WEEK 5 PSYCOPATHOLOGY

Comprehensive vocabulary flashcards covering diagnostic criteria, clinical presentations, behavioural cycles, and treatments for anxiety and obsessive-compulsive related disorders.

OCD Diagnostic Criteria – Compulsions

1. Repetitive behaviours or mental acts: Actions like washing, checking, ordering, counting, or praying that a person feels forced to do because of an obsession or strict rules.

2. Reduce Anxiety or Prevent Fear: Done to reduce stress or prevent something bad from happening, but the actions are unrealistic or excessive and don't actually prevent the feared event.

Note: Young children may not be able to explain why they perform these behaviours or mental acts.

OCD Diagnostic Criteria { B,C,D}

• B : OCD Diagnostic - Time Threshold = Obsessions or compulsions take more than 1 hour/day OR cause significant distress or problems in daily life (social, work, or other important activities)

• C : OCD diagnostic - Not Caused by Substances or Medical Conditions = OCD symptoms cannot be caused by drugs, medications, or another medical condition.

• D : OCD Diagnostic - Not Better Explained by Another Mental Disorder = OCD is diagnosed only when symptoms meet the criteria and are not better explained by another condition.

OCD diagnostic criteria - levels of insight

• 1. With good or fair insight = he individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true

• 2. With poor insight = The individual thinks obsessive- compulsive disorder beliefs are probably true.

• 3. With absent insight/delusional beliefs = The individual is completely convinced that obsessive-compulsive disorder beliefs are true

OCD Subtypes

4 Common Types:

• Contamination: Fear of germs, dirt, or illness (e.g., excessive handwashing).

• Checking: Repeatedly checking things to prevent harm (e.g., locks, stoves).

• Symmetry & Order: Need for things to be perfectly arranged, balanced, or organized.

• Forbidden Thoughts: Unwanted, disturbing thoughts about harm, sex, or religion.

OCD and stigma

Less Stigma: OCD is often seen as less stigmatized than other mental illnesses.

Misuse of “So OCD”: People use this phrase to describe being neat or clean, which minimizes the seriousness of OCD.

Lack of Awareness: Many people don't understand all OCD symptoms, so some forms may be less recognized or stigmatized.

The OCD Cycle

A four-stage vicious cycle consisting of Obsessions (unwanted distressing thoughts, urges, or mental images), Anxiety (fear, distress, or worry acting as a false alarm), Compulsions (behaviours or mental acts performed to neutralize the anxiety), and temporary Relief, which reinforces the cycle and causes obsessions to return sooner.

Exposure with Response Prevention (ERP)

Rituals are prevented while patients are gradually and systematically exposed to feared thoughts or situations. How rituals are prevented doesn't matter, as long as patients learn that fear decreases without performing rituals.

Cognitive interventions may help some patients: Confronting certainty: Learning to accept uncertainty. And de-catastrophization: Learning not to expect the worst.

Hoarding Disorder

• A. Difficulty discarding: Ongoing trouble throwing away possessions, even if they have little or no value.

• B. Need to save: Feel a strong need to keep items and become distressed when throwing them away.

• C. Clutter: Items pile up and make living spaces difficult to use. If spaces are clear, it's usually because others (family, cleaners, authorities) helped.

• D. Daily life: Hoarding causes serious distress or problems with work, relationships, daily activities, or keeping the environment safe.

• E. Not a medical condition: Hoarding isn't caused by another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome).

• F. Not another mental disorder: Hoarding isn't better explained by another disorder (e.g., OCD, depression, schizophrenia, major neurocognitive disorder, or autism).

Animal Hoarding

A manifestation of hoarding disorder defined by the accumulation of a large number of animals combined with a failure to provide minimal standards of nutrition, sanitation, and veterinary care.

Hoarding Disorder With Excessive Acquisition

Buying or collecting items that aren't needed or that there's no space for. Occurs in 80–90% of people with hoarding disorder.

hoarding

• Difficulty discarding: Trouble throwing away items is NOT related to their actual value.

• Reasons for saving: Items may seem useful (perceived utility), beautiful (aesthetic value), or emotionally important (sentimental value).

• Valuable items: People may also save valuable things, often mixed in piles with less valuable items.

• Fear of losing information: Commonly worry about throwing away important information.

• Commonly saved items: Newspapers, magazines, clothing, bags, books, mail, and papers, but almost anything can be saved.

Diagnostic Criteria for Social Anxiety Disorder

• A. Social fear: Intense fear of being judged in social situations (e.g., talking, eating, or performing in public). In children, must also occur with peers.

• B. Negative evaluation: Fear of embarrassment, humiliation, rejection, or offending others.

• C. Anxiety: Social situations almost always cause fear. Children may cry, freeze, cling, have tantrums, shrink back, or refuse to speak.

• D. Avoidance: Avoid social situations or endure them with intense anxiety.

• E. Excessive fear: Fear is greater than the actual threat, considering social and cultural context.

• F. Duration: Lasts 6+ months.

• G. Impairment: Causes significant distress or problems in daily life, work, or relationships.

• H. Not substance-related: Not caused by drugs, medications, or medical conditions.

• I. Not another mental disorder: Not better explained by panic disorder, body dysmorphic disorder, or autism.

• J. Medical conditions: If another condition exists (e.g., Parkinson's, obesity, disfigurement), fear must be unrelated or excessive.

Specify if: Performance only — Fear is limited to public speaking or performing.

Consequences of Social Anxiety Disorder

• School & work: Higher dropout rates, lower employment, productivity, income/social status, well-being, and quality of life.

• Relationships: More likely to be single, unmarried, divorced, or childless, especially men.

• Older adults: Difficulty with caregiving and volunteering.

• Leisure: Limits participation in enjoyable activities.

• Treatment: Only about 50% seek treatment in Western societies, often after 15–20 years of symptoms.

• Unemployment: Strong predictor that social anxiety disorder will continue (persist).

Who Is Barry Manilow?

• Barry Manilow: Successful American singer and songwriter who won a Grammy, Tony, and Emmy (EGOT — missing the Oscar).

• Music success: Had 10 Top 10 songs, including 3 number-one hits.

• Career peak: 1975–1978.

• Famous songs: Mandy, I Write the Songs, Could It Be Magic?, New York City Rhythm, Can't Smile Without You, Looks Like We Made It, and Copacabana.

Normal Shyness

• Shyness (social reticence): A common personality trait, not a disorder by itself. Cultural differences: Some societies view shyness positively.

• Social Anxiety Disorder: Should be considered when shyness seriously affects social life, work, or other important daily activities.

• 12%: Only 12% of people who identify as shy meet the diagnostic criteria for social anxiety disorder.

Susan Cain – Extrovert Ideal

- Extrovert Ideal: A popular belief in Western society that the ideal person is outgoing (gregarious), dominant/confident (alpha), and comfortable being the centre of attention.

• Good speaker ≠ good ideas: Speaking confidently doesn't mean having better ideas.

• Forced teamwork: Can cause groupthink (agreeing with others instead of thinking independently).

Panic Attacks

Definition: Sudden intense fear or discomfort that peaks within minutes, with 4+ symptoms. Can occur when calm or anxious.

13 Symptoms: Racing heart, sweating, shaking, shortness of breath, choking, chest pain, nausea, dizziness/faintness, chills or heat, numbness/tingling (paresthesias), feeling surroundings aren't real (derealization) or detached from yourself (depersonalization), fear of losing control or “going crazy,” and fear of dying.

Panic Attacks cont

• Essential feature: Sudden intense fear or discomfort with 4+ of 13 physical or cognitive symptoms, reaching peak intensity within minutes (literally only a few minutes).

• Expected panic attacks: Have an obvious trigger (e.g., situations where attacks occurred before).

• Unexpected panic attacks: Have no obvious trigger, even when relaxing or sleeping (nocturnal panic attack).

Panic Disorder

At least one panic attack is followed by 1 month or more of one or both:

1. Persistent worry: Fear of more attacks or their consequences (e.g., losing control, heart attack, “going crazy”).

2. Maladaptive behaviour: Unhelpful behaviour changes to avoid attacks (e.g., avoiding exercise or unfamiliar situations).

Agoraphobia

• A. Fear of 2+ of 5 situations: Public transportation, open spaces, enclosed places, crowds/lines, or being outside home alone.

• B. Fear of escape/help: Worry that escape will be difficult or help unavailable during panic-like, incapacitating, or embarrassing symptoms (e.g., falling or incontinence).

• C. Anxiety: Situations almost always cause fear.

• D. Avoidance: Avoid situations, need a companion, or endure intense anxiety.

• E. Excessive fear: Greater than actual danger, considering cultural context.

• F. Duration: Lasts 6+ months.

• G. Impairment: Causes significant distress or problems in social life, work, or daily functioning.

Anxiety Disorders in Children

• Most frequent: Anxiety disorders are the most common mental disorders in children and adolescents.

• Long-term effects: Most children with a diagnosed anxiety disorder will experience the same disorder or other mental disorders later in life (e.g., other anxiety disorders, depression, or substance use disorders).

Selective Mutism

Definition: A child consistently cannot speak in certain social situations (e.g., school) but can speak normally in others (e.g., home).

Diagnostic Criteria (A–E) :

• A. Cannot speak in situations where speaking is expected, despite speaking elsewhere.

• B. Interferes with school, work, or social communication.

• C. Lasts at least 1 month (not just the first month of school).

• D. Not caused by unfamiliarity or discomfort with the language.

• E. Not better explained by a communication disorder or occurring exclusively during autism spectrum disorder or a psychotic disorder.

selective mutism features

• Excessive shyness, fear of embarrassment, social withdrawal, clinginess, tantrums, or oppositional behaviour.

• Strongly associated with social anxiety disorder.

Onset and Course:

• Onset: Usually before age 5.

• Often becomes noticeable when children start school.

• Many children eventually outgrow selective mutism, but symptoms of social anxiety may persist.

Separation Anxiety Disorder

Definition: Excessive fear of separation from attachment figures (parents/caregivers). Normal in young children but becomes a disorder when unusually intense, persistent, or impairing.

Associated Features:

• Fears: Dark, monsters, kidnapping, accidents, danger to family/self.

• Homesickness: Extreme discomfort away from home.

• School refusal: Academic/social problems.

• Anger/aggression: When forced to separate.

• Unusual perceptions: Seeing figures/feeling watched when alone at night.

Onset:

• Normal: Around age 1; may reflect secure attachment.

• Disorder: Preschool through adolescence.

• Key: Normal anxiety fades; disorder persists and impairs functioning.

Separation Anxiety Disorder - DSM-5 Criteria (A–D)

A. At least 3 of 8 symptoms:

1. Excessive distress before/during separation.

2. Worry about losing attachment figures or harm to them (illness, injury, death).

3. Worry about events causing separation (getting lost, kidnapped, accidents, illness).

4. Refusal to leave home, attend school/work due to separation fears.

5. Fear of being alone or without attachment figures.

6. Refusal to sleep away from home or without attachment figures nearby.

7. Repeated nightmares about separation.

8. Physical symptoms during/anticipating separation (headaches, stomachaches, nausea, vomiting).

B. Duration: ≥4 weeks in children/adolescents; typically ≥6 months in adults.

C. Significant distress or impairment (social, academic, occupational, daily functioning).

D. Not better explained by another mental disorder:

• Autism: Won’t leave home due to resistance to change.

• Psychosis: Separation fears caused by delusions/hallucinations.

• Agoraphobia: Won’t go outside without a trusted person.

• GAD: Worries about loved ones getting sick or harmed (not specifically separation).

• Illness anxiety: Worries about having an illness.