Abnormal Psychology (Advance Reading)

CHAPTER 1.1 ABNORMAL PSYCHOLOGY 8. Course

→ Individual pattern of disorders.
Psychology o Chronic : disorders tend to last a long
→ It is the scientific study of human behavior and time, sometimes a lifetime.
mental processes. o Episodic: an individual is likely to
recover within a few months only to
Abnormal Psychology suffer a reoccurrence of the disorder at
→ is the branch of psychology that studies unusual a later time.
patterns of behavior, emotion and thought. o Time-Limited: the disorder will
→ branch of psychology that investigates abnormal improve without treatment in a
behavior. relatively short period.
9. Prognosis
Psychopatology → a prediction of the course, duration, severity,
→ the scientific study of psychological disorders
and outcome of a condition, disease, or
disorder. ( good prognosis and bad
Psychological Disorder prognosis)
→ The most widely accepted definition used in
10. Onset
DSM-5 describes "
→ the chronological age at which symptoms of
“abnormal” as behavior psychological or biological
a disease or disorder first appear in an
dysfunctions that are unexpected in their cultural
individual.
context and associated with present distress and
o Acute Onset: disorders begin suddenly
impairment in functioning.
o Insidious Onset : disorders develop
gradually over an extended period.
CRITERIA DEFINING A PSYCHOLOGICAL
DISORDER
1. Dysfunction: refers to a breakdown or deficit in
one or more aspects of life cognitive, emotional
or behavior.
2. Deviance: different from the societal
norms/culture/situation (ex eating one’s own
hair, hearing voices, speaking strange words.)
3. Distress/Discomfort: something feels not right
(sadness, distraction) --- more of subjective
4. Danger: danger/threat towards self, others,
property.

SOME CLINICAL TERMS USED:

1. “Presents” or “Presenting Problem”
→ Is a traditional shorthand way of indicating
why the person came to the clinic.
2. Clinical Description
→ Represents the unique combination of
behaviors, thoughts, and feelings that make
up a specific disorder.
3. Clinical
→ Refers both to the types of problems or
disorders that you would find a clinic or
hospital and to the activities connected with
assessment and treatment.
4. Prevalence
→ Total Number of affected persons in a given
period of time.
5. Incidence
→ number of new cases in a given period of
time.
6. Sex Ratio
→ What percentage of males and females
have the disorder, and the typical age of
onset, which often differs from one disorder
to another.
7. Etiology
→ or the study of origins, has to do with why a
disorder begins (what causes it) and
includes biological, psychological and social
dimensions.

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Chapter 1.2 Historical views of Bethlehem in the City of London.
Abnormal Psychology
The Biological Tradition
THE SUPERNATURAL TRADITION Humoral Theory of Disorders (Hippocrates and
Galen)
900−600 BC →brain functioning was related to four bodily
→ all physical and mental disorders are work of fluids or humors: blood, black bile, yellow bile,
evil 14th century and phlegm
→ religious and lay authorities believe more →Psychological disorders is to “chemical
strongly on the influencd of demons and imbalance”
witches. →Psychological disorders are caused by brain
→ Treatment included exorcism, in which pathology and head trauma.
various rituals were performed. →Can be influence by heredity.
→Recognized the importance of psychological
Stress and Melancholy and interpersonal contributions to pathology.
→Insanity was a natural phenomenon, caused
by mental or emotional stress.
→In the 14th century, Nicholas Oresme, one of John P. Grey (1854)
the chief advisers to the King of France, a →head of New York’s Utica Hospital believes
bishop and philosopher suggested that that insanity is the result of physical causes,
melancholy(depression) was the source of thus de-emphasizing psychological treatments.
bizarre behavior, rather than demons. Louis Pasteur (1870)
→develops his germ theory of disease, which
helps identify the bacterium cause syphillis.
Hysteria Josef Breuer (1895)
Mass Hysteria →treats the “hysterical” Anna O. leading to
→A fascinating phenomenon characterized by Freud’s
large scale outbreaks of bizarre behavior →development of psychoanalytic theory.
→In Europe, groups of people were
simultaneously compelled to run out in the The Psychological Tradition
streets, dance, shout, rave and jump around.
→Some hypothesized it as caused by insect Plato
bites (tarantism). →causes of maladaptive behavior were the
social and cultural influences Aristotle
Modern Mass Hysteria: →social environment (fantasies, dreams, and
→It started when a 14 year old girl reported a cognitions) Advocacy of humane and
funny smell. Soon many of the students and responsible care for individuals with
teacher experienced similar symptoms. psychological disturbances (development of
Inspection of the school building by public moral therapy)
authorities revealed no apparent cause for the
reactions, and teams of physicians revealed
no physical abnormalities.
Moral Treatment (19th century)
Emotional contagion →The term “moral” referred more to emotional
→the experience of an emotion seems to spread or psychological factors rather than to a code
to those around us. of conduct.
→People are suggestible when they are in →This includes treating institutionalized patients
states of high emotion. as normally as possible in a setting that
→In popular language, this shared response is encouraged and reinforced normal social
sometimes referred to mob psychology. interaction.

The moon and the stars Philippe Pinel

→During the period of enlightenment, reformer
Paracelsus Philippe Pinel,the director of major asylum in
→suggest movements of the moon and stars Paris in the late 1700s,
had profound effects on people’ s behavior. ordered that the chains be removed from the
→Gravitational effects of the moon on bodily mental patients and that patients be treated
fluids might be a possible cause of mental humanely.
disorders William Tuke
→ development of hospitals based on modern
The Birth of Asylums ideas of Around the same time in England,
Asylum William Tuke advocated the established a
→came from the earliest (religious) institutions country retreat in which patients lived and
which provided asylum in the sense of refuge worked.
to the mentally ill. Benjamin Rush
→One of the oldest such institutions was → In the United States, Benjamin Rush
Bethlem, which began in 1247 as part of the promoted the use of Moral therapy with
Priory of the New Order of our Lady of mentally ill (a treatment philosophy that

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encouraged the use of compassion and
patience rather than physical punishment or
restraints).

Psychoanalytic Theory
1. Franz Anton Mesmer and bodily magnetism and
hypnosis
2. Jean-Martin Charcot and hysteria
3. Freud and Breuer and the “unconscious”
4. Freud and the Psychoanalytic model
5. Development of Psychoanalytic thought

Diagnostic and Statistical Manual of Mental

Disorders (DSM)
o 1952, United States: Diagnosis. American
Psychiatric Association publishes Diagnostic and
Statistical Manual of Mental Disorders.
o 1968, United States: Diagnosis. American
Psychiatric Association publishes the second
edition of Diagnostic and Statistical Manual of
Mental Disorders.
o In the 1980s, the publication of the third edition
of the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental
Disorders (DSM) led to increased attention on
the value of structured interview approaches to
gathering diagnostic information.
o 1987 DSM-III R is published
o 1994 DSM-IV is published
o 2000 DSM-IV-TR is published
o 2010 DSM-V is published

Humanistic Theory
→emphasized the positive, optimistic side of
human nature
→all of us could reach our highest potential, in
all areas of functioning ,if
→only we had the freedom to grow
Behavioral Model
→development of a more scientific approach to
psychological aspects of psychopathology
→Pavlov, Skinner and Watson

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CHAPTER 2: INTEGRATIVE APPROACH TO

PSYCHOPATHOLOGY

MODEL
→In a general sense, a model is defined as a
representation or imitation of an object
(dictionary.com).
→Models help mental health professionals
understand mental illness since disorders
such as depression cannot be touched or
experienced firsthand.
→Visualization, easily visualize to what you
want to represent, to easily represent mental
illness that not easily seen by the eyes.
BIOLOGICAL VIEWPOINT
ONE−DIMENSIONAL MODEL → Mental disorders are viewed as diseases,
→ Stated that psychopathology is a caused by a thus, they are disorders of the central
physical abnormality or by conditioning is to nervous system, autonomic nervous system,
accept a linear or one- dimensional model, or the endocrine system, that are either
which attempts to trace the origins of behavior inherited or caused by some pathological
to a single cause. causes.
o Example: Schizophrenia or a phobia is
caused by a chemical imbalance or by Biological Causal Factors:
growing up surrounded by 1. Neurotransmitter and Hormonal Imbalances
overwhelming conflicts among family
member.
2. Genetic Vulnerabilities
→ Chromosomal Abnormalities ( Faulty genes)
→ One cause of the psychopathology, single
cause 3. Constitutional Liabilities
→ Physical handicap
o Example: Genetics alone, environment,
→ Temperament
life-circumstances
→ SINGLE ETIOLOGY 4. Brain Dysfunction and Neural Plasticity
5. Physical Deprivation or Disruption
MULTI−DIMENSIONAL MODEL → Basic physiological needs
→ This perspective on causality is systemic, → Stimulation and activity
which derives from the word system
→ Implies that any particular influence PSYCHOLOGICAL VIEWPOINT
contributing to psychopathology cannot be → We begin life with few built-in patterns and a
considered out of context. great capacity to learn from experience. What
→ In this case, the biology and behavior of the we do learn from our experiences may help us
individual, as well as the cognitive, emotional, face challenges resourcefully and may lead to
social, and cultural environment, because any resilience in the face of future stressors.
one component of the system inevitably
affects the other components.
→ Considering all the possible causes. Psychological Causal Factors:
→ Looking for the etiology is systemic, they 1. Schema and self-schema
have different perspective 2. Assimilation and Accommodation
3. Early Deprivation or Trauma
4. Inadequate Parenting Styles
→Parental psychopathology
→Parenting Styles
→Inadequate, irrational, angry communication
5. Marital Discord and Divorce
6. Maladaptive Peer Relationships

SOCIOCULTURAL VIEWPOINT
→The development of maladaptive behavior can
be affected by the social and cultural context.
→Outside of biological and psychological factors
on mental illness, race, ethnicity, gender,
religious orientation, socioeconomic status,
sexual orientation, etc. also play a role, and
this is the basis of sociocultural viewpoint.

Causal Factors:
1. Social Roles (e.g., gender roles) Pathogenic
Societal Influences • Low Socioeconomic

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Status and Unemployment
→Disorder-Engendering Social Roles (e.g.,
Soldier)
→Prejudice and Discrimination
→Social Change and Uncertainty

BIOPSYCHOSOCIAL VIEWPOINT
→Most disorders are the result of many
interacting causal factors— biological,
psychosocial, and sociocultural.
→The combination of causal factors may be
relatively unique for an individual.

DIATHESIS−STRESS MODEL
DIATHESIS
→ A predisposition toward developing a disorder
is termed a diathesis.
→ Many mental disorders are believed to
develop when some kind of stressor operates
on a person who has a diathesis or
vulnerability for that disorder

STRESS
→It is the response or experience of an
individual to demands that he or she
perceives as taxing or exceeding his or her
personal resources. - It usually occurs when
an individual experiences chronic or episodic
events that are undesirable and lead to
behavioral, physiological, and cognitive
accommodations (Baum & Posluszny, 1999).

NOTE:
It is important to note that factors contributing to the
development of a diathesis are themselves
sometimes highly potent stressors, as when a child
experiences the death of a parent and may hereby
acquire a predisposition or diathesis for becoming
depressed later in life.

THE PSYCHOPATHOLOGY OF THE MASSES IS

ROOTED IN THE PSYCHOLOGY OF THE
INDIVIDUAL
−CG JUNG

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Chapter 3.1: CLINICAL ASSESSMENT AND →Develop & maintain therapeutic relationship
DIAGNOSIS o Communicate empathy, respect,
competence & interest - Create
CLINICAL ASSESSMENT atmosphere of trust
→It is the systematic evaluation and o Encourage patient to talk honestly
measurement of psychological, biological, and →Communicate information about problem &
social factors in an individual presenting with a treatment plan
possible psychological disorder.
MENTAL STATUS EXAMINATION (MSE)
DIAGNOSIS →This involves the systematic observation of an
→ It is the process of determining whether the individual’s behavior. This type of observation
particular problem afflicting the individual occurs when any one person interacts with
meets all criteria for a psychological disorder, another.
as set forth in the DSM-5 →Mental status exams can be structured and
detailed but mostly they are performed
relatively quickly by experienced clinicians in
BASIC CONCEPTS IN ASSESSMENTS the course of interviewing or observing a
Valueof assessment depends on: patient.

 RELIABILITY: The degree to which a MAJOR COMPONENTS OF MSE

measurement is consistent. (Kapag nag re test 1. Appearance and behavior
ka sa iba ganon padin result.) 2. Thought Process
 VALIDITY: The degree to which a technique 3. Mood and Affect
measures what its is designed to meaure 4. Intellectual Functioning
STANDARDIZATION: Application of certain

5. Sensorium
standards to ensure consistency across different
measurements. (Compare your score sa katulad
SEMISTRUCTURED INTERVIEW
mo)
→These are made up of questions that have
been carefully phrased and tested to elicit
Clinical assessment consists of strategies and useful information in a consistent manner so
procedures that help clinicians acquire the that clinicians can be sure they have
information they need to understand their patients inquired about the most important aspects
and assist them. These procedures are the following: of particular disorders
THE CLINICAL INTERVIEW
BEHAVIORAL ASSESSMENT
DESCRIPTION
→takes this process one step further by using
→This is the core of most clinical work,and is
direct observation to assess formally an
used by psychologists, psychiatrists,and other
individual’s thoughts, feelings, and behavior in
mental health professionals.
specific situations or contexts.
→Professional communication with a sense of
→In behavioral assessment, target behaviors
purpose, compassion & curiosity
are identified and observed with the goal of
rapid,unfeeling questions & undirected
determining the factors that seem to influence
conversation are avoided
them.
→Organized & structured gathering of data
→Gather information on current and past
PSYCHOLOGICAL TESTING
behavior, attitudes, and emotions, as well as a
→includes specific tools to determine cognitive,
detailed history of the individual’s life in
emotional, or behavioral responses that might
general and of the presenting problem.
be associated with a specific disorder and
→Clinicians determine when the specific
more general tools that assess long standing
problem started and identify other events (for
personality features, such as a tendency to be
example, life stress, trauma, or physical
suspicious
illness) that might have occurred about the
same time.
PROJECTIVE TEST
→Gathering of some information on the patient’s
→includes a variety of methods in which
current and past interpersonal and social
ambiguous stimuli, such as pictures of people
history, including family makeup (for example,
or things, are presented to people who are
marital status, number of children, or college
asked to describe what they see.
student
→People project their own personality and
→currently living with parents), and on the
unconscious fears onto other people and
individual’s upbringing.
things—in this case, the ambiguous stimuli—
→Information on sexual development, religious
and, without realizing it, reveal their
attitudes (current and past), relevant cultural
unconscious thoughts to the therapist.
concerns (such as stress induced by
discrimination), and educational history are
INTELLIGENCE TEST
also routinely collected.
→is occasionally used to determine the client’s
level of cognitive functioning.
OBJECTIVES
→Intelligence testing consists of a series of
→Determine nature of problem

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tasks asking the patient to use both verbal
and nonverbal skills.
o An example is the Stanford-Binet
Intelligence test which is used to assess
fluid reasoning, knowledge, quantitative
reasoning, visual-spatial processing and
working memory.

PHYSICAL EXAMINATION
→Many patients with problems first go to a
family physician and are given a physical. If
the patient presenting with psychological
problems has not had a physical exam in the
past year, a clinician might recommend one,
with particular attention to the medical
conditions sometimes associated with the
specific psychological problem.

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Chapter 3.2 Clinical Assessment and Diagnosis features, and course (type of remission-partial
(DSM) or full- or recurrent) can be provided with the
diagnosis. The final diagnosis is based on the
Diagnostic and Statistical Manual of Mental clinical interview, text description, criteria, and
Disorders clinical judgement.

→The most widely used classification sytem in the 2. Subtypers and Specifiers
United States. Currently in the 5th edition → Since the same disorder can be manifested
produced by American Psychiatric Assosiation. in different ways in different individuals (when
→Alternatively the World Health Organization an individual has comorbid disorders). The
produces the International Statistical DSM uses subtypes and specifiers to better
Classification of Dieseses and Related Health characterize an imdividual's disorder.
Problems. (ICD) Subtypes denote "mutually exclusive and
jointly exhaustive phnomenological
subgroupings within a diagnosis"
DSM Revisions
3. Principal Diagnosis
1952
→A principal diagnosis is used when more than
→The first edition of Diagnostic and Statistical
one diagnosis is given for an individual (when
Manual (DSM-I) is published.
an individual has comorbid disorders.) The
→Contained 60 disorders and was based on
principal diagnosis is the reason for the
theories of abnormal psychology snd
admission in an inpatient setting or the reason
psychopatology.
for a visit resulting in ambulatory care medical
services in outpatient settings. The principal
1968 diagnosis is generally the main focus of
→DSM-II is published. treatment.
→Changes in DSM-II included eleven major
diagnostic categories, with 185 total diagnoses

for mental disorder. 4. Provisional Diagnosis

1980 → If not enough information is available for a
→DSM-III is published. mental health professional to make a definitive
→DSM-II provided specific diagnostic criteria for diagnosis, but there is a strong presumption
265 diagnoses. that the full criteria will be met with additional
information or time
1987
→ DSM-III R is published
→ ➢ 297 diagnoses.
1994
→DSM-IV is published
→365 diagnoses

2000
→DSM-IV-TR is published
→This volume is heavily research based and
includes information about the etiologies of the
disorder.

2013
→DSM-V is published
→312 diagnoses

Elements of a Diagnosis
The DSM 5 states that the following make up the key
elements of a diagnosis. (APA, 2013)

1. Diagnostic Criteria and Descriptors

→ Diagnostic criteria are the guidelines for
making a diagnosis. When the full criteria are
met, mental health professionals can add
severity and course specifiers to imdicate the
patients current presentation. If the full criteria
are not met, designators such as "other
specified" or "unspecified" can be used. If
applicable, an indication of severity (mild,
moderate, severe or extreme), descriptive

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TYPICAL SIGNS AND SYMPTOMS IN PSYCHOPATHOLOGY

SIGNS AND SYMPTOMS

The major differences between signs and symptoms are described on the table below:

SIGNS SYMPTOMS
Objective Subjective
Based from clinician’s observation Subjective experiences of the patient

However, psychopathological signs and symptoms are not clearly differentiated, they often overlap. A
syndrome, or a constellation of signs and symptoms that make up a recognizable condition, is often used to
show the overlap of the two.

TYPICAL SIGNS AND SYMPTOMS IN PSYCHOPATHOLOGY

DISTURBANCES OF CONSCIOUSNESS Consciousness

− state of awareness
 Apperception: perception modified by one’s thoughts and emotions.

 Sensorium: (sometimes used as another term for consciousness) refers to the state of
functioning of the special senses
1. Disorientation – disturbed orientation regarding time, place, or person.
2. Delirium – patient exhibits confusion, restlessness, bewilderment, and a disoriented reaction that
is usually associated with hallucinations and fear.
3. Clouding of consciousness – a state of perceptual and cognitive confusion.
4. Stupor – a general condition wherein the patient exhibits extreme unresponsiveness and loss of
orientation to the environment.
5. Twilight state – a disturbance in consciousness, with hallucinations.
6. Dreamlike state – another term for psychomotor epilepsy or complex partial seizure.
7. Somnolence – abnormal drowsiness, usually displayed in organic processes.
8. Coma vigil (akinetic mutism) – patient appears to be sleeping but is aroused easily.
9. Coma – profound level of consciousness, abnormal state of deep stupor that is accompanied by a
total loss of consciousness, loss of voluntary behavior and some reflexes.
DISTURBANCES OF ATTENTION
Attention – selective aspects of perception; quantity of effort given to focusing on parts of an
experience; ability to concentrate
1. Distractibility – the inability to concentrate or focus attention because patient is easily drawn to
irrelevant external stimuli.
2. Selective attention – blocking out of anxiety−causing stimuli.
3. Hyper vigilance – excessive focus and attention is given to all internal and external stimuli due to
paranoia.

DISTURBANCES IN SUGGESTIBILITY
Suggestibility − uncritical and compliant response to influence or an idea.
1. Folie a deux (or folie a trois) – emotional/mental illness shared between two (or three) persons;
also called shared psychosis between two (or three) persons.
2. Hypnosis – artificially induced consciousness characterized by heightened suggestibility.

DISTURBANCES IN EMOTION
Emotion – a complex feeling or state related to mood and affect with psychic, somatic, and behavioral
components.

Affect – the expression or outward manifestation of emotion observable to others.

1. Appropriate affect – a normal condition wherein emotional tone is in harmony or is consistent
with the accompanying thought, idea, or speech. It is also described as broad or full affect wherein a
full range of emotions is appropriately expressed.
2. Inappropriate affect – inconsistency between the emotional tone and the idea, thought, or
speech accompanying it.
3. Blunted affect – characterized by a severe reduction in the intensity of the externalized feeling
tone.

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4. Restricted or constricted affect – reduction in the intensity of feeling tone. It is less severe than
blunted affect.
5. Flat affect – the absence or near absence of any signs of affective expression. It can be
characterized by an immobile face and a monotonous voice.
6. Labile affect – rapid and abrupt changes in the emotional feeling tone which is unrelated to an
external stimuli.

Mood – the sustained and pervasive emotion subjectively experienced and reported by the patient, and
is observable to others.
1. Dysphoric Mood – unpleasant mood
2. Euthymic Mood – normal range of mood
3. Expansive Mood – the expression of one’s feelings without any restraint. It is frequently and
overestimation of one’s significance or importance.
4. Irritable Mood – the person is easily provoked to anger and is easily annoyed.
5. Mood Swings (labile mood) – moving between euphoria and depression or anxiety.
6. Elevated Mood – characterized by an air of enjoyment and confidence. A mood which ismore
cheerful than normal but is not considered pathological.
7. Euphoria – intense elation with feelings of grandeur.
8. Ecstasy – feeling of intense
9. rapture or delight.
10. Depression – the psychopathological feeling of sadness.
11. Anhedonia – loss of interest and withdrawal from all regular and pleasurable activities. Often
associated with depression.
12. Grief or Mourning – sadness that is appropriate to a real loss.
13. Alexithymia – the inability or difficulty in describing one’s moods or emotions.

Other Emotions
1. Anxiety – a feeling of apprehension that is caused by anticipation of internal or external
danger/threat.
2. Free-floating anxiety – unfocused and pervasive fear that is not attached to any idea.
3. Fear – anxiety caused by a consciously recognized and realistic danger.
4. Agitation – motor restlessness associated with severe anxiety.
5. Tension – unpleasant increased motor and psychological activity.
6. Panic – acute, episodic, intense anxiety attack associated with overwhelming feelings of dread.
7. Apathy – dulled emotional tone associated with indifference or detachment
8. Ambivalence – presence of two opposing impulses toward the same thing, in the same person,at
the same time.

Physiological disturbances associated with mood

− Signs that refer to the somatic (usually autonomic) dysfunction of a person, which are most often
associated with depression; also known as vegetative signs.
1. Anorexia – loss of or decrease in appetite.
2. Hyperphagia – increase in appetite and food intake.
3. Insomnia – difficulty or lack the lack of ability to fall asleep.
a. Initial – difficulty in falling asleep. (early onset)
b. Middle – difficulty in sleeping through the night without waking up; difficulty in going back to
sleep if awaken in the middle of the night. (middle onset)
c. Terminal – early morning awakening. (late onset)
4. Hypersomnia – excessive sleeping.
5. Diurnal variation – mood is regularly worst in morning, immediately after awakening, and
improves as the day progresses.
6. Diminished libido – decreased sexual interest, drive, and performance.
*Increased libido is usually associated with manic states.
7. Constipation – inability or difficulty in defecating.

DISTURBANCES IN MOTOR FUNCTIONING

1. Motor Behavior – the aspect of the psyche which includes impulses, motivations, wishes,
drives,as expressed by a person’s behavior or motor activity.
2. Echopraxia – the person’s pathological imitation of movements of another person.
3. Catatonia – motor anomalies in non−organic disorders (as opposed to disturbances of

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consciousness and motor activity secondary to organic pathology)
a. Catalepsy – general term used to describe an immobile position that is constantly
maintained.
b. Catatonic Excitement – agitated, purposeless motor activity that is uninfluenced by external
stimuli.
c. Catatonic Stupor – noticeable slowed motor activity, often to a point of immobility and
seeming unawareness of surroundings.
d. Catatonic Rigidity – voluntary assumption of a rigid posture, held against all efforts to be
moved.
e. Catatonic Posturing – voluntary assumption of an inappropriate or bizarre posture which is
generally maintained for long periods of time.
f. Cerea Flexibilitas (Waxy Flexibility) – a condition wherein the person can be molded into a
position that is then maintained. When the examiner moves the person’s limb, the limb feels
as if it were made of wax.
3. Negativism – motiveless resistance to all instructions or to all attempts to be moved.
4. Cataplexy – temporary muscle weakness and loss of muscle tone precipitated by a variety of
emotional states.
5. Stereotypy – repetitive fixed pattern of physical action or speech.
6. Mannerism – deep−seated/ingrained and habitual involuntary movement.
7. Automatism – automatic performance of an act or acts generally representative of unconscious
symbolic activity.
8. Command Automatism –automatic following of suggestions. (automatic obedience)
9. Mutism – voicelessness that is not caused by structural abnormalities or physical conditions.
10. Overactivity – abnormality in motor behavior that can manifest itself as psychomotor agitation,
hyperactivity, tic, sleepwalking, or compulsions
a. Psychomotor Agitation – excessive motor and cognitive overactivity, usually nonproductive
and in response to inner tension.
b. Hyperactivity (Hyperkinesis) – restless, aggressive, and destructive activity, often associated
with some underlying organic pathology.
c. Tic – involuntary, spasmodic motor movement.
d. Sleepwalking (Somnambulism) – motor activity during sleep.
e. Akathisia – subjective feeling of muscular tension secondary to antipsychotic or other
medication, which can cause restlessness, pacing, repeated sitting and standing; can be
mistaken for psychotic agitation.
f. Compulsion – uncontrollable impulse to perform an act repetitively
i. Dipsomania – compulsion to drink alcohol.
ii. Kleptomania – compulsion to steal.
iii. Nymphomania– excessive and compulsive need for coitus in a woman.
iv. Satyriasis – excessive and compulsive need for coitus in a man.
v. Trichotillomania – compulsion to pull out one’s hair.
vi. Ritual – automatic activity compulsive in nature, anxiety−reducing in origin.

11. Hypoactivity (Hypokinesis) – decreasedmotor and cognitive activity, as in psychomotor

retardation;visible slowing of thought, speech and movements.
12. Mimicry – simple, imitative motor activity of childhood.
13. Aggression – forceful goal−directed action that may be verbal or physical; the motor counterpart
of the affect of rage, anger, or hostility.
14. Acting out – direct expression of an unconscious wish or impulse in action; unconscious fantasy is
lived out impulsively in behavior.

DISTURBANCES IN THINKING/THOUGHT
Thinking – the goal−directed flow of ideas. Symbols and associations initiated by problem or task and
leading toward a reality−oriented conclusion.
General disturbances in form or process of thinking
1. Mental disorder – clinically significant behavioral or psychological syndrome that is associated
with distress or disability, and not just an expected response to a particular event.
2. Psychosis – inability to distinguish reality from fantasy. Impairment in reality testing, with creation
of a new reality.
3. Reality testing – the objective evaluation and judgment of the world outside the self.
4. Formal though disorder – disturbance in the form of thought instead of the content of thought.
Thinking is characterized by loosened associations, neologisms, and illogical constructs. Thought

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process is disordered and the person defined psychotic.
5. Illogical thinking – thinking containing erroneous conclusions or internal contradictions. It is
considered psychopathological only when it is marked and when not caused by cultural values or
intellectual deficit.
6. Dereism – mental activity not concordant with logic experience.
7. Autistic Thinking – thinking that gratifies unfulfilled desires but has no regard for reality; a
preoccupation phase in children in which thoughts, words, or actions assume power.
8. Magical thinking – a form of dereistic thought; thinking similar to that of the preoperational phase in
children (Jean Piaget), in which thoughts, words, or actions assume power (e.g., to cause or to
prevent events).
9. Primary process thinking – general term for thinking that is dereistic;
normally found in dreams, abnormally in psychotics.

Specific disturbances in form of thought

1. Neologism – new word or phrase whose derivation cannot be understood; often seen in
schizophrenia; it has also been used to mean a word that has been incorrectly constructed but
whose origins are nonetheless understandable (e.g., headshoe to mean hat), but such
constructions are more properly referred to as word approximations.
2. Word Salad – incoherent, essentially incomprehensible, mixture of words and phrases commonly
seen in far−advanced cases of schizophrenia (See also incoherence.).
3. Circumstantiality – disturbance in the associative thought and speech processes in which a patient
digresses into unnecessary details and inappropriate thoughts before communicating the central
idea; observed in schizophrenia, obsessional disturbances, and certain cases of dementia.
4. Tangentiality – oblique, digressive, or even irrelevant manner of speech in which the central idea
is not communicated.
5. Incoherence – thought that, generally is not understandable; patient never gets from desired
point to desired goal.
6. Perseveration – pathological repetition of the same response to different stimuli, as in a repetition of
the same verbal response to different questions; persistent repetition of specific words or
concepts in the process of speaking. Seen in cognitive disorders, schizophrenia, and other mental
illness.
7. Verbigeration – meaningless and stereotyped repetition of words or phrases, as seen in
schizophrenia; also called cataphasia.
8. Echolalia – a person’s psychopathological repeating of words or phrases of by another; tends to
be repetitive and persistent. Seen in certain kinds of schizophrenia, particularly the catatonic
types.
9. Condensation – mental process in which one symbol stands for a number of components.
10. Irrelevant answer – answer that is not in harmony with question asked.
11. Loosening of associations – characteristic schizophrenic thinking or speech disturbance
involving a disorder in the logical progression of thoughts; manifested as a failure to communicate
verbally adequately; unrelated and unconnected ideas shift from one subject to another.
12. Derailment – gradual or sudden deviation in train of thought without blocking; sometimes used
synonymously with loosening of association.
13. Flight of ideas – rapid succession of fragmentary thoughts or speech in which
content changes abruptly and speech may be incoherent.
14. Clang association – association or speech directed by the sound of a word rather than by its
meaning; words have no logical connection; punning and rhyming may dominate the verbal
behavior. Seen most frequently in schizophrenia or mania.
15. Blocking – abrupt interaction in train of thinking before a thought or idea is finished after brief
pause, person indicates no recall of what was being said or was going to be said.
16. Glossolalia – unintelligible jargon that has meaning to the speaker but not to the listener; occurs
in schizophrenia.

Specific disturbances in content of thought

1. Poverty of content – thought that gives little information because of vagueness, empty
repetitions, or obscure phrases.
2. Overvalued idea – false or unreasonable belief or idea that is sustained beyond the bounds of
reason; it is held with less intensity or duration than a delusion, but is usually associated with
mental illness.
3. Delusion – false belief, based on incorrect inference about external reality, not consistent with
patient’s intelligence and cultural background that cannot be corrected by reasoning
a. Bizarre delusion – false belief that is patently absurd or fantastic (e.g., invaders from space
have implanted electrodes in a person's brain), common in schizophrenia.

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b. Systematized delusion – group of elaborate delusions related to a single event or theme.
c. Mood-congruent delusion – delusion with content that is mood appropriate (e.g., depressed
patients who believe that they are responsible for the destruction of the world).
d. Mood-incongruent delusion – delusion with content that has no association to mood or is
mood−neutral.
e. Nihilistic delusion – depressive delusion that the world and everything related to it have
ceased to exist.
f. Delusion poverty – false belief that one is bereft or will be deprived of all material
g. Somatic Delusion – delusion pertaining to the functioning of one's body.
h. Paranoid delusions – includes persecutory delusions and delusions of reference, control,
and grandeur
i. Delusion of persecution – false belief of being harassed or persecuted; often found in
litigious patients who have a pathological tendency to take legal action because of
imagined mistreatment. (most common delusion)
ii. Delusion of grandeur – exaggerated conception of one's importance, power, or identity.
iii.Delusion of reference – false belief that the behavior of others refers to oneself or that
events, objects, or other people have a particular and unusual significance, usually of a
negative nature; derived from idea of reference, in which persons falsely feel that others are
talking about them (e.g., belief that people on television or radio are talking to or about the
person). See also thought broadcasting.
i. Delusion of self-accusation – false feeling of remorse and guilt. Seen in depression with
psychotic features
j. Delusion of Control -false belief that a person's will, thoughts, or feelings are being controlled
i. Thought withdrawal – delusion that one’s thoughts are being removed from one’s mind
by other people or forces.
ii. Thought insertion – delusion that thoughts are being implanted in one's mind by other
people or forces.
iii.Thought broadcasting – feeling that one's thoughts are being broadcast or projected
into the environment.
k. Delusion of infidelity – false belief that one's lover is unfaithful. Sometimes called
pathological jealousy.
l. Erotomania – delusional belief, more common in women than in men, that someone is deeply
in love with them (also known as de Clérembault syndrome).
m. Pseudologia fantastica – a type of lying, in which the person appears to believe in the
reality of his or her fantasies and acts on them.
4. Preoccupation of thought – centering of thought content on a particular idea, associated with a
strong affective tone, such as a paranoid trend or a suicidal or homicidal preoccupation.
5. Egomania – morbid self−preoccupation or self−centeredness.
6. Monomania – mental state characterized by preoccupation with one subject.
7. Hypochondria – exaggerated concern about health that is based not on real medical pathology,
but on unrealistic interpretations of physical signs or sensations as abnormal.
8. Obsession – persistent and recurrent idea, thought, or impulse that cannot be eliminated from

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9. Compulsion – pathological need to act on an impulse that, if resisted, produces anxiety; repetitive
behavior in response to an obsession or performed according to certain rules, with no true end in
itself other than to prevent something from occurring in the future.
10. Coprolalia – involuntary use of vulgar or obscene language. Observed in some cases of
schizophrenia and in Tourette's syndrome.
11. Phobia – persistent, pathological, unrealistic, intense fear of an object or situation; the phobic
person may realize that the fear is irrational but, nonetheless, cannot dispel it.
a. Simple phobia – circumscribed dread of a discrete object or situation.
b. Social phobia – fear of public humiliation, as in fear of public speaking, performing, or eating
c. Acrophobia – fear of high places.
d. Algophobia – fear of pain.
e. Claustrophobia – Abnormal fear of closed or confining spaces.
f. Xenophobia – Abnormal fear of strangers.
g. Zoophobia – Abnormal fear of animals.

12. Noesis – a revelation in which immense illumination occurs in association with a sense that one
has been chosen to lead and command.
13. Unio mystica – feeling of mystic unity with an infinite power.

Disturbances in Speech
Speech –ideas, Thoughts, feelings as expressed through language; communication through the use of
words and language.
1. Pressure of Speech – rapid speech that is increased in amount difficult to interpret.
2. Volubility (logorrhea) – copious, coherent, logical speech; excessive talking observed in manic
episodes of bipolar disorder. (also known as tachylogia, verbomania)
3. Poverty of Speech – restriction in the amount of speech used; replies may be mono−syllabic.
4. Nonspontaneous speech – verbal responses given only when asked or spoken to directly; no
selfinitiation of speech.
5. Poverty of content of speech – speech that is adequate in amount but conveys little information
because of vagueness, emptiness or stereotyped phrases.
6. Dysprosod – loss of normal speech melody. (called prosody)
7. Dysarthria – difficulty in articulation, not in word finding or in grammar.
8. Excessively loud or soft speech – loss of modulation of normal speech volume; may reflect a
variety of pathological conditions ranging from psychosis to depression to deafness.
9. Stuttering – frequent repetition or prolongation of a sound or syllable, leading to markedly
impaired speech fluency.
10. Cluttering – erratic and dysrhythmic speech, consisting of rapid and jerky spurts.

APHASIC DISTURBANCES (disturbances in language output)

1. Motor Aphasia – disturbance of speech caused by an organic mental disorder in which
understanding remains but ability to speak is grossly impaired; speech is halting laborious, and
inaccurate. (also known as Broca’s, non−fluent, or expressive aphasia)
2. Sensory Aphasia – organic loss of ability to comprehend the meaning of words; speech is fluid and
spontaneous, but incoherent and nonsensical. (also known as Wernicke’s, fluent, or receptive
aphasia)
3. Nominal Aphasia – difficulty in finding correct name for an object. (also termed anomia)
4. Syntactical Aphasia – inability to arrange words in proper sequence.
5. Jargon Aphasia – words produced are totally neologistic; nonsense words repeated with various
intonations and inflections.
6. Global Aphasia – combination of a grossly non−fluent aphasia and a severe fluent aphasia.

DISTURBANCES OF PERCEPTION
Perception – process of transferring physical stimulation into psychological information; the mental
process by which sensory stimuli are brought into awareness.
1. Hallucination – false sensory perception not associated with real external stimuli; there may or
may not be a delusional interpretation of the hallucinatory experience; hallucinations indicate a
psychotic disturbance only when associated with impairment in reality testing
a. Hypnagogic Hallucination – false sensory perception occurring while falling asleep;
generally considered a non−pathological phenomenon.
b. Hypnopompic Hallucination – false perception occurring while awakening from sleep;
generally considered non−pathological.
c. Auditory Hallucination – false perception of sound, usually voices but also other noises such

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as music; most common hallucination in psychiatric disorders.
d. Visual Hallucination – false perception involving sight consisting of both formed images(e.g.
people) and unformed images (e.g. flashes of light); most common in organically determined
disorders.
e. Olfactory Hallucination – false perception in smell; most common in organic disorders.
f. Gustatory Hallucination – false perception of taste, such as unpleasant taste caused by an
uncinate seizure; most common in organic disorders.
g. Tactile (Haptic) Hallucination – false perception of touch or surface sensation, as from an
amputated limb (phantom limb), crawling sensation on or under the skin (formication).
h. Somatic Hallucination – false sensation of things occurring in or to the body, most often
visceral in origin (also known as cenesthetsic hallucination).
i. Lilliputian Hallucination – false perception in which objects are seen as reduced in size
(also termed micropsia).
j. Mood-congruent Hallucination – a kind of hallucination wherein the content of which is
consistent with either a depressed or manic mood (e.g. a depressed patient hears voices
saying that the patient is a bad person; a manic patient hears voices saying that the patient is
inflated of worth, power, knowledge, etc.)
k. Mood-incongruent Hallucination – Hallucination whose content is not consistent with either
depressed or manic mood (e.g. in depression, hallucinations not involving such themes as
guilt, deserved punishment, or inadequacy; in mania, hallucinations not involving such
themes as inflated worth or power)
l. Hallucinosis – Hallucinations, most often auditory, that are associated with chronic alcohol
abuse and that occur within a clear sensorium.
m. Trailing Phenomenon – perceptual abnormality associated with hallucinogenic drugs in which
moving object are seen as a series of discrete and discontinuous stages.
2. Illusion – misperception or misinterpretation of real external sensory stimuli.

DISTURBANCES ASSOCIATED WITH ORGANIC MENTAL DISORDER

Agnosia – an inability to recognize and interpret the significance of sensory Impressions.
1. Anosognosia – inability to recognize illness as occurring to oneself.
2. Autotopagnosia – inability to recognize a body part as one’s own.
3. Visual Agnosia – inability to recognize objects or persons.
4. Astereognosia – inability to recognize objects by touch.
5. Prosopagnosia – inability to recognize faces.
6. Apraxia – inability to carry out specific tasks.

DISTURBANCES ASSOCIATED WITH CONVERSION AND DISSOCIATIVE PHENOMENA

Somatization of repressed material or the development of physical and distortions involving the
voluntary muscle or special sense organs; not under voluntary control and not explained by any physical
disorder.

1. Hysterical Anesthesia – loss of sensory modalities resulting from emotional conflicts.

2. Macropsia – state in which objects seemlarger than they are.
3. Micropsia – state in which objects seem smaller than they are (both macropsia and micropsia can
also be associated with clear organic conditions such as complex partial seizures).
4. Depersonalization – a subjective sense of being unreal, strange, or unfamiliar to oneself.
5. Derealization – a subjective sense that the environment is strange or unreal; a feeling of changed
reality.
6. Fugue – taking on a new identity with amnesia for the old identity; often involves travel or
wandering to new environments.
7. Multiple personality – one person who appears at different times to be in possession of an
entirely different personality and character.

DISTURBANCES OF MEMORY
Memory – function by which information stored in the brain is later recalled to consciousness
1. Amnesia – partial or total inability to recall past experiences; may be organic or emotional in
origin.
2. Paramnesia – falsification of memory by distortion of recall.
a. Fausse reconnaissance – false recognition.

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b. Retrospective falsification – memory becomes unintentionally (unconsciously) distorted by

being filtered through patient’s present emotional, cognitive, and experiential state.
c. Confabulation – unconscious filling of gaps in memory by imagined or untrue experiences
that patient believes but that have no basis in fact; most often associated with organic
pathology
d. Déjà vu – illusion of visual recognition in which a new situation is correctly regarded as a
repetition of a previous memory.
e. Déjà entendu – illusion of auditory recognition.
f. Déjà pense – illusion that a new thought is recognized as a thought previously felt or
expressed.
g. Jamias vu – false feeling of unfamiliarity with a real situation one has experienced.
– a person’s recollection and belief by the patient of an event that did not

3. Hypermnesia – exaggerated degree of retention and recall.

4. Eidetic image – visual memory of almost hallucinatory vividness.
5. Screen memory – a consciously tolerable memory covering for a painful memory.
6. Repression – a defense mechanism characterized by unconscious forgetting of unacceptable
ideas or impulses.
7. Lethologica – temporary inability to remember a name or a proper noun.
8. Blackout – amnesia experienced by alcoholics about behavior during drinking bouts; usually
indicates that reversible brain damage has occurred.

Levels of Memory
a. Immediate – reproduction or recall of perceived material within seconds to minutes.
b. Recent – recall of events over past few days.
c. Recent past – recall of events over past few months.
d. Remote – recall of events in distant past.

DISTURBANCES OF INTELLIGENCE
Intelligence – the ability to understand, recall, mobilized, and constructively integrates previous
learning in meeting new situations.
1. Mental Retardation: Lack of intelligence to a degree in which there is interference with social and
vocational performance:
a. Mild (I.Q. of 50 or 55 to approximately 70)
b. Moderate (I.Q. of 35or 40 to 50 or 55)
c. Severe (I.Q. of 20 or 25 to 35 or 40)
d. Profound (I.Q. below 20 or 25)Obsolete terms are <idiot= (mental age less than 3 years),
<imbecile= (mental age of 3 to 7 years), and <moron= (mental age of about 8)
2. Dementia – organic and consciousness without clouding of consciousness
a. Dyscalculia – loss of ability to do calculations not caused by anxiety or impairment in
concentration.
b. Dysgraphia – loss of ability to write in cursive style; loss of word structure.
3. Pseudodementia – clinical features resembling a dementia not caused by an organic mental
dysfunction; most often caused by depression.
4. Concrete thinking – literal thinking; limited use of metaphor without understanding of nuances of
meaning; one dimensional thought.
5. Abstract thinking – ability to appreciate nuances of meaning; multidimensional thinking with
ability to use metaphors and hypotheses appropriately.

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Chapter 4.1 Anxiety Disorder

● Phobia
● Fear
● Anxiety

Fear
→ is the emotional response to real or perceived imminent threat.
→ It is an immediate alarm reaction to danger.

Anxiety
→ It is a specific type of disorder which means there is fear that occurs when there is nothing to be
afraid of.
→ “fear of the unknown”

Phobia
→ is a persistent, excessive, unrealistic fear of an object, person, animal, activity or situation.
→ A person with a phobia either tries to avoid the thing that triggers the fear, or endures it with
great anxiety and distress.

Causes
- Genes
- Social
- Psychological
PANIC / PANIC ATTACK/ PANIC DISORDER : It is a sudden overwhelming reaction.
→ An abrupt experience of intense fear or acute discomfort, accompanied by physical symptoms.

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.

Generalized Anxiety Disorder (GAD) - Uncontrollable, unproductive worrying about everyday events.
→ Feeling of impending catastrophe even after success.Diagnostic Criteria

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.
C. The anxiety and worry are associated with three (or more) of the following six 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 for children.
1.Restlessness or feeling keyed up or on edge.
2.Being easily fatigued.

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3.Difficulty concentrating or mind going blank.
4.Irritability.
5.Muscle tension.
6.Sleep disturbance (difficulty falling or staying asleep, or restless,
unsatisfying sleep).
D.The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a
medication) or another medical condition
(e.g., hyperthyroidism).
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 social anxiety disorder [social phobia], contamination or
other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety
disorder, reminders of traumaticevents in posttraumatic stress disorder, gaining weight in anorexia nervosa,
physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder,
having a serious illness in illness anxiety disorder, or the content of delusional beliefs in
schizophrenia or delusional disorder).

Social Anxiety Disorder (SAD): Being fearful or anxious about or avoidant of social interactions and
situations that involve the possibility of being scrutinized.

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).
C.The social situations almost always provoke fear or 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 social situations are avoided or endured with intense fear or anxiety.
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 is persistent, typically lasting for 6 months or more.
G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
H.The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance
(e.g., a drug of abuse, a medication) or another medical condition.
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.
J. If another medical condition (e.g Parkinson's disease, obesity, disfigurement from bums or injury)
is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.
Specify if:
Performance only: If the fear is restricted to speaking or performing in public.

SEPARATION ANXIETY: Being fearful or anxious about separation from attachment figures to a degree
that is developmentally inappropriate.
→ Is characterized by children’s unrealistic and persistent worry that something will happen to
them or to their parents or other important people in their life.

Diagnostic Criteria
A. 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:
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

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to them, such as illness, injury, disasters, or death.
3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost,
being kidnapped, having an accident, becoming ill) that causes 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.
5. Persistent and excessive fear of or reluctance about being alone or without major attachment
figures at home or in other settings.
6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a
major attachment figure.
7. Repeated nightmares involving the theme of separation.
8. Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea,
vomiting) when separation from major attachment figures occurs or is anticipated.
B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents
and typically 6 months or more in adults.
C. The disturbance causes clinically significant distress or impairment in social, academic, occupational,
or other important areas of functioning.
D. The disturbance is not better explained by another mental disorder, such as refusing to leave home
because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations
concerning separation in psychotic disorders; refusal to go outside without a trusted companion in
agoraphobia; worries about ill health or other harm befalling significant others in generalized anxiety disorder;
or concerns about having an illness in illness
anxiety disorder.

SPECIFIC PHOBIA: Being fearful or anxious about or avoidant of circumscribed objects or situations.

Diagnostic Criteria
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.
C. The phobic object or situation is actively avoided or endured with intense fear or anxiety.
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.
E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
G. The disturbance is not better explained by the symptoms of another mental disorder, including
fear, anxiety, and avoidance of situations associated with panic-like symptoms or other
incapacitating symptoms (as in agoraphobia): objects or situations related to obsessions (as in
obsessive-compulsive disorder); reminders of traumatic events (as in posttraumatic stress disorder);
separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in
social anxiety
disorder).

AGORAPHOBIA: being fearful and anxious about two or more of the following situations: using
public transportation; being in open spaces; being in enclosed places; standing in line or being in a
crowd; or being outside of the home alone in other situations.

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Chapter 4.2 Trauma-and Stressor-Related And

Obsessive-Compulsive and Related Disorders
Trauma- and Stressor- Related Disorders
→ These disorders are serious psychological reactions that develop in some individuals following
exposure to a traumatic or stressful event such as childhood neglect, childhood physical/sexual
abuse, combat, physical assault, sexual assault, natural disaster, an accident or torture.

Post Traumatic Stress Disorder

Reactive Attachment Disorder (RAD)

→ is characterized by serious problems in emotional attachment to others.
→ These children rarely seek comfort when distressed and are minimally emotionally responsive to
others.
→ Results from a pattern of insufficient caregiving or emotional neglect that limits an infant’s
opportunities to form stable attachments.

Disinhibited Social Engagement Disorder

→ is characterized by a pattern of behavior that involves culturally inappropriate, overly familiar
behavior with unfamiliar adults and strangers.

Adjustment Disorders
→ are characterized by the development of emotional or behavioral symptoms in response to an
identifiable stressor (e.g., problems at work, going off to college). Adjustment disorder symptoms
must occur within three months of the stressful event. Symptoms do not persist more than six
months.

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Acute Stress Disorder
→ is similar to PTSD but the duration of the psychological distress last only three days to one month
following exposure to a traumatic or stressful events.

Obsessive-Compulsive Disorder (OCD)

→ is a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring
thoughts (obsessions) and/or behaviors (compulsions) that he or she feels the urge to repeat over
and over.

Obsessions Compulsions

➢ are intrusive and mostly ➢ are a repetitive

nonsensical thoughts, behaviors performed
images, or urges that in response to
individuals try to resist or uncontrollable urges
eliminate. (persistently and or to a ritualistic set
repeatedly comes into a person’s or rules.
mind and causes ➢ Excessive cleaning
distress) and/or
➢ Fear of germs or handwashing
contamination ➢ Ordering and arranging
➢ Unwanted forbidden or taboo things in a particular,
thoughts involving sex, precise way
religion, or harm ➢ Repeatedly checking on
➢ Aggressive thoughts things, such as repeatedly
towards checking to see if the door
others or self is locked or that the oven is
➢ Having things symmetrical or off
in a perfect order ➢ Compulsive counting

OCD DIAGNOSTIC CRITERIA

A. 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 of action (I.e., by performing 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.
C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance
(e.g., a drug of abuse, a medication) or another medical condition.
D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive
worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder;
difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania
[hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic
movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or
gambling, as in substance-related and addictive disorders;

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eoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic
disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major
depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other
psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder). 266

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 probably true. With absent insight/delusional beliefs: The
individual is completely convinced that obsessive-compulsive disorder beliefs are true.

Specify if:
Tic-related: The individual has a current or past history of a tic disorder.

NOTE:
Not all rituals or habits are compulsions. Everyone double checks things sometimes. But a person
with OCD generally:
• Can't control his or her thoughts or behaviors, even when those thoughts or behaviors are
recognized as excessive
• Spends at least 1 hour a day on these thoughts or behaviors
• sn’t get pleasure when performing the behaviors or rituals, but may feel brief relief from the
anxiety the thoughts cause
• Experiences significant problems in their daily life due to these thoughts or behaviors.

BODY DYSMORPHIC DISORDER

•Preoccupation with some imagined defects in appearance by someone who actually looks
reasonably normal.
• “imagined ugliness”

Diagnostic Criteria for Body Dysmorphic Disorder

A. Preoccupation with one or more defects or flaws in appearance (not observable or appear slight
to others)
B. Perform repetitive behaviors or mental acts in response to the appearance of concerns
C. The preoccupation causes clinically significant distress or impairment
D. The appearance preoccupation is not better explained by concerns with body fat or weight in an
individual whose symptoms meet diagnostic criteria for an eating
disorder

Other OCD and Related Disorders HOARDING DISORDER

➢ People with hoarding disorder excessively save items that others may view as worthless. They
have persistent difficulty getting rid of or parting with
possessions, leading to clutter that disrupts their ability to use their living or work spaces.
▪ acquisition
▪ Difficulty discarding
▪ Living with excessive clutter (gross organization)

TRICHOTILLOMANIA : also referred to as “hair-pulling disorder,” is a mental disorder classified under

Obsessive-Compulsive and Related Disorders and involves recurrent, irresistible urges to pull hair from the
scalp, eyebrows, eyelids, and other areas of the body, despite repeated attempts to stop or decrease hair
pulling.

EXCORIATION: (also referred to as chronic skin-picking or dermatillomania) is a mental illness

related to obsessive-compulsive disorder. It is characterized by repeated picking at one’s own skin
which results in skin lesions and causes significant disruption in one’s life.

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