Psychological Disorders

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Psychological Disorders

• Chapter 16

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DSM-IV-TR

• DSM Diagnostic and Statistical Manual of Mental
  Disorders (4th Edition, Text Revision)
• Book that contains
• Characteristics that define each disorder
• Additional features that are usually present
• How to distinguish this disorder from others
• List of symptoms that must be present (diagnostic
  criteria)
• NOS Not Otherwise Specified

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DSM-IV-TR

• Axis I - clinical disorders, including major
  mental disorders, (typically what we think the
  diagnosis is)
• Axis II long standing personality disorders,
  maladaptive traits, and mental retardation
• Axis III physical disorders, general medical
  conditions (that will impact Axis I, II)
• Axis IV current stress level, environmental
  factors
• Axis V Global Assessment of Functioning

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SIGNS VS. SYMPTOMS

• Signs any features, feelings, noticed by
  someone that is NOT the client (What the
  psychologist would notice)
• Symptoms any features, feelings, noticed and
  reported by the patient client (What the client
  usually comes in about)
• Malingering pretending to have symptoms that
  you do not actually have

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Disorders Diagnosed in Infancy, Childhood, or
Adolescence

• Onset must be before age 18
• Cannot function in daily life as a normal
  person of that age
• impairments in social interaction, impairments in
  communication, restricted interests and
  repetitive behavior

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Disorders Diagnosed in Infancy, Childhood, or
Adolescence

• Mental Retardation (Axis II) Diagnostic
  Criteria
• IQ is below 70
• Two or more are below what is expected for the
  persons age 1) Communication, 2) Caring for
  self, 3) Safety, 4) Working, 5) Relating to
  Others, 6) Living at home, 7) Health, 8) Using
  Free Time, 9) Academic Functioning, 10) Directing
  Self, 11) Using Community Resources
• Begins before age 18

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Disorders Diagnosed in Infancy, Childhood, or
Adolescence

• Mental Retardation IQ is below 70

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• IQ RANGE CLASSIFICATION
• 144 up Genius
• 130-144 Gifted
• 115-129 Above Average
• 100-114 Higher Average
• 85-99 Lower Average
• 70-84 Below Average
• 50/55-70 Mild Mental Retardation
• 35/40-50/55 Moderate M.R.
• 20/25-35/40 Severe M.R.
• Below 20/25 Profound M.R.

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Disorders Diagnosed in Infancy, Childhood, or
Adolescence

• Autism - impairments in social interaction,
  impairments in communication, restricted
  interests and repetitive behavior
• Behavior is noticed before age of 2 or 3

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Disorders Diagnosed in Infancy, Childhood, or
Adolescence

• Autism Diagnostic Criteria
• Two or more of the following 1) Deficient
  social interaction via nonverbal behaviors, i.e.,
  eye contact, facial expression, body posture, and
  gestures 2) Inappropriate peer relationships 3)
  Absence of sharing achievements, interests or
  pleasure 4) Absence of social or emotional
  reciprocity

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Disorders Diagnosed in Infancy, Childhood, or
Adolescence

• One or more of the following 1) Delayed or
  absent development of spoken language without
  compensation through gestures 2) Unable to begin
  or sustain conversation (of those who can speak)
  3) Repetitive, stereotyped or idiosyncratic
  language 4) social imitative play or
  spontaneous, make-believe play is absent.

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Disorders Diagnosed in Infancy, Childhood, or
Adolescence

• One or more of the following 1) Intense
  preoccupation with stereotyped and restricted
  interests, i.e., spinning things 2) Routines or
  rituals with no apparent function 3) Repetitive
  or stereotyped mannerisms, i.e., hand flapping
  4) Absorbed with parts of objects
• Lack one or more before the age of three 1)
  Social interaction 2) Language used in social
  communication 3) Play that is imaginative and
  symbolic

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APPLIED BEHAVIOR ANALYSIS

• http//www.youtube.com/watch?vim04U9Be4mA
• http//www.youtube.com/watch?vwTTvTweONQQfeature
  related

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DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR
ADOLESCENCE

• Aspergers Disorder high functioning Autism
  IQ is more normal, behavior is more normal, but
  social interactions are still not quite there

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DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR
ADOLESCENCE

• (A )Qualitative impairment in social interaction,
  as manifested by at least two of the following
• marked impairment in the use of multiple
  nonverbal behaviors such as eye-to-eye gaze,
  facial expression, body postures, and gestures to
  regulate social interaction
• failure to develop peer relationships appropriate
  to developmental level
• a lack of spontaneous seeking to share enjoyment,
  interests, or achievements with other people
  (e.g., by a lack of showing, bringing, or
  pointing out objects of interest to other people)
• lack of social or emotional reciprocity.

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DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR
ADOLESCENCE

• (B)Restricted repetitive and stereotyped patterns
  of behavior, interests, and activities, as
  manifested by at least one of the following
• encompassing preoccupation with one or more
  stereotyped and restricted patterns of interest
  that is abnormal either in intensity or focus
• apparently inflexible adherence to specific,
  non-functional routines or rituals
• stereotyped and repetitive motor mannerisms
  (e.g., hand or finger flapping or twisting, or
  complex whole-body movements)
• persistent preoccupation with parts of objects

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DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR
ADOLESCENCE

• Oppositional Defiant Disorder - ongoing pattern
  of disobedient, hostile and defiant behavior
  toward authority figures which goes beyond the
  bounds of normal childhood behavior

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DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR
ADOLESCENCE

• A. A pattern of negativistic, hostile, and
  defiant behavior lasting at least 6 months,
  during which four (or more) of the following are
  present ?(1) often loses temper ?(2) often
  argues with adults ?(3) often actively defies or
  refuses to comply with adults' requests or
  rules ?(4) often deliberately annoys people ?(5)
  often blames others for his or her mistakes or
  misbehavior ?(6) is often touchy or easily
  annoyed by others ?(7) is often angry and
  resentful ?(8) is often spiteful or vindictive 
• ?Note Consider a criterion met only if the
  behavior occurs more frequently than is typically
  observed in individuals of comparable age and
  developmental level. 

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DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR
ADOLESCENCE

• Conduct Disorder - repetitive behavior wherein
  the rights of others or social norms are violated
  takes place in childhood and/or adolescence
  goes beyond normal rebellion

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DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR
ADOLESCENCE

• Conduct Disorder Diagnostic Criteria
• A. A repetitive and persistent pattern of
  behavior in which the basic rights of others or
  major age-appropriate societal norms or rules are
  violated, as manifested by the presence of three
  (or more) of the following criteria in the past
  12 months, with at least one criterion present in
  the past 6 months Aggression to people and
  animals (1) often bullies, threatens, or
  intimidates others ?(2) often initiates physical
  fights ?(3) has used a weapon that can cause
  serious physical harm to others (e.g., abat,
  brick, broken bottle, knife, gun) ?(4) has been
  physically cruel to people ?(5) has been
  physically cruel to animals ?(6) has stolen while
  confronting a victim (e.g., mugging, purse
  snatching, extortion, armed robbery) ?(7) has
  forced someone into sexual activity 

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• Destruction of property (8) has deliberately
  engaged in fire setting with the intention of
  causing serious damage ?(9) has deliberately
  destroyed others' property (other than by fire
  setting)Deceitfulness or theft (10) has broken
  into someone else's house, building, or car ?(11)
  often lies to obtain goods or favors or to avoid
  obligations (i.e., "cons" others) ?(12) has
  stolen items of nontrivial value without
  confronting a victim (e.g., shoplifting, but
  without breaking and entering forgery) Serious
  violations of rules (13) often stays out at
  night despite parental prohibitions, beginning
  before age 13 years ?(14) has run away from home
  overnight at least twice while living in parental
  or parental surrogate home (or once without
  returning for a lengthy period) ?(15) is often
  truant from school, beginning before age 13 years 

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• B. The disturbance in behavior causes clinically
  significant impairment in social, academic, or
  occupational functioning. 
• C. If the individual is age 18 years or older,
  criteria are not met for Antisocial Personality
  Disorder. Specify type based on age at
  onset (Childhood or Adolescence)

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Substance Related Disorders

• Drug Addiction both psychological (you think
  you need it) and physiological addictions (your
  body needs it, and needs more)
• Tolerance the body gets used to a certain
  amount of drugs so it needs more and more and
  more and more (this is true even of something
  like Advil)
• Dependence
• Abuse
• Intoxication
• Withdrawal

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Schizophrenia Psychotic Disorders

• thought processes are not based on reality, and
  are expressed in different ways
• Symptoms
• Positive Delusions, hallucinations (things
  added)
• Negative - flat affect (things taken away)
• Symptoms not due to other medical conditions/drug
  use

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Schizophrenia Psychotic Disorders

• Subtypes
• Paranoid delusions, auditory hallucinations
  (hearing voices)
• Catatonic remain motionless in unusual
  positions (waxy flexibility)
• Disorganized inappropriate emotions, laughing
  for no reason
• Undifferentiated criteria for schizophrenia is
  met, but not paranoid, catatonic, or disorganized
• Residual still have a few symptoms of
  schizophrenia, but no more delusions/
  hallucinations

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Schizophrenia Psychotic Disorders

• Diagnostic Criteria
• A. Characteristic symptoms Two (or more) of the
  following, each present for a significant portion
  of time during a 1-month period (or less if
  successfully treated) 
• (1) delusions
• (2) hallucinations
• (3) disorganized speech (e.g., frequent
  derailment or incoherence) 
• (4) grossly disorganized or catatonic behavior
• (5) negative symptoms, i.e., affective
  flattening, alogia, or avolition 

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• Note Only one Criterion A symptom is required if
  delusions are bizarre or hallucinations consist
  of a voice keeping up a running commentary on the
  person's behavior or thoughts, or two or more
  voices conversing with each other. 
• B. Social/occupational dysfunction For a
  significant portion of the time since the onset
  of the disturbance, one or more major areas of
  functioning such as work, interpersonal
  relations, or self-care are markedly below the
  level achieved prior to the onset (or when the
  onset is in childhood or adolescence, failure to
  achieve expected level of interpersonal,
  academic, or occupational achievement). 

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• C. Duration Continuous signs of the disturbance
  persist for at least 6 months. This 6-month
  period must include at least 1 month of symptoms
  (or less if successfully treated) that meet
  Criterion A (i.e., active-phase symptoms) and may
  include periods of prodromal(start) or residual
  (end) symptoms. During these prodromal or
  residual periods, the signs of the disturbance
  may be manifested by only negative symptoms or
  two or more symptoms listed in Criterion A
  present in an attenuated form (e.g., odd beliefs,
  unusual perceptual experiences). 

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Catatonic Schizophrenia

• A type of Schizophrenia in which the clinical
  picture is dominated by at least two of the
  following 
• (1) motoric immobility as evidenced by catalepsy
  (including waxy flexibility) or stupor (2)
  excessive motor activity (that is apparently
  purposeless and not influenced by external
  stimuli) (3) extreme negativism (an apparently
  motiveless resistance to all instructions or
  maintenance of a rigid posture against attempts
  to be moved) or mutism (4) peculiarities of
  voluntary movement as evidenced by posturing
  (voluntary assumption of inappropriate or bizarre
  postures), stereotyped movements, prominent
  mannerisms, or prominent grimacing (5) echolalia
  or echopraxia

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Disorganized Schizophrenia

• A type of Schizophrenia in which the following
  criteria are met 
• A. All of the following are prominent 
• (1) disorganized speech (2) disorganized
  behavior (3) flat or inappropriate affect 
• B. The criteria are not met for Catatonic Type.

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Paranoid Schizophrenia

• A type of Schizophrenia in which the following
  criteria are met 
• A. Preoccupation with one or more delusions or
  frequent auditory hallucinations.
•  B. None of the following is prominent
  disorganized speech, disorganized or catatonic
  behavior, or flat or inappropriate affect.

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Residual Schizophrenia

• A type of Schizophrenia in which the following
  criteria are met 
• A. Absence of prominent delusions,
  hallucinations, disorganized speech, and grossly
  disorganized or catatonic behavior. 
• B. There is continuing evidence of the
  disturbance, as indicated by the presence of
  negative symptoms or two or more symptoms listed
  in Criterion A for Schizophrenia, present in an
  attenuated form (e.g., odd beliefs, unusual
  perceptual experiences).

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Undifferentiated Schizophrenia

• A type of Schizophrenia in which symptoms that
  meet Criterion A are present, but the criteria
  are not met for the Paranoid, Disorganized, or
  Catatonic Type.

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Schizophrenia Psychotic Disorders

• Schizoaffective Disorder
• A. An uninterrupted period of illness during
  which, at some time, there is either a Major
  Depressive Episode, a Manic Episode, or a Mixed
  Episode concurrent with symptoms that meet
  Criterion A for Schizophrenia. Note The Major
  Depressive Episode must include Criterion A1
  depressed mood. 
• B. During the same period of illness, there have
  been delusions or hallucinations for at least 2
  weeks in the absence of prominent mood symptoms. 
• C. Symptoms that meet criteria for a mood episode
  are present for a substantial portion of the
  total duration of the active and residual periods
  of the illness. 

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SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS

• Schizoaffective Disorder a combination of
  delusions/hallucinations (schizophrenia) with
  mood changes (bipolar)

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Mood Disorders

• Manic Episode lasts a week, with at least three
  of the following symptoms
• (1) inflated self-esteem or grandiosity(2)
  decreased need for sleep (e.g., feels rested
  after only 3 hours of sleep) (3) more talkative
  than usual or pressure to keep talking (4)
  flight of ideas or subjective experience that
  thoughts are racing(5) distractibility (i.e.,
  attention too easily drawn to unimportant or
  irrelevant external stimuli) (6) increase in
  goal-directed activity (either socially, at work
  or school, or sexually) or psychomotor
  agitation(7) excessive involvement in
  pleasurable activities that have a high potential
  for painful consequences (e.g., engaging in
  unrestrained buying sprees, sexual indiscretions,
  or foolish business investments) 
• These symptoms must be severe enough to make
  functioning in society impossible and may run the
  risk of hospitalization

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MOOD DISORDERS

• Hypomanic Episode displays the same symptoms of
  a manic episode EXCEPT, it lasts around 4 days
  (instead of a week) and the person is still able
  to function properly in society
• Depressive episode for two weeks includes (at
  least five) symptoms such as depressed mood, loss
  of interest, weight gain/loss, insomnia/hypersomni
  a, restlessness, feelings of worthlessness,
  feelings of guilt, inability to concentrate,
  thoughts of death

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MOOD DISORDERS

• Bipolar I your basic bipolar the most people
  have heard of presence of manic (or hypomanic)
  episodes and depressive episodes usually stay in
  each episode for a significant amount of time
  before switching (not just mood swings)
• Bipolar II bipolar without the presence of a
  manic episode (only hypomanic and major
  depressive)

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MOOD DISORDERS

• Major Depressive Disorder a reoccurrence of at
  least two major depressive episodes within two
  months
• Dysthymic Disorder (Eeyore) for at least two
  years, displaying depressed symptoms more often
  than not (hopelessness, not eating, low
  self-esteem, low energy, etc.) NO
  manic/hypomanic/major depressive episodes this
  is low grade depression

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MOOD DISORDERS

• Dysthymic DisorderA. Depressed mood for most of
  the day, for more days than not, as indicated
  either by subjective account or observation by
  others, for at least 2 years. Note In children
  and adolescents, mood can be irritable and
  duration must be at least 1 year. 
• B. Presence, while depressed, of two (or more) of
  the following 
• (1) poor appetite or overeating (2) Insomnia or
  Hypersomnia(3) low energy or fatigue (4) low
  self-esteem (5) poor concentration or difficulty
  making decisions (6) feelings of hopelessness 

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• C. During the 2-year period (1 year for children
  or adolescents) of the disturbance, the person
  has never been without the symptoms in Criteria A
  and B for more than 2 months at a time. 
• D. No Major Depressive Episode has been present
  during the first 2 years of the disturbance (1
  year for children and adolescents) i.e., the
  disturbance is not better accounted for by
  chronic Major Depressive Disorder, or Major
  Depressive Disorder, In Partial Remission. Note
  There may have been a previous Major Depressive
  Episode provided there was a full remission (no
  significant signs or symptoms for 2 months)
  before development of the Dysthymic Disorder. In
  addition, after the initial 2 years (1 year in
  children or adolescents) of Dysthymic Disorder,
  there may be superimposed episodes of Major
  Depressive Disorder, in which case both diagnoses
  may be given when the criteria are met for a
  Major Depressive Episode. 
• E. There has never been a Manic Episode, a Mixed
  Episode, or a Hypomanic Episode, and criteria
  have never been met for Cyclothymic Disorder. 

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MOOD DISORDERS

• Cyclothymic low grade bipolar no manic
  episodes (only hypomanic) and no major depressive
  (more like dysthymic) symptoms must be present
  for at least 2 years with no longer than 2 months
  without symptoms
• Seasonal Affective Disorder depression when it
  is cold/dark out (winter) treated with
  fluorescent light (tanning bed)

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MOOD DISORDERS

• Major Depressive DisorderA. Presence of two or
  more Major Depressive Episodes. functioning at
  least one of the symptoms is either    (1)
  depressed mood or   (2) loss of interest or
  pleasure. Note Do not include symptoms that are
  clearly due to a general medical condition, or
  mood-incongruent delusions or hallucinations. 
• Note To be considered separate episodes, there
  must be an interval of at least 2 consecutive
  months in which criteria are not met for a Major
  Depressive Episode. 
• Major Depressive Episode. Five (or more) of the
  following symptoms have been present during the
  same 2-week period and represent a change from
  previous

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MOOD DISORDERS

• Major Depressive Episode(1) depressed mood most
  of the day, nearly every day, as indicated by
  either subjective report (e.g., feels sad or
  empty) or observation made by others (e.g.,
  appears tearful). Note In children and
  adolescents, can be irritable mood. (2) markedly
  diminished interest or pleasure in all, or almost
  all, activities most of the day, nearly every day
  (as indicated by either subjective account or
  observation made by others) (3) significant
  weight loss when not dieting or weight gain
  (e.g., a change of more than 5 of body weight in
  a month), or decrease or increase in appetite
  nearly every day. Note In children, consider
  failure to make expected weight gains. (4)
  Insomnia or Hypersomnia nearly every day 

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• (5) psychomotor agitation or retardation nearly
  every day (observable by others, not merely
  subjective feelings of restlessness or being
  slowed down) (6) fatigue or loss of energy
  nearly every day (7) feelings of worthlessness
  or excessive or inappropriate guilt (which may be
  delusional) nearly every day (not merely
  self-reproach or guilt about being sick) (8)
  diminished ability to think or concentrate, or
  indecisiveness, nearly every day (either by
  subjective account or as observed by others) (9)
  recurrent thoughts of death (not just fear of
  dying), recurrent suicidal ideation without a
  specific plan, or a suicide attempt or a specific
  plan for committing suicide 

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MOOD DISORDERS

• Cyclothymic Disorder
• A. For at least 2 years, the presence of numerous
  periods with hypomanic symptoms (see p. 338) and
  numerous periods with depressive symptoms that do
  not meet criteria for a Major Depressive Episode.
  Note In children and adolescents, the duration
  must be at least 1 year. 
• B. During the above 2-year period (1 year in
  children and adolescents), the person has not
  been without the symptoms in Criterion A for more
  than 2 months at a time. 

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• C. No Major Depressive Episode, Manic Episode, or
  Mixed Episode has been present during the first 2
  years of the disturbance. Note After the
  initial 2 years (1 year in children and
  adolescents) of Cyclothymic Disorder, there may
  be superimposed Manic or Mixed Episodes (in which
  case both Bipolar I Disorder and Cyclothymic
  Disorder may be diagnosed) or Major Depressive
  Episodes (in which case both Bipolar II Disorder
  and Cyclothymic Disorder may be diagnosed). 

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MOOD DISORDERS

• Bipolar I
• Diagnosis of this Bipolar Disorder requires at
  least one Manic episode, but there may be
  episodes of Hypomania or Major Depression as
  well. (This diagnosis conforms to the classic
  concept of manic depressive illness.)

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MOOD DISORDERS

• Manic EpisodeA. A distinct period of abnormally
  and persistently elevated, expansive, or
  irritable mood, lasting at least 1 week (or any
  duration if hospitalization is necessary). 
• B. During the period of mood disturbance, three
  (or more) of the following symptoms have
  persisted (four if the mood is only irritable)
  and have been present to a significant degree 
• (1) inflated self-esteem or grandiosity(2)
  decreased need for sleep (e.g., feels rested
  after only 3 hours of sleep) (3) more talkative
  than usual or pressure to keep talking (4)
  flight of ideas or subjective experience that
  thoughts are racing(5) distractibility (i.e.,
  attention too easily drawn to unimportant or
  irrelevant external stimuli) (6) increase in
  goal-directed activity (either socially, at work
  or school, or sexually) or psychomotor
  agitation(7) excessive involvement in
  pleasurable activities that have a high potential
  for painful consequences (e.g., engaging in
  unrestrained buying sprees, sexual indiscretions,
  or foolish business investments) 
•   C. The mood disturbance is sufficiently severe
  to cause marked impairment in occupational
  functioning or in usual social activities or
  relationships with others, or to necessitate
  hospitalization to prevent harm to self or
  others, or there are psychotic features. 

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ANXIETY DISORDERS

• Anxiety a vague, generalized feeling that one
  is in danger
• Anxiety disorders are usually irrational and
  causes inability to function properly in society

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ANXIETY DISORDERS

• Panic (with or without agoraphobia) having
  panic attacks followed by a month of worry about
  having another one, concern of what will happen
  if another one occurs, etc
• Panic attack four of the following within ten
  minutes increased heart rate, sweating,
  shaking, shortness of breath, feeling of choking,
  chest pain, nausea, dizziness, derealization/deper
  sonalization, fear of going crazy, fear of dying,
  numbness, chills/hot flashes
• Agoraphobia fear of being in a place where
  escape may be difficult

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ANXIETY DISORDERS

• Specific phobia irrational fear of a certain
  thing/situation even the anticipation of that
  thing causes anxiety interferes with daily
  lifeTypes Animal Natural Environment
  (heights, storms), Blood-Injection-Injury,
  Situational (airplanes, enclosed spaces),
  Other

53
ANXIETY DISORDERS

• Social Phobia fear of acting in a way that will
  be humiliating or embarrassing in front of
  peers/elders or unfamiliar people these
  situations are avoided as much as possible or are
  entered with much anxiety (possible panic attacks)

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ANXIETY DISORDERS

• Obsessive Compulsive Disorder (OCD) 1.
  Obsessions recurrent thoughts impulses,
  excessive worries, attempting to ignore thoughts,
  
• 2. Compulsions repetitive behaviors aimed to
  reduce stress, are excessive
• It is understood that the obsessions and
  compulsions are irrational consumes more than
  one hour of the day
• Not the same as OCPD

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ANXIETY DISORDERS

• Posttraumatic Stress Disorder (PTSD)
• Traumatic Event experience, witness event where
  actual or threatened death is present response
  involves fear helplessness or horror
• Event is reexperienced through intrusive
  thoughts, dreams, reliving the experience
  (flashbacks/hallucinations), distress when
  external cues occur, physiological response
• Avoidance of activities, places, recollections,
  detachment, restricted affect (emotions)
• Acute less than 3 months
• Chronic more than 3 months

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Anxiety Disorders

• Acute Stress very similar to PTSD except the
  duration happens 2 days after event up to 4
  weeks lasting longer may become PTSD
• Generalized Anxiety excessive worry for at
  least 6 months (more often than not) including
  restlessness or on edge, easily fatigued,
  difficulty concentrating, irritability, muscle
  tension, sleep disturbance

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SOMATOFORM DISORDERS

• Defined physical symptoms for which there is no
  apparent physical cause
• Somatization before age of 30, with no prior
  medical conditions (related) or no lab results
  confirming problems four or more of the
  following at the same time, in four different
  body parts
• Four general body pain symptoms
• Two gastrointestinal symptoms
• One Sexual symptom
• One Pseudoneurological symptom

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SOMATOFORM DISORDERS

• Conversion Disorder a condition in which the
  person is experiencing neurological symptoms
  (numbness, paralysis) and the cause is not
  physiological, but psychological (stressors in
  life)
• Hypochondriasis for at least 6 months, fears of
  having a serious disease regardless of
  reassurance from a doctor (and is not any other
  disorder)

59
SOMATOFORM DISORDERS

• Body Dysmorphic Disorder a slight flaw is seen
  as excessively worse than it actually is
  preoccupation with this is so significant that is
  causes problems social/occupational functioning

60
SOMATOFORM DISORDERS

• Body Dysmorphic Disorder
• A. Preoccupation with an imagined defect in
  appearance. If a slight physical anomaly is
  present, the person's concern is markedly
  excessive. 
• B. The preoccupation causes clinically
  significant distress or impairment in social,
  occupational, or other important areas of
  functioning. 
• C. The preoccupation is not better accounted for
  by another mental disorder (e.g., dissatisfaction
  with body shape and size in Anorexia Nervosa).

61
SOMATOFORM DISORDERS

• Conversion Disorder
• A. One or more symptoms or deficits affecting
  voluntary motor or sensory function that suggest
  a neurological or other general medical
  condition. 
• B. Psychological factors are judged to be
  associated with the symptom or deficit because
  the initiation or exacerbation of the symptom or
  deficit is preceded by conflicts or other
  stressors. 
• C. The symptom or deficit is not intentionally
  produced or feigned (as in Factitious Disorder or
  Malingering). 

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SOMATOFORM DISORDERS

• A. Preoccupation with fears of having, or the
  idea that one has, a serious disease based on the
  person's misinterpretation of bodily symptoms. 
• B. The preoccupation persists despite appropriate
  medical evaluation and reassurance. 
• C. The belief in Criterion A is not of delusional
  intensity (as in Delusional Disorder, Somatic
  Type) and is not restricted to a circumscribed
  concern about appearance (as in Body Dysmorphic
  Disorder). 
• D. The preoccupation causes clinically
  significant distress or impairment in social,
  occupational, or other important areas of
  functioning. 
• E. The duration of the disturbance is at least 6
  months. 

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SOMATOFORM DISORDERS

• Somatization Disorder
• A. A history of many physical complaints
  beginning before age 30 years that occur over a
  period of several years and result in treatment
  being sought or significant impairment in social,
  occupational, or other important areas of
  functioning. 
• B. Each of the following criteria must have been
  met, with individual symptoms occurring at any
  time during the course of the disturbance 
• (1) four pain symptoms a history of pain related
  to at least four different sites or functions
  (e.g., head, abdomen, back, joints, extremities,
  chest, rectum, during menstruation, during sexual
  intercourse, or during urination) (2) two
  gastrointestinal symptoms a history of at least
  two gastrointestinal symptoms other than pain
  (e.g., nausea, bloating, vomiting other than
  during pregnancy, diarrhea, or intolerance of
  several different foods) (3) one sexual symptom
  a history of at least one sexual or reproductive
  symptom other than pain (e.g., sexual
  indifference, erectile or ejaculatory
  dysfunction, irregular menses, excessive
  menstrual bleeding, vomiting throughout
  pregnancy) (4) one pseudoneurological symptom a
  history of at least one symptom or deficit
  suggesting a neurological condition not limited
  to pain (conversion symptoms such as impaired
  coordination or balance, paralysis or localized
  weakness, difficulty swallowing or lump in
  throat, aphonia, urinary retention,
  hallucinations, loss of touch or pain sensation,
  double vision, blindness, deafness, seizures
  dissociative symptoms such as amnesia or loss of
  consciousness other than fainting) 

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• C. Either (1) or (2) 
• (1) after appropriate investigation, each of the
  symptoms in Criterion B cannot be fully explained
  by a known general medical condition or the
  direct effects of a substance (e.g., a drug of
  abuse, a medication) (2) when there is a related
  general medical condition, the physical
  complaints or resulting social or occupational
  impairment are in excess of what would be
  expected from the history, physical examination,
  or laboratory findings 
• D. The symptoms are not intentionally feigned or
  produced (as in Factitious Disorder or
  Malingering).

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DISSOCIATIVE DISORDERS

• Dissociative Amnesia inability to recall
  important information (who you are, where you
  live, who family members are) as a result of
  something extremely stressful, and is not just
  ordinary forgetfulness
• Dissociative Fugue sudden, unexpected (or
  unplanned) travel away from home where a new
  identity (full or partial) is formed

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DISSOCIATIVE DISORDERS

• Dissociative Identity Disorder two or more
  distinct personalities (each with own traits,
  world views, etc.) people with this disorder
  usually have been sexually or verbally abused
• Not all of the personalities know about each
  other
• Host the main personality usually the actual
  person but not necessarily their true personality
  (more fearful, reserved)
• Formerly known as Multiple Personality Disorder
  EXTREMELY rare and highly debated

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DISSOCIATIVE DISORDERS

• Dissociative Amnesia
• A. The predominant disturbance is one or more
  episodes of inability to recall important
  personal information, usually of a traumatic or
  stressful nature, that is too extensive to be
  explained by ordinary forgetfulness. 
• B. The disturbance does not occur exclusively
  during the course of Dissociative Identity
  Disorder, Dissociative Fugue, Posttraumatic
  Stress Disorder, Acute Stress Disorder, or
  Somatization Disorder and is not due to the
  direct physiological effects of a substance
  (e.g., a drug of abuse, a medication) or a
  neurological or other general medical condition
  (e.g., Amnestic Disorder Due to Head Trauma). 
• C. The symptoms cause clinically significant
  distress or impairment in social, occupational,
  or other important areas of functioning.

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DISSOCIATIVE DISORDERS

• Dissociative Fugue
• A. The predominant disturbance is sudden,
  unexpected travel away from home or one's
  customary place of work, with inability to recall
  one's past. 
• B. Confusion about personal identity or
  assumption of a new identity (partial or
  complete). 

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DISSOCIATIVE DISORDERS

• Dissociative Identity Disorder
• A. The presence of two or more distinct
  identities or personality states (each with its
  own relatively enduring pattern of perceiving,
  relating to, and thinking about the environment
  and self). 
• B. At least two of these identities or
  personality states recurrently take control of
  the person's behavior. 
• C. Inability to recall important personal
  information that is too extensive to be explained
  by ordinary forgetfulness. 

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ADJUSTMENT DISORDERS

• Adjustment Disorder over a three month period
  (no longer than six months) where a stressor
  causes significant emotional or behavioral
  symptoms (but does not meet criteria for other
  disorders
• Chronic longer than six months
• Acute less than six months

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ADJUSTMENT DISORDERS

• Six types
• With Anxiety fearful, nervous, worried
• With Depressed Mood hopeless, tearful, sad
• With Disturbance of Conduct not following
  rules, violates others rights
• With Mixed Anxiety and Depressed Mood
• With Mixed Disturbance of Emotions and Conduct
  both conduct and emotional problems
• Unspecified problems that are social, physical,
  job related, personal, etc.

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ADJUSTMENT DISORDERS

• Adjustment Disorder
• A. The development of emotional or behavioral
  symptoms in response to an identifiable
  stressor(s) occurring within 3 months of the
  onset of the stressor(s). 
• B. These symptoms or behaviors are clinically
  significant as evidenced by either of the
  following 
• (1) marked distress that is in excess of what
  would be expected from exposure to the
  stressor (2) significant impairment in social or
  occupational (academic) functioning 
• C. The stress-related disturbance does not meet
  the criteria for another specific Axis I disorder
  and is not merely an exacerbation of a
  preexisting Axis I or Axis II disorder. 
• D. The symptoms do not represent Bereavement. 
• E. Once the stressor (or its consequences) has
  terminated, the symptoms do not persist for more
  than an additional 6 months. 

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PERSONALITY DISORDERS

• Personality Disorders are AXIS II
• Usually can be traced from childhood/adolescence
  and are consistent throughout ones life
• Thoughts, emotions, interpersonal functioning and
  impulse control deviate from what is normal
  within ones culture

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PERSONALITY DISORDERS

• Paranoid Personality Disorder
• Paranoid personality disorder is characterized by
  a distrust of others and a constant suspicion
  that people around you have sinister motives.
  People with this disorder tend to have excessive
  trust in their own knowledge and abilities and
  usually avoid close relationships. They search
  for hidden meanings in everything and read
  hostile intentions into the actions of others.
  They are quick to challenge the loyalties of
  friends and loved ones and often appear cold and
  distant. They usually shift blame to other people
  and tend to carry long grudges.

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PERSONALITY DISORDERS

• Schizoid Personality Disorder
• People with schizoid personality disorder avoid
  relationships and do not show much emotion.
  Unlike avoidants, schizoids genuinely prefer to
  be alone and do not secretly wish for popularity.
  They tend to seek jobs that require little social
  contact. Their social skills are often weak and
  they do not show a need for attention or
  acceptance. They are perceived by others as
  humorless and distant and often are termed
  loners.

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PERSONALITY DISORDERS

• Schizotypal Personality Disorder
• Many believe that schizotypal personality
  disorder represents mild schizophrenia. The
  disorder is characterized by odd forms of
  thinking and perceiving, and individuals with
  this disorder often seek isolation from others.
  They sometimes believe to have extra sensory
  ability or that unrelated events relate to them
  in some important way. They generally engage in
  eccentric behavior and have difficulty
  concentrating for long periods of time. Their
  speech is often over elaborate and difficult to
  follow.

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PERSONALITY DISORDERS

• Antisocial Personality Disorder
• A common misconception is that antisocial
  personality disorder refers to people who have
  poor social skills. The opposite is often the
  case. Instead, antisocial personality disorder is
  characterized by a lack of conscience. People
  with this disorder are prone to criminal
  behavior, believing that their victims are weak
  and deserving of being taken advantage of.
  Antisocials tend to lie and steal. Often, they
  are careless with money and take action without
  thinking about consequences. They are often
  aggressive and are much more concerned with their
  own needs than the needs of others.

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PERSONALITY DISORDERS

• Borderline Personality Disorder
• Frantically avoids abandonment, unstable
  relationships, poor self-image, self-damaging
  impulsivity (spending money, reckless driving,
  sex, use of alcohol/drugs, etc.), self-mutilating
  behavior/suicidal, feelings of emptiness/mood
  swings, etc.
• Very, very needy
• Borderline personality disorder is characterized
  by mood instability and poor self-image. People
  with this disorder are prone to constant mood
  swings and bouts of anger. Often, they will take
  their anger out on themselves, causing injury to
  their own body. Suicidal threats and actions are
  not uncommon. Borderlines think in very black and
  white terms and often form intense,
  conflict-ridden relationships. They are quick to
  anger when their expectations are not met.

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PERSONALITY DISORDERS

• Histrionic Personality Disorder
• - People with histrionic personality disorder are
  constant attention seekers. They need to be the
  center of attention all the time, often
  interrupting others in order to dominate the
  conversation. They use grandiose language to
  describe everyday events and seek constant
  praise. They may dress provocatively or
  exaggerate illnesses in order to gain attention.
  Histrionics also tend to exaggerate friendships
  and relationships, believing that everyone loves
  them. They are often manipulative.

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PERSONALITY DISORDERS

• Narcissistic Personality Disorder
• Narcissistic personality disorder is
  characterized by self-centeredness. Like
  histrionic disorder, people with this disorder
  seek attention and praise. They exaggerate their
  achievements, expecting others to recognize them
  as being superior. They tend to be choosy about
  picking friends, since they believe that not just
  anyone is worthy of being their friend.
  Narcissists tend to make good first impressions,
  yet have difficulty maintaining long-lasting
  relationships. They are generally uninterested in
  the feelings of others and may take advantage of
  them.

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PERSONALITY DISORDERS

• Avoidant Personality Disorder
• Avoidant personality disorder is characterized by
  extreme social anxiety. People with this disorder
  often feel inadequate, avoid social situations,
  and seek out jobs with little contact with
  others. Avoidants are fearful of being rejected
  and worry about embarrassing themselves in front
  of others. They exaggerate the potential
  difficulties of new situations to rationalize
  avoiding them. Often, they will create fantasy
  worlds to substitute for the real one. Unlike
  schizoid personality disorder, avoidants yearn
  for social relations yet feel they are unable to
  obtain them. They are frequently depressed and
  have low self-confidence.

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PERSONALITY DISORDERS

• Dependent Personality Disorder
• Dependent personality disorder is characterized
  by a need to be taken care of. People with this
  disorder tend to cling to people and fear losing
  them. They may become suicidal when a break-up is
  imminent. They tend to let others make important
  decisions for them and often jump from
  relationship to relationship. Dependents often
  remain in abusive relationships. Over-sensitivity
  to disapproval is common. Dependents often feel
  helpless and depressed.

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PERSONALITY DISORDERS

• Obsessive Compulsive Personality Disorder
• While Obsessive-Compulsive personality disorder
  (OCDP) sounds similar in name to
  obsessive-compulsive anxiety disorder, the two
  are markedly different disorders. People with
  obsessive-compulsive personality disorder are
  overly focused on orderliness and perfection.
  Their need to do everything right often
  interferes with their productivity. They tend to
  get caught up in the details and miss the bigger
  picture. They set unreasonably high standards for
  themselves and others, and tend to be very
  critical of others when they do not live up to
  these high standards. They avoid working in
  teams, believing others to be too careless or
  incompetent. They avoid making decisions because
  they fear making mistakes and are rarely generous
  with their time or money. They often have
  difficulty expressing emotion.