4. Experiencing repeated or extreme exposure to aversive details of the traumatic
term reactions include unpredictable emotions, flashbacks, strained relationships, event(s) (e.g., first responders collecting human remains; police officers repeatedly
and even physical symptoms like headaches or nausea (APA). exposed to details of child abuse).
POST-TRAUMATIC STRESS DISORDER Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or
 Long-lasting emotional disorders that can occur after a variety of traumatic events. pictures, unless this exposure is work related.
Symptoms usually begin within the first 3 months after the trauma, although
there may be a delay of months, or even years, before criteria for the diagnosis are B. Presence of one (or more) of the following intrusion symptoms associated
met. with the traumatic event(s), beginning after the traumatic event(s) occurred:
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
 The setting event for PTSD, as exposure to a traumatic event during which an
Note: In children older than 6 years, repetitive play may occur in which themes or
individual experiences or witnesses death or threatened death, actual or aspects of the traumatic event(s) are expressed.
threatened serious injury, or actual or threatened sexual violation. 2. Recurrent distressing dreams in which the content and/or effect of the dream are
 Flashback – When memories occur suddenly, accompanied by strong emotion, related to the traumatic event(s).
and the victims find themselves reliving the event. Victims tend to reexperience the Note: In children, there may be frightening dreams without recognizable content.
event through memories and nightmares. 3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the
 PTSD with delayed onset – individuals show few or no symptoms immediately or traumatic event(s) were recurring. (Such reactions may occur on a continuum, with
the most extreme expression being a complete loss of awareness of present
for months after a trauma, but at least 6 months later, and perhaps years afterward
surroundings.)
develop full-blown PTSD. Note: In children, trauma-specific reenactment may occur in play.
 In the population as a whole, surveys indicate that 6.8% have experienced PTSD 4. Intense or prolonged psychological distress at exposure to internal or external cues
at some point in their life. The highest rates are associated with experiences of that symbolize or resemble an aspect of the traumatic event(s).
rape; being held captive, tortured, or kidnapped; or being badly assaulted. 5. Marked physiological reactions to internal or external cues that symbolize or
 CAUSE: Close exposure or experience of trauma seems to be necessary to resemble an aspect of the traumatic event(s)
developing this disorder. Those who experienced the disaster most personally and
directly seemed to be the ones most affected. C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning
 PTSD tends to last (i.e., it runs a chronic course; Symptoms change over time, after the traumatic event(s) occurred, as evidenced by one or both of the following:
more for some people than for others, which may be due to individual differences 1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about
or closely associated with the traumatic event(s).
in resiliency, coping skills, levels of trauma exposure, early adversities, ongoing
2. Avoidance of or efforts to avoid external reminders (people, places, conversations,
stress, and even the presence of mild traumatic brain injuries. activities, objects, situations) that arouse distressing memories, thoughts, or feelings
 Social factors play a major role in developing PTSD. If you have a strong and about or closely associated with the traumatic event(s).
supportive group of people around you, it is much less likely you will develop PTSD
after a trauma. -To be continued next page-
POST-TRAUMATIC STRESS DISORDER TREATMENT:

– DIAGNOSTIC CRITERIA  In psychoanalytic therapy, reliving emotional trauma to relieve emotional
D. Negative alterations in cognitions and mood associated with the traumatic suffering is called catharsis. The trick is in arranging the re-exposure so that it
event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced will be therapeutic rather than traumatic.
by two (or more) of the following:
 Most clinicians agree that victims should face the original trauma, process the
1. Inability to remember an important aspect of the traumatic event(s) (typically due to
dissociative amnesia and not to other factors such as head injury, alcohol, or drugs)
intense emotions, and develop effective coping procedures in order to overcome
2. Persistent and exaggerated negative beliefs or expectations about oneself, others, the debilitating effects of the disorder.
or the world (e.g., "I am bad," "No one can be trusted," ''The world is completely  Cognitive therapy to correct negative assumptions about the trauma—such as
dangerous," "My whole nervous system is permanently ruined") blaming oneself in some way, feeling guilty, or both—is another part of treatment.
3. Persistent, distorted cognitions about the cause or consequences of the traumatic  Imaginal exposure – the content of the trauma and the emotions associated
event(s) that lead the individual to blame himself/herself or others with it are worked through systematically.
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame)
 Prolonged exposure therapy – develop a narrative of the traumatic experience
5. Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others. and to expose the patients for an extended period of time to the image that is
7. Persistent inability to experience positive emotions (e.g., inability to experience then reviewed extensively in treatment.
happiness, satisfaction, or loving feelings)  Some of the drugs, such as SSRIs (e.g., Prozac and Paxil), that are effective for
anxiety disorders in general have been shown to be helpful for PTSD.
E. Marked alterations in arousal and reactivity associated with the traumatic event(s),
beginning or worsening after the traumatic event(s) occurred, as evidenced by two
(or more) of the following:
1. Irritable behavior and angry outbursts (with little or no provocation) typically
expressed as verbal or physical aggression toward people or objects.
2. Reckless or self-destructive behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
G. The disturbance causes clinically significant distress or impairment in social,

occupational, or other important areas of functioning.
H. The disturbance is not attributable to the physiological effects of a substance (e.g.

medication, alcohol) or another medical condition.
Specify if:
With delayed expression: If the full diagnostic criteria are not met until at least 6 months after
the event (although it is understood that onset and
expression of some symptoms may be immediate).
Specify whether:
With Dissociative Symptoms: The individual’s symptoms meet the criteria for post-traumatic
stress disorder, and in addition, in response to the stressor, the individual experiences
persistent or recurrent symptoms of either depersonalization or derealization.
ADJUSTMENT DISORDER
 Adjustment disorders describe anxious or depressive reactions to life stress that
are generally milder than one would see in acute stress disorder or PTSD but REACTIVE ATTACHMENT DISORDER – DIAGNOSTIC CRITERIA
are nevertheless impairing in terms of interfering with work or school C. The child has experienced a pattern of extremes of insufficient care as
performance, interpersonal relationships, or other areas of living. evidenced by at least one of the following:
 The stressful events themselves would not be considered traumatic, but it is clear 1. Social neglect or deprivation in the form of persistent lack of having basic
that the individual is nevertheless unable to cope with the demands of the emotional needs for comfort, stimulation, and affection met by caregiving adults.
situation and some intervention is typically required. 1. Repeated changes of primary caregivers that limit opportunities to form stable
attachments (e.g., frequent changes in foster care)
 Adjustment disorders may be diagnosed following the death of a loved one when 2. Rearing in unusual settings that severely limit opportunities to form selective
the intensity, quality, or persistence of grief reactions exceeds what normally attachments (e.g., institutions with high child-to-caregiver ratios)
might be expected, when cultural, religious, or age-appropriate norms are taken
into account. A more specific set of bereavement-related symptoms has been D. The care in Criterion C is presumed to be responsible for the disturbed behavior
designated, persistent complex bereavement disorder. in Criterion A (e.g., the disturbances in Criterion A began following the lack of
 The disturbance in adjustment disorders begins within 3 months of onset of a adequate care in Criterion C).
stressor and lasts no longer than 6 months after the stressor or its consequences
have ceased. If the stressor is an acute event (e.g., being fired from a job), the E. The criteria are not met for autism spectrum disorder.
onset of the disturbance is usually immediate (i.e., within a few days) and the
F. The disturbance is evident before age 5 years.
duration is relatively brief (i.e., no more than a few months). If the stressor or its
consequences persist, the adjustment disorder may also continue to be present G. The child has a developmental age of at least 9 months.
and become the persistent form.
Specify if:
ATTACHMENT DISORDERS Persistent: The disorder has been present for more than 12 months.
 Attachment disorders refers to disturbed and developmentally inappropriate
Specify current severity:
behaviors in children, emerging before five years of age, in which the child is Reactive attachment disorder is specified as severe when a child exhibits all symptoms of
unable or unwilling to form normal attachment relationships with caregiving the disorder, with each symptom manifesting at relatively high levels.
adults.
 CAUSE: Inadequate or abusive child-rearing practices
➢ Disinhibited Social Engagement Disorder – a similar set of child-rearing
circumstances— perhaps including early persistent harsh punishment—
➢ Reactive Attachment Disorder – the child will very seldom seek out a
would result in a pattern of behavior in which the child shows no inhibitions
caregiver for protection, support, and nurturance and will seldom respond
whatsoever to approaching adults.
to offers from caregivers to provide this kind of care.
o The essential feature of disinhibited social engagement disorder is a
pattern of behavior that involves culturally inappropriate, overly familiar
REACTIVE ATTACHMENT DISORDER – DIAGNOSTIC CRITERIA behavior with relative strangers.
A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult

caregivers, manifested by both of the following: DISINHIBITED SOCIAL ENGAGEMENT DISORDER – DIAGNOSTIC CRITERIA
1. The child rarely or minimally seeks comfort when distressed. A. A pattern of behavior in which a child actively approaches and interacts with
2. The child rarely or minimally responds to comfort when distressed. unfamiliar adults and exhibits at least two of the following:
B. A persistent social and emotional disturbance characterized by at least two of the 1. Reduced or absent reticence in approaching and interacting with unfamiliar adults.
following: 2. Overly familiar verbal or physical behavior (that is not consistent with culturally
1. Minimal social and emotional responsiveness to others. sanctioned and with age-appropriate social boundaries).
2. Limited positive affect. 3. Diminished or absent checking back with adult caregiver after venturing
3. Episodes of unexplained irritability, sadness, or fearfulness that are evident even away, even in unfamiliar settings.
during nonthreatening interactions with adult caregivers. 4. Willingness to go off with an unfamiliar adult with minimal or no hesitation.
DISINHIBITED SOCIAL ENGAGEMENT DISORDER – DIAGNOSTIC CRITERIA ACUTE STRESS DISORDER – DIAGNOSTIC CRITERIA
B. The behaviors in Criterion A are not limited to impulsivity (as in attention- Intrusion Symptoms
deficit/hyperactivity disorder) but include socially disinhibited behavior. 1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
Note: In children, repetitive play may occur in which themes or aspects of the traumatic
C. The child has experienced a pattern of extremes of insufficient care as event(s) are expressed.
2. Recurrent distressing dreams in which the content and/or affect of the dream are
evidenced by at least one of the following:
related to the event(s).
1. Social neglect or deprivation in the form of persistent lack of having basic emotional
Note: In children, there may be frightening dreams without recognizable content.
needs for comfort, stimulation, and affection met by caregiving adults.
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the
2. Repeated changes of primary caregivers that limit opportunities to form stable
traumatic event(s) were recurring. (Such reactions may occur on a continuum, with
attachments (e.g., frequent changes in foster care).
the most extreme expression being a complete loss of awareness of present
3. Rearing in unusual settings that severely limit opportunities to form selective
surroundings.)
attachments (e.g., institutions with high child-to-caregiver ratios)
Note: In children, trauma-specific reenactment may occur in play.
4. Intense or prolonged psychological distress or marked physiological reactions in
D. The care in Criterion C is presumed to be responsible for the disturbed behavior response to internal or external cues that symbolize or resemble an aspect of the
in Criterion A (e.g,1 the disturbances in Criterion A began following the pathogenic traumatic event(s).
care in Criterion C).
Negative Mood
5. Persistent inability to experience positive emotions (e.g., inability to experience
E. The child has a developmental age of at least 9 months.
happiness, satisfaction, or loving feelings)
Specify if: Dissociative Symptoms
Persistent: The disorder has been present for more than 12 months. 6. An altered sense of the reality of one's surroundings or oneself (e.g., seeing oneself
from another's perspective, being in a daze, time slowing)
7. Inability to remember an important aspect of the traumatic event(s) (typically due to
Disinhibited social engagement disorder is specified as severe when the child dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
exhibits all symptoms of the disorder, with each symptom manifesting at relatively
high levels. Avoidance Symptoms
8. Efforts to avoid distressing memories, thoughts, or feelings about or closely
associated with the traumatic event(s)
ACUTE STRESS DISORDER 9. Efforts to avoid external reminders (people, places, conversations, activities,
 Similar to PTSD and occurring within the first month after the trauma, but the objects, situations) that arouse distressing memories, thoughts, or feelings about or
closely associated with the traumatic event(s)
different name emphasizes the severe reaction that some people have
immediately. Arousal Symptoms
10. Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep).
ACUTE STRESS DISORDER – DIAGNOSTIC CRITERIA 11. Irritable behavior and angry outbursts (with little or no provocation), typically
expressed as verbal or physical aggression toward people or objects.
A. Exposure to actual or threatened death, serious injury, or sexual violation in one 12. Hypervigilance
13. Problems with concentration
(or more) of the following ways:
14. Exaggerated startle response
1. Directly experiencing the traumatic event(s)
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the event(s) occurred to a close family member or close friend. C. Duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after
Note: In cases of actual or threatened death of a family member or friend, the event(s) trauma exposure.
must have been violent or accidental. Note: Symptoms typically begin immediately after t h e trauma, b u t persistence for
4. Experiencing repeated or extreme exposure to aversive details of the traumatic at least 3 days and up to a month is needed to meet disorder criteria.
event(s) (e.g., first responders collecting human remains, police officers repeatedly
exposed to details of child abuse). D. The disturbance causes clinically significant distress or impairment in social,
Note: This does not apply to exposure through electronic media, television, movies, or occupational, or other important areas of functioning.
pictures, unless this exposure is work related.
E. The disturbance is not attributable to the physiological effects of a substance
B. Presence of nine (or more) of the following symptoms from any of the five (e.g., medication or alcohol) or another medical condition (e.g., mild traumatic brain
categories of intrusion, negative mood, dissociation, avoidance, and arousal, injury) and is not better explained by brief psychotic disorder.
beginning or worsening after the traumatic event(s) occurred:
OBSESSIVE-COMPULSIVE RELATED DISORDERS

OBSESSIVE-COMPULSIVE DISORDER OBSESSIVE-COMPULSIVE DISORDER – DIAGNOSTIC CRITERIA
 OCD is characterized by the presence of obsessions and/or compulsions. 2. The behaviors or mental acts are aimed at preventing or reducing anxiety or
distress, or preventing some dreaded event or situation; however, these behaviors
 Obsessions – recurrent and persistent thoughts, urges, or images that are or mental acts are not connected in a realistic way with what they are designed to
experienced as intrusive and unwanted. neutralize or prevent, or are clearly excessive.
 Compulsions – repetitive behaviors or mental acts that an individual feels driven Note: Young children may not be able to articulate the aims of these behaviors or mental acts.
to perform in response to an obsession or according to rules that must be applied
rigidly. Compulsions are used to suppress the obsessions and provide relief. They B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour
are believed to reduce stress or prevent a dreaded event. Moreover, compulsions per day) or cause clinically significant distress or impairment in social, occupational,
can either be behavioral (e.g., washing hands) or mental (e.g. mentally reciting or other important areas of functioning.
words in a specific order, counting, etc.)
C. The obsessive-compulsive symptoms are not attributable to the physiological
 In OCD, the dangerous event is a thought, image, or impulse that the client effects of a substance (e.g., a drug of abuse, a medication) or another medical
attempts to avoid. condition.
 FOUR MAJOR TYPES OF OBSESSIONS
Thought-Action Fusion D. The disturbance is not better explained by the symptoms of another mental
When clients with OCD equate disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation
thoughts with the specific with appearance, as in body dysmorphic disorder; difficulty discarding or parting
actions or activity represented with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-
by the thoughts. May be pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies,
caused by attitudes of as in stereotypic movement disorder; ritualized eating behavior, as in eating
excessive responsibility and disorders; preoccupation with substances or gambling, as in substance-related and
addictive disorders; preoccupation with having an illness, as in illness anxiety
resulting guilt developed
disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in
during childhood, when even a
disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major
bad thought is associated with depressive disorder; thought insertion or delusional preoccupations, as in
evil intent. schizophrenia spectrum and other psychotic disorders; or repetitive patterns of
behavior, as in autism spectrum disorder).
Specify if:
With good or fair insight: The individual recognizes that obsessive-compulsive
disorder
beliefs are definitely or probably not true or that they may or may not be true.
With poor insight: The individual thinks obsessive-compulsive disorder beliefs are
OBSESSIVE-COMPULSIVE DISORDER – DIAGNOSTIC CRITERIA probably true.
With absent insight/delusional beliefs: The individual is completely convinced
A. Presence of obsessions, compulsions, or both:
that obsessive-compulsive disorder beliefs are true.
Obsessions are defined by (1) and (2):
1. Recurrent and persistent thoughts, urges, or images that are experienced, at
sometime during the disturbance, as intrusive and unwanted, and that in most Specify if:
individuals cause marked anxiety or distress. Tic-related: The individual has a current or past history of a tic disorder.
2. The individual attempts to ignore or suppress such thoughts, urges, or images, or
to neutralize them with some other thought or action (i.e., by performing a
compulsion).
TREATMENTS
 Clomipramine or the SSRIs.
Compulsions are defined by (1) and (2):  Exposure and ritual prevention (ERP) - a process whereby the rituals are
1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., actively prevented and the patient is systematically and gradually exposed to the
praying, counting, repeating words silently) that the individual feels driven to perform feared thoughts or situations.
in response to an obsession or according to rules that must be applied rigidly.
 Psychosurgery is one of the more radical treatments for OCD. “Psychosurgery”
is a misnomer that refers to neurosurgery for a psychological disorder.
 People with BDD also have “ideas of reference,” which means they think
everything that goes on in their world somehow is related to them—in this case, to
their imagined defect.
BODY DYSMORPHIC DISORDER – DIAGNOSTIC CRITERIA

A. Preoccupation with one or more perceived defects or flaws in physical
appearance that are not observable or appear slight to others.
B. At some point during the course of the disorder, the individual has performed
repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking,
reassurance seeking) or mental acts (e.g., comparing his or her appearance
with that of others) in response to the appearance concerns.
C. The preoccupation causes clinically significant distress or impairment in social,

D. The appearance preoccupation is not better explained by concerns with boy fat
or weight in an individual whose symptoms meet diagnostic criteria for an eating
disorder.
Specify if:
With muscle dysmorphia: The individual is preoccupied with the idea that his or her
body build is too small or insufficiently muscular. This specifier is used even if the
individual is preoccupied with other body areas, which is often the case.
BODY DYSMORPHIC DISORDER
 Referred to as “Imagined ugliness”, and formerly known as dysmorphophobia Specify if:
 Characterized by cognitive symptoms such as perceived defects or flaws in Indicate degree of insight regarding body dysmorphic disorder beliefs (e.g., "I look
ugly" or "I look deformed").
physical appearance.
 Body dysmorphic disorder is associated with high levels of anxiety, social anxiety, With good or fair insight: The individual recognizes that the body dysmorphic
social avoidance, depressed mood, neuroticism, and perfectionism as well as low disorder beliefs are definitely or probably not true or that they may or may not be
extroversion and low self-esteem. true.
 People with BDD complain of persistent, intrusive, and horrible thoughts about With poor insight: The individual thinks that the body dysmorphic disorder beliefs
their appearance, and they engage in such compulsive behaviors as repeatedly are probably true.
looking in mirrors to check their physical features. BDD and OCD also have With absent insight/ delusional beliefs: The individual is completely convinced
approximately the same age of onset and run the same course. that the body dysmorphic disorder beliefs are true.
o Men tend to focus on body build, genitals, and thinning hair and tend to
have more severe BDD. A focus on muscle defects and body building is
nearly unique to men with the disorder. TREATMENT
o Women focus on more varied body areas and are more likely to also have  Exposure and response prevention, the type of cognitive-behavioral therapy
an eating disorder. effective with OCD, has also been successful with BDD.
 Muscle dysmorphia, a form of body dysmorphic disorder occurring almost  Clomipramine (Anafranil) and fluvoxamine (Luvox) – drugs that block the re-
exclusively in males, consists of preoccupation with the idea that one's body is too uptake of serotonin
small or insufficiently lean or muscular.
 Patients with BDD believe they are physically deformed in some way and go to
medical doctors to attempt to correct their deficits.
HOARDING DISORDER HOARDING DISORDER – DIAGNOSTIC CRITERIA
 Three major characteristics:
o Excessive acquisition of things Specify if:
o Difficulty discarding anything With excessive acquisition: If difficulty discarding possessions is accompanied by
o Living with excessive clutter under conditions best characterized as gross excessive acquisition of items that are not needed or for which there is no available
space.
disorganization
 Characterized by persistent difficulty discarding or parting with possessions, regardless Specify if:
of their actual value, as a result of a strong perceived need to save the items and to With good or fair insight: The individual recognizes that hoarding-related beliefs and
distress associated with discarding them. behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are
 These individuals usually begin acquiring things during their teenage years and often problematic.
experience great pleasure, even euphoria, from shopping or otherwise collecting
various items. With poor insight: The individual is mostly convinced that hoarding-related beliefs and
behaviors (pertaining to difficulty discarding items, cl utter, or excessive acquisition) are
 “Retail Therapy” – shopping or collecting things may be a response to feeling down not problematic despite evidence to the contrary.
or depressed.
 These individuals experience strong anxiety and distress about throwing anything With absent insight/delusional beliefs: The individual is completely convinced that
away, because everything has either some potential use or sentimental value in their hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter,
minds, or simply becomes an extension of their own identity. or excessive acquisition) are not problematic despite evidence to the contrary.
 Studies suggests it suggests it has similarities and differences with both OCD and
impulse control disorders. TRICHOTOLOMANIA (HAIRPULLING)
 OCD tends to wax and wane, whereas hoarding behavior can begin early in life and  The urge to pull out one’s own hair from anywhere on the body, including the scalp,
get worse with each passing decade. eyebrows, and arms. Hair pulling may occur from any region of the body in which hair
grows; the most common sites are the scalp, eyebrows, and eyelids, while less
HOARDING DISORDER – DIAGNOSTIC CRITERIA common sites are axillary, facial, pubic, and peri-rectal regions.
A. Persistent difficulty discarding or parting with possessions, regardless of their  This behavior results in noticeable hair loss, distress, and significant social
actual value. impairments.
 Hair pulling may also be preceded or accompanied by various emotional states; it may
B. This difficulty is due to a perceived need to save the items and to distress be triggered by feelings of anxiety or boredom, may be preceded by an increasing
associated with discarding them.
sense of tension (either immediately before pulling out the hair or when attempting to
resist the urge to pull), or may lead to gratification, pleasure, or a sense of relief when
C. The difficulty discarding possessions results in the accumulation of
possessions that congest and clutter active living areas and substantially the hair is pulled out.
compromises their intended use. If living areas are uncluttered, it is only  The majority of individuals with trichotillomania also have one or more other body-
because of the interventions of third parties (e.g., family members, cleaners, focused repetitive behaviors, including skin picking, nail biting, and lip chewing.
authorities).
TRICHOTOLOMANIA – DIAGNOSTIC CRITERIA
D. The hoarding causes clinically significant distress or impairment in social, A. Recurrent pulling out of one's hair, resulting in hair loss.
occupational, or other important areas of functioning (including maintaining a
safe environment for self and others). B. Repeated attempts to decrease or stop hair pulling.
C. The hair pulling causes clinically significant distress or impairment in social,
E. The hoarding is not attributable to another medical condition (e.g., brain injury,
occupational, or other important areas of functioning
cerebrovascular disease, Prader-Willi syndrome).
D. The hair pulling or hair loss is not attributable to another medical condition (e.g.,
F. The hoarding is not better explained by the symptoms of another mental disorder a dermatological condition)
(e.g., obsessions in obsessive-compulsive disorder, decreased energy in major
depressive disorder, delusions in schizophrenia or another psychotic disorder, E. The hair pulling is not better explained by the symptoms of another mental
cognitive deficits in major neurocognitive disorder, restricted interests in autism disorder (e.g., attempts to improve a perceived defect or flaw in appearance in
spectrum disorder). body dysmorphic disorder).
EXCORIATION (SKIN PICKING) DISORDER
 Characterized by repetitive and compulsive picking of the skin, leading to tissue SOMATIC SYMPTOM AND RELATED DISORDERS
damage  Somatic symptom disorders have in common is that there is an excessive or
 The most commonly picked sites are the face, arms, and hands, but many individuals maladaptive response to physical symptoms or to associated health concerns.
pick from multiple body sites. Individuals may pick at healthy skin, at minor skin  These disorders are sometimes grouped under the shorthand label of “medically
irregularities, at lesions such as pimples or calluses, or at scabs from previous picking. unexplained physical symptoms”.
 Most individuals pick with their fingernails, although many use tweezers, pins, or other  Soma means body, and the problems preoccupying these people seem, initially, to be
objects. physical disorders.
 In addition to skin picking, there may be skin rubbing, squeezing, lancing, and biting.  Individuals are pathologically concerned with the functioning of their bodies.
 Skin picking causes clinically significant distress or impairment in social, occupational,  Individuals with disorders with prominent somatic symptoms are commonly
or other important areas of functioning. The term distress includes negative effects that encountered in primary care and other medical settings but are less commonly
may be experienced by individuals with skin picking, such as feeling a loss of control, encountered in psychiatric and other mental health settings
embarrassment, and shame.
SOMATIC SYMPTOM DISORDER
EXCORIATION – DIAGNOSTIC CRITERIA  Formerly known as “Briquet’s Syndrome”
A. Recurrent skin picking resulting in skin lesions  The symptoms sometimes represent normal bodily sensations or discomfort that does
not generally signify serious disease. Somatic symptoms without an evident medical
B. Repeated attempts to decrease or stop skin picking.
explanation are not sufficient to make this diagnosis.
C. The skin picking causes clinically significant distress or impairment in social,  The individual's suffering is authentic, whether or not it is medically explained.
occupational, or other important areas of functioning.  The prevalence of somatic symptom disorder in the general adult population may be
around 5%-7%.
D. The skin picking is not attributable to the physiological effects of a substance (e.g.,
cocaine) or another medical condition (e.g., scabies)
SOMATIC SYMPTOM DISORDER – DIAGNOSTIC CRITERIA
E. The skin picking is not better explained by symptoms of another mental disorder
(e.g., delusions or tactile hallucinations in a psychotic disorder, attempts to A. One or more somatic symptoms that are distressing or result in significant
improve a perceived defect or flaw in appearance in body dysmorphic disorder, disruption of daily life
stereotypies in stereotypic movement disorder, or intention to harm oneself in B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or
non-suicidal self-injury). associated health concerns as manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of one's
TREATMENT: symptoms.
2. Persistently high level of anxiety about health or symptoms.
 Psychological treatments, particularly an approach called “habit reversal training,” 3. Excessive time and energy devoted to these symptoms or health concerns.
has the most evidence for success with these two disorders.
o In this treatment, patients are carefully taught to be more aware of their C. Although any one somatic symptom may not be continuously present, the state
of being symptomatic is persistent (typically more than 6 months)
repetitive behavior, particularly as it is just about to begin, and to then
substitute a different behavior, such as chewing gum, applying a soothing
Specify if:
lotion to the skin, or some other reasonably pleasurable but harmless behavior With predominant pain (previously pain disorder): This specifier is for individuals
whose somatic symptoms predominantly involve pain
Specify if:
Persistent: A persistent cou rse is characterized by severe symptoms, marked
impairment, and long duration (more than 6 months)
Mild: Only one of the symptoms specified in Criterion B is fulfilled.
Moderate: Two or more of the symptoms specified in Criterion B are fulfilled.
Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there
are multiple somatic complaints (or one very severe somatic symptom)
ILLNESS ANXIETY DISORDER CAUSE:
 Formerly, and widely known as “Hypochondriasis”  Although it is not certain, the cause is unlikely to be found in isolated biological
 Characterized by anxiety or fear that one has a serious disease. Therefore, the or psychological factors.
essential problem is anxiety, but its expression is different from that of the other anxiety  For some patients, the fundamental causes of these disorders are similar to
disorders those implicated in the anxiety disorders.
 Physical symptoms are either not experienced at the present time or are very mild, but  Some individuals who develop somatic symptom disorder or illness anxiety
severe anxiety is focused on the possibility of having or developing a serious disease. disorder have learned from family members to focus their anxiety on specific
 If one or more physical symptoms are relatively severe and are associated with anxiety physical conditions and illness.
and distress, the diagnosis would be somatic symptom disorder.  Three other factors that may contribute to the etiology of IAD:
 The concern is primarily with the idea of being sick instead of the physical symptom 1. These disorders seem to develop in the context of a stressful life event,
itself. The individual is preoccupied with bodily symptoms, misinterpreting them as as do many disorders, including anxiety disorders
indicative of illness or disease. 2. People who develop these disorders tend to have had a disproportionate
 Another important feature of this disorder is that reassurances from numerous doctors incidence of disease in their family when they were children.
that all is well and the individual is healthy have, at best, only a short-term effect. 3. An important social and interpersonal influence may be involved
 Diseases conviction: Individuals have a difficult-to-shake belief that they have a
disease.
 The 1- to 2-year prevalence of health anxiety and / or disease conviction in community
surveys and population-based samples ranges from 1 .3% to 10%.
ILLNESS ANXIETY DISORDER – DIAGNOSTIC CRITERIA

A. Preoccupation with having or acquiring a serious illness.
B. Somatic symptoms are not present or, if present, are only mild in intensity. If
another medical condition is present or there is a high risk for developing a
medical condition (e.g., strong family history is present), the preoccupation is
clearly excessive or disproportionate.
C. There is a high level of anxiety about health, and the individual is easily alarmed
about personal health status.
D. The individual performs excessive health-related behaviors (e.g., repeatedly TREATMENT:

checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g.,  Clinical reports indicate that reassurance and education can be effective in
avoids doctor appointments and hospitals) some cases with health anxiety
 “Explanatory Therapy” – in which the clinician went over the source and
E. Illness preoccupation has been present for at least 6 months, but the specific origins of their symptoms in some detail.
illness that is feared may change over that period of time.  Taking the time to explain in some detail the nature of the patient’s disorder in
an educational framework was associated with a significant reduction in fears
F. The illness-related preoccupation is not better explained by another mental
and beliefs about somatic symptoms and a decrease in health-care usage,
disorder, such as somatic symptom disorder, panic disorder, generalized anxiety
disorder, body dysmorphic disorder, obsessive-compulsive disorder, or delusional and these gains were maintained at the follow-up (although explanatory
disorder, somatic type. therapy most likely only benefits those with more mild forms of the disorders).
Specify whether:
Care-seeking type: Medical care, including physician visits or undergoing tests and
procedures, is frequently used.
Care-avoidant type: Medical care is rarely used.

PSYCHOLOGICAL FACTORS AFFECTING OTHER MEDICAL CONDITION  Some people have seizures, which may be psychological in origin, because no
 The presence of a diagnosed medical condition such as asthma, diabetes, or significant electroencephalogram (EEG) changes can be documented. These
severe pain clearly caused by a known medical condition such as cancer that is “seizures” are usually called psychogenic non-epileptic seizures.
adversely affected (increased in frequency or severity) by one or more
psychological or behavioral factors. CONVERSION DISORDER – DIAGNOSTIC CRITERIA
 These behavioral or psychological factors would have a direct influence on the A. One or more symptoms of altered voluntary motor or sensory function.
course or perhaps the treatment of the medical condition. B. Clinical findings provide evidence of incompatibility between the symptom and
recognized neurological or medical conditions.
PSYCHOLOGICAL FACTORS AFFECTING OTHER MEDICAL CONDITION
C. The symptom or deficit is not better explained by another medical or mental
disorder.
A. A medical symptom or condition (other than a mental disorder) is present.
B. Psychological or behavioral factors adversely affect the medical condition in one D. The symptom or deficit causes clinically significant distress or impairment in
of the following ways: social, occupational, or other important areas of functioning or warrants medical
1. The factors have influenced the course of the medical condition as shown by a close evaluation.
temporal association between the psychological factors and the development or
exacerbation of, or delayed recovery from, the medical condition. Coding note: The I CD-9-CM code for conversion disorder is 300.11, which is assigned
2. The factors interfere with the treatment of the medical condition (e.g., poor regardless of the symptom type. The ICD-1 0-CM code depends on the symptom type (see
adherence). below).
3. The factors constitute additional well-established health risks for the individual
Specify symptom type:
4. The factors influence the underlying pathophysiology, precipitating or exacerbating
(F44.4) With weakness or paralysis
symptoms or necessitating medical attention
(F44.4) With abnormal movement (e.g., tremor, dystonic movement, gait disorder)
C. The psychological and behavioral factors in Criterion B are not better explained (F44.4) With swallowing symptoms
by another (F44.4) With speech symptom (e.g., dysphonia, slurred speech)
mental disorder (e.g., panic disorder, major depressive disorder, posttraumatic stress (F44.5) With attacks or seizures
disorder) (F44.6) With anesthesia or sensory loss
(F44.6) With special sensory symptom (e.g., visual, olfactory, or hearing disturbance
Specify current severity: (F44.7) With mixed symptoms
Mild: Increases medical risk (e.g., inconsistent adherence with antihypertension
treatment) Specify if:
Acute episode: Symptoms present for less than 6 months.
Moderate: Aggravates underlying medical condition (e.g., anxiety aggravating
Persistent: Symptoms occurring for 6 months or more.
asthma).
Severe: Results in medical hospitalization or emergency room visit. Specify if:
Extreme: Results in severe, life-threatening risk (e.g., ignoring heart attack symptoms) With psychological stressor (specify stressor)
. Without psychological stressor
CONVERSION DISORDER FACTITIOUS DISORDER

 Popularized by Freud, who believed the anxiety resulting from unconscious  Fall somewhere between malingering (faking) and conversion disorders.
conflicts somehow was “converted” into physical symptoms to find expression.  The symptoms are under voluntary control, as with malingering, but there is
 Functional Neurological Symptom Disorder: is a subtitle to conversion disorder no obvious reason for voluntarily producing the symptoms except, possibly,
because the term is more often used by neurologists who see the majority of to assume the sick role and receive increased attention.
patients receiving a conversion disorder diagnosis, and because the term is more  Factitious Disorder Imposed on Another (Munchausen syndrome by
acceptable to patients (“functional” refers to a symptom without an organic cause). proxy): When an individual deliberately makes someone else sick.
 Generally, have to do with physical malfunctioning, such as paralysis, blindness,  Individuals’ with Munchausen syndrome typically lack awareness of the
or difficulty speaking (aphonia), without any physical or organic pathology to abuse.
account for the malfunction.  The essential feature of factitious disorder is the falsification of medical or
 Globus Hystericus: the sensation of a lump in the throat that makes it difficult to psychological signs and symptoms in oneself or others that are associated
swallow, eat, or sometimes talk with the identified deception.
 The diagnosis requires demonstrating that the individual is taking surreptitious 4. Fourth, the individual receives greatly increased attention and sympathy from
actions to misrepresent, simulate, or cause signs or symptoms of illness or loved ones and may also be allowed to avoid a difficult situation or task. Freud
injury in the absence of obvious external rewards. considered such attention or avoidance to be the secondary gain, the
secondarily reinforcing set of events.
FACTITIOUS DISORDER – DIAGNOSTIC CRITERIA
TREATMENT
Factitious Disorder Imposed on Self  Cognitive-Behavioral Programs:
A. Falsification of physical or psychological signs or symptoms, or induction of o A principal strategy in treating conversion disorder is to identify and attend
injury or disease, associated with identified deception. to the traumatic or stressful life event, if it is still present (either in real life
B. The individual presents himself or herself to others as ill, impaired, or injured. or in memory).
C. The deceptive behavior is evident even in the absence of obvious external o The therapist must also work hard to reduce any reinforcing or supportive
rewards. consequences of the conversion symptoms (secondary gain).
D. The behavior is not better explained by another mental disorder, such as
delusional disorder or another psychotic disorder.
Specify:
Single episode
Recurrent episodes (two or more events of falsification of illness and/or induction of
injury)
Factitious Disorder Imposed on Another (Previously Factitious Disorder by

Proxy)
A. Falsification of physical or psychological signs or symptoms, or induction of
injury or disease, in another, associated with identified deception.
B. The individual presents another individual (victim) to others as ill, impaired,
or injured.
C. The deceptive behavior is evident even in the absence of obvious external
rewards.
D. The behavior is not better explained by another mental disorder, such as
delusional disorder or another psychotic disorder.
Note: The perpetrator, not the victim, receives this diagnosis.
Specify:
Single episode
Recurrent episodes (two or more events of falsification of illness and/or induction of
injury)
CAUSES
 Freud described four basic processes in the development of conversion disorder.
1. First, the individual experiences a traumatic event— in Freud’s view, an
unacceptable, unconscious conflict.
2. Second, because the conflict and the resulting anxiety are unacceptable, the
person represses the conflict, making it unconscious.
3. Third, the anxiety continues to increase and threatens to emerge into
consciousness, and the person “converts” it into physical symptoms, thereby
relieving the pressure of having to deal directly with the conflict. This reduction
of anxiety is considered to be the primary gain or reinforcing event that
maintains the conversion symptom.
DISSOCIATIVE DISORDERS  In Derealization, surroundings may be experienced as artificial, colorless, or

lifeless. Commonly accompanied by subjective visual distortions, such as
 Characterized by a disruption of and/or discontinuity in the normal integration of blurriness, heightened acuity, widened or narrowed visual field, two-dimensionality
consciousness, memory, identity, emotion, perception, body representation, motor or flatness, exaggerated three-dimensionality, or altered distance or size of objects
control, and behavior. (i.e., macropsia or micropsia). Auditory distortions can also occur, whereby voices
 There are alterations in our relationship to the self, to the world, or to memory or sounds are muted or heightened.
processes.  Onset can range from extremely sudden to gradual. Duration of
 Two types of experiences: depersonalization/derealization disorder episodes can vary greatly, from brief
o Depersonalization: Your perception alters so that you temporarily lose the (hours or days) to prolonged (weeks, months, or years). The course of the disorder
sense of your own reality, as if you were in a dream and you were watching is often persistent.
yourself.
▪ Often part of a serious set of conditions in which reality, experience,
DEPERSONALIZATION-DEREALIZATION DISORDER
and even identity seem to disintegrate.
o Derealization: Your sense of the reality of the external world is lost. Things
A. The presence of persistent or recurrent experiences of depersonalization,
may seem to change shape or size; people may seem dead or mechanical.
derealization, or both:
 Dissociative symptoms are experienced as: 1) Depersonalization: Experiences of unreality, detachment, or being an
1) Unbidden intrusions into awareness and behavior with accompanying outside observer with respect to one's thoughts, feelings, sensations, body,
losses of continuity in subjective experience (i.e., "positive" dissociative or actions (e.g., perceptual alterations, distorted sense of time, unreal or
symptoms such as fragmentation of identity, depersonalization, and absent self, emotional and/ or physical numbing)
derealization) 2) Derealization: Experiences of unreality or detachment with respect to
2) Inability to access information or to control mental functions that normally surroundings (e.g., individuals or objects are experienced as unreal,
are readily amenable to access or control (i.e., "negative" dissociative dreamlike, foggy, lifeless, or visually distorted)
symptoms such as amnesia).
B. During the depersonalization or derealization experiences, reality testing remains
intact.
DEPERSONALIZATION-DEREALIZATION DISORDER
C. The symptoms cause clinically significant distress or impairment in social,
 When feelings of unreality are so severe and frightening that they dominate an
individual’s life and prevent normal functioning
 Feelings of depersonalization and derealization are part of several disorders, but D. The disturbance is not attributable to the physiological effects of a substance (e.g.,
when severe depersonalization and derealization are the primary problem, the a drug of abuse, medication) or another medical condition (e.g., seizures).
individual meets criteria for depersonalization- derealization disorder.
E. The disturbance is not better explained by another mental disorder, such as
 Characterized by clinically significant persistent or recurrent depersonalization
schizophrenia, panic disorder, major depressive disorder, acute stress disorder,
(i.e., experiences of unreality or detachment from one's mind, self, or body) and/
posttraumatic stress disorder, or another dissociative disorder.
or derealization (i.e., experiences of unreality or detachment from one's
surroundings).
 There is no evidence of any distinction between individuals with predominantly DISSOCIATIVE AMNESIA
depersonalization versus derealization symptoms. Therefore, individuals with this  Types:
disorder can have depersonalization, derealization, or both. o Generalized Amnesia: People who are unable to remember anything,
 Participants with depersonalization disorder showed a distinct cognitive profile, including who they are. This may be lifelong or may extend from a period
reflecting some specific cognitive deficits on measures of attention, processing of in the more recent past, such as 6 months or a year previously.
information, short-term memory, and spatial reasoning. These patients were easily o Localized Amnesia: a failure to recall events during a circumscribed
distracted and were slow to perceive and process new information. period of time.
o They seem to correspond with reports of “tunnel vision” (perceptual o Selective Amnesia: The individual can recall some, but not all, of the
distortions) and “mind emptiness” (difficulty absorbing new information) events during a circumscribed period of time.
that characterize these patients.  In most cases of dissociative amnesia, the forgetting is selective for traumatic
events or memories rather than generalized.
 Dissociation Fugue: fugue literally meaning “flight” (fugitive is from the same
root); a subtype of DA where memory loss revolves around a specific incident— DISSOCIATIVE IDENTITY DISORDER
an unexpected trip (or trips). Mostly, individuals just take off and later find
themselves in a new place, unable to remember why or how they got there.  In DID, identity has fragmented, and the defining feature of this disorder is that
Usually, they have left behind an intolerable situation. During these trips, a certain aspects of the person’s identity are dissociated.
person sometimes assumes a new identity or at least becomes confused about  People with DID may adopt as many as 100 new identities, all simultaneously
the old identity. coexisting, although the average number is closer to 15.
o Fugue states usually end rather abruptly, and the individual returns  In some cases, the identities are complete, each with its own behavior, tone of
home, recalling most, if not all, of what happened. In this disorder, the voice, and physical gestures. But in many cases, only a few characteristics are
disintegrated experience is more than memory loss, involving at least distinct, because the identities are only partially independent.
some disintegration of identity, if not the complete adoption of a new one.  People with DID experience:
 Dissociative amnesia seldom appears before adolescence and usually occurs in a) Recurrent, inexplicable intrusions into their conscious functioning and
adulthood. It is rare for dissociative amnesia to appear for the first time after an sense of self (e.g., voices; dissociated actions and speech; intrusive
individual reaches the age of 50. Once dissociative disorders do appear, thoughts, emotions, and impulses)
however, they may continue well into old age. b) Alterations of sense of self (e.g., attitudes, preferences, and feeling
 Estimates of prevalence range anywhere from 1.8% to 7.3%, suggesting that like one’s body or actions are not one's own)
dissociative amnesia is the most prevalent of all the dissociative disorders. c) Odd changes of perception (e.g., depersonalization or derealization,
such as feeling detached from one's body while cutting)
DISSOCIATIVE AMNESIA – DIAGNOSTIC CRITERIA d) Intermittent functional neurological symptoms.
A. An inability to recall important autobiographical information, usually of a traumatic DISSOCIATIVE IDENTITY DISORDER – DIAGNOSTIC CRITERIA
or stressful nature, that is inconsistent with ordinary forgetting.
A. Disruption of identity characterized by two or more distinct personality states,
Note: Dissociative amnesia most often consists of localized or selective amnesia for which may be described in some cultures as an experience of possession. The
a specific event or events; or generalized amnesia for identity and life history. disruption in identity involves marked discontinuity in sense of self and sense of
agency, accompanied by related alterations in affect, behavior, consciousness,
B. The symptoms cause clinically significant distress or impairment in social, memory, perception, cognition, and/or sensory-motor functioning. These signs
occupational, or other important areas of functioning. and symptoms may be observed by others or reported by the individual.
C. The disturbance is not attributable to the physiological effects of a substance (e.g., B. Recurrent gaps in the recall of everyday events, important personal information,
alcohol or other d rug of abuse, a medication) or a neurological or other medical and/ or traumatic events that are inconsistent with ordinary forgetting.
condition (e.g., partial complex seizures, transient global amnesia, sequelae of a
closed head injury/ traumatic brain injury, other neurological condition). C. The symptoms cause clinically significant distress or impairment in social,
D. The disturbance is not better explained by dissociative identity disorder,
posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, D. The disturbance is not a normal part of a broadly accepted cultural or religious
or major or mild neurocognitive disorder. practice.
Note: In children, the symptoms are not better explained by imaginary playmates or
Specify if: other fantasy play.
With dissociative fugue: Apparently purposeful travel or bewildered wandering that
is associated with amnesia for identity or for other important autobiographical E. The symptoms are not attributable to the physiological effects of a substance
information. (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical
condition (e.g., complex partial seizures)
 Alters is the shorthand term for the different identities or personalities in DID. TREATMENT:
o The person who becomes the patient and asks for treatment is
usually a “host” identity.  Individuals who experience dissociative amnesia or a fugue state usually get
 Host personalities usually attempt to hold various fragments of identity together better on their own and remember what they have forgotten.
but end up being overwhelmed.  The episodes are so clearly related to current life stress that prevention of
 The first personality to seek treatment is seldom the original personality of the future episodes usually involves therapeutic resolution of the distressing
person. Usually, the host personality develops later. situations and increasing the strength of personal coping mechanisms.
 Switch: The transition from one personality to another  When necessary, therapy focuses on recalling what happened during the
o Physical transformations may occur during switches. Posture, facial amnesic or fugue states.
expressions, patterns of facial wrinkling, and even physical  There are some documented successes of attempts to reintegrate identities
disabilities may emerge through long-term psychotherapy.
 When alternate personality states are not directly observed, the disorder can be  The fundamental goal is to identify cues or triggers that provoke memories of
identified by two clusters of symptoms: trauma, dissociation, or both, and to neutralize them.
1) Sudden alterations or discontinuities in sense of self and sense of  Hypnosis is often used to access unconscious memories and bring various
agency (Criterion A) alters into awareness. Because the process of dissociation may be similar to
2) Recurrent dissociative amnesias (Criterion B) the process of hypnosis, the latter may be a particularly efficient way to access
 Individuals with dissociative identity disorder may report the feeling that they have traumatic memories.
suddenly become depersonalized observers of their "own" speech and actions,  Treatment of dissociative disorders involves helping the patient reexperience
which they may feel powerless to stop (sense of self). Such individuals may also the traumatic events in a controlled therapeutic manner to develop better
report perceptions of voices (e.g., a child's voice; crying; the voice of a spiritual coping skills. Particularly essential with this disorder is a sense of trust
being). between therapist and patient.
 Individuals with the disorder typically report multiple types of interpersonal  Occasionally, medication is combined with therapy, but there is little
maltreatment during childhood and adulthood. indication that it helps much. What little clinical evidence there is indicates that
 The onset is almost always in childhood, often as young as 4 years of age, antidepressant drugs might be appropriate in some cases.
although it is usually approximately 7 years after the appearance of symptoms
before the disorder is identified.
 CAUSE: DID is rooted in a natural tendency to escape or “dissociate” from the
unremitting negative affect associated with severe abuse.
 SUGGESTIBILITY: is a personality trait. Some people are more suggestible than
others; some are relatively immune to suggestibility and the majority fall in the
midrange.
o A hypnotic trance is also similar to dissociation. People in a trance tend
to be focused on one aspect of their world, and they become vulnerable
to suggestions by the hypnotist.
o There is also the phenomenon of self-hypnosis, in which individuals can
dissociate from most of the world around them and “suggest” to
themselves that, for example, they won’t feel pain in one of their hands.
o According to the autohypnotic model, people who are suggestible may be
able to use dissociation as a defense against extreme trauma.
o According to this view, when the trauma becomes unbearable, the
person’s very identity splits into multiple dissociated identities.
o People who are less suggestible may develop a severe posttraumatic
stress reaction but not a dissociative reaction.
MOOD DISORDERS AND SUICIDE

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ABNORMAL PSYCHOLOGY REVIEWER

1. Core of most clinical work

EXPECTED (Cued): Have a sensible

UNEXPECTED (Uncued): Have no

SPECIFIC PHOBIA – DIAGNOSTIC CRITERIA SOCIAL ANXIETY DISORDER – DIAGNOSTIC CRITERIA

SOCIAL ANXIETY DISORDER – DIAGNOSTIC CRITERIA

PANIC DISORDER – DIAGNOSTIC CRITERIA

A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense

Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache,

AGORAPHOBIA – DIAGNOSTIC CRITERIA GENERALIZED ANXIETY DISORDER (GAD)

NOTE: Only one item is required in children.

1. Restlessness or feeling keyed up or on edge. SUBSTANCE / MEDICATION-INDUCED ANXIETY DISORDER

Significant stress makes them apprehensive

POST-TRAUMATIC STRESS DISORDER TREATMENT:

F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.

G. The disturbance causes clinically significant distress or impairment in social,

H. The disturbance is not attributable to the physiological effects of a substance (e.g.

A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult

OBSESSIVE-COMPULSIVE RELATED DISORDERS

BODY DYSMORPHIC DISORDER – DIAGNOSTIC CRITERIA

C. The preoccupation causes clinically significant distress or impairment in social,

ILLNESS ANXIETY DISORDER – DIAGNOSTIC CRITERIA

D. The individual performs excessive health-related behaviors (e.g., repeatedly TREATMENT:

Care-avoidant type: Medical care is rarely used.

CONVERSION DISORDER FACTITIOUS DISORDER

Factitious Disorder Imposed on Another (Previously Factitious Disorder by

DISSOCIATIVE DISORDERS  In Derealization, surroundings may be experienced as artificial, colorless, or

MOOD DISORDERS AND SUICIDE

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