abnormal psych

Abnormal Psychology

What is Psychological Disorder?

  • Definition: A psychological disorder is characterized by behavioral, emotional, or cognitive dysfunctions that are unexpected in an individual's cultural context.

  • Diagnostic Reference: According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR and DSM V), it is associated with personal distress or substantial impairment.

Historical Context

  • The understanding and classification of psychological disorders have evolved over time, taking into account both cultural expectations and scientific advancements in psychology.

Integrative Approach

  • An integrative approach to psychological disorders considers biological, psychological, and social factors in understanding mental health.

Mental Health Services: Legal and Ethical Issues

  • Mental health services must navigate complex ethical issues regarding patient care, confidentiality, and legal protections for individuals with psychological disorders.

Nature of Psychological Disorders

Cognitive, Emotional, and Behavioral Dysfunctions

  • Cognitive Dysfunction: Impaired decision-making, memory issues, or distorted perceptions.

  • Emotional Dysfunction: Severe mood fluctuations, such as depression or anxiety.

  • Behavioral Dysfunction: Actions that deviate significantly from cultural norms or expectations.

Personal Distress and Impairment

  • Disorders often lead to significant personal distress and impair an individual's ability to function effectively in everyday life.

  • Personal issues include not being able to maintain relationships, work, or daily activities due to the disorder.

Distinction from Behavioral Disorders

  • Not every behavior that is atypical or culturally unexpected qualifies as a psychological disorder. It must be associated with personal distress.

Definition According to DSM

  • The DSM (Diagnostic and Statistical Manual of Mental Disorders), including the most recent DSM V, classifies mental disorders within a multi-axial format which helps clinicians describe the mental state of their patients comprehensively.

DSM Structure

  • Axis 1: Clinical disorders and other conditions that may require clinical attention.

  • Axis II: Personality disorders and mental retardation, important for long-term diagnosis and treatments.

  • Example Disorders in Axis 1: Delirium, dementia, substance-related disorders.

Prevalence and Incidence

  • Prevalence Rate: The proportion of a population that exhibits a disorder during a specified time.

  • Incidence Rate: The rate of new cases that occur during a specific period.

  • Understanding these rates is crucial for diagnosing and planning effective treatment strategies.

Course of Disorder

  • Chronic: Disorders that last a long time and are often persistent.

  • Episodic: Disorders characterized by occurrences of symptoms that can fluctuate in severity.

  • Limited: Disorders that may resolve after a certain period, often with treatment.

Onset of Disorder

  • Acute Onset: Symptoms begin suddenly.

  • Insidious Onset: Symptoms develop gradually over time.

  • Knowledge of the onset is critical for planning treatment and prognosis.

Importance of Knowledge of Course and Onset

  • Understanding the course and onset allows clinicians to:

    • Advise on the type of treatment necessary.

    • Anticipate the likely prognosis and progression of the disorder.

Glossary of Essential Psychological Disorders

Major Depressive Disorder (MDD)

  1. Symptoms Recognition: At least five symptoms present for two weeks, including:

    • (1) Depressed mood most of the day.

    • (2) Loss of interest or pleasure in most daily activities.

    • (3) Significant weight change (>5% of body weight).

    • (4) Sleep disturbances (insomnia/hypersomnia).

    • (5) Psychomotor agitation or retardation.

    • (6) Fatigue or energy loss.

    • (7) Feelings of worthlessness or excessive guilt.

    • (8) Difficulty concentrating.

    • (9) Recurrent thoughts of death or suicidal ideation.

  2. Impairment: Symptoms must cause significant impairment in social or occupational functioning.

  3. Exclusion Criteria: Not attributable to physiological effects of a substance or another medical condition.

Persistent Depressive Disorder (Dysthymia)

  1. Duration: Depressed mood most of the day, more days than not, for at least 2 years.

  2. Additional Symptoms: Presence of at least two additional symptoms including:

    • Poor appetite or overeating.

    • Insomnia or hypersomnia.

    • Low energy.

    • Low self-esteem.

    • Poor concentration.

    • Feelings of hopelessness.

  3. Continuity: No symptom-free period of more than two months during the two years.

  4. Exclusion Criteria: Must not be better explained by schizoaffective disorder, schizophrenia, or physiological effects of another condition.

Schizophrenia

  1. Key Symptoms: Presence of two or more of the following for a significant portion of time during a month:

    • Delusions.

    • Hallucinations.

    • Disorganized speech.

    • Grossly disorganized or catatonic behavior.

    • Negative symptoms (e.g. lack of emotional expression).

  2. Functional Impairment: Marked deterioration in functioning since onset.

  3. Duration: Continuous symptoms for at least 6 months.

  4. Exclusion Criteria: Other conditions that could explain symptoms must be ruled out.

Obsessive-Compulsive Disorder (OCD)

  1. Obsessions: Recurrent and persistent thoughts or urges that cause significant anxiety.

    • Must attempt to suppress or neutralize these thoughts through compulsive behaviors.

  2. Compulsions: Repetitive behaviors or mental acts performed to reduce anxiety. Must be time-consuming (1 hour or more daily) or significantly impair functioning.

  3. Exclusion Criteria: Symptoms should not be better explained as part of another mental disorder.

Hoarding Disorder

  1. Symptoms: Persistent difficulty discarding possessions due to perceived need to save items.

  2. Consequences: Accumulation of possessions that clutter living areas, causing significant distress or impairment.

  3. Exclusion Criteria: Not attributable to medical conditions or other mental disorders.

Trichotillomania (Hair-Pulling Disorder)

  1. Symptoms: Recurrent pulling out of hair resulting in noticeable hair loss.

  2. Attempts: Repeated attempts to stop the hair pulling.

  3. Impact: Causes clinically significant distress or impairment in functioning.

  4. Exclusion Criteria: Not explained by other medical or mental health conditions.

Bipolar I & II Disorders

  • Both disorders involve mood episodes that include manic episodes but vary in severity and duration of symptoms.

Manic Episode

  • Characterized by an elevated mood lasting at least one week, with symptoms such as inflated self-esteem, reduced need for sleep, distractibility, and impulsivity leading to risky behaviors.

Hypomanic Episode

  • Similar to manic but less severe; does not markedly impair functioning or require hospitalization.

Diagnostic Criteria for Anorexia Nervosa

  1. Energy Restriction: Significantly low body weight due to energy intake restriction relative to requirements.

  2. Fear of Weight Gain: Intense fear of gaining weight or behavior that interferes with weight gain.

  3. Disturbed Body Image: Disturbance in the way one perceives body weight or shape.

  4. Types:

    • Restricting Type: Weight loss through dieting, fasting, or excessive exercise.

    • Binge Eating/Purging Type: Binge eating or purging behaviors present.

Diagnostic Criteria for Bulimia Nervosa

  1. Binge Eating Episodes: Characterized by consuming large amounts in a discrete period, accompanied by lack of control.

  2. Inappropriate Compensatory Behaviors: Engaging in behaviors such as self-induced vomiting or misuse of laxatives to prevent weight gain.

  3. Frequency: Occurs at least once a week for three months.

  4. Disturbance in Self-evaluation: Self-evaluation excessively influenced by body shape and weight.

Common Disorders in Children and Teens

  1. Autism Spectrum Disorder

  2. Intellectual Disability

  3. Attention Deficit Hyperactivity Disorder (ADHD) - Three types: Inattentive, Hyperactive-Impulsive, Combined.

  4. Conduct Disorder

  5. Depressive Disorders (including bipolar disorders)

  6. Anxiety Disorders and OCD

  7. Trauma and Stress-related Disorders

  8. Substance Use Disorders

Supporting Individuals with Psychological Disorders

  • Clinical diagnosis is crucial, but equally, if not more importantly, is the support provided to family members and individuals with psychological disorders. Empathy and understanding can significantly enhance recovery and management of symptoms.