Unit 12 Abnormal Psych Wendell

DSM 5 TR

Diagnostic & Statistical Manual of mental health

1st edition (DSM-1) recognized 106 abnormalities / conditions

5th edition published 2013

Text revision published in 2023

ICD 10 CM

International Classification of Disease

Used in conjunction with the DSM

Published by the World Health Organization

Clinical Criteria for DSM

1. Symptoms of the condition intensify & become increasingly more sever if left untreated

2. Condition affects ones’ ability to maintain interpersonal / social relationships

3. Condition interferes with one’s “quality of life”

4. Condition poses immediate or potential threat to the physical safety of oneself and/or others

Biological Perspective

Brain Anatomy - Injury, disease

Genetics- predispositions, mutations

Neurological Defects - bioelectrical irregularities

Bio Chemical Imbalances

1. Amount of production (Surpluses & deficiencies)

2. Accelerated rate of consumption

3. Misdirected Distribution

Behavioral Perspective

Reactions to social factors & circumstances

Behaviors learned from one’s environment

Cognitive Perspective

Persistent illogical / irrational thought patterns

Humanistic Perspective

Restriction of fulfillment of psychological needs, personal growth

Psychoanalysis / Psychodynamic

Result of unresolved subconscious conflicts

Unconscious responses to stress and trauma

Pathological

Mental impairments & disorders linked to biological abnormalities stemming from disease, injury, biochemistry and/or genetics

Organic = bio medical causes, factors, and symptoms

Idiopathic

Any condition of physical or mental health that cannot be explained biologically, medically = disorders of unknown causes

Psychosomatic

Medical / physical symptoms caused or exacerbated by psychological factors

Comorbidity

The simultaneous existence of 2 or more health conditions

Ambivalence

The coexistence of 2 opposing, contradicting impulses / emotions towards the same thing, at the same time, causing emotional distress (cognitive dissonance)

Congenital

conditions, traits, abnormalities that are present at birth

Predisposition

Biological, genetic vulnerability for developing an abnormality

Maladaptive Behavior

Abnormalities with inappropriate time adjustment and responses to stress and social situations

Dysfunctional Behavior

Unhealthy behaviors & cognitive patterns that are considered wrong, inappropriate, and/or socially unacceptable

Anergia

Having a lack of physical energy for daily tasks / activities

Avolition

Having a lack of psychological motivation for daily tasks / activities

Anhedonia

Having a general loss of interest in / withdrawal from activities that were once enjoyable

Mania (Manic Episodes)

Periods of extreme elevated emotion, increased energy, euphoria, racing thoughts, talkative, impulsivity, hyperactivity

Delusions

Dysfunctional, exaggerated emotions and extreme false beliefs

Hallucinations

Severe alterations / sensory misperceptions of reality

Hearing voices, seeing images that do not exist

Catatonia

Behaviors marked with erratic muscular movements and body contortions

Cataplexy

A sudden loss of muscle tone & voluntary motor control functions while awake / conscious causing paralysis & immobilization

Stupor

A state of altered consciousness in which an individual does not react to their surroundings or show cognitive awareness

Insanity

legal term not medical / psychological term

Criminal defense plea that requires evaluation of mental competency to stand trial

Acknowledgment of a crime committed but is not subject to prosecution due to sever psychological abnormalities

Neuro-cognitive Disorders

Group of DSM related conditions marked with significant declines in at least one of the domains of cognition

1. Executive functioning

2. Complex focus & attention

3. Language & social communication skills

4. Memory processing

5. Learning and problem solving

6. Perceptual motor skills

Delirium

Sensory condition causing severe disruptions of consciousness

Disorganized and incoherent thinking, confusion, inattentiveness

Acute Onset: Rapid Onset (min, hrs), More intense symptoms, not long lasting

Dementia

Neurodegenerative condition characterized with a progressive intellectual decline with impaired memory and cognitive focus

Erratic mood swings and changes personality

Alzheimer's Disease (ALZ)

Neurodegenerative disease caused by an abnormal buildup of proteins (Lewy bodies) causing progressive damage to neuron cells

Gradual cognitive decline in memory retrieval & problem solving

Incoherent speech patterns (often slurred or jumbled speech)

Changes in mood & personality: irritable, aggressive, agitated

Delusions, Hallucinations

Promotes loss of muscle control & general deterioration of health

Neurodevelopmental Disorders

Group of DSM related conditions in which the growth and development of the brain is negatively affected

Disorders include developmental abnormalities with language, emotional regulation, memory & learning, behavioral impulsivity

Attention Deficit/ Hyperactivity Disorder

Chronic condition of persistent lack of focus & concentration that is inconsistent with the child’s appropriate development age level

Easily distracted by external stimuli and internal thoughts

Prone to cycles of hyperactivity & impulsivity (impulse control)

Poor executive functioning (organization, emotional regulation)

In-complete tasks / schoolwork (“starters, not finishers”)

Persistent Motor or Vocal Tic Disorder

Tic= Compulsive, repetitive vocalizations or body movements

Chronic display of one or more motor tics

• Blinking, shrugging shoulders, twitching

Chronic display of one or more vocal tics

• Humming, coughing / clearing throat, yelling words / phrases

Tourette’s Disorder

Chronic Display of both motor and vocal tics for at least 1 year

Affects 1% of US population

Autistic Spectrum Disorder

Broad spectrum of related cognitive disorders characterized with dysfunctional abnormalities of social interaction, communication, and sensorimotor processing

Primary Symptoms -

Not developing adequate speech and language skills

Social Interaction abnormalities

Sensorimotor processing abnormalities - Link between nerves and muscles

Hypersensitivity to loud noises etc

Depressive Disorders

Group of related DSM pathologies with biological, behavioral, cognitive, humanistic, and psychodynamic causes & symptoms

Originally attributed to biochemical disruptions primarily within the prefrontal cortex (Frontal Lobe)

Serotonin

Norepinephrine

Causes of Biochemical Imbalances

Genetic predispositions

Biological factors such as diet, brain injury, drug abuse

Psychosocial Maladaptation - Bereavement, daily stressors, personal circumstances

Dysfunctional Cognitive Patterns - negative irrational, intrusive thoughts

Disruptive Mood Dysregulation Disorder (DMDD)

Condition diagnosed in children or adolescents with sever mood disorders and behavioral outburst

intense anger coupled with temper outburst (rage)

Chronically irritable mood most of the day, nearly everyday

Recurrent major depressive episodes

Diagnosis must be independent of Autistic Spectrum Disorder

Major Depressive Disorder

Formerly known as Clinical Depression

Anhedonia (loss of interest in activities, social reclusion, withdrawal)

Anergia (lacking physical energy) & Avolition (lacking motivation)

Emotional Symptoms- sadness, despair, anxiety, irritability

Physical Symptoms- headaches, muscle aches, GI discomfort, Hypersomnia, Insomnia, appetite fluctuations

Cognitive symptoms- intrusive thoughts, delusions, hallucinations

Major Depressive Disorder with Perinatal Onset

Formerly known as Postpartum Depression

Depression & anxiety experienced during pregnancy and after birth

Affects 8-10% of all mothers within the first year after giving birth

Acute Psychosis with Perinatal onset

A sever mental health condition characterized by a sudden onset of psychotic symptoms

Dellusions, hallucinations, disorganized thinking and impaired judgement

Depression, confusion, disorientation

Major Depressive Disorder with Seasonal Pattern

Formerly known as Seasonal Affective Disorder

Depressive cycles that correspond with the seasonal calendar (decreased availability of light)

Patterns of recurring major depressive episodes in the fall & winter

Neuro chemical & vitamin deficiencies lead to serotonin unbalances

Decreased Activity & social interaction during winter season

Decreased effectiveness of immune system during winter season

Persistent Depressive Disorder

Formerly known as Dysthymia

Chronic, but low level depression lasting for at least 2 years

Symptoms are milder than MDD, but are longer lasting

Bipolar 1 Disorder

Formerly known as Manic Depression

Marked by recurrent episodes of depression and mania

Manic episodes - phases of extreme elevated emotion, euphoria

Increase in energy, racing thoughts, impulsivity

Typically marked with mild to moderate depression

Bipolar II Disorder

Marked by recurrent episodes of depression and hypomania

Hypomania - milder form of mania with less extreme symptoms

Typically marked with moderate to severe depression

Cyclothymic Disorder

Often referred to as Bipolar III Disorder

Similar to Bipolar II, but with less severe mood fluctuations

Low grade symptoms must persist for 2 years for diagnosis

Anxiety

Emotional distress experienced in anticipation of negative or threatening stimuli / events = dysfunctional disorders

Irrational fear, exaggerate nervousness & worrying, depression

reduced immune system, sleep disruptions, appetite fluctuations, GI issues, avoidance behaviors

Causes are combinations of Nature (Serotonin Imbalance) + Nurture (Learned Behaviors)

Separation Anxiety Disorder

Most commonly diagnosed in children but is applicable to adults

Difficult being away from parents or other loved ones

Excessive worry about harm to loved ones

Excessive worry about danger to self, fear of being alone

Difficulty leaving the house, excessive stress to go to school, work

feeling physically ill when away from loved ones

Selective Mutism

Paradoxical anxiety disorder marked by intense fear of speaking in social situations, but exceptionally vocal when in the company of familiar people (home environment)

Diagnosis must be independent of autistic spectrum disorder

Indicative of future (adult) anxiety conditions

4:1 prevalence rate of girls to boys

Generalized Anxiety Disorder

Chronic, excessive, uncontrollable nervousness & anxiety

GAD is not limited to singular stressor

• Generalized = multiple contributing factors of anxiety

Difficulty coping with daily problems, feeling overwhelmedd

Everyday stresses become magnified

Specified Phobias

Intense, irrational fears that lead to stimuli avoidance

Phobias are stimuli specific

Generalized Anxiety = symptoms onset by multiple stimuli

DSM recognizes over 500 types

Animal related type

Natural environmental type

Blood injection bodily injury type

Situational type

Phobias not otherwise specified

Agoraphobia

Classified as a situational Type phobia

Fear of environments in which one can’t escape / evacuate

• Large crowds

• Open spaces

• Places with limited emergency exits

Most common cause for persistent panic attacks

Panic Disorder

Panic Disorder with Agoraphobia Specifier

Persistent panic attacks - periods of intense fear, disorientation, hyperventilation, elevated pulse, and altered consciousness

Sudden & temporary “nervous breakdowns” but with residual cognitive, emotional, physical symptoms that last for hours

Feelings of lacking physical & emotional control

Social Anxiety Disorder

Formerly known as Social Phobia Disorder

acute anxiety onset by interacting within a social environment

fear of people watching you while in public

fear of doing / saying something embarrassing while in public

rapid heart rate, perspiration, stiff muscles, upset stomach

Avoidance of social situations

Anxiety

Emotional distress experienced in anticipation of negative or threatening stimuli / events = dysfunctional disorders

Stress

Emotional distress experienced in response to negative or threatening stimuli / events = maladaptive disorders

Reactive Attachment Disorder

A condition where a child doesn’t from healthy emotional bonds with their caretakers (parental figures), often because of emotional neglect or abuse at an early age

Hypervigilant and fearful of dangers

Avoidance of affection & emotional contact - hugs, etc

Disinhibited Social Engagement Disorder

Diagnosable in early to middle childhood

Apathy / disinterest in caretakers and / or family members

Willingness to leave family member with strangers

seeking physical contact & attention from strangers - hugs etc

Typically attributed to emotional neglect from parents

Social Adjustment Disorders

Collection of maladaptive reactions to psychosocial stressors

• Loss of a job

• loss of a relationship - divorce, breakup, etc

• Starting school, changing schools, graduating from school

Prolonged Grief Disorder

Formerly known as Maladaptive Bereavement disorder

Considered a specific type of social adjustment disorder concerning the death of loved one

Intense emotional anguish (sorrow, anger, resentment, anxiety)

Or emotional numbness and social withdrawal

Symptoms persist & intensify more severely over time

Acute Stress Disorder

Severe Maladaptive reactions following a traumatic event or a series of related traumatic events, diagnosis window starts 3 days after the event, until 1 month

Post Traumatic Stress Disorder

Severe maladaptive reactions following a traumatic event or a series of related traumatic events

Unlike acute stress disorder, PTSD is chronic condition

Diagnosis begins 1 month after the traumatizing event

Specified as “combat related” or “non combat”

1. Intrusive thoughts, flashbacks, nightmares, etc

2. Hyper vigilance - easily startled (fight or flight)

3. Avoidance Behaviors - learned associations with fear / trauma

Disruptive, Impulse control & conduct disorders

Collection of diverse DSM disorders linked with

• difficulty regulating emotions

• difficulty controlling aggressive behaviors

• difficulty maintaining self control

• difficulty regulating impulsivity

Oppositional Defiant Disorder

Chronic display of aggressive, disobedient, and hostile misbehavior - typically directed towards authority figures

Argumentative, spiteful, seeking revenge (vindictiveness)

Shares several symptoms with Disruptive Mood Dysregulation, but ODD does not display episodes of depressive mood, and is generally considered less severe than DMDD

Intermittent Explosive Disorder

Recurring episodes of anger and behavioral outbursts (rag)

Difficulty self regulating & expressing emotions

Diagnosis for Disruptive Mood Dysregulation Disorder requires display of chronic mood abnormalities

Rage symptoms relate to medical / organic factors

• rapid onset of energy - “adrenaline rush”

• heart palpitations, muscle tremors, hyperventilation

• elevated body temperature, perspiration

Conduct Disorder

Persistent display of unsafe / inappropriate behaviors

• aggressing towards others - fighting, menacing, bullying

• cruelty towards people and animals

• breaking rules: curfew, truancy, school misconduct

• breaking laws: fire-setting, vandalism, trespassing

Symptoms displayed in adulthood = diagnosed as Antisocial PD

Kleptomania

Failure to resist impulses to steal objects (behavioral addiction)

stolen objects are typically of trivial value and are not taken to obtain profit / monetary gain

Actions produce euphoric feelings of excitement (mania)

As with most all addictions, kleptomania is prone to tolerance and leads to progressively riskier actions

Pyromania

Compulsive actions of purposely setting fire

Unlike arson - setting fire is not for monetary gain, intimidation or destruction of property or evidence

Reason for fire setting is for gratification and dysfunctional fascination (obsession motivated by mania)

Gambling Disorder

Classified as a Non-Substance Related Addiction Disorder

Formerly known as Maladaptive Gambling Disorder

Psychological addiction to gambling, the various games / vices, and the thrill of winning (or the fear of losing)

Amount of $$$ risked must increase in order to elicit same level of thrill, excitement = tolerance

Inability to stop when ahead, reckless wagering when behind

Obsessive Compulsive & Related Disorders

Related group of DSM disorders marked by persistent, intrusive thoughts and repetitive dysfunctional behavioral patterns

Obsessions

Cognitive symptoms

Dysfunctional, persistent intrusive thoughts & emotions

Compulsions

Behavioral Symptoms

Repetitive actions and impulsive, uncontrollable behaviors

Trichotillomania

Cognitive behavioral disorder marked by the repetitive impulse to pull one’s Hair body and head

typically related with anxiety / stress responses

Excoriation Disorder

Cognitive behavioral disorder marked by the repetitive impulse to pick one’s skin and/or bite nails

Body Dysmorphic Disorder

General obsession with the appearance of one’s body (not health)

Specific obsession with an exaggerated / imagined flaw of the body

Incongruencies between one’s self-perceptions and reality

Compulsive behavior leads to “fixing flaws” via dysfunctional acts

• compulsive exercise, disordered eating

• habitual cosmetic surgeries

Obsessive Compulsive Disorder

Pathological disorder (anatomical & biochemical) characterized with both cognitive obsessions and behavioral compulsions

Obsessions are irrational and torturous, can’t stop thinking

• morbid thoughts of illness, injury, danger, death, etc

Compulsive behaviors are intended to stop obsessive thoughts

Repetitive actions as “Preventative measures”

Hoarding Disorder

Originated as a subtype of OCD

Overwhelming need to possess objects largely of sentimental value that accumulates over time, making it hard to part with

• collecting, compulsive shopping, rummaging, etc

Largely develops as a maladaptive response to times of scarcity

Discarding object = discarding memory

Psychosis

Sever psychiatric conditions with altered states of consciousness

Characterized with a disconnection or distortions of reality

Delusions (Cognitive)

Dysfunctional, exaggerate emotions and extreme false beliefs

Hallucinations

Severe alterations / sensory misperceptions of reality

Hearing voices, seeing images that do not exist

Delusional Disorder

Formerly known as Delusional Psychosis

Marked by the existence of at least one powerful delusion

Devotion to false beliefs negatively alters the basis for reality

Acute Psychotic Disorder

Sudden temporary onset of psychotic symptoms that last less than 1 month, followed by full remission

Possible episodes of recurrent future relapses

Extreme maladaptive responses to psychosocial stress & trauma

Medical reactions to pathological causes

Schizophrenia Spectrum Disorder

Spectrum of chronic, diverse symptoms including

• psychosis via delusions

• psychosis via hallucinations

• Disorganizations with though and speech

• social and behavioral abnormalities

Affects 1-2 % of American population - 4 million

Diagnosed in nearly 50% of all patients committed in psychiatric hospitals or institutions for the criminally insane

General Pathology of Schizophrenia

Schizophrenic conditions tend to originate in early puberty but typically do not display noticeable symptoms until adulthood 30+

Normal progression includes a 10-15 year incubation

Symptoms develop so slowly, they are largely undetected until too late, by then the disease has evolved into the patient’s reality

Disease will continue to escalate in severity if left untreated

Flat Affect

Lack of human Emotion

Paranoid Type

Psychotic condition that includes all the general symptoms of schizophrenia but is marked with distinct delusional paranoia

Disorganized type

Psychotic condition that is characterized with extreme cognitive disruptions in all aspects of behavior

• especially speech & thought

• gross neglect of appearance & personal hygiene

Catatonic Type

Psychotic condition volatile mood swings & emotional outbursts

characterized with recurring catatonic episodes

Catatonia - Behaviors marked with erratic muscular movements and unusual body positions and contortions

Undifferentiated Type

Psychotic condition that displays most general symptoms of schizophrenia, but does not meet specified criteria for diagnosis of the paranoid, disorganized, or catatonic types

Known and Correlated causes of Schizophrenia

Misdirected flow of dopamine pathways within the brain

• excessive amounts within the frontal lobe

• deficiencies within the Thalamus

Neuroleptics operate as Dopamine agonists, reducing its effects

Genetics

Viral Infections

Winter born children

Habitual drug use

Tardive Dyskinesia

Neurological antipsychotic side effect

Uncontrollable muscle spasms in the afce and body resulting from dopamine deficiencies within motor neurons

Schizophreniform Disorder

Mental health condition with temporary Schizophrenia symptoms

Delusions, hallucination, disorganized speech less than 6 months

2/3 of people diagnosed with Schizophreniform disorder are later diagnosed with Schizophrenia (common pre-diagnosis)

Schizoaffective Disorder

Syndrome including the existence of Schizophrenia and episodes of disordered mood

• Major depressive Disorder

• Bipolar disorder

Schizophrenia + mood disorder symptoms may occur at the same time or at different times

Somatic Symptom & related disorders

Group of DSM abnormalities involving relationships between dysfunctional psychological symptoms and medical conditions

Somatic Symptom Disorder

Merge of 2 DSM-IV Somatoform Disorders

Formerly known as Somatization Disorder

Psychological obsessions of an existing medical health symptom

Formerly known as Psychosomatic Conversion Disorder

Psychological stress is converted into physical / medical symptoms

Illness-Anxiety Disorder

Formerly known as Hypochondrasis

Somatoform disorder marked with excessive concern for one’s physical health and fear of the contraction of a disease

(Body Dyssmorphic Disorder = obsession with body’s appearance)

Believing minor symptoms are signs of serious health issues

similar to OCD, but with no compulsions = “health anxiety”

Factiious Disorder

Formerly known as Munchausen’s Syndrome

Condition characterized by perpetually faking illnesses or injuries to illicit emotional support and sympathy from others

Disorder is based upon faking/exaggerating medical symptoms as primarily means to fill psychological needs (attention)

Factitious Disorder by Proxy

Primary care provider (typically the mother) seeks attention by purposely making and keeping their child ill

Chronic cases can lead to the death of the child