UNIVERSITY OF CALOOCAN CITY

Biglang Awa Street, 12th Avenue, Grace Park East, Caloocan City
COLLEGE OF LIBERAL ARTS AND SCIENCES PSYCHOLOGY DEPARTMENT

Summary of Chapters 5, 6, 7, and 8

In Partial Fulfillment for Abnormal Psychology

Submitted by:
Alforte, Julia B.
Bachelor of Science in Psychology 3B

Submitted to
Ms. Louella Obra
Chapter 5: Anxiety, Trauma- and Stressor-
Related, and Obsessive-Compulsive and
Related Disorders
Anxiety. Anxiety is a negative mood state that is characterized by tension
in the body and fear for the future. It may be behavioral, physiological or
subjective. Although anxiety is often perceived as unpleasant, in moderation
it can be beneficial. According to researchers, people function better in
social, physical and intellectual performance when they are slightly anxious.

 Negative Affect
 Somatic symptoms of tension
 Future-oriented
 Feelings that one cannot predict or control upcoming events

Fear. Fear is an immediate alarm reaction to danger. Like anxiety, it can be

beneficial as it activates the autonomic nervous system, leading to
immediate alarm response, or the flight or fight response.

 Negative Affect
 Strong sympathetic nervous system arousal
 Immediate alarm reaction characterized by strong escapist tendencies
in response to present danger or life-threatening emergencies

Panic. Sudden overwhelming reaction when a person experiences the

alarm response of fear when there is nothing to be afraid of.

Panic Attack. It is defined as an abrupt experience of intense fear or

acute discomfort, accompanied by physical symptoms that usually include
heart palpitations, chest pain, shortness of breath, and, possibly, dizziness.

Anxiety Disorders
Generalized Anxiety Disorders
 Excessive anxiety and worry occurring more days than not for at least
6 months (DSM-5).
 Individual finds it difficult to control the worry.
 Characterized by muscle tension, mental agitation, vulnerability to
fatigue, some irritability, and difficulty in sleeping.
  Worry, anxiety, or physical symptoms considerably hinder social,
professional, or other critical areas of functioning or create discomfort.

Panic Disorder
 Individual experience recurrent severe and unexpected panic attacks.
 One or both of the following have persisted for at least 1 month of the
attacks: Persistent concern or worry about additional panic attacks or
their consequences or a significant maladaptive change in behavior
related to the attacks (avoidance).

Agoraphobia
 Fear and avoidance of situation in which an individual feels unsafe.
These situations include public transportation, open spaces, enclosed
places, standing in line or being in a crowd, being outside home alone
 Individual avoids situations because of the thoughts that escape could
be difficult or help might not be available.
 Agoraphobic situations almost always provoke fear or anxiety.
 The fear, anxiety or avoidance is persistent, that typically lasting for 6
months or more.

Specific Phobia
 Specific Phobia is unreasonable fear associated with a particular object
or situation that significantly interferes with individual’s ability to
function.
 The phobic object or situation almost always provoke immediate fear
or anxiety.
 The phobic object or situation is endured with intense fear or anxiety or
avoided.
 Persistent anxiety, fear or avoidance, typically 6 months or more.

Separation Anxiety Disorder

 defined by individual’s unrealistic and persistent fear that something
will happen to whom they are attached or other significant figures in
their lives,
 Symptoms present for at least 4 weeks in children/adolescents and 6
months or more in adults.

Social Anxiety Disorder (Social Phobia)

  Social anxiety is Fear of social situations, especially when it involves
having to "perform" in front of others.

Selective Mutism
 Rare childhood disorder characterized by lack of speech in one or more
settings in which speaking is socially expected.
 Symptoms persist for at least 1 month nor including a child’s 1 st month
in school.

Trauma and Stressor-Related Disorders

Stress - A person’s biological and psychological responses to adjusted
demands.

Attachment disorder
- Adjustment disorder is the development of anxiety or depression in
response to stressful, but not traumatic, life events

Reactive Attachment Disorder

- young children who are reticent and emotionally distant, unable to
establish a bond with carers.

Disinhibited Social Engagement Disorder

- characterizes children who improperly approach every stranger, acting
as though they had had lastingly deep and affectionate relationships
with them.

Post Traumatic Stress Disorder

 Exposure to actual or threatened death, serious injury, or sexual
violence in one or more of the following ways:
a) Directly experienced traumatic event(s).
b) Witnessing in person the traumatic event(s) that occurred to
others.
c) Experienced repeated or extreme exposure to aversive details of
the traumatic events(s).
 Presence of one or more of the following intrusion symptoms
associated the traumatic event(s).
a) Unpleasant, persistent, involuntary memories of the traumatic
incident(s).
 b) Recurrent, distressing dreams where the subject matter and/or
affect are connected to the traumatic incidents(s).
c) Dissociative reactions, such as flashbacks, it occurs when an
individual acts of feels as if the traumatic event(s) are happening
again.
d) Intense and prolonged psychological distress when exposed to
stimuli, whether internal or external, that represent or bear
similarities to a traumatic incident or event(s).
e) Marked physiological reactions to internal or external cues that
symbolize or resemble an aspect of the traumatic event(s).
 Persistent avoidance of stimuli associated with the traumatic event(s).
a) Avoiding, or trying to avoid, upsetting memories, feelings, ideas,
or conversations related to the traumatic event(s).
b) Avoiding or trying to avoid environmental cues that trigger
painful memories, such as persons, places, conversations,
activities, things, or circumstances ideas or sentiments
connected to the painful incident or events.
 Negative alterations in cognitions and mood associated with the
traumatic event(s).
 Significant changes in responsiveness and arousal related to the
traumatic event(s).
 Sleep disturbance, either difficulty falling or staying asleep or restless
sleep.
 Disturbance lasting more than 1 month.

Obsessive-Compulsive and Related Disorders

 Presence of obsessions, compulsions or both:

Obsessions are intrusive and mostly absurd ideas, pictures, or urges that
the individual tries to ignore of suppress.

Compulsion are the repetitive thoughts, or excessive behaviors used to

suppress the obsessions and relieve them.

 The obsessions or compulsion are time consuming, or cause clinically

distress or impairment in social, occupational or other important area
of functioning
 It is common in women than men and begins in childhood.
Body Dysmorphic Disorder
 Preoccupation with some imagined defect in appearance by someone
who looks normal. The disorder has been referred to as “imagined
ugliness”.
 The individual has performed repetitive behaviors or mental acts in
response to appearance concerns.
o Example: Mirror checking, excessive grooming, skin picking,
reassurance seeking.

Hoarding Disorder
 Characterized by an excessive amount of material possessions, having
trouble getting rid of anything and having too much junk under
circumstances that are best described as gross disorganization

Trichotillomania (Hair pulling disorder)

 The impulse to pull one's own hair off from any part of the body,
including the arms, brows, and scalp. This result in significant
noticeable loss of hair.

“Dermatillomania” Excoriation (Skin picking disorder)

 Characterized by repetitive and compulsive skin picking, resulting in
tissue injury.

Chapter 6: Somatic Symptom and Related

Disorders and Dissociative Disorders
Soma means body, and the problems these people appear to be dealing
with, to be physical disorder.
A commonality among somatic symptom disorders is excessive or
maladaptive in response to related health concerns or physical symptoms.
Occasionally, these conditions are combined under the abbreviated term of
"physical symptoms that are medically unexplained."

 One or more somatic symptoms that are dressing and/or result in

significant disruption of daily life.
 Excessive thoughts, feelings, and behaviors associated with the
physical signs or related health issues as they appeared by a minimum
of one of the following:
a) Disproportionate and persistent thoughts on the severity of one's
symptoms.
b) High levels of health-related anxiety.
c) Spending too much time and effort on these symptoms or health
issues.
 Any one symptom may not be continuously present, the state of being
symptomatic is persistent, typically more than 6 months.

Illness Anxiety Disorder

Illness anxiety disorder is a condition where individuals feel seriously ill and
become anxious about this possibility, even without experiencing any
physical symptoms.

 Formerly known as "hypochondriasis”. In illness anxiety disorder,

physical symptoms are either not experienced at the present time or
are very mild but severe anxiety is focused on the possibility of having
or developing a serious disease.
 preoccupation with worrying that one will get a terrible illness.
 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
 There is a high level of anxiety about health, and the individual is
easily alarmed about personal health status
 Excessive health-related behaviors or exhibits maladaptive avoidance.
 Preoccupation with illness has persisted for at least 6 months.
Nevertheless, the precise ailment that is feared could alter over that
duration.
Conversion Disorder (Functional Neurological Symptom
Disorder)
Conversion disorder involves physical malfunction without apparent issues,
making it difficult to distinguish between conversion reactions, real disorders,
and outright malingering or factitious disorder, where symptoms are feigned.

The term conversion has been used off and on since the Middle Ages (Mace,
1992) but was popularized by Freud. This allowed the person to express
some anxiety without feeling it. Like phobic conditions, the anxiety that
follows disputes that are unconscious could be "displaced" upon another
object.

“Functional neurological symptom disorder” is a subtitle to conversion

disorder because the term is more often used by neurologists who see most
patients receiving a conversion disorder diagnosis, and because the term is
more acceptable to patients. “Functional” refers to a symptom without an
organic cause

 Conversion disorder often involve physical malfunctions like paralysis,

blindness, or trouble communicating (aphonia) with no biological or
physical pathology. Conversion symptoms indicate neurological
conditions affecting sensory-motor systems.
 One or more symptoms of altered voluntary motor sensory function.
 Clinical findings provide evidence of incompatibility between the
symptom and recognized neurological or medical conditions
 The symptom or deficit is not better explained by another medical or
mental disorder

Closely Related Disorders

Malingering (faking) - is sometimes difficult. Several factors can help,
but one symptom, widely regarded as a diagnostic sign, has proved not to be
useful.

La Belle Indifférence - is a term that describes when someone seems

strangely unconcerned about their physical or mental symptoms, even when
those symptoms are severe.
Factitious Disorders
 Fall somewhere between malingering and conversion disorders.
 The symptoms are under voluntary control, as with malingering, but
there is no obvious reason for voluntarily producing the symptoms
except, possibly, to assume the sick role and receive increased
attention.
 When an individual deliberately makes someone else sick, the
condition is called factitious disorder imposed on another. It was
previously known as Munchausen syndrome by proxy.
 Defined as falsification of physical or psychological signs or symptoms,
or induction of injury or disease, associated with identified deception.
 The deceptive behavior is evident even in the absence of obvious
external rewards.
 The behavior is not better accounted for by another mental disorder
such as delusional belief system or acute psychosis.

Treatment
Somatic symptom disorders can be treated with reassurance, social support,
and stress reduction interventions, with tailored cognitive-behavioral therapy
being particularly successful in treating these conditions.

Dissociative Disorders
When individuals feel detached from themselves or their surroundings,
almost as if they are dreaming or living in slow motion, they are having
dissociative experiences.

 Refers to a mental state or process where a person's thoughts,

feelings, identity, or consciousness become disconnected or separated
from one another, feeling detached from one ' s surroundings.

Dissociative disorders and somatic symptoms are closely linked. Evidence

and history suggest they have similar features. They were once placed under
a single, broad heading, "Hysterical neurosis."

According to psychoanalytic theory, the term "neurosis" suggested a

particular cause for disorders, specifically neurotic disorders resulted from
underlying unconscious conflicts, anxiety that resulted from those conflicts,
and the result of use of ego defensive systems. In 1980, neurosis was
removed from the diagnostic framework because to its excessive ambiguity,
which encompassed nearly all nonpsychotic illnesses, and as it suggested a
particular but unknown reason for these illnesses.

Hysteria – The word "hysteria," which was first used by the Egyptians
and Greek physician Hippocrates, implies that the origin of the disorder,
which were formerly believed to affect women exclusively, can be linked to a
"wandering uterus," however the term "hysterical” became more widely
used to describe physical symptoms without a known natural source or to
spectacular or "histrionic" conduct believed to be a quality shared by
women.

Depersonalization-Derealization Disorder
Depersonalization: Experiences of unreality, detachment, or being an
outside observer with respect to one’s thoughts, feelings, sensation, body or
actions.

During episode of depersonalization, perception alters so that individuals

temporarily lose the sense of reality, as if they were in a dream and they
were watching themselves.

Derealization: Experiences of unreality or detachment with respect to

surrounding.

During an episode of derealization, sense of the reality of the external world

is lost. Things may seem change shape or size, people may seem dead or
mechanical.

 The presence of persistent or recurrent experiences of

depersonalization, derealization, or both.
 During the depersonalization or derealization experience, reality
testing remains intact.
 The symptoms cause clinically significant distress or impairment on
social, occupational, or other important areas of functioning.

Dissociative Amnesia
An incapacity to recollect crucial personal details, typically of an uneven,
unpleasant, or stressful nature with regular forgetfulness. Notably,
dissociative amnesia typically comprises selective or localized amnesia
related to a certain incident or occurrences, or widespread forgetfulness of
one's identity and past.

Generalized Amnesia
 People who are unable to remember anything, including who they are.
 Generalized amnesia may be lifelong or may extend from a period in
the more recent past, such as 6 months or a year previously.

Localized or Selective Amnesia

 a failure to recall specific events, usually traumatic, that occur during a
specific period.
 In most cases of dissociative amnesia, the forgetting is selective for
traumatic events or memories rather than generalized.

Dissociative Fugue
 A subtype of dissociative amnesia. fugue literally meaning “flight”
(fugitive is from the same root)
 Memory loss revolves around a specific incident- an unexpected trip (or
trips).
 Fugue states typically come to a sudden conclusion, and the person
comes home and remembers most of what happened, if not all of it. In
this disorder, the disintegrated experience extends beyond memory
loss, entailing the complete adoption of a new identity, if not at least
partial identity dissolution.

Amok “running amok”

- Distinct dissociative state not found in Western cultures. Amok has
attracted attention because individuals in this trancelike state often
brutally assault and sometimes kill people or animals. If the person is
not killed himself, he probably will not remember the episode. Running
amok is a syndrome where an individual enters a trance, suddenly
imbued with mysterious energy, and suddenly runs or flees for a long
time.

Dissociative Identity Disorder

Dissociative identity disorder (DID) can lead to the adoption of up to 15 new
identities, with some being complete, while others are partially independent,
resulting in "multiple" complete personalities.

Host – The person who becomes the patient and seeks treatment is typically
a "host" identity, attempting to manage fragments of identity but often
becoming overwhelmed. The first personality to seek treatment is seldom
the original personality of the person

Alters – Is the shorthand term for the different identities or personalities in

DID.

Switch – The transition from one personality to another. Usually, the switch
is instantaneous, physical transformations may occur during switches.
Posture, facial expressions, patterns of facial wrinkling, and even physical
disabilities may emerge.

 Identity disruption, characterized by distinct personality states, can be

experienced as possession in some cultures, causing alterations in
affect, behavior, consciousness, memory, perception, cognition, and
sensory-motor functioning.
 Recurrent gaps in recall of everyday events, important personal
information, and/or traumatic events are inconsistent with ordinary
forgetting.

Treatment
Dissociative disorders (DID) require long-term therapy to help patients
reexperience traumatic events and develop better coping skills, requiring
trust between therapist and patient.

Chapter 7: Mood Disorders and Suicide

Depression and Mania
The fundamental experiences of depression and mania contribute to all
mood disorders, either individually or together.
Depression (Depressive Disorder)
- Common mental disorder, it involves a depressed mood or loss of
pleasure or interest in activities for long periods of time.

Mania
- An extremely unstable euphoric or irritable mood along with an excess
activity or energy level, excessively rapid thought and speech, reckless
behavior and feeling of invincibility.

Manic Episode
A distinct period of abnormally and persistently elevated, expansive, or
irritable mood and abnormally and persistently increased goal-directed
activity or energy, lasting at least 1 week and present most of the day,
nearly every day (or any duration if hospitalization is necessary).

 DSM-5 criteria for a manic episode require a duration of 1 week, with

hospitalization if severe enough. Irritability is common during a manic
episode, and anxiety or depression is also common. Untreated manic
episodes typically last 3 to 4 months, with symptoms such as self-
destructive buying sprees and anxiety.

Hypomanic episode
DSM-5 defines a hypomanic episode as a less severe version of a manic
episode, lasting only 4 days and not causing significant impairment in social
or occupational functioning. Although not problematic, its presence
contributes to the definition of several mood disorders.

The Structure of Mood Disorders

Unipolar Mood Disorder
- Individuals with unipolar mood disorders experience depression or
mania, with their mood remaining at one pole of the depression-mania
continuum. Unipolar mania is rare, as most individuals with a disorder
eventually develop depression.

Bipolar Mood Disorder

 - A bipolar mood disorder involves alternating between depression and
mania, traveling from one "pole" of the depression-elation continuum
to another and back again.

Mixed Features
- Manic symptoms can manifest simultaneously with depression or
anxiety or be depressed with a few symptomatic mania symptoms.

Depressive Disorders
DSM-5 categorizes depressive disorders into chronic or non-chronic types,
based on frequency, severity, and course of symptoms.

Major Depressive Disorders

It is characterized by the absence of manic or hypomanic episodes, and the
occurrence of one isolated depressive episode in a lifetime is now relatively
rare. The major depressive disorder is recurrent, which is crucial for
predicting its future course.

Major Depressive Episode

 The most diagnosed and most severe depression.
 Defines it as a severe mood state lasting at least 2 weeks,
characterized by cognitive symptoms like worthlessness and
indecisiveness, and disturbed physical functions like altered sleep
patterns and weight changes. This episode often leads to a loss of
interest in life, resulting in difficulty in achieving personal or
professional goals.

Dysthymia (Persistent Depressive Disorder)

Dysthymia shares symptoms with major depressive disorder but differs in
course, with fewer symptoms but remaining consistent over long periods,
sometimes 20-30 years.

 A person with a persistently depressed mood for at least two years, as

indicated by subjective accounts or observations by others.
 Presence, while depressed, of two (or more) of the following
 a) Poor appetite or overeating
b) Insomnia or hypersomnia
c) Low energy or fatigue
d) Low self esteem
e) Poor concentration or difficulty making decisions
f) Feelings of hopelessness
 The individual has consistently experienced symptoms over two
months at a time during a 2-year period of disturbance.
 There has never been a manic episode or a hypomanic episode, and
criteria have never been met for cyclothymic disorder

Double Depression
- Individuals with both major depressive episodes and persistent
depression with fewer symptoms
- Few depressive symptoms typically develop early, followed by major
episodes that revert to the underlying pattern after the episode has
ended.

Additional Defining Criteria for Depressive

Disorders
Depressive disorders are described using eight basic specifiers, along with
rating severity as mild, moderate, or severe.

1. Psychotic features specifiers. During a major depressive episode,

individuals may experience psychotic symptoms like hallucinations
(seeing or hearing things that aren’t there) and delusions (strongly
held but inaccurate beliefs).
2. Anxious distress specifiers. The severity and presence of comorbid or
non-comorbid anxiety symptoms, whether they meet all the criteria for
an anxiety disorder.
3. Mixed features specifiers. Predominantly depressive episodes that
have several (at least three) symptoms of mania.
4. Melancholic features specifiers. Include severe physical symptoms like
early-morning awakenings, weight loss, loss of libido, excessive guilt,
and anhedonia, which can lead to reduced interest or pleasure in
activities.
 5. Catatonic features specifiers. Catatonic condition is characterized by
an absence of movement or catalepsy, where muscles are waxy and
semirigid, and may also involve excessive, random, or purposeless
movement.
6. Atypical features specifiers. Individuals with depression often oversleep
and overeat, leading to weight gain and a higher diabetes incidence.
7. Peripartum onset specifiers. Peri means “surrounding,” in this case the
period just before and just after the birth.
8. Seasonal pattern specifiers. This temporal specifier is used for
recurrent major depressive disorder and bipolar disorders, referring to
episodes occurring during specific seasons.

Seasonal Affective Disorder (SAD) – The most usual pattern is

Depressive episodes typically occur in late fall and spring, lasting at least two
years without non-seasonal major episodes, with no evidence of non-
seasonal major episodes.

Other Depression Disorders

Premenstrual Dysphoric Disorder (PMDD)
In most menstrual cycles, at least five symptoms must be present in the final
week before the onset of menses, start to improve within a few days after
the onset of menses, and become minimal or absent in the week post-
menstrual cycle.

 One or more of the following symptoms must be present:

a) Affective lability (mood swings, feeling suddenly sad or tearful,
sensitivity to rejection)
b) Irritability or anger or increased interpersonal conflicts.
c) Depressed mood, feeling of hopelessness, or self-deprecating
thoughts.
d) Anxiety, tension
 Other symptoms must be present must be present, to reach total of
five or more symptoms.
a) Decreased interest in usual activities.
 b) Subjective difficulty in concentration.
c) Lethargy, easy tangibility, lacked energy.
d) Change in appetite
e) Hypersomnia or insomnia
f) Sense of overwhelmed or out of control
g) Psychical symptoms

Disruptive Mood Dysregulation Disorder (DMDD)

A condition in which children or adolescents experience ongoing irritability,
anger, and frequent, intense temper outbursts. The symptoms of DMDD go
beyond a “bad mood.” DMDD symptoms are severe.

 A severe recurrent temper outburst, manifested verbally or

behaviorally, is characterized by verbal rages and physical aggression
towards people or property, out of proportion to the situation or
provocation.
 The temper outbursts are inconsistent with developmental level.
 The temper outbursts occur, on average, three or more times per
week.
 The mood between temper outbursts is persistently irritable or angry
most of the day, nearly every day, and is observable by others (e.g.,
parents, teachers, peers)
 Symptoms have been present for 12 or more months. Throughout that
time, the person has not had a period lasting 3 or more consecutive
months without all the symptoms.

Bipolar Disorders
Mental illness that causes unusual shifts in a person's mood, energy, activity
levels, and concentration. These shifts can make it difficult to carry out day-
to-day tasks. The key identifying feature of bipolar disorders is the tendency
of manic episodes to alternate with major depressive episodes in an
unending roller-coaster ride from the peaks of elation to the depths of
despair.

 Bipolar I the individual experiences a full manic episode.

 Bipolar II individual suffered from major depressive episodes alternate
with hypomanic episodes rather than full manic episodes.

Cyclothymic Disorder
  Milder but more chronic version of bipolar disorder.
 Cyclothymic disorder is a chronic cycle of mood elevation and
depression, typically lasting for at least 2 years, with few neutral
periods. It is not severe enough to cause major depressive episodes
and is more common in children and adolescents.

Causes of Mood Disorders

Biological Dimensions
Determine the genetic contribution to a particular disorder or class of
disorders. Researchers are particularly interested in the stress
hypothesis and the role of neurohormones

Familial and Genetic Influences

 Family studies reveal that the prevalence of a disorder in first-degree

relatives of a known disorder (proband) is 2 to 3 times higher than in
relatives of non-disordered controls, despite variability.
 Twin Studies – the best evidence that genes have something to do
with mood disorders. Several twin studies suggest that mood disorders
are heritable.

Neurotransmitter System

 Mood disorders have been the subject more extensive neurobiological

research than any other psychopathology area.
 Research implicates low levels of serotonin in the causes of mood
disorders, but only in relation to other neurotransmitters, including
norepinephrine and dopamine

Endocrine System

 Over the years, researchers have shifted focus from neurotransmitters

to the endocrine system and the "stress hypothesis" of depression's
etiology, recognizing that patients with endocrine system diseases
often experience depression.
 Neurotransmitter activity in the hypothalamus regulates hormone
release affecting the HPA axis, (starting in the hypothalamus and
running through the pituitary gland) there neurohormones a crucial
area of study in psychopathology.
Psychological Dimensions
Focus on learned helplessness and the depressive cognitive schemas,
as well as interpersonal disruptions.

Stressful Life Events

 Stress and trauma significantly contribute to the cause of psychological

disorders, influencing psychopathology and influencing the widespread
adoption of the diagnosis.
 Stressful life events are strongly related to the onset of mood
disorders.

Learned Helplessness

 Seligman suggests people become anxious and depressed when they

decide that they have no control over the stress in their lives.
 Seligman's theory suggests that anxiety is the initial response to
stressful situations, followed by depression due to hopelessness in
coping with challenging life events.

Social and Cultural Dimensions

Several social and cultural factors contribute to the onset or
maintenance of depression.

Marital Status

 Interpersonal stress, particularly marital dissatisfaction, significantly

influences depression and bipolar disorder, as disruptions in
relationships often lead to depression.
 Men were more likely to develop a mood disorder after a divorce.

Mood Disorder in Women

 Gender imbalances in mood disorders are evident, with nearly 70% of

individuals with major depressive disorder and persistent depressive
disorder being women.
 Women value intimate relationships more than men, potentially
protecting them if strong social networks exist. However, disruptions in
these relationships and an inability to cope with them are more
 damaging to women (Kendler & Gardner, 2014; Nolen-Hoeksema &
Hilt, 2009).
 Susan Nolen-Hoeksema (1990, 2000; NolenHoeksema, Wisco, &
Lyubomirsky, 2008) suggested that Women tend to ruminate more
than men about their situation and blame themselves for being
depressed.

Social Support

 Social factors significantly influence depression, with a supportive

network of friends and family aiding in recovery from depressive
episodes but not from manic episodes (Johnson, Winett, Meyer,
Greenhouse, & Miller, 1999; Johnson et al., 2008, 2009).
 People who live alone are 80% more likely to develop depression.

Treatment of Mood Disorders

Antidepressants
Antidepressant medications have been effective in treating severe
depression and preventing suicide in numerous patients worldwide, but
many refuse or are unable to use them due to concerns about long-term side
effects. Four main types of antidepressant medications are used to treat
depression: selective-serotonin reuptake inhibitors (SSRIs), mixed reuptake
inhibitors, tricyclic antidepressants, and monoamine oxidase (MAO)
inhibitors.

Lithium Carbonate
It is often effective in preventing and treating manic episodes. Therefore, it is
most often referred to as a mood-stabilizing drug.

Electroconvulsive Therapy
 If medication fails or severe cases persist, clinicians may consider
electroconvulsive therapy (ECT), the most controversial treatment for
psychological disorders post-psychosurgery.
  Patients are anesthetized and given muscle-relaxing drugs to prevent
bone breakage during seizures. Electric shock is administered directly
through the brain, causing a seizure and brief convulsions.
 In current practice, treatments are administered every other day,
totaling 6 to 10 treatments, with fewer if the patient's mood returns to
normal.

Transcranial Magnetic Stimulation

 Another method for altering electrical activity in the brain by setting up
a strong magnetic field has been introduced.
 A magnetic coil-based procedure generates a localized electromagnetic
pulse without anesthesia, causing minimal headaches, and showing
promise in treating depression, as initially reported.

Psychological Treatments for Depression

Cognitive-Behavioral Therapy
- Clients are taught to examine their thoughts during depression and
identify depressive errors. These errors can cause depression, and
treatment involves correcting cognitive errors and substituting fewer
depressing thoughts with more realistic ones.

Internal Psychotherapy
 IPT is a structured approach that focuses on resolving existing
relationships and forming new ones, typically taking 15-20 sessions per
week. It identifies stressors causing depression and works
collaboratively with the patient.
 After helping identify the dispute, the next step is to bring it to a
resolution.
1. Negotiation stage. Both partners are aware it is a dispute, and
they are trying to renegotiate it
2. Impasse stage. The dispute, which is deeply rooted and leads to
low-level resentment, is not resolved.
3. Resolution stage. The partners are considering various options,
including divorce, separation, or recommitting to the marriage.
Suicide
Suicide is often associated with mood disorders but can occur in their
absence or in the presence of other disorders. Suicide is officially the 11th
leading cause of death in the United States, and most epidemiologists agree
that the actual number of suicides may be 2 to 3 times higher than what is
reported.

To completed suicides, three other important indices of suicidal behavior are

suicidal ideation (thinking seriously about suicide), suicidal plans (the
formulation of a specific method for killing oneself), and suicidal attempts
(the person survives).

 Suicide is not limited to adolescents and adults; children aged 2-5 have
attempted suicide at least once, often injuring themselves, (Rosenthal
& Rosenthal, 1984; Tishler, Reiss, & Rhodes, 2007) making it the fifth
leading cause of death from ages 5-14 (Minino et al., 2002).
 Although males commit suicide more often than females in most of the
world, females attempt suicide at least 3 times as often (Berman &
Jobes, 1991; Kuo et al., 2001).

Chapter 8: Eating and Sleep-Wake Disorders

Major Types of Eating Disorders

Bulimia nervosa
 Recurrent out-of-control eating episodes, or binges, then followed by
recurrent inappropriate compensatory behaviors to prevent weight
gain, such as self-induced vomiting, excessive use of laxatives, or other
attempts to purge (get rid of) the food.
 The binge eating and inappropriate compensatory behaviors both
occur, on a
 average, at least a week for 3 months.
 Self-Evaluation in unduly influenced by body shape and weight.
Purging Type – Involve self-induced vomiting after eating, using laxatives
and diuretics to relieve constipation and increase fluid loss through increased
frequency of urination.

Non-purging type – Some exercise excessively and fasting (although

rigorous exercising is more usually a characteristic of anorexia nervosa)

Medical Consequences
1. Repeated vomiting can lead to salivary gland enlargement, resulting in
a chubby appearance on the face.
2. Repeated vomiting also erodes the dental enamel on the inner surface
of the front teeth as well as tear the esophagus.
3. Continued vomiting can disrupt the chemical balance of bodily fluids,
including sodium and potassium levels, called Electrolyte imbalance.
4. Intestinal problems resulting from laxative abuse.
5. Individuals often develop marked calluses on their fingers or hands due
to contact with teeth and throat while repeatedly sticking fingers down
their throat to stimulate the gag reflex.

Associated Psychological Disorder

 Individuals with bulimia often exhibit additional psychological
disorders, specifically anxiety and mood disorders.
 Eating disorders may not be solely a form of depression, as evidence
suggests that depression may be a reaction to bulimia (Brownell &
Fairburn, 1995; Steiger et al., 2013).
 Bulimia seems strongly related to anxiety disorders and somewhat less
so to mood and substance use disorders.

Anorexia nervosa
 Individual eats only minimal amounts of food or exercise vigorously to
offset food intake so body weight sometimes drops dangerously.
 Anorexia nervosa is less common than bulimia, but there is a great
deal of overlap, many individuals with bulimia have a history of
anorexia, where they used fasting to reduce their body weight below
desirable levels.
  Intense fear of gaining weight of becoming fat, anorexics are never
pleased with their body wight loss. Gaining weight or maintaining the
same weight every day is likely to result in severe panic, anxiety, and
panic depression.

Restricting Type – People diet to limit calories intake

Binge-eating-purging type – They rely on purging. Anorexics who
engage in binge-eating-purging tend to consume smaller amounts of food
and purge more consistently, sometimes even each time they eat.

Anorexia and bulimia are both distinguished by a morbid fear of

becoming overweight and unable to control one's eating. The
primary whether the person is successful in losing weight appears
to make a difference. Anorexia sufferers take great pride in their
eating regimens and their amazing mastery. Bulimics feel ashamed
of themselves. of their inability to exercise control and their eating
disorders.

Medical Consequences
1. Dry skin, brittle hair or nails, and sensitivity to or intolerance of cold
temperatures.
2. It is related to common to see lanugo, downy hair on the limbs and
cheeks.
3. Cardiovascular problems, such as chronically low blood pressure and
heart rate.

Associated Psychological Disorders

 Anxiety problems and mood disorders are common in people with
anorexia nervosa.
 One anxiety disorder that seems to co-occur often with anorexia is
obsessive-compulsive disorder (OCD).
 Substance abuse is also common in individuals with anorexia nervosa

Binge-eating disorder (BED)

 Individuals may binge repeatedly, and find it distressing, but they do
not attempt to purge the food.
 Binge eating is characterized by both of the following:
 a) Eating, in discrete period, an amount of food that is definitely larger
than what most people would eat in a similar period of time under
similar circumstances.
b) A sense of lack of control overeating during the episode.
 The binge-eating episodes are associated with three (or more) of the
following
a) Eating fast
b) Eating until feeling uncomfortably full.
c) Eating large amounts of foods when not feeling hungry.
d) Eating alone because of feeling embarrassed
e) Feeling disgusted with oneself, depressed, or very guilty afterward.
 The binge eating occurs on average, at least once a week for 3 weeks.

Causes of Eating Disorders

Apart from the influences of society, potential biological and hereditary
susceptibilities (the illnesses often have run in families), social, psychological
(poor self-esteem), and anxiety (fear of being rejected), and skewed
perceptions of one's body (relatively individuals who are regular weight
consider themselves to be ugly and overweight.

Social Dimensions
- Young women prioritize appearance over health in competitive
environments, where self-worth, happiness, and success are largely
determined by body measurements and fat percentage. This cultural
imperative leads to dieting, a dangerous step towards anorexia and
bulimia, as well as other health issues.

Dietary Restraint
- Cultural pressures to be thin are significant triggers for eating
disorders, particularly in athletes like ballet dancers. These athletes
face extraordinary pressures to be thin, which can lead to eating
disorders. A conservative estimate suggests that at least 25% of these
girls developed eating disorders during the study's two-year period.
Similar results are observed among female athletes, such as gymnasts.

Family Influences
 - The researcher found that successful, hard-driving families with
anorexia often deny or ignore conflicts, focusing on external
appearances and maintaining harmony. They attribute problems to
others, reducing open communication.

Biological Dimension
- Research indicates that relatives of patients with eating disorders are
4-5 times more likely to develop eating disorders themselves, with
female relatives having higher risks.
- The link between neurobiological functions and eating disorders
remains unclear, but it is generally agreed that some neurological
abnormalities do exist in individuals with eating disorders.

Psychological Dimensions
- Clinical observations show that young women with eating disorders
often have low self-esteem and a diminished sense of personal control,
possibly due to inherited perfectionistic attitudes or attempts to exert
control over significant life events.
- Women with eating disorders often worry about their appearance and
perceive themselves as frauds, leading to increased social anxiety and
feelings of impostors in their social groups.

Treatment of Eating Disorders

- Various psychosocial treatments, including cognitive-behavioral
approaches, family therapy, and interpersonal psychotherapy, are
effective, while drug treatments are currently less effective.

Obesity
 One of the most dangerous epidemics confronting the world today.
 Cultural norms and genetic factors contribute to obesity, which is
challenging to treat. While professional behavior modification programs
are effective, government policy changes on nutrition seem the most
promising prevention approach.

Sleep-Wake Disorders
Sleep-wake disorders are categorized into two main types: dyssomnias and
parasomnias. Dyssomnias involve sleep issues, such as difficulty falling
asleep at the wrong time, and complaints about sleep quality.

Parasomnias involve abnormal behavioral or physiological events during

sleep, such as nightmares and sleepwalking.

Polysomnographic Evaluation (PSG) - The most comprehensive and

clear understanding of your sleep habits can be determined through PSG.

 The patient is monitored in a sleep laboratory for one or more nights,

observing respiration, oxygen desaturation, leg movements, brain
wave activity, eye movements, muscle movements, and heart activity.
Daytime behavior and sleep patterns are also noted.

Actigraph - One alternative to the comprehensive assessment of sleep is to

use a wristwatch-size device called an actigraph.

 The device measures arm movements and sleep quality, enabling

computer to accurately monitor their sleep during sleep. Studies have
shown it can reliably detect sleep patterns, wake-up times, and the
restfulness of in-space sleep.

Insomnia Disorder
Insomnia is a common sleep-wake disorder, characterized by constant
wakefulness. However, it is not possible to go completely without sleep, as it
can occur after one or two nights.

 A common complaint is dissatisfaction with the quantity or quality of

sleep, often linked to one or more of the following symptoms:
a) Difficulty initiating sleep.
b) Difficulty maintaining sleep, characterized by frequent awakenings
or problems returning to sleep after awakenings.
c) Early-morning awakening with inability to return to sleep.
 The sleep disturbance causes clinically significant distress in social,
occupational, educational, behavioral, or other important areas of
functioning.
 The sleep difficulty occurs at least 3 night per weeks.
  The difficulty is present for at least 3 months.
 The sleep difficulty happens despite enough opportunity for sleep.

Rebound Insomnia - Many people take over-the-counter sleeping pills

to cope with disrupted sleep, unaware of rebound insomnia, where problems
reappear when medication is withdrawn. This can lead to re-reading the
medication, maintain sleep issues and the cycle.

Associated Psychological Disorders

 Insomnia is linked to various psychological disorders, including
depression, substance use, anxiety, and Alzheimer's disease, with
alcohol use often causing sleep disorders, highlighting the concerning
interrelationship between these conditions.
 Women often experience insomnia twice as frequently as men, often
experiencing difficulties initiating sleep due to hormonal differences or
differential reporting of sleep issues.

Causes
Insomnia is a condition characterized by physical discomfort, inactivity, and
respiratory issues, often linked to issues with the biological clock, drug use,
and environmental factors like light, noise, or temperature changes.

Hypersomnolence Disorders
Insomnia disorder involves not getting enough sleep (the prefix in means
“lacking” or “without”), on the other hand hypersomnolence disorders
involve sleeping too much (hyper means “in great amount” or “abnormal
excess”).

People with hypersomnolence sleep through the night and appear rested
upon awakening but still complain of being excessively tired throughout the
day. Another sleep problem that can cause a similar excessive sleep illness is
a breathing-related sleep disorder called sleep apnea.
  The individual reported experiencing excessive sleepiness, including
hypersomnolence, despite a primary sleep period lasting at least 7
hours, and experiencing at least one of the following symptoms:
a) Recurrent periods of sleep or lapses into sleep within the same day.
b) A prolonged main sleep episode of more than 9 hours per day that
is non-restorative (i.e., unrefreshing).
c) Difficulty being fully awake after abrupt awakening.
 The hypersomnolence occurs at least three times per week, for at least
3 months.

Narcolepsy
Recurrent periods of irrepressible need to sleep, lapsing into sleep, or
napping occurring within the same day. These must have been occurring at
least three times per week over the past 3 months.

 Patients may experience cataplexy, a sudden loss of muscle tone,

which can range from slight facial weakness to complete physical
collapse, occurring while awake and lasting from several seconds to
several minutes, often preceded by strong emotions like anger or
happiness.
 People with Narcolepsy experience at least one of the following:
a) Episodes of cataplexy
b) Hypocretin deficiency, measured by cerebrospinal fluid (CSF)
hypocretin-1 immunoreactivity values
c) Nocturnal sleep polysomnography indicates rapid eye movement
(REM) sleep latency less than 15 minutes, or a multiple sleep
latency test with a mean latency of 8 minutes and two or more REM
periods.

Two other characteristics of narcolepsy.

Sleep paralysis – Brief period after awakening when they can’t move or
speak that is often frightening to those who go through it.

Hypnagogic hallucinations – Vivid and often terrifying experiences

that begin at the start of sleep and are said to be unbelievably realistic
because they include not only visual aspects but also touch, hearing, and
even the sensation of body movement.

Breathing-Related Sleep Disorders

Individuals with interrupted breathing during sleep often experience
numerous brief arousals throughout the night and do not feel fully rested
even after 8-9 hours of sleep. Sleeping muscles relax, constricting the upper
airway and making breathing difficult. Some individuals experience
significant constriction, labored (hypoventilation) or short periods of sleep
apnea (10-30 seconds), where they stop breathing altogether, resulting in
sleep apnea.

Three Types of Apneas

1. Obstructive Sleep Apnea / Hypopnea syndrome – Occurs when
airflow stops despite continued activity by the respiratory system.
 Polysomnography revealed at least five obstructive apneas or
hypopneas per hour of sleep, along with the following sleep symptoms:
(a) Nocturnal breathing disturbances, such as snoring, gasping, or
breathing pauses during sleep, can cause significant health issues.
(b)Daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient
opportunities is not better explained by another mental disorder or
medical condition.
 Polysomnography results show 15 or more obstructive apneas or
hypopneas per hour of sleep, regardless of accompanying symptoms.

2. Central Sleep Apnea – Chronic respiratory failure is a condition

characterized by brief cessation of respiratory activity, often linked to
central nervous system disorders like cerebral vascular disease, head
trauma, and degenerative disorders.
 Central sleep apnea patients wake up frequently at night, but do not
report excessive daytime sleepiness or often lack awareness of a
serious breathing issue.

3. Sleep-related Hyperventilation – Breathing difficulties, which

involve a decrease in airflow without a complete pause, can increase
carbon dioxide levels due to insufficient air exchange with the
environment, disrupting sleep and causing symptoms similar to
insomnia.
Circadian Rhythm Sleep-Wake Disorders – Sleep disruption is a
persistent or recurrent pattern caused by an alteration in the circadian
system or a misalignment between the endogenous rhythm and the
individual's physical, social, or professional schedule.

 The sleep disruption leads to excessive sleepiness or insomnia, or both.

 Episodic: symptoms last at least 1 month but less than 3 months.
 Persistent: symptoms last 3 months or longer.
 Recurrent: Two or more episodes occur within the space of 1 year.

Treatment of Sleep Disorders

Medical Treatments
Benzodiazepine medications are effective for short-term dyssomnia
treatment, but careful use is necessary to avoid rebound insomnia, a
withdrawal experience worsening sleep problems after discontinuation. Long-
term treatment should include psychological interventions like stimulus
control and sleep hygiene.

Psychological Treatments
Cognitive Behavioral Therapy – The approach aims to change sleepers'
unrealistic expectations and beliefs by providing information on normal sleep
amounts and compensating for lost sleep, thereby reducing the belief that
less than 8 hours of sleep is harmful.

Guided imagery relaxation – This method aids in relaxation during

bedtime or after a night waking for individuals experiencing anxiety due to
sleep difficulties.

Paradoxical intention - The technique involves instructing individuals to

perform the opposite behavior from the desired outcome, such as
encouraging poor sleepers to lie in bed and stay awake.
Parasomnias
Parasomnias are abnormal events that occur during sleep or during the
twilight time between sleeping and waking. While some events are not
unusual if they occur during sleep, they can be distressing if they occur
during sleep.

Nightmares (or nightmare disorder)

Nightmares are distressing dreams that impair a person's ability to perform
normal activities, such as sleeping. Researchers differentiate between
nightmares and bad dreams based on whether the person wakes up, with
nightmares being disturbing dreams that awaken the sleeper, and bad
dreams being those that do not.

 Dreams of extreme dysphoria, often during the second half of a major

sleep episode, are repeated and often involve avoiding threats to
survival, security, or physical integrity.
 Upon waking from dysphoric dreams, the individual quickly becomes
oriented and alert.

Disorder of Arousal – Includes several motor movements and

behaviors during NREM sleep such as sleepwalking, sleep terrors, and
incomplete awakening.

Sleep Terrors
Sleep terrors, often affecting children, start with a piercing scream, causing
extreme upset, sweating, and rapid heartbeat. They resemble nightmares
but occur during NREM sleep, making them difficult to waken and comfort.
Despite their dramatic impact, children do not remember sleep terrors.

Somnambulism (Sleepwalking)
This parasomnia is a condition where people walk in their sleep, is usually
not a dream, occurring during the first few hours of deep sleep.

 Sleepwalking, a deep sleep disorder, requires the person to leave the

bed, with less active episodes involving small motor behaviors.
Wakefulness during sleepwalking is difficult, as the person typically
 forgets what happened. While not necessarily dangerous, it is
challenging.

TABULAR SHEET
Disorder Symptoms Duration Differential
diagnosis
Generalized Excessive anxiety and More days Major depressive
Anxiety worry, muscle tension, than not for at disorder, panic
Disorder mental agitation, fatigue, least 6 months disorder, social
irritability, difficulty anxiety disorder
sleeping

Panic Recurrent severe panic At least 1 Heart conditions,

Disorder attacks, worry about month other anxiety
additional attacks, disorders
significant maladaptive
change in behavior
Agoraphobia Fear and avoidance of Persistent, Specific phobia,
situations where escape typically social anxiety
might be difficult, lasting 6 disorder, panic
avoiding public months or disorder
transportation, more
open/enclosed spaces,
standing in line, or being
in crowds
Specific Immediate fear or Persistent, Agoraphobia,
Phobia anxiety about a specific typically 6 social anxiety
object or situation, months or disorder
intense fear or avoidance more
Separation Unrealistic fear about Persistent, Avoidant
Anxiety losing significant figures, typically personality
Disorder distress when separated lasting 6 disorder, panic
months or disorder,
more generalized
anxiety disorder
Selective Lack of speech in specific At least 1 Social anxiety
Mutism social settings where month (not disorder,
speaking is expected including the communication
first month of disorders
school)

Disorder Symptoms Duration Differential

diagnosis
 Post Intrusive memories, Disturbance Acute stress
Traumatic distressing dreams, lasting more disorder,
Stress flashbacks, intense than 1 month adjustment
Disorder distress at exposure to disorders, other
cues, avoidance, anxiety disorders
negative mood changes,
heightened arousal
Obsessive- Obsessions (intrusive Body dysmorphic
Compulsive thoughts) and/or disorder, hoarding
Disorder compulsions (repetitive disorder,
behaviors) trichotillomania
Body Preoccupation with Persistent Obsessive-
Dysmorphic perceived physical compulsive
Disorder defects, repetitive disorder, eating
behaviors like mirror disorders
checking
Hoarding Difficulty discarding Persistent Obsessive-
Disorder possessions, cluttered compulsive
living spaces, significant disorder, major
distress or impairment depressive
disorder
Trichotilloma Recurrent pulling out of Persistent Obsessive-
nia one's hair, noticeable compulsive
hair loss disorder, body
dysmorphic
disorder
Excoriation Recurrent skin picking Persistent Obsessive-
Disorder resulting in skin lesions compulsive
disorder, body
dysmorphic
disorder

Disorder Symptoms Duration Differential

Diagnosis
Somatic One or more somatic Persistent, Physical
Symptom symptoms causing typically >6 disorders, anxiety
Disorder distress, excessive months disorders,
thoughts, feelings, depressive
behaviors disorders
Illness Preoccupation with At least 6 Somatic symptom
Anxiety having a serious illness, months disorder, anxiety
Disorder mild or no physical disorders,
symptoms depressive
disorders
 Conversion Altered voluntary motor Neurological
Disorder or sensory function, disorders,
incompatibility with malingering,
medical conditions factitious disorder
Factitious Falsification of symptoms Malingering,
Disorder without external somatic symptom
incentives disorder,
conversion
disorder
Depersonaliz Experiences of unreality Persistent or Anxiety disorders,
ation- or detachment from recurrent depressive
Derealization oneself or surroundings disorders,
Disorder schizophrenia
Dissociative Inability to recall Substance-related
Amnesia important personal disorders,
information, usually of a neurological
traumatic nature conditions, PTSD
Dissociative Presence of two or more Bipolar disorder,
Identity distinct personality schizophrenia,
Disorder states, memory gaps PTSD

Disorder Symptoms Duration Differential

Diagnosis
Major Severe mood state At least 2 Bipolar Disorder
Depressive lasting at least 2 weeks, weeks (no manic or
Disorder cognitive symptoms hypomanic
(worthlessness, episodes present)
indecisiveness), physical
symptoms (altered sleep,
weight changes), loss of
interest in life
Persistent Depressed mood for at At least 2 Major Depressive
Depressive least 2 years, poor years Disorder (fewer
Disorder appetite or overeating, symptoms but
(Dysthymia) insomnia or chronic)
hypersomnia, low energy,
low self-esteem, poor
concentration,
hopelessness
Double Combination of major Major episodes Major Depressive
Depression depressive episodes and within Disorder,
persistent depressive persistent Persistent
disorder depressive Depressive
disorder Disorder
Premenstrual Affective lability, Symptoms Major Depressive
Dysphoric irritability, depressed present in the Disorder (timing
Disorder mood, anxiety, final week with menstrual
 (PMDD) decreased interest in before cycle)
activities, difficulty menses,
concentrating, lethargy, improving
change in appetite, sleep within a few
disturbances, feeling days after
overwhelmed, physical onset and
symptoms minimal/absen
t in the week
post-menses
Disruptive Severe recurrent temper At least 12 Bipolar Disorder
Mood outbursts (verbal or months (age of onset,
Dysregulatio behavioral), persistent presence of
n Disorder irritability or anger, irritability without
(DMDD) symptoms present for 12 distinct mood
or more months, no episodes)
periods of 3 or more
consecutive months
without symptoms
Bipolar I Full manic episode, may Manic episode Major Depressive
Disorder include major depressive lasting at least Disorder, Bipolar
episodes 1 week II Disorder
Bipolar II Major depressive Hypomanic Major Depressive
Disorder episodes alternate with episodes Disorder, Bipolar I
hypomanic episodes lasting at least Disorder
4 days
Cyclothymic Chronic cycle of mood At least 2 Bipolar Disorder,
Disorder elevation and depression years Major Depressive
not severe enough to Disorder
meet criteria for major
depressive or manic
episodes

Disorder Symptoms Duration Differential

Diagnosis
Narcolepsy Recurrent need to sleep, At least 3 hypersomnia,
cataplexy, sleep times per other sleep
paralysis, hypnagogic week over disorders,
hallucinations past 3 months epilepsy
Obstructive Nocturnal breathing Continuous Central sleep
Sleep disturbances, daytime apnea, primary
Apnea/Hypop sleepiness, fatigue snoring, obesity
nea hypoventilation
syndrome
Central Sleep Cessation of respiratory Continuous Obstructive sleep
Apnea activity, frequent night apnea, idiopathic
waking central alveolar
hypoventilation
Sleep-related Decreased airflow, Continuous Obstructive sleep
Hypoventilati increased carbon dioxide apnea, chronic
on levels, disrupted sleep obstructive
pulmonary
disease (COPD)
Circadian Sleep disruption due to Episodic: 1-3 Insomnia
Rhythm circadian rhythm months disorder,
Sleep-Wake misalignment, excessive Persistent: ≥3 hypersomnia
Disorders sleepiness or insomnia Recurrent: ≥2 disorder, mood
years disorders, delayed
sleep-wake phase
disorder