ABNORMAL PSYCHOLOGY

ANXIETY DISORDERS
include disorders that share features of excessive fear and anxiety and related
behavioral disturbances.

SEPARATION ANXIETY

Developmentally inappropriate and excessive fear or anxiety concerning separation

from those to whom the individual is attached, as evidenced by at least three of the
following criteria.

1. Recurrent excessive distress when anticipating or experiencing separation from

home or from major attachment figures.
2. Persistent and excessive worry about losing major attachment figures or about
possible harm to them, such as illness, injury, disasters, or death.

SELECTIVE MUTISIM

A. Consistent failure to speak in specific social situations in which there is an

expectation for speaking (e.g., at school) despite speaking in other situations.
B. The disturbance interferes with educational or occupational achievement or with
social communication.

SOCIAL ANXIETY DISORDER

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).

SPECIFIC PHOBIA

A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights,
animals, receiving an injection, seeing blood).

Note: In children, the fear or anxiety may be expressed by crying, tantrums,

freezing, or clinging.

B. The phobic object or situation almost always provokes immediate fear or anxiety.

PANIC DISORDER

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.

a. Palpitations, pounding heart, or accelerated heart rate.

b. Sweating.

c. Trembling or shaking.

d. Sensations of shortness of breath or smothering.

e. Feelings of choking.

f. Chest pain or discomfort.

g. Nausea or abdominal distress.

h. Feeling dizzy, unsteady, light-headed, or faint.

i. Chills or heat sensations.

 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:
1. Persistent concern or worry about additional panic attacks or their consequences
(e.g., losing control, having a heart attack, “going crazy”).
2. 2. A significant maladaptive change in behavior related to the attacks (e.g.,
behaviors designed to avoid having panic attacks, such as avoidance of exercise
or unfamiliar situations).

AGORAPHOBIA

A. Marked fear or anxiety about two (or more) of the following five situations:
1. Using public transportation (e.g., automobiles, buses, trains, ships, planes).
2. Being in open spaces (e.g., parking lots, marketplaces, bridges).
3. Being in enclosed places (e.g., shops, theaters, cinemas).
4. Standing in line or being in a crowd.
5. Being outside of the home alone.

B. The individual fears or avoids these situations because of thoughts that escape might
be difficult or help might not be available in the event of developing panic- like
symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the
elderly; fear of incontinence).

GENERALIZED ANXIETY DISORDER

A. Excessive anxiety and worry (apprehensive expectation), occurring more days

than not for at least 6 months, about a number of events or activities (such as
work or school performance)
B. The individual finds it difficult to control the worry.
TRAUMA AND STRESSOR RELATED DISORDERS

REACTIVE ATTACHMENT DISORDER

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

caregivers, manifested by both of the following:
1. The child rarely or minimally seeks comfort when distressed.
2. The child rarely or minimally responds to comfort when distressed.

DISINHIBITED SOCIAL ENGAGEMENT DISORDER

A. A pattern of behavior in which a child actively approaches and interacts with

unfamiliar adults and exhibits at least two of the following:
1. Reduced or absent reticence in approaching and interacting with unfamiliar
adults.
2. Overly familiar verbal or physical behavior (that is not consistent with culturally
sanctioned and with age-appropriate social boundaries).

POSTTRAUMATIC STRESS DISORDER

The following criteria apply to adults, adolescents, and children older than 6.

A. Exposure to actual or threatened death, serious injury, or sexual violence in one

(or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.

ACUTE STRESS DISORDER

A. Exposure to actual or threatened death, serious injury, or sexual violence in one

(or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
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 one or
both of the following:
1. Marked distress that is out of proportion to the severity or intensity of the
stressor, taking into account the external context and the cultural factors that
might influence symptom severity and presentation.
2. Significant impairment in social, occupational, or other important areas of
functioning.

PROLONGED GRIEF DISORDER

A. The death, at least 12 months ago, of a person who was close to the bereaved
individual (for children and adolescents, at least 6 months ago).
B. Since the death, the development of a persistent grief response characterized by
one or both of the following symptoms, which have been present most days to a
clinically significant degree. In addition, the symptom(s) has occurred nearly
every day for at least the last month:
1. Intense yearning/longing for the deceased person.
2. Preoccupation with thoughts or memories of the deceased person (in children
and adolescents, preoccupation may focus on the circumstances of the death).

OBSESSIVE COMPULSIVE AND RELATED DISORDERS

OBSESSIVE-COMPULSIVE DISORDER

Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):

1. Recurrent and persistent thoughts, urges, or images that are experienced, at some
time during the disturbance, as intrusive and unwanted, and that in most individuals
cause marked anxiety or distress.

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).

Compulsions are defined by (1) and (2):

1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g.,
praying, counting, repeating words silently) that the individual feels driven to perform in
response to an obsession or according to rules that must be applied rigidly.

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 or mental acts
are not connected in a realistic way with what they are designed to neutralize or
prevent, or are clearly excessive.

Note: Young children may not be able to articulate the aims of these behaviors or
mental acts.

B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per
day) or cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning.

BODY DYSMORPHIC DISORDER

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.
HOARDING DISORDER

A. Persistent difficulty discarding or parting with possessions, regardless of their

actual value.
B. This difficulty is due to a perceived need to save the items and to distress
associated with discarding them.

TRICHOTILLOMANIA (HAIR-PULLING DISORDER)

A. Recurrent pulling out of one’s hair, resulting in hair loss

B. Repeated attempts to decrease or stop hair pulling.

EXCORIATION (SKIN-PICKING) DISORDER

A. Recurrent skin picking resulting in skin lesions.

B. Repeated attempts to decrease or stop skin picking.

DISSOCIATIVE DISORDERS
are characterized by a disruption of and/or discontinuity in the normal integration of
consciousness, memory, identity, emotion, perception, body representation, motor
control, and behavior.

DISSOCIATIVE IDENTITY DISORDER

A. Disruption of identity characterized by two or more distinct personality states,
which may be described in some cultures as an experience of possession. The
disruption in identity involves marked discontinuity in sense of self and sense of
agency, accompanied by related alterations in affect, behavior, consciousness,
memory, perception, cognition, and/or sensory-motor functioning. These signs
and symptoms may be observed by others or reported by the individual.
B. Recurrent gaps in the recall of everyday events, important personal information,
and/or traumatic events that are inconsistent with ordinary forgetting.
DISSOCIATIVE AMNESIA
A. An inability to recall important autobiographical information, usually of a traumatic
or stressful nature, that is inconsistent with ordinary forgetting.
Note: Dissociative amnesia most often consists of localized or selective amnesia for a
specific event or events; or generalized amnesia for identity and life history.
B. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.

DEPERSONALIZATION/DEREALIZATION DISORDER
A. The presence of persistent or recurrent experiences of depersonalization,
derealization, or both:
1. Depersonalization: Experiences of unreality, detachment, or being an
outside observer with respect to one’s thoughts, feelings, sensations,
body, or actions (e.g., perceptual alterations, distorted sense of time,
unreal or absent self, emotional and/or physical numbing).
2. Derealization: Experiences of unreality or detachment with respect to
surroundings (e.g., individuals or objects are experienced as unreal,
dreamlike, foggy, lifeless, or visually distorted).
B. During the depersonalization or derealization experiences, reality testing remains
intact.

SOMATIC SYMPTOMS AND RELATED DISORDERS

SOMATIC SYMPTOM DISORDER

A. One or more somatic symptoms that are distressing or result in significant

disruption of daily life.
B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or
associated health concerns as manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of one’s
symptoms.
2. Persistently high level of anxiety about health or symptoms.
 3. Excessive time and energy devoted to these symptoms or health concerns.

ILLNESS ANXIETY DISORDER

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.

FUNCTIONAL NEUROLOGICAL SYMPTOM DISORDER

(CONVERSION DISORDER)

A. One or more symptoms of altered voluntary motor or sensory function.

B. Clinical findings provide evidence of incompatibility between the symptom and
recognized neurological or medical conditions

FACTITIOUS DISORDER

Factitious Disorder Imposed on Self

A. Falsification of physical or psychological signs or symptoms, or induction of injury
or disease, associated with identified deception.
B. The individual presents himself or herself to others as ill, impaired, or injured.

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.
MENTAL STATUS EXAMINATION
Mental Status is a cross section of the patient’s psychological life and represents the
sum total of the psychiatrist’s observations and impressions at the moment. It also
serves for future comparison to follow the progress of the patient.

GENERAL APPEARANCE: ○ Sad

○ Unhappy
● Gait (way of walking) ● Voice
● Dress ○ Faint
● Grooming (neat or unkempt) ○ Loud
● Posture ○ Hoarse
● Gestures ● Eye contact
● Facial expressions
● Does patient apears older or ATTITUDE DURING INTERVIEW:
younger than stated age?
How patient relates to examiner—
MOTORIC BEHAVIOR:
● Irritable
Level of activity— ● Aggressive
● Seductive
● Psychomotor agitation or ● Guarded
Psychomotor retardation: ● Defensive
○ Tics ● Indifferent
○ Tremors ● Apathetic
○ Automatism ● Cooperative
○ Mannerisms ● Sarcastic
○ Grimacing
○ Stereotypes MOOD:
○ Negativism
○ Apraxia Steady or sustained emotional state—
○ Echopraxia
● Gloomy
○ Waxy flexibility
● Tense
● Emotional appearance:
● Hopeless
○ Anxious
● Ecstatic
○ Tense
● Resentful
○ Panicky
● Happy
○ Bewildered
 ● Bashful ● Logorrhea
● Sad ● Mute
● Exultant ● Paucity
● Elated ● Stilted
● Euphoric
● Depressed PERCEPTUAL DISORDERS:
● Apathetic
● Hallucinations
● Anhedonic
○ Olfactory
● Fearful
○ Auditory
● Suicidal
○ Haptic (tactile)
● Grandiose
○ Gustatory
● Nihilistic
○ Visual
AFFECT: ● Illusions
● Hypnopompic or Hypnagogic
Feeling tone associated with with idea— experiences:
○ Feelings of unreality
● Labile ○ Déjà vu
● Blunt ○ Déjà entendu
● Appropriate to content ○ Macropsia
● Inappropriate
● Flat THOUGHT CONTENT:
● La belle indifference
● Delusions—
SPEECH: ○ Persecutory (paranoid)
○ Grandiose
● Slow ○ Infidelity
● Fast ○ Somatic
● Pressured ○ Sensory
● Garrulous ○ Thought broadcasting
● Spontaneous ○ Thought insertion
● Taciturn ○ Ideas of reference
● Stammering ○ Ideas of unreality
● Stuttering ○ Phobias
● Slurring ○ Obsessions
● Staccato ○ Compulsions
● Pitch ○ Ambivalence
● Articulation ○ Autism
● Aphasia ○ Dereism
● Coprolalia ○ Blocking
● Echolalia
● Incoherent
 ○ Suicidal or homicidal MEMORY:
preoccupation
○ Conflicts ● Remote memory (long term
○ Nihilistic ideas memory)
○ Hypochondriasis ● Recent memory
○ Depersonalization ● Immediate memory
○ Derealization
CONCENTRATION AND
○ Flight of ideas
CALCULATION:
○ Idèe fixe
○ Magical thinking ● Ability to pay attention
○ Neologism ● Distractibility
● Ability to do simple math.
THOUGHT PROCESS:
INFORMATION AND INTELLIGENCE:
● Goal-directed ideas
● Loosened association ● Use of vocabulary
● Illogical ● Level of education
● Tangential ● Fund of knowledge
● Relevant
● Circumstantial JUDGEMENT:
● Rambling
● Ability to abstract ● Ability to understand relationships
● Flight of ideas between facts and to draw
● Clang associations conclusions.
● Perseveration ○ Response in social
situations
SENSORIUM:
INSIGHT LEVEL:
Level of consciousness—
● Realizing that there is a physical
● Alert and mental problem
● Clear ○ Denial of illness
● Confused ○ Ascribing blame to outside
● Clouded factors
● Comatose ● Recognizing need for treatment
● Stuporous
○ Orientation to time, place,
person.
● Cognition