Abnormal Psychology: Comprehensive University Reviewer

Philippine Laws and Regulations in Psychology and Mental Health

R.A. 10029 (Philippine Psychology Act of 2009): An Act to Regulate the Practice of Psychology Creating for This Purpose a Professional Regulatory Board of Psychology, Appropriating Funds Therefor and for Other Purposes.
R.A. 10912 (CPD Act of 2016): An Act Mandating and Strengthening the Continuing Professional Development Program for All Regulated Professions, Creating the Continuing Professional Development Council, and Appropriating Funds Therefor, and for Other Related Purposes.
R.A. 11036 (Mental Health Act): An Act Establishing a National Mental Health Policy for The Purpose of Enhancing the Delivery of Integrated Mental Health Services, Promoting and Protecting the Rights of Persons Utilizing Psychosocial Health Services, Appropriating Funds Therefor and Other Purposes.
R.A. 7610 (Special Protection of Children Against Abuse, Exploitation and Discrimination Act): An Act Providing for Stronger Deterrence and Special Protection Against Child Abuse, Exploitation and Discrimination, and for Other Purposes.
R.A. 9710 (Magna Carta of Women): An Act Providing for The Magna Carta of Women.
R.A. 7277 (Magna Carta for Disabled Persons): An Act Providing for The Rehabilitation, Self-Development and Self-Reliance of Disabled Persons and Their Integration into the Mainstream of Society and For Other Purposes.
R.A. 7877 (Anti-Sexual Harassment Act of 1995): An Act Declaring Sexual Harassment Unlawful in the Employment, Education or Training Environment, and for Other Purposes.
R.A. 9258 (Guidance and Counseling Act of 2004): An Act Professionalizing the Practice of Guidance and Counseling and Creating for This Purpose a Professional Regulatory Board of Guidance and Counseling, Appropriating Funds Therefor and For Other Purposes.

Components and Definition of Abnormal Behavior

Statistical Deviancy / Statistical Rarity: - Abnormal behavior is defined by its infrequency (e.g., episodes of depression and mania). - Normal behavior does not deviate significantly from the average in a particular trait or behavior pattern. - Key Principle: Not all deviant behavior is abnormal, but all abnormal behavior is deviant. Deviance alone is not indicative of a mental disorder.
Violation of Standards of Society (Norms): - Involves cultural expectations regarding right and wrong ways to act. - Considered the weakest component because norms vary significantly from place to place.
Maladaptiveness: Behavior that interferes with an individual's welfare and ability to function.
Disability: Impairment in an important area of life (e.g., social, occupational, or academic).
Suffering or Personal Distress: - Behavior is flagged as abnormal if it creates great distress or torment for the person experiencing it. - In the absence of biological markers, personal distress must be clinically significant to be considered pathological. - Distress can also be experienced by others around the individual.
Social Discomfort: Those in proximity to someone exhibiting abnormal behavior experience a sense of discomfort or unease.
Irrationality and Unpredictability: Evaluates whether the person can maintain control over their behavior.
Dangerousness: Refers to the risk of harm to self or others associated with a particular behavior.

Epidemiological and Clinical Concepts

Prevalence: Represents the total number of people in the population as a whole who have the disorder (includes active cases and those who have recovered). - Point Prevalence: Counts only active cases at a specific point in time (e.g., a week, a month, or multiple months). - 1-year Prevalence: Counts anyone who had the condition at any point during that entire year; excludes those who recovered before that year started. - Lifetime Prevalence: The most expansive measure, counting anyone who has ever had the disorder in their lifetime, even if they are currently recovered.
Incidence: Refers to the number of new cases that occur during a specific period (e.g., one year); preexisting cases are excluded.
Course: The individual pattern of the disorder. - Chronic: Tends to last a long time, potentially a lifetime (e.g., Schizophrenia). - Episodic: Likely to recover within a few months, only to suffer a recurrence later (e.g., Major Depressive Disorder).
Onset: How the disorder began. - Acute: The disorder began suddenly (e.g., Delirium). - Insidious: The disorder developed gradually over time.
Prognosis: The anticipated or predicted course of the disorder.

The 5 P’s of Case Presentation

Presenting Problem: A description of the individual’s current difficulties and the reason they sought clinical assistance.
Predisposing Factor: Factors that increase vulnerability to developing problems, including biological, socioeconomic, and social factors.
Precipitating Factor: The immediate triggers for the current presenting issues; what occurred immediately prior to the symptoms.
Protecting Factor: Positive qualities (e.g., open-minded personality traits) that help maintain emotional health and resilience.
Perpetuating Factor: Factors that maintain the problem or reinforce the symptoms, preventing recovery.

Neurodevelopmental Disorders

Intellectual Developmental Disorder (IDD): - Formerly known as "mental retardation." - Characterized by deficits in intellectual and adaptive functioning during the developmental period. Causes are often genetic or chromosomal. - Criterion A (General Mental Abilities): Requires an IQ test score typically $2\,SD$ below the mean (score of $\leq 70$ ). Instruments used include Wechsler, Stanford-Binet $5$ , or Woodcock-Johnson. - Criterion B (Adaptive Functioning): Deficits in practical skills ("street smarts"), social skills, and conceptual skills (language, reasoning, knowledge, memory). Measured using the Vineland Adaptive Behavior Scales (VABS). - Criterion C (Onset): Must occur during the developmental period. - Severity Levels Based on IQ: - Mild ( $55-70$ IQ): Educable until Grade $6$ . - Moderate ( $40-54$ IQ): Trainable until Grade $2$ . - Severe ( $25-39$ IQ): Learning sight words; focus on survival skills. - Profound ( $< 25$ IQ): Highly dependent on others for care. - Etiology: - Down's Syndrome is the most common cause. - Phenylketonuria (PKU): Inability to break down phenylalanine. - Lesch-Nyhan Syndrome: X-linked recessive disease carried by the mother and passed to the son. - Down Syndrome (Trisomy 21): Extra $21^{st}$ chromosome. - Fragile X Syndrome: X chromosome abnormality; more evident in boys ( $XY$ ) than girls ( $XX$ ). - Treatment: Focuses on skills and communications training.
Communication Disorders: - Language Disorder: Language is not developed; features limited vocabulary, grammar, and discourse (expressive and receptive). Not related to sensory impairment. - Speech Sound Disorder: Difficulty with phonological knowledge of speech sounds or coordination of body parts for sound production. - Social (Pragmatic) Communication Disorder: Deficits in social communication resulting in functional limitations. Children cannot change communication context (e.g., speaking the same way to a peer vs. an authority figure). - Childhood-onset Fluency Disorder (Stuttering): Disturbance in normal fluency and time patterning, including monosyllabic repetition. Causes anxiety about speaking.
Attention-Deficit/Hyperactivity Disorder (ADHD): - Characterized by inattention and/or hyperactivity ( $\geq 6$ symptoms for $\geq 6$ months). - Symptoms must be present before age $12$ and in $\geq 2$ settings. - Presentations: Predominantly Inattentive, Predominantly Hyperactive-Impulsive, or Combined. - Clinical Notes: Hyperactivity declines with age; ADHD is a predictor of Antisocial Personality Disorder; involves frontal lobe issues (stimulants increase activity here).
Specific Learning Disorder: - Difficulties learning academic skills despite interventions; observed during school age. - Specifics: Dyslexia (reading), Dyscalculia (mathematics), and written expression impairment.
Autism Spectrum Disorder (ASD): - Deficits in social communication and social-emotional reciprocity. - Presence of restricted, repetitive patterns of behavior (e.g., stimming, echolalia, idiosyncratic phrases). - Treatment includes SPED, Occupational Therapy (OT), and Applied Behavior Analysis (ABA).
Global Developmental Delay (GDD): Diagnosed for children under age $5$ when clinical severity cannot be reliably assessed via IQ testing.
Motor Disorders: - Developmental Coordination Disorder: Deficit in fine and gross motor skills (clumsiness). - Stereotypic Movement Disorder: Repetitive, purposeless motor behaviors. - Tic Disorders: Sudden, rapid, non-rhythmic movements or vocalizations onset before age $18$ . - Tourette's Disorder: Multiple motor and $\geq 1$ vocal tic (not necessarily concurrent). - Persistent Motor or Vocal Tic Disorder: Motor OR vocal tics, but not both. - Provisional Tic Disorder: Tics present for $< 1$ year.

Impulse Control-Related Disorders

Linked to serotonin levels; behaviors provide relief from high tension.
Kleptomania: Urge to steal objects not needed for personal use or monetary value. Unlike OCD, it involves a "craving" and gratification.
Pyromania: Irresistible urge to set fires. Note: Not all arsonists are pyromaniacs.
Intermittent Explosive Disorder (IED): Episodic aggressive outbursts disproportionate to the stressor. No premeditation; involves regret/remorse afterward.
Disruptive Mood Dysregulation Disorder (DMDD): Chronic, severe irritability between temper tantrums. Unlike IED, the baseline mood is persistently angry.
Oppositional Defiant Disorder (ODD): Angry/irritable mood, argumentative/defiant behavior, and vindictiveness toward authority figures.
Conduct Disorder (CD): Violation of the basic rights of others and societal norms (aggression to animals/people, destruction of property, theft, serious rule violations). High risk for Antisocial PD if persistent after age $18$ .

Anxiety Disorders

Conditions of Anxiety: Fear (emotional), Apprehension (cognitive), and Tension (behavioral).
Perspectives: - Psychoanalytic: Internal conflicts/unconscious motives. - Behavioral: Inability to cope with situations. - Cognitive: Focus on perceived danger and potential threats. - Biological: Strong genetic evidence.
Social Anxiety Disorder: Fear of negative evaluation in social or performance situations ( $\geq 6$ months).
Specific Phobia: Avoidance of specific objects or situations ( $\geq 6$ months). Onset can be via direct experience, observation, or false panic attacks.
Panic Disorder: Recurrent, unexpected (uncued) panic attacks and $\geq 1$ month of worry about future attacks. Requires $\geq 4$ symptoms (less is a "symptom-limited" attack).
Generalized Anxiety Disorder (GAD): Excessive worry about various events $\geq 50\%$ of the time for $\geq 6$ months. Symptoms include restlessness, fatigue, and muscle tension.
Separation Anxiety Disorder: Excessive fear regarding separation from attachment figures ( $4$ weeks in children/adolescents; $6$ months in adults).
Agoraphobia: Fear of situations where escape might be difficult (e.g., public transpo, open/enclosed spaces, lines/crowds, being outside alone). Requires $\geq 2$ categories for $\geq 6$ months.
Theories: - Preparedness Theory (Seligman): Evolutionary predisposition to fear certain stimuli (e.g., snakes over guns). - Learned Helplessness (Seligman): Passive behavior resulting from perceived lack of control. - Cognitive Distortions: Catastrophizing, Black-and-white thinking, Magnification, Selective abstraction, Fortune telling, and Arbitrary inference.

Mood Disorders

Episodes: - Major Depressive Episode (MDE): Prototypical sadness and anhedonia (loss of pleasure). Requires $\geq 5$ symptoms for $\geq 2$ weeks. - Manic Episode: Elevated, expansive, or irritable mood for $\geq 1$ week. Includes flight of ideas, decreased need for sleep, and impulsivity. Requires hospitalization or features psychosis. - Hypomanic Episode: Milder mania lasting $\geq 4$ days. No psychotic features; impairment is not marked.
Bipolar Disorders: - Bipolar I: At least one manic episode (depressive episodes common but not required for diagnosis). - Bipolar II: At least one hypomanic episode AND at least one major depressive episode. - Cyclothymic Disorder: Chronic ( $2$ years adults; $1$ year children) fluctuation between hypomanic and depressive symptoms that never meet full criteria for episodes.
Depressive Disorders: - Persistent Depressive Disorder (Dysthymia): Depressed mood for $\geq 2$ years ( $1$ year for youth). - Double Depression: Concurrent PDD and a Major Depressive Episode. - Premenstrual Dysphoric Disorder (PMDD): Mood lability and anxiety symptoms prior to menses.
Suicide (Emile Durkheim's Types): - Fatalistic: Response to pervasive oppression. - Anomic: Response to disappointment or disillusionment. - Egoistic: Low social integration. - Altruistic: Sacrifice for the community's benefit.
Paradoxical Suicide: Committing suicide when depressive symptoms begin to lift because the individual finally has the energy to carry out the act.

Dissociative Disorders

Depersonalization-Derealization Disorder: - Depersonalization: Losing sense of own reality (feeling like a movie observer). - Derealization: Reality of the external world is lost (environment looks different).
Dissociative Identity Disorder (DID): - Presence of $\geq 2$ personality states (alters). Average number of alters is $12-15$ . - Host Personality: Manages executive functions and seeks treatment. - Original Personality: The identity the person was born with. - Switch: The transition from one identity to another.
Dissociative Amnesia: - Localized: Forgetting a specific circumscribed period (most common). - Selective: Forgetting some but not all details of a traumatic event. - General: Loss of entire life history, including procedural memory (rare). - Systematized: Forgetting a specific category of information (e.g., a specific person). - Continuous: Forgetting new events as they occur. - Dissociative Fugue: Unexpected travel and assumption of a new identity with memory loss of the past.

Eating Disorders

Bulimia Nervosa: Binge eating followed by compensatory purging (e.g., vomiting).
Anorexia Nervosa: Intense fear of weight gain leading to self-starvation and significant low weight. - Mild: $BMI \geq 17\,kg/m^2$ - Moderate: $BMI \approx 16-16.99\,kg/m^2$ - Severe: $BMI \approx 15-15.99\,kg/m^2$ - Extreme: $BMI < 15\,kg/m^2$ - Types: Restricting type and Binge-eating/purging type.
Binge-Eating Disorder: Repeated bingeing without purging.
Pica: Consumption of non-nutritive substances (e.g., dirt, paper).
Adonis Complex: Obsession with bodybuilding and muscle mass.

Trauma and Stressor-Related Disorders

Post-traumatic Stress Disorder (PTSD): Persistent intrusion, avoidance, and negative cognitions following trauma ( $> 1$ month).
Acute Stress Disorder (ASD): Similar to PTSD but duration is $3$ days to $1$ month.
Adjustment Disorder: Emotional/behavioral symptoms in response to an identifiable stressor within $3$ months of onset. Symptoms end within $6$ months after the stressor is gone.
Reactive Attachment Disorder (RAD): Social/emotional withdrawal from caregivers due to neglect.
Disinhibited Social Engagement Disorder (DSED): Pattern of approaching and interacting with unfamiliar adults without inhibition.

Somatic Symptom and Related Disorders

Somatic Symptom Disorder: Real physical pain/symptoms with no medical cause and excessive worry ( $6$ months).
Illness Anxiety Disorder (Hypochondriasis): Severe anxiety about having or acquiring a serious disease; minimal somatic symptoms.
Conversion Disorder (Functional Neurological Symptom Disorder): Physical malfunctioning (e.g., blindness, paralysis) with no organic cause. May exhibit "La belle indifference" (lack of concern).
Factitious Disorder (Munchausen): Faking symptoms for primary gain (attention/sympathy).
Malingering: Faking symptoms for secondary gain (e.g., avoiding work, insurance money). Not a mental disorder.

Schizophrenia Spectrum and Psychotic Disorders

Schizophrenia: Requires $\geq 2$ symptoms for $\geq 1$ month (at least one must be Delusions, Hallucinations, or Disorganized Speech); total duration $\geq 6$ months. - Positive Symptoms (Type 1): Delusions (most common: persecutory), Hallucinations (most common: auditory), disorganized behavior. - Negative Symptoms (Type 2): Alogia (lack of speech), Avolition (lack of motivation), Affective flattening, Anhedonia, Asociality.
Brief Psychotic Disorder: Symptoms last $> 1$ day but $< 1$ month.
Schizophreniform Disorder: Symptoms last $1-6$ months; no functional decline required.
Schizoaffective Disorder: Active phase symptoms of schizophrenia plus a major mood episode.
Delusional Disorder: $\geq 1$ month of delusions without other psychotic symptoms. Types: Erotomanic, Grandiose, Jealous, Persecutory, Somatic.
Phases: Prodromal (noticeable changes), Active (psychosis), and Residual (after-effects).
Formal Thought Disorders: Clang association (rhyming), Word Salad (incoherence), Neologism (new words), Circumstantiality (roundabout speech), Tangentiality (not hitting the point).
Catatonic Specifiers: Catalepsy (posture against gravity), Stupor (no activity), Waxy flexibility (resistance to positioning).
Specific Syndromes: - Capgras: Belief that loved ones are replaced by imposters. - Cotard's: Belief that one is dead or missing organs (Nihilistic). - Folie à deux: Shared psychosis between two people.

Neurocognitive Disorders

The Alzheimer’s Triad: - Aphasia: Language comprehension/production problems. - Agnosia: Inability to recognize objects (Prosopagnosia is facial agnosia). - Apraxia: Loss of motor planning/muscle coordination.
Genetic Factors in Alzheimer’s: - Protective: $APOE-E2$ - Risk Factors: Presenilin $1$ , Presenilin $2$ , and $APOE-E4$ (late onset).

Personality Disorders

Cluster A (Odd/Eccentric): - Paranoid: Pervasive distrust. - Schizoid: Detachment, no desire for relationships. - Schizotypal: Magical thinking and eccentricities.
Cluster B (Dramatic/Erratic): - Antisocial: Disregard for rights of others; lack of remorse. - Borderline: Instability in relationships and self-image; fear of abandonment. - Histrionic: Excessive emotion and attention-seeking. - Narcissistic: Grandiosity, lack of empathy, need for admiration.
Cluster C (Anxious/Fearful): - Avoidant: Social inhibition due to fear of rejection. - Dependent: Pervasive need to be taken care of. - Obsessive-Compulsive PD (OCPD): Preoccupation with orderliness and perfection (Ego-syntonic, unlike OCD).

History and Key Figures in Psychology

Hippocrates & Galen: Humoral theory; biological basis of disorders.
Philippe Pinel: Humane treatment of patients.
Emil Kraepelin: Classification system; coined "dementia praecox."
Eugen Bleuler: Coined "schizophrenia" (splitting of the mind).
Dorothea Dix: Mental hygiene movement.
Alois Alzheimer: Alzheimer's disease identification.
Aaron Beck: Cognitive triad (self, world, future).
Albert Ellis: Rational Emotive Behavioral Therapy (REBT).
Viktor Frankl: Logo Therapy (finding meaning).

Forensic and Ethical Guidelines

Legal Rules for Insanity: - M’Naghten Rule: Defendant didn't know what they were doing or that it was wrong. - Irresistible Impulse Test: Mental defect made it impossible to resist an impulse. - Durham Rule: Act was a product of mental disease. - ALI Rule: Lacks capacity to appreciate criminality or conform to law.
Ethics in Practice: - Boundary Crossing: Non-harmful (e.g., accepting a small gift). - Boundary Violation: Harmful (e.g., sexual contact, business relations). - Pseudo Boundary Violation: Legally mandated actions (e.g., Tarasoff warnings/duty to warn).