Clinical Comp Exam Flashcards
When taking the California clinical comp exam, what are the four areas of priority to consider before answering the question?
1) Safety
2) ethics
3) culture
4) intervention
The three clinical core concepts are:
(1) therapy emphasizes _______ over content
(2) therapy creates/facilitates a _____________
(3) therapy must have client _______ specificity
process
corrective emotional experience
response
a symptom or problem that is offered by a client or a patient as the reason for seeking treatment. In psychotherapy, for example, a client may present with depression, anxiety, panic, anger, chronic pain, or family or marital problems; such symptoms may become the focus of treatment or may represent a different, underlying problem that is not recognized or regarded by the client as requiring help
Presenting Problem
The ___________ isn’t just the person - even if only a single person is interviewed - it is the set of relationships in which the person is embedded
unit of treatment
Five stages of change are:
1) Pre-contemplation
2) Contemplation
3) Preparation
4) Action
5) Maintenance
Stage of Change - client denies the problem, therefore no need for change [raise client’s awareness towards the urgency of the issues and the pain/fear that issue may cause, suggest change could be possible]
1) Pre-contemplation
Stage of Change - client displays ambivalence and experiences the pros and cons about making the change, they are aware of the problem but not ready for change [explore both sides of ambivalence, validate and help client identify the barriers to change and the strengths that will make change possible]
2) Contemplation
Stage of Change - client is gathering information and preparing for action, not quite ready to take action yet, learning about what might need to happen if change were to occur, taking small steps related to change and thinking about possible goals [goal setting]
(3) preparation
Stage of Change - client is making change already, may move into stage while in therapy, able to make changes without seeking help [support client gains and help with setbacks]
(4) action
Stage of Change - client has achieved goal and is ready to move out of therapy [plan for ways to cope with temptations to fall back into old patterns, relapse preparation, planning for ways to reward success]
(5) maintenance
All factors of assessment (intake, psychosocial stressors, DSM criteria, developmental stages), _______________, and impact on the therapeutic process.
cultural and spiritual diversity
SCAGSO → Cultural Diversity acronym
Socioeconomic status
Culture (ethnicity and race)
Age
Gender (sex roles and orientation)
Spiritual values
Other (profession, psychological profile)
___________ refers to all identities that make up an individual (Race, Sex, Gender, Ethnicity, Sexual Orientation, Religious/Spiritual Views, etc.).
Cultural competency
Erikson Stage 1
Trust vs mistrust → 0 - 1 ½
Is the world a safe place? Can I trust?
Leads to virtue of HOPE
Erikson Stage 2
autonomy vs shame → 1 ½ - 3
Is it ok to be me? Self control without loss of self-esteem
Leads to virtue of WILL
Erikson Stage 3
initiative vs guilt → 3 - 5
Is it okay for me to do, move, act? Children assert themselves more frequently, interact with other children, plan activities, make up games, initiate activities involving others
Virtue of PURPOSE
Erikson Stage 4
industry vs inferiority → 5 - 12
Can I make it in this world? Capable of completing increasingly complex tasks, seeks more approval for accomplishments
Leads to virtue of COMPETENCE
Erikson Stage 5
identity vs role confusion → 12 - 18 (adolescence)
Who am I? Ability to relate to others and form genuine relationships, learn roles they will occupy as an adult, sexual and occupational identities, goal is reintegrated sense of self and identity
Leads to virtue of FIDELITY
Erikson Stage 6
Intimacy vs isolation → 18 - 40 (adulthood)
Will I be loved or alone? Romantic relationships, companionship, marriage, starting a family, isolation means avoiding commitment, intimacy or fearing relationships
Leads to virtue of LOVE
Erikson Stage 7
generativity vs stagnation → 40 - 65
We give back to society, raising children, being productive at work, becoming involved in community, by failing - we feel stagnant and unproductive
Leads to virtue of CARE
Erikson Stage 8
ego integrity vs despair → 65 +
Ego integrity - feeling of being whole, not scattered, comfortable with oneself, development of wisdom and integrity, success and satisfaction, despair - aspects of the present that cause unremitting pain and inescapable death
Leads to virtue of WISDOM
Piaget Developmental Stages - simple reflexes, reflexive movements, primary circular reactions, secondary circular reactions, coordination of secondary reactions, tertiary circular reactions, internalization of schemas
Sensorimotor (birth - 2 years)
Piaget Developmental Stages - symbolic function, egocentric thinking diminishes, precausal reasoning, magical thinking, irreversibility, inability to conserve, animism centration
Preoperational (2 - 7 years)
Piaget Developmental Stages - ability to reason logically about direct experiences and perceptions, can solve concrete problems, understand relationships such as size, cognizant of others viewpoints “stop and think before you ask”, skills (seriation, classification, decentering, reversibility, achieving conservation)
Concrete operational (7 - 11 years)
Piaget Developmental Stages - concrete operations are carried out on things where formal operations are carried out on ideas, use rational and critical thinking not so concrete, less reliance on concrete and can work things out in own mind, third eye problem
Formal operational (12 - 18 years)
Family Life Cycle Stages:
Single adult
Marriage
Family with young children
Family with adolescent children
Launching children
Later life
Family Life Cycle Stage - Financial resources, Separation/individuation (mode of communicating with family-of-origin, Autonomy/responsibility, Skills/life goals, Gender identity/rules concerning privacy, Health issues (substance use, nutrition, AIDS, etc), Family history (abuse, substance use, separation from their families, etc.), Unresolved past issues affecting current relationships
Between families (single person – late teen – early 20’s)
Family Life Cycle Stage - Goals/values (financial, educational, social, children, etc.), Communication skills/conflict resolution (general/sexual), Cross-cultural differences, Role/gender issues; areas of responsibility, Development of family rituals/traditions, Family of origin issues, Unfinished business with other relationships, Negotiation – what is couple vs. individual domain; appropriate boundaries, Scheduling couple time/recreation, Chemical abuse
Marriage (young couple)
Family Life Cycle Stage - Balancing of child care/work responsibilities, Parenting responsibilities/values/expectations, Discipline/abuse, Communication/conflict resolution/stress management, Appropriate/inappropriate expectations (marital, children, work, etc.), Family of origin issues/role of grandparents/closeness or distance, Development of children (generic/idiosyncratic – special needs child), Child as carrier of family symptoms?, Scheduling – family time, couple time, alone time, vacations
Family with Young Children
Family Life Cycle Stage - Sibling interactions, Roles taken by different children in family (how evolved/how dealt with), Diversity of skills/interests/values – how does family handle?, Parental expectations re: kids’ increasing responsibilities, Parental responsibility for their aging parents, Parental values re: education; appropriate expectations for children, School problems – appropriate level/school/assignments?, Behavior problems (symptomatic of family distress?), Health issues (family nutrition, eating patterns, substance use), Abuse/molestation, Parental role modeling (same and opposite sex)
Family with Adolescents
Family Life Cycle Stage - Family in transition (school, work, members at home, etc.), Meeting financial demands (college, care for elderly or ill family member), Mother may start new career, Mid-life issues (job/family accomplishment, health, menopause, etc.), Sexuality issues for parents/teens, Return to “couple status” – may be positive or difficult change, Grief issues/losses (grandparents, job, power, idealism, children leaving), Dealing with stress/conflict (substance use)
Launching children
Family Life Cycle Stage - Later-life issues (menopause, loss of hopes/dreams, futility, declining health, dying/death of parents, decreased income, etc.) Empty next (children gone); stuffed nest (adult children returning), Planning for retirement (need for new friends, activities, interests), Vocational/avocational/ grandparenting issues, Decline in sexual ability; increase in divorce, Need to move to smaller housing; disposing of personal belongings, Planning for eventual death of spouse/self (writing will, etc.)
Family in Later Life
Bronfenbrenner’s Ecological Systems Theory - What are the 5 systems in the wheel?
Macrosystem
Exosystem
Mesosystem
Microsystem
Individual (center)
Adverse Childhood Experiences Study (ACES) is used to assess:
Trauma
Trauma Informed Care (TIC) includes:
Realizing the _________ of trauma
Recognizing the _________
Responding through policies, procedures, and practices
Resisting re-traumatization
impact
signs and symptoms
The ________ impact of trauma can be: Denial, Anger, Fear, Sadness, Shame, Confusion, Anxiety, Depression, Numbness, Guilt, Hopelessness, Irritability, Difficulty Concentrating
Emotional/Psychological
The ________ impact of trauma can be: headaches. digestive symptoms. Fatigue, racing heart, sweating, feeling jumpy, hyperarousal
Physical
The five stages of grief are:
denial, anger, depression, bargaining, and acceptance (not linear)
_____________ → a future oriented mood state in which one is ready or prepared to attempt to cope with upcoming negative events
Anxiety Disorders
Anxiety Disorder: (A) consistent failure to speak in social situations where there is an expectation for speaking (like school), despite speaking in other situations (B) disturbance interferes with educational or occupational achievement or with social communication (C) duration: least 1 month (D) high anxiety (E) uncommon (F) childhood (2-4 years old)
Selective mutism (F94.0) (child only)
Anxiety Disorder: developmentally inappropriate and excessive fear or anxiety concerning separation from person(s) their attached to // child or adult // recurrent excessive distress in anticipating or experiencing separation // persistent and excessive worry about losing them or serious harm or illness // worry about experiencing untoward event // reluctance or refusal to go out // 4 weeks in children 6 months in adults
Separation anxiety disorder (F93.0)
Anxiety Disorder: (A) persistent fear of object or situation (B) exposure to phobic situation evokes immediate anxiety response (C) Avoid situations or endure through anxiety and distress (D) fear or anxiety out of proportion to actual threat (E) 6 months or more // Many types → animal type, natural environmental type, blood/injections type, situational type, other type
Specific phobia (F40.0)
Anxiety Disorder: (A) persistent fear of social or performance situations in which person possibly exposed to scrutiny (B) individual fears they will be embarrassing or humiliating (C) exposure to feared situation almost always provokes fear and anxiety
Social anxiety disorder (F40.10)
Anxiety Disorder: (A) recurrent unexpected panic attacks (palpitations, accelerated heart rate, sweating, trembling shaking, shortness of breath, smothering, feeling of choking, chest pain or discomfort, nausea or abdominal distress, feeling dizzy, unsteady, lightheaded, chills or heat sensation, paresthesia (tingling or numbness), derealization or depersonalization, fear of losing control or going crazy, fear of dying) (B) at least one attack has been followed by a month of 1 or both → persistent concern about having additional attacks or its consequences // a significant maladaptive change in behavior related to the attacks (C) not due to substance or medication (D) not accounted for by another mental disorder [important to consider concurrent mood disorder]
Panic disorder (F41.0)
Anxiety Disorder: (A) anxiety of fear about 2 of the 5 ( 1 using public transportation 2 being in open spaces 3 being in enclosed spaces 4 standing in line or being crowded 5 being outside of the home alone ) (B) situations almost always provoke fear and anxiety (C) situations are actively avoided (D) fear or anxiety disproportionate to danger (E) fear escaping would be difficult or help wouldn’t be available (F) persistent for 6 months or more
Agoraphobia (F40.0)
Anxiety Disorder: (A) excessive anxiety or worry, occurring more days than not for 6 months or more about a number of events or activities (B) person finds it difficult to control the worry (C) anxiety and worry is associated with 3 or more of the following ( 1 restless of feeling keyed up or on edge 2 being easily fatigued 3 difficulty concentrating or mind going blank 4 irritability 5 muscle tension 6 sleep disturbance ) (D) the anxiety, worry, or physical symptoms are causing clinically significant distress or impairment in functioning (E) disturbance not due to substance or medication
Generalized anxiety disorder (F41.1)
Anxiety Disorder: common substances: marijuana, amphetamines, caffeine // evidence from history, physical examination, or laboratory findings (1) symptoms developed during or soon after substance intoxication or withdrawal or after exposure to medication (2) involved substance/medication is capable of producing symptoms
Substance/medication-induced anxiety disorder
Anxiety Disorder: examples: hyperthyroidism, hypothyroidism, seizure disorders, cardiopulmonary conditions // evidence from history, physical examination, or laboratory findings that disturbance is the direct pathophysiological consequence of another medical condition
Due to another medical condition
_________________ → emotion (affect) gives richness and meaning to our world and depth and scope of the human experience. When affect becomes inappropriately extreme, it can become a source of overwhelming psychological distress
Mood Disorders (BPD & MDD)
Mood Disorders: manic episode criteria: (A) distinct period of abnormally and persistently elevated, expansive, or irritable mood (at least 1 week or any duration of hospitalization occurs) (B) during the period of mood disturbance 3 of the following symptoms have persisted (4 if only irritable mood) → inflated self-esteem or grandiosity, decreased need for sleep, more talkative than usual or pressure to keep talking, flight of ideas or racing thoughts, distractibility, increase in goal-directed activity or psychomotor agitation, excessive involvement in pleasurable activities that have potential for painful consequences // people w/ bipolar depression often stayed depressed longer, relapse more frequently, display more depressive symptoms, show more severe symptoms, have more delusions, hallucinations, commit more suicides, require more hospitalizations.
Bipolar and Related Disorders
Mood Disorder: Diagnostic Criteria: (A) the presence of a manic episode currently or most recently (B) manic episode is not better accounted for by schizoaffective disorder (patient may or may not have history of a MDE or Hypomanic episode)
Bipolar I disorder
Mood Disorder: Diagnostic criteria: (A) presence or history of one or more MDE’s (B) presence or history of at least one hypomanic episode (C) there has never been a manic or mixed episode (D) mood symptoms not accounted for in schizoaffective, schizophrenia, or another psychotic disorder (E) symptoms cause clinically significant distress or impairment // major genetic components for inheriting BPD // onset occurs averagely in mid 20s, women experience more depressive episodes than man which leads to BPD II diagnosis
Bipolar II disorder
Mood Disorder: (A) for at least 2 years (1 year for child/adolescents) have experienced numerous periods with hypomanic symptoms that do not meet criteria for hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for MDE (B) during 2 year period the hypomanic and depressive periods have been present for at least half the time and the individual has not been without symptoms for more than 2 months at a time (C) criteria for major depressive, manic, or hypomanic episode have never been met (D) symptoms in A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified psychotic disorder (E) symptoms not due to effects of substance or other medical condition (F) symptoms cause clinically significant distress or impairment in important areas of functioning.
Cyclothymic disorder (F34.0)
Mood Disorder: evidence from history, physical examination, or laboratory findings (1) symptoms developed during or soon after substance intoxication or withdrawal or after exposure to medication (2) involved substance/medication is capable of producing symptoms
Due to substance-induced or another medical condition
Mood Disorder: evidence from history, physical examination, or laboratory findings that disturbance is the direct pathophysiological consequence of another medical condition
Unspecified bipolar and related disorder
Depressive Disorders: depressed mood or anhedonia (inability to feel pleasure) // biological or vegetative signs or symptoms (appetite loss, unintentional weight gain or loss, sleep disturbance, change in energy, psychomotor retardation or agitation, diminished libido) (diurnal mood variation: person feels worse in the morning and a little better at night) // they see the world through gray-tinted lenses // ruminates over personal failures (real or imagined) // the happiness of everyday life comes and goes but the dysphoria of MDD never leaves // Diagnostic criteria (A) presence of a major depressive episode (B) episode not better accounted by schizoaffective, schizophrenia or any other mental disorder (C) never been manic, mixed or hypomanic episode // genetic and environmental or learned components // greater association with family history of depression or mood disorders // leading cause of disability in US // early onset before age 20 // increases risk of heart attack, and complicating factor for stroke, diabetes, and cancer // pathways to depression → learned helplessness, loss and separation, stress, cognitive distortions, interpersonal PT of depression,
Major depressive disorder
Depressive Disorders: (A) severe recurrent temper outbursts verbally and/or behaviorally that are out of proportion of intensity or duration to the situation (B) temper outbursts inconsistent with age (C) occur, on average 3x per week (D) mood between outbursts is irritable or angry most of the day nearly everyday and is noticeable by others (E) Criteria A-D have been present for 12 months, during time person has not been without symptoms for more than 3 months at a time (F) the criteria are present in at least 2 of 3 (home, school, with peers) and are severe in at least 1 (G) diagnosis should not be made for the first time before age 6 or after age 18 (H) by history or observation onset of symptoms is before age 10
Disruptive mood dysregulation disorder (F34.8)
Depressive Disorders: 5 or more of the following symptoms present during the same 2 week period and is different than previous functioning: at least 1 symptom is either depressed mood or loss of interest or pleasure ( 1 depressed mood most of the day 2 marked diminished interest or pleasure in almost all activities most of the day 3 significant weight loss or gain or decrease or increase in appetite 4 insomnia or hypersomnia 5 psychomotor agitation or retardation 6 fatigue or loss of energy 7 feelings of worthlessness or excessive or inappropriate guilt 8 diminished ability to think or concentrate or indecisiveness 9 recurrent thought of death or suicidal ideation )
Major depressive EPISODE disorder
Depressive Disorders: (A) depressed mood for most of the day, for most days, as indicated by self or observation of others for 2 years (B) Presence of 2 or more: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness (C) during 2 years (1 year for children) individual has never been without symptoms in A and B for more than 2 months (D) diagnosis of MDD present for more than 2 years (E) never been manic or hypomanic episode (F) no schizophrenia (G) no substance or medication (H) symptoms cause clinically significant distress or impairment in important areas of functioning
Persistent depressive disorder (dysthymia) (F34.1)
Depressive Disorders: (A) in majority of menstrual cycles at least 5 symptoms have been 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 week postmenses (B) 1 or more must be present: 1 marked affective lability (mood swings, feeling suddenly sad or tearful, increased sensitivity to rejection); 2 marked irritability or anger or increased interpersonal conflicts; 3 marked depressed mood, feelings of hopelessness, self-deprecating thoughts; 4 marked anxiety, tension, feelings of being keyed up or on edge (C) 1 or more of the following symptoms must be present to reach a total of 5 symptoms between criteria B and C: 1 decreased interest in usual activities; 2 subjective difficulty in concentration; 3 lethargy, easy fatigability; 4 change in appetite, overeating or specific food cravings; 5 hypersomnia or insomnia; 6 sense of being overwhelmed or out of control; 7 breast tenderness or swelling, joint or muscle pain, bloating, weight gain, physical symptoms [criteria must be met for most menstrual cycles] (D) causes clinically significant distress
Premenstrual dysphoric disorder (N94.3)
Depressive Disorders: evidence from history, physical examination, or laboratory findings (1) symptoms developed during or soon after substance intoxication or withdrawal or after exposure to medication (2) involved substance/medication is capable of producing symptoms
Substance/Medication-induced depressive disorder
Depressive Disorders: evidence from history, physical examination, or laboratory findings that disturbance is the direct pathophysiological consequence of another medical condition
Mood disorder due to another medical condition
__________: extreme reduction of intake, extreme overeating, extreme distress or concern about body weight or shape, significantly impairs physical health or psychosocial functioning
Eating Disorders
Eating Disorders: eating non nutritive, nonfood substances > 1 month, eating behavior inappropriate to developmental level of individual // in adults it can be an underlying medical condition (ex zinc or iron deficiency) // comorbid w/ autism and intellectual disability // different terms for different preferences
Pica
Eating Disorders: repeated regurgitation of food at least 1 month, food may be rechewed, re-swallowed or spit out // repeated regurgitation not due to GI or other medical condition // generally at least several times per week often daily // more common among those with intellectual disabilities // con occur across lifespan
Rumination Disorder (F98.21)
Eating Disorders: eating disturbance (ex lack of interest in food) manifested in persistent failure to meet nutritional or energy needs, as seen by 1 or more; weight loss or failure to achieve expected weight gain in children, significant nutritional deficiency, dependence on external feeding or nutritional supplements, marked interference with psychosocial functioning (inability to participate in normal school activities) // commonly develops in infancy or childhood, but may persist into adulthood
Avoidant/Restrictive Food Intake Disorder (F50.8)
Eating Disorders: Diagnostic criteria: 85% or less of expected body weight dropped, significantly low weight, less than energy needs, intense fear of gaining weight, even though underweight, disturbance in how body/weight is experienced, undue influence on self-evaluation, amenorrhea (absence of 3 menstrual cycles but controversial and criteria dropped) // specifiers of extremity and remission // long-term habit leads to thinning of the bones, brittle hair or nails, dry and yellowish skin, growth of fine hair over body // other symptoms; mild anemia, muscle weakness and loss, severe constipation, low blood pressure, slowed breathing and pulse, drop in internal body temperature, causing a person to feel cold all the time, lethargy
Anorexia Nervosa
Anorexia Nervosa __________: during current episode, has not regularly engaged in binge-eating or purging (dieting, fasting, exercising)
Restricting type (F50.01)
Anorexia Nervosa __________: person has regularly engaged in binge-eating/purging (ex self-induced vomiting, misuse of laxatives, diuretics, or enemas)
Binge eating/purging type (F50.02)
Eating Disorders: binge eating + compensatory behaviors, recurrent episodes of binge eating (larger amounts of food or sense of lack of self control), recurrent inappropriate compensatory behavior to prevent weight grain (self-induced vomiting, misuse of laxatives, diuretics, enemas, fasting, exercising), at least once a week for 3 months, self-evaluation unduly influenced by body weight and shape // other symptoms; chronically inflamed sore throat, swollen glands in neck and below jaw, worn tooth enamel and increasingly sensitive and decaying teeth due to stomach acids, gastroesophageal reflux disorder, intestinal distress and irritation from laxative abuse, kidney problems from diuretic abuse, severe dehydration from purging of fluids
Bulimia Nervosa (F50.2)
Eating Disorders: recurrent episodes of binge eating, definition of binge eating, marked distress over binge eating, binge-eating occurs at least once a week for 3 months, no use of compensatory behaviors (purging or nonpurging) as a result of binging // need 3 of the following; (1) eating much more rapidly than usual (2) eating until feeling uncomfortably full (3) eating large amounts of food when not feeling physically hungry (4) eating alone because of being embarrassed (5) feeling disgusted, depressed, or guilty for overeating
Binge-Eating Disorder (F50.8)
______________: (A) persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development by inattention and/or hyperactivity-impulsivity // 6 or more of following symptoms have persisted for 6 months that is inconsistent with developmental level and that negatively impacts directly on social and academic-occupational activities // older adolescents or adults are 5 or more required
Attention Deficit Hyperactivity Disorder
Attention Deficit Hyperactivity Disorder - 1) Symptoms of __________ → often fails to give close attention to detail or makes mistakes, has difficulty sustaining attention in tasks or activities, does not seem to listen when spoken to directly, does not follow through on instructions and fails to finish schoolwork or workplace duties, has difficulty organizing tasks and activities, avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort, loses things necessary for tasks and activities, easily distracted by extraneous stimuli, forgetful in daily activities
inattention
Attention Deficit Hyperactivity Disorder - 2) Symptoms of ____________ → fidgets with or taps hands and feet, or squirms in seat, leaves seat in situations when remaining in seat is expected, runs and climbs in situations when it is inappropriate (adolescents or adults may feel restlessness), unable to play or engage in leisure activities quietly, “on the go” acting as if “driven by a motor”, talks excessively, blurts out answers before question has completed, difficulty waiting their turn, interrupts or intrudes on others
hyperactivity
____________: (B) several inattentive or hyperactive-impulsive symptoms were present prior to age 12 (C) several symptoms present in 2 or more settings (home, school, work, with friends or relatives, other activities) (D) clear evidence that symptoms interfere with or reduce quality of social, academic, or occupational functioning (E) symptoms not due to another mental disorder or substance induced
Attention Deficit Hyperactivity Disorder
Disruptive, Impulse Control, and Conduct Disorders - _________________: (A) pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting least 6 months, exhibited by least 4 symptoms and during interaction with least 1 individual who is not a sibling: (angry/irritable mood) 1 often loses temper, 2 often touchy or easily annoyed, 3 often angry and resentful; (argumentative/defiant behavior) 4 argues with authority, or for adolescents with adults, 5 actively defies or refuses to comply with requests from authority or rules, 6 deliberately annoys others, 7 blames others for their mistakes or behaviors; (vindictiveness) 8 been spiteful or vindictive at least 2x in last month (under 5 - almost everyday for 6 months) (over 5 - at least 1x week for 6 months) (B) behaviors associated with distress in individual or others (C) behaviors do not occur exclusively during course of a psychotic, substance use, depressive or bipolar disorder
Oppositional Defiant Disorder (F91.3)
Disruptive, Impulse Control, and Conduct Disorders - _________________: (A) recurrent behavioral outbursts representing failure to control aggressive impulses as manifested by either: 1 verbal or physical aggression toward property, animals, or other individuals 2x per week (on average) for 3 months, physical aggression does not result in damage or destruction of property and does not result in physical injury to animals or others 2 three behavioral outbursts involving damage or destruction of property and/or physical assault involving physical injury against animals or others occurring within 12 month period (B) magnitude of aggressiveness expressed during recurrent outbursts is grossly out of proportion (C) recurrent aggressive outbursts are not premeditated and are impulsive and are not committed to achieve some tangible objective (D) outbursts cause marked distress in individual or impairment in occupational or interpersonal functioning, or are associated with financial/legal consequences (E) 6 years old or equivalent developmental age (F) not better explained by other mental disorder
Intermittent Explosive Disorder (F63.81)
Disruptive, Impulse Control, and Conduct Disorders - _________________: (A) repetitive and persistent pattern of behavior in which basic rights of others or age-appropriate societal norms or rules are violated, as manifested by presence of least 3 criteria in past 12 months, with at least 1 being past 6 months: (aggression to people and animals) 1 often bullies, threatens, or intimidates others, 2 initiates physical fights, 3 used a weapon that can cause serious physical harm to others, 4 been physically cruel to people, 5 physically cruel to animals, 6 stolen while confronting a victim, 7 forced someone into sexual activity; (destruction of property) 8 deliberately engaged in fire setting with intention of causing serious damage, 9 deliberately destroyed other’s property; (deceitfulness or theft) 10 broken into someone else’s house, building, or car, 11 lies to obtain goods or favors to avoid obligations “cons”, 12 stolen items of nontrivial value without confronting a victim; (serious violations of rules) 13 stays out at night despite parental prohibitions, beginning before age 13 years, 14 has run away overnight at least 2 living with parental home or once without returning for lengthy period, 15 truant from school beginning before age 13 (B) disturbance in behavior causes clinically significant impairment in functioning (C) IF 18 years or older (criteria not met for antisocial personality disorder) // consider lack of remorse or guilt, callous-lack of empathy, unconcerned about performance, shallow or deficient affect
Conduct Disorder
Disruptive, Impulse Control, and Conduct Disorders - _________________: fire setting
Pyromania (F63.1)
Disruptive, Impulse Control, and Conduct Disorders - _________________: steal objects
Kleptomania (F63.3)
__________________ → includes intoxication, withdrawals, and other substance/medication-induced mental disorders
Substance Related and Addictive Disorders
Substance Related and Addictive Disorders: (A) problematic pattern of use leading to clinically significant impairment or distress, manifested by 2 of following within 12 month period: 1 often taken in larger amounts or over a longer period than was intended; 2 persistent desire or unsuccessful efforts to cut down or control use; 3 great deal of time is spent in activities necessary to obtain substance, substance use, or recover from effects; 4 craving or strong desire or urge to use; 5 recurrent use resulting in failure to fulfill major role obligations at work, school or home; 6 continued use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by effects; 7 important social, occupational, or recreational activities are given up re reduced because of use; 8 recurrent use in situations in which it is physically hazardous; 9 use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by use; 10 tolerance as defined by need for increased amounts to achieve desired effects or diminished effect with continued use of the same amount; 11 withdrawal
Substance/Medication-Induced Mental Disorders Use Disorder
Substance Related and Addictive Disorders: (Intoxication symptoms: inappropriate sexual or aggressive behavior, mood lability, impaired judgement, slurred speech, incoordination, unsteady gait, nystagmus, impairment in attention or memory, stupor or coma) (Withdrawal symptoms: autonomic hyperactivity sweating or high pulse rate, increased hand tremor, insomnia, nausea or vomiting, transient visual, tactile, or auditory hallucinations or illusions, psychomotor agitation, anxiety, generalized tonic-clonic seizures)
Alcohol Use Disorder
Substance Related and Addictive Disorders: Intoxication symptoms: restlessness, nervousness, excitement, insomnia, flushed face, diuresis, gastrointestinal disturbance, muscle twitching, rambling flow or thought of speech, tachycardia or cardiac arrhythmia, periods of inexhaustibility, psychomotor agitation) (withdrawal symptoms: headache, marked fatigue or drowsiness, dysphoric mood, depressed mood, irritability, difficulty concentrating, flu-like symptoms)
Caffeine
Substance Related and Addictive Disorders: (Intoxication symptoms: impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgement, social withdrawal, conjunctival injection red eye, increased appetite, dry mouth, tachycardia) (Withdrawal symptoms: irritability, anger, or aggression, nervousness or anxiety, sleep difficulty insomnia or disturbing dreams, decreased appetite or weight loss, restlessness, depressed mood, least 1 of following physical symptoms causing significant discomfort - abdominal pain, shakiness/tremors, sweating, fever, chills, headache)
Cannabis Use Disorder
Substance Related and Addictive Disorders: (Phencyclidine): (Intoxication symptoms: belligerence, assaultiveness, impulsiveness, unpredictability, psychomotor agitation, impaired judgement, can be smoked, snorted, or used intravenously, vertical or horizontal nystagmus, hypertension or tachycardia, numbness or diminished responsiveness to pain, ataxia, dysarthria, muscle rigidity, seizures or coma, hyperacusis (Hallucinogen): (Intoxication symptoms: anxiety or depression, ideas of reference, fear of losing one’s mind, paranoid ideation, impaired judgement, subjective intensification of perceptions, depersonalization, derealization, illusions, hallucinations, synthesias, pupillary dilation, tachycardia, sweating, palpitations, blurring vision, tremors, incoordination)
Hallucinogen-Related Disorders
Substance Related and Addictive Disorders: (Intoxication symptoms: belligerence, assaultiveness, apathy, impaired judgement, dizziness, nystagmus, incoordination, slurred speech, unsteady gait, lethargy, depressed reflexes, psychomotor retardation, tremor, generalized muscle weakness, blurred vision or diplopia, stupor or coma, euphoria)
Inhalant-Related Disorder
Substance Related and Addictive Disorders: (Intoxication symptoms: initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgement, pupillary constriction or dilation, drowsiness or coma, slurred speech, impairment in attention or memory) (Withdrawal symptoms: dysphoric mood, nausea or vomiting, muscle aches, lacrimation or rhinorrhea, pupillary dilation, piloerection, or sweating, diarrhea, yawning, fever, insomnia)
Opioid-Related Disorders
Substance Related and Addictive Disorders: (Intoxication symptoms: inappropriate sexual or aggressive behavior, mood lability, impaired judgement, slurred speech, incoordination, unsteady gait, nystagmus, impairment in cognition attention or memory, stupor or coma) (Withdrawal symptoms: autonomic hyperactivity sweating or high pulse, hand tremor, insomnia, nausea or vomiting, transient visual, tactile, or auditory hallucinations or illusions, psychomotor agitation, anxiety, grand mal seizures)
Sedative, hypnotic, or anxiolytic use disorder
Substance Related and Addictive Disorders: (Intoxication symptoms: euphoria or affective blunting, changes in sociability, hypervigilance, interpersonal sensitivity, anxiety, tension, or anger, stereotyped behaviors, impaired judgement, tachycardia or bradycardia, pupillary dilation, elevated or lowered blood pressure, perspiration or chills, nausea or vomiting, evidence of weight loss, psychomotor agitation or retardation, muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias, confusion, seizures, dyskinesias, dystonias, or coma) (Withdrawal symptoms: fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, psychomotor retardation or agitation)
Stimulant Use Disorder
Substance Related and Addictive Disorders: (WIthdrawal symptoms: irritability, frustration or anger, anxiety, difficulty concentrating, increased appetite, restlessness, depressed mood, insomnia)
Tobacco Use Disorder
Substance Related and Addictive Disorders: (A) persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress indicated by 4 or more within 12 month period: 1 needs to gamble with increasing amounts of money in order to achieve the desired excitement; 2 restless or irritable when attempting to cut down or stop; 3 made repeated unsuccessful efforts to control, cut back, or stop; 4 often preoccupied with gambling; 5 gambles when feeling distressed; 6 often returns another day after losing money to get even; 7 lies to conceal extent of involvement; 8 jeopardized or lost significant relationships, job, or educational or career opportunity; 9 relies on others to provide money to relieve desperate financial situations (B) not better explained by manic episode
Gambling Disorder (F63.0)
Trauma & Stressor Related Disorders: childhood disorder - limited research available (A) emotionally withdrawn behavior from adult caregivers, manifested by rarely seeking comfort when distressed & rarely responding to comfort when distressed (B) has 2 or more: minimal social responsiveness to others, limited positive affect, periods of unexplained irritability, sadness or fearfulness during nonthreatening interactions with adult caregivers (C) patterns of extremes of insufficient care as evidenced by at least 1; social neglect or deprivation, lacking basic emotional needs for comfort, stimulation and affection, repeated changes of primary caregivers that limit opportunities to form stable attachments, reared in unusual setting that severely limit opportunities to form selestice attachments // rule out ASD // disturbance evident before age 5 but after 9 months // risk factor: serious emotional neglect // overlap with disinhibited social engagement disorder
Reactive Attachment Disorder (F94.1)
Trauma & Stressor Related Disorders: childhood disorder // child actively approaches unfamiliar adults - overly familiar social and verbal behavior, diminished checking in with adult caregiver, willingness to go with unfamiliar adult with little hesitation // extreme situation of insufficient care - social neglect or deprivation, frequent changes in foster care, limited opportunities to form selective attachments
Disinhibited Social Engagement Disorder (F94.2)
Trauma & Stressor Related Disorders: an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened (different criteria if under 6 years old) // (A) exposure to actual or threatened death, serious injury or sexual violence - directly experiencing the traumatic event, witnessing (in person) the event, learning event occurred to close family/friend, experiencing repeated or extreme exposure to aversive details of T event (first responders, police, humans) (B) presence of 1 or more intrusion symptoms associated with T event - involuntary distressing memories, distressing dreams, dissociative reactions like flashbacks, distress with exposure to internal or external cues that resemble aspect of T event, marked physiological reactions to those cues (C) Persistent avoidance of stimuli associated with the T event (1 or more) - efforts to avoid distressing memories, thoughts, or feelings related to T event, efforts to avoid external reminders of the event (D) negative alterations in cognitions & mood associated with T event (2 or more) - loss of memory of events, persistent negative beliefs about self or world, distortions about causes and consequences of trauma resulting in blame of self or others, persistent negative emotional state, diminished interest in significant activities, feelings of detachment or estrangement from others, persistent inability to experience positive emotions (E) marked arousal and reactivity associated with the T events (2 or more) - irritable behavior or angry outbursts, reckless or self-destructive behavior, hypervigilance, exaggerated startle response, problems with concentration, sleep disturbance // symptoms are longer than 1 month // co-occurring w/ depression, alcohol or other substance abuse, anxiety disorders // specify whether depersonalization (persistent or recurrent experiences of feeling detached, or feeling outside observer of one’s own mental processes or body, like a dream, unreality of self or body or time moving slowly) or derealization (persistent or recurrent experiences of unreality of surroundings, world is dreamlike, distant)
Post-Traumatic Stress Disorder (PTSD) (F43.10)
Trauma & Stressor Related Disorders: (A) exposure to actual threatened death, serious injury, or sexual violence in 1: directly experiencing the T event, witnessing in person as it occurred to others, especially primary caregivers, learning the T events occurred to parent or caregiver (B) presence of 1 intrusive symptoms associated with T event, after T event occurred: recurrent, involuntary and intrusive distressing memories of T event (may be expressed as play reenactment), recurrent distressing dreams relating to T event, dissociative reactions (flashbacks) when they act as if thought it is happening (may occur in play), intense or prolonged psychological distress at exposure to internal or external cues, psychological reactions to reminders of event (C) 1 of symptoms representing either persistent avoidance of stimuli associated or negative alterations in cognitions and mood associated with T event, must be present after events or worsen after: avoidance or effort to avoid activities, places, physical reminders, avoidance of or efforts to avoid people, conversations, or interpersonal situations of reminders, substantial increase of frequency of negative emotional states, diminished interest or participation in significant activities, including play, socially withdrawn behavior, reduction in expression of positive emotions (D) alterations in arousal and reactivity associated with T event 2 or more: irritable behavior or angry outbursts (verbal or physical aggression, extreme temper tantrums), hypervigilance, exaggerated startle response, problems with concentration, sleep disturbance (E) duration more than 1 month (F) clinically significant distress or impairment (G) not attributable to psychological effects of substance, medication, or medical condition
PTSD Under 6 years old
Trauma & Stressor Related Disorders: symptom patterns similar to PTSD // duration of symptoms from 3 days to a month after trauma exposure
Acute Stress Disorders (F43.0)
Trauma & Stressor Related Disorders: development of symptoms to an identifiable stressor within 3 months of onset of stressor // symptoms are clinically significant, leading to marked distress out of proportion to the stressor, or significant impairment in social, occupational or other functioning (with depressed mood, anxiety, conduct, or mixed emotions)
Adjustment Disorders (F43.2x)
____________________ - clients who are preoccupied with obsessional ideas or certain repetitive behaviors
Obsessive-Compulsive and Related Disorders
Obsessive-Compulsive and Related Disorders: (A) either obsessions or compulsions or both (B) obsessions or compulsions cause marked distress, are time consuming ( > 1 hour), or significantly interfere with functioning (C) disturbance is not due to substance or general medical condition // onset typically adolescence or early adulthood // more common in high SES and high intellectual and is genetically hereditary
Obsessive-Compulsive Disorder (F42.0)
Obsessive-Compulsive Disorder (F42.0): ______are persistent ideas, thoughts impulses, or images that are experienced as intrusive and unwanted that cause marked anxiety or distress // the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
Obsessions
Obsessive-Compulsive Disorder (F42.0):______ are repetitive behaviors or mental acts the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure or gratification // behaviors or mental acts are aimed at preventing or reducing distress or prevented some dreaded event or situation; behaviors and mental acts are not connected in a realistic way to what they are trying to prevent or do and are clearly excessive
Compulsions
Obsessive-Compulsive and Related Disorders: preoccupation with an imagined defect or flaw in physical appearance not observable or appear slight to others // has engaged in repetitive behaviors or mental acts in response to the appearance concerns // dissatisfaction with overall body shape and anorexia nervosa are excluded // onset typically in adolescence // risk factors are child abuse/neglect and relative to OCD // comorbid with depression and social anxiety, OCD
Body Dysmorphic Disorder (F45.22)
Obsessive-Compulsive and Related Disorders: (1) persistent difficulty discarding or parting with possessions, regardless of their value (2) difficulty due to a perceived need to save the items and to distress associating with discarding them (3) difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use (if uncluttered it is only due to interventions of a 3rd party) // more common amongst older adults // onset can begin in adolescence and gets worse every decade, becomes clinically impairing in 30s // risk factors: indecisive temperament, familial history // comorbid with mood or anxiety disorder and also OCD
Hoarding Disorder (F42)
Obsessive-Compulsive and Related Disorders: (A) recurrent hair pulling resulting in noticeable hair loss (B) repeated attempts to decrease or stop // an increasing sense of tension before pulling hair or when attempting to resist and they feel pleasure or gratification or relief when pulling // onset typically in childhood or adolescence // risk factors: genetically vulnerable, OCD
Trichotillomania (F63.2)
Obsessive-Compulsive and Related Disorders:
(1) repeated skin picking resulting in skin lesions (2) repeated unsuccessful attempts to decrease or stop // onset typically in adolescence // risk factors: more common in those with OCD or relative OCD
Excoriation
Obsessive-Compulsive and Related Disorders: evidence from history, physical examination, or laboratory findings (1) symptoms developed during or soon after substance intoxication or withdrawal or after exposure to medication (2) involved substance/medication is capable of producing symptoms
Substance/Medication Induced
Obsessive-Compulsive and Related Disorders: evidence from history, physical examination, or laboratory findings that disturbance is the direct pathophysiological consequence of another medical condition
Related Disorders due to another medical condition
Obsessive-Compulsive and Related Disorders: ________ - odd or eccentric, with unusual behavior ranging from distrust and suspiciousness to social detachment
Cluster A
Obsessive-Compulsive and Related Disorders: (A) pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in variety of contexts as evidenced by 4 or more: 1 suspects, without sufficient base, that others are exploiting, harming, or deceiving them; 2 preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates; 3 reluctant to confide in others because of unwarranted fear that the info will be used maliciously against them; 4 reads hidden demeaning or threatening meanings into benign remarks or events; 5 persistently bears grudges; 6 perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or to counterattack; 7 recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner (B) does not occur exclusively during another mental health disorder or effects of substance or other medical condition
Paranoid Personality Disorder (F60.0)
Obsessive-Compulsive and Related Disorders: (A) pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning in early adulthood and present in a variety of contexts as indicated by 4 or more: 1 neither desires nor enjoys close relationships, including family; 2 almost always chooses solitary activities; 3 has little, if any, interest in having sexual experiences with another person; 4 takes pleasure in few, if any activities; 5 lacks close friends or confidants other than 1st degree relatives; 6 appears indifferent to praise or criticism of others; 7 shows emotional coldness, detachment, or flattened affectivity (B) does not occur exclusively during another mental health disorder or effects of substance or other medical condition
Schizoid Personality Disorder (F60.1)
Obsessive-Compulsive and Related Disorders: (A) pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts as indicated by 5 or more: 1 ideas of reference (excluding delusions of reference); 2 odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (superstitiousness, sixth sense, telepathy) (in children - bizarre fantasies or preoccupations); 3 unusual perceptual experiences, including bodily illusions; 4 odd thinking or speech (vague, circumstantial, metaphorical); 5 suspiciousness or paranoid ideation; 6 inappropriate or constricted affect; 7 behavior or appearance that is odd, eccentric, or peculiar; 8 lack of close friends or confidants other than 1st degree relatives; 9 excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid features rather than negative judgements about self (B) does not occur during course of other psychotic disorder or ASD
Schizotypal Personality Disorder (F21)
Obsessive-Compulsive and Related Disorders: pervasive pattern or disregard for and violation of the rights of others, occurring since age 15, as indicated by 3 or more: 1 failure to conform to societal norms with respect to lawful behaviors, like repeatable performing acts that are ground for arrest; 2 deceitfulness, like repeated lying, use of aliases, or conning others for personal profit or pleasure; 3 impulsivity or failure to plan ahead; 4 irritability and aggressiveness, like repeated physical fights or assaults; 5 reckless disregard for safety of self or others; 6 consistent irresponsibility, like repeated failure to sustain consistent work behavior or honor financial obligations; 7 lack of remorse, like being indifferent to or rationalizing having hurt, mistreated, or stolen from another (B) must be at least 18; (C) evidence of conduct disorder with onset before age 15 (D) not exclusively during course of schizophrenia or bipolar disorder
Antisocial Personality Disorder (F60.2)
Obsessive-Compulsive and Related Disorders: (A) pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning early adulthood and present in variety of context by 5 or more: 1 frantic efforts to avoid real or imagined abandonment; 2 pattern of unstable and intense interpersonal relationships characterized by alternating between extreme idealizations and devaluation; 3 identity to disturbance: persistently unstable self-image or sense of self; 4 impulsivity in at least 2 areas that are potentially self-damaging (spending, sex, substance abuse, reckless driving, binge eating); 5 recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior; 6 affective instability due to reactivity of mood (intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days); 7 chronic feelings of emptiness; 8 inappropriate, intense anger or difficulty controlling anger (frequent displays of temper, constant anger, recurrent physical fights); 9 transient, stress-related paranoid ideation or severe dissociative symptoms
Borderline Personality Disorder (F60.3)
Obsessive-Compulsive and Related Disorders: (A) pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts by 5 or more: 1 uncomfortable in situations in which they are not the center of attention; 2 interacting with others is often characterized by inappropriate sexually seductive or provocative behavior; 3 displays rapidly shifting and shallow expression of emotions; 4 consistently uses physical appearance to draw attention to self; 5 has a style of speech that is excessively impressionistic and lacking in detail; 6 shows self-dramatization, theatrically, and exaggerated expression of emotion; 7 is suggestible (easily influenced by others or circumstances); 8 considers relationships to be more intimate than they actually are
Histrionic Personality Disorder (F60.4)
Obsessive-Compulsive and Related Disorders: (A) pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in variety of contexts by 5 or more: 1 grandiose sense of self-importance (exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements); 2 preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love; 3 believes that they are “special” and unique and can only be understood by, or should associate with, other special or high-status people or institutions; 4 requires excessive admiration; 5 has a sense of entitlement (unreasonable expectations of especially favorable treatment or automatic compliance with their expectations); 6 interpersonally exploitative (takes advantage of others to achieve their own ends); 7 lacks empathy: is unwilling to recognize or identify with the feelings and needs of others; 8 often envious of others or believes that others are envious of them; 9 shows arrogant, haughty behaviors or attitudes
Narcissistic Personality Disorder (F60.81)
Obsessive-Compulsive and Related Disorders: _______ - the quality of being impressive and imposing in appearance or style, pertensiously .
Grandiosity
Obsessive-Compulsive and Related Disorders: (A) pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in variety of contexts by 4 or more: 1 avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection; 2 unwilling to get involved with people unless certain of being liked; 3 shows restraint within intimate relationships because of the fear of being shamed or ridiculed; 4 preoccupied with being criticised or rejected in social situations; 5 inhibited in new interpersonal situations because of feelings of inadequacy; 6 views self as socially inept, personally unappealing, or inferior to others; 7 usually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing
Avoidant Personality Disorder (F60.6)
Obsessive-Compulsive and Related Disorders: (A) pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in variety of contexts by 5 or more: 1 has difficulty making everyday decisions without an excessive amount of advice and reassurance from others; 2 needs others to assume responsibility for most major areas of their life; 3 difficulty expressing disagreement with others because of fear of loss of support or approval; 4 difficulty initiating projects or doing things on their own (because of lack of self-confidence in judgement or abilities rather than lack of motivation or energy); 5 goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant; 6 feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for themselves; 7 urgently seeks another relationship as a source of care and support when a close relationship ends; 8 unrealistically preoccupied with fears of being left to take care of themselves
Dependent Personality Disorder (F60.7)
Obsessive-Compulsive and Related Disorders: (A) pervasive pattern of preoccupation with orderliness, perfectionism, and mental interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in variety of contexts by 4 or more: 1 preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost; 2 shows perfectionism that interferes with task completion (unable to complete a project because of their own overly strict standards not met); 3 excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity); 4 overconscientious, scrupulous, and inflexible about matters of morality, ethics or values (not accounted for by cultural or religious identification); 5 unable to discard worn-out or worthless objects even when they have no sentimental value; 6 reluctant to delegate tasks or to work with others unless they submit to exactly their way of doing things; 7 adopts a miserly spending style toward both self and others, money is viewed as something to be hoarded for future catastrophes; 8 shows rigidity or stubbornness
Obsessive-Compulsive PD (F60.5)
Obsessive-Compulsive and Related Disorders: persistent deficits in social communication and social interaction across multiple contexts (social-emotional reciprocity, nonverbal communicative behaviors, developing maintaining and understanding relationships) // restricted, repetitive patterns of behavior, interests or activities (stereotyped or repetitive motor movements use of objects or speech, insistence on sameness, inflexible adherence to routines or ritualized patterns of verbal or nonverbal behavior, highly restricted, fixated interests that are abnormal in intensity or focus, hyper or hypo reactivity to sensory input or unusual interest in sensory aspects of environment
Autism Spectrum Disorder (ASD) (F84.0)
Obsessive-Compulsive and Related Disorders: (A) identity characterized by 2 or more distinct personality states (seems like possession) it involves discontinuity in sense of self and sense of agency accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, sensory-motor functioning observable by self or others (B) recurrent gaps in recall of everyday events, important personal info, and T events that you wouldn’t normally forget (C) clinically significant distress or impairment
Dissociative Identity Disorder (F44.81)
______ - an event or circumstance that prevents therapy from preceding until the crisis is stabilized, requires active role of therapist, situation has gone beyond control of individual’s resources, a turning point where things will either get better or worse, interruption in normal psychological state of an individual or family unit
Crisis
__________ includes knowledge, interventions and management of child abuse, elder and dependent adult abuse, self-destructive behaviors, harm to others
Crisis Management
QRMOTHS to assess for crisis:
Questions
Referrals/resources
Mental status exam (MSE)
Observing
Testing
History
Social support
Child Abuse categories:
Physical
Willful harm and endangerment
Neglect (general and severe)
Sexual (assault and exploitation)
(PNWS)
Mental/Emotional (optional)
Child abuse - physical injury inflicted on child (not by accident) or intentionally injuring the child
Physical abuse
Child abuse - includes assault and exploitation, sex acts with children, intentional masturbation in presence of children, child molestation. Selling or distributing pornographic materials with children
Sexual abuse
Child abuse - unjustifiable pain or mental suffering or endangerment of the child’s person or health. Mental suffering may be reported
Willful cruelty and unjustified punishment
Child abuse - willfully inflicted, resulting in traumatic condition
Unlawful corporal punishment or injury
Child abuse reporting requirements:
Report when there is reasonable suspicion. If you suspect, report.
Written Report - Within 36 Hours
Verbal Report - Immediately, Within 24 hours, phone call to Child Protective Services
6 reportable types of elder abuse
Physical
Abduction
Isolation
Neglect
Financial
Abandonment
(PAINFA)
Elder abuse - sexual assault, beating, slapping, shoving, or kicking
Physical abuse
Elder abuse - verbal harassment, threats, or other forms of intimidation, like threat of placing them in nursing home for punishment
Psychological (emotional) abuse
Elder abuse - stealing or misuse of property or other assets, like house, bank account
Financial
Elder abuse - failure to provide basic necessities such as food, shelter, and medical care
Neglect
Reporting of the most serious form of elder abuse: Serious bodily injury IN a long-term care facility VERY serious injury that requires hospitalization, surgery, or involves something being broken.
Report immediately or within 2 hours verbally to law enforcement and written to law enforcement, local ombudsman, and long term care facility’s licensing agency
Reporting of least serious form of elder abuse: Client is NOT in a long-term care facility or state hospital, they were abused in the home, NO serious bodily injury.
Report it to Adult Protective Services verbally immediately or within 24 hours and written within 2 working days
Tarasoff/Duty to Protect steps:
Call law enforcement
Make reasonable effort to warn victim(s)
Only release information required for the report
Consider hospitalizations for client
DOCUMENT
Client verbally communicates (or receives communication from significant family member): serious threat or harm (physical violence) a reasonably identifiable person outside the treatment unit
Tarasoff/Duty to Protect
Suicidality: ethical responsibility with legal ramifications
(1) Directly ask if they have _______ of suicide
(2) suicidal _______ (intent): new or old idea
(3) do they have a _______? Is it specific?
(4) are the ________ readily available?
(5) any previous history of suicide attempt by self or family member
thoughts
ideation
plan
means
CARL (Suicidal ideation assessment)
chronology (how long ago the attempt)
Awareness (did the person believe the means was lethal)
Rescue (did they help in their own rescue, did they attempt where they could be found)
Lethality (how lethal was the attempt)
TIPM (Suicidal ideation assessment)
Thoughts (are they thinking about killing self?
Want to go to sleep? Never wake up?)
Intent (is person intending to act on thoughts?)
Plan (have a plan?) Means (can they carry this plan out?)
SAL (Suicidal ideation assessment)
Specific, Availability, Lethality
Management of Clients with Potential __________
Institute a “safety plan”
Increase session frequency
Telephone contact between sessions
Consider the hospitalization of the client
Medication
Consult with a colleague or supervisor
Have the client dispose of the means
Comply with your agency’s policies
Only provide information necessary to meet the legal requirement when contacting law enforcement
Document all steps
Homicidal Behavior
1) Couple’s therapy is rarely recommended, not recommended unless the batterer is in treatment
2) The batterer interested in treatment can be referred to a group or have individual sessions.
3) Physical and emotional safety are primary concerns for survivors
4) Introduce the Power and Control Wheel & Equality Wheel
Management of Domestic Violence
Management of Domestic Violence
There is no mandate or provision to report domestic violence
Refer to a medical doctor, as they can report domestic violence
Create a safety plan, when possible including extended family
Describe the Cycle of Violence
The Cycle of Violence stages:
1) Honeymoon
2) Tension
3) Violence
The Cycle of Violence stages: When the abuser will apologize or try to make up for their abusive actions.
They may blame abusive behaviors on the victim
Ignore or deny abuse
Honeymoon
The Cycle of Violence stages: Walking on eggshells
Threats and intimidation
Fear
Guilt
Unpredictable behavior
Tension
The Cycle of Violence stages: When the abuse actually occurs
Violent behaviors
Emotional, physical, financial, and/or sexual abuse
Violence
Safety first _________ second. Safety is the most important thing in any situation.
relationship
Therapists are _______ and ________ bound to protect others from harm.
legally and ethically
Knowledge and application of theoretical models, stages of treatment, the impact of diversity on treatment, collateral, and adjunctive services, issues of termination
Treatment Planning
________ Considerations and Goals:
Immediate concerns: risk factors, emergency interventions, stabilize any crisis, fulfill any legal obligations, protect the client or others, discuss confidentiality
Create a therapeutic framework: what brought the client to treatment (presenting problem), establish rapport, address issues related to trust, boundaries, human diversity, etc. that might be relevant
Management practice issues: client and issue should be within scope of practice, get informed consent, releases of information, no secrets policy, make arrangements for payment, confidentiality agreements
Assess and gather information
Make preliminary assessment and diagnosis
Begin constructing treatment plan and establish treatment goals with client
MAPS: measurable, attainable, positive, specific
First Stage of treatment
________ Considerations and Goals:
Use specific theoretical orientation
Generally: feelings work, release of emotions, separate thoughts and feelings, understand the difference, normalize feelings, empty chair work, letter writing
Reduce core symptoms of the condition or disorder, work toward specific behavioral changes, increase, decrease, develop, implement, etc. plan, reinforce behaviors, confront behaviors, restore to previous level of functioning
Identify and strengthen coping abilities for the current problem, relapses and future problems; model, guide, rehearse skills, like communication skills, problem solving, conflict resolution (regulation), parenting, assertiveness, anger management, relaxation
Decrease isolation, mobilize social support by making appropriate referrals
Increase self-esteem, practice tasks, provide positive feedback
Address family factors, FOO issues, influences, expectations
Interpret client’s defenses and transference reactions
Evaluate progress and make adjustments to treatment plan, examine resistance and barriers to change, discuss secondary gains, encourage direct communication with client, reinterpret possible resistance to reduce defenses
Be sensitive to countertransference issues
Middle stage goals
________ Considerations and Goals:
(P) premature leaving, financial issues? Was client uncomfortable? Too much denial or defenses?
(L) losses, look at the losses of leaving, bring up old losses
(A) anticipate any future difficulties, coping skills and possible bumps down the road
(R) referrals, make referrals for future support
(G) goals, were goals met? Are there more to consider at a later time?
(O) open door, open door policy that client may leave and return at any time
Process loss of therapy → explore feelings, reframe, open door policy
Maintain gains and prevent relapse → review goals, plan for obstacles
Final stage (termination)
Process → (1) therapist joins family and defines presenting complaint (2) highlight problem-maintaining interactions (3) explore alternative ways of relating while recognizing and acknowledge family strengths, clarify and improve boundaries and limit-setting among family members (4) therapist reduces role from joiner to observer
First 3 sessions → (1) join with and accommodate to family rules, patterns, and structure, acknowledge family members feelings and reflect a sense of empathy, track and maintain family interactional style while acknowledging hierarchy and rules (2) assess family structure and boundaries, observe enactments that reflect negative communication patterns, initiate parental subsystem sessions to address parenting //
Structural Family Therapy
Goals → decrease negative interactional patterns and promote more functional communication styles
Structural Family Therapy
Central Constructs: family structure, coalitions, subsystems, boundaries
Family structure → set of rules that determine who talks to whom who plays with whom // when 2 people join together to create a family they are bringing remnants of rules and interactional patterns from their families of origin
Coalitions → 2 or more members join together // interactional patterns are critical // repeated patterns of interactions maintain family structure
Subsystems → smaller groupings within the family (parental subsystem, sibling subsystem)
Boundaries → rules that specify who who participates in the coalitions and subsystems of family // can cause dysfunction in how members relate to one another // disengaged (rigid) boundaries occur due to lack of communication; high sense of individuality encouraged // Enmeshed (unclear, permeable, blurred) boundaries cause intense transmission of stress; conformity and loyalty are expected // Healthy boundaries occur when rules and roles are clearly defined; communication is open but not overly so
Structural Family Therapy
Family Systems Theory includes:
Satir approach
Structural Therapy
Strategic Therapy
Bowen’s Family Systems Theory
________ therapy models approach things practically instead of analytically and focus on identifying the stagnant patterns of behavior within groups or families
Systemic
Role of therapist in _______ therapy → introduce creative nudges to support the changing of the system
Systemic
Process of therapy:
Stage 1) Making Contact: family members act in a way that reflects their patterns and beliefs, therapist “makes contact” and creates a space for change, process is emphasized over content
Stage 2) Chaos: (disturbing the status quo) explore patterns and dynamics of family and how they result in chaos; explore conflicts, normalize feelings, examine FOO and family rules, uncover unexpressed feelings and thoughts; communicate in the “immediate” or here and now
Stage 3) Integration of New Skills: (The new status quo) uncover possibilities for change and more adaptive ways of communicating “moving on”; experiment with changes in family dynamics; explore feelings and thoughts associated with the shift in communication; closure/termination of treatment
Satir Theory
First 3 sessions → (1) develop working counseling relationship, establish rapport and hope and reflect empathy, explore barriers to and expectations of treatment (2) assess individual, systemic and broader cultural dynamics, obtain detailed description of problem behavioral sequences, encouraging non-blaming descriptions of each person’s actions, identify patterns involving boundaries, subsystems, and triangles that contribute to the family conflict
Satir Theory
Central Constructs: Individual growth and development, communication, self-esteem
Individual growth → (a) Genetic Endowment (b) learning acquired over a lifetime (c) Body-Mind connection: primary survival triad (Mother, Father, and child - important in positive or negative self concept); essential interacting parts include physical, intellectual, emotional, interactional contextual, nutritional and spiritual
Communication → (a) incongruent communication: discrepancies between verbal and nonverbal cues; double-bind messages - the member receives conflicting messages, each of which negates the other, making it impossible to resolve the conflict (b) survival stances: protecting one’s self worth against perceived threats by others (placater - context and other are acknowledged but self is not; blamer - self and context are acknowledged but other is not; super-reasonable - computer like, only context is acknowledge, self and other are not; congruence - words and feelings match, self context and other are acknowledged)
Self-esteem → the degree to which an individual values themselves regardless of the opinions of others // (a) all people possess the resources for positive growth (b) discomfort and pain signal the need for change (c) every person, thing, or situation is impacted by every other person, thing or situation
Satir Theory
Interventions → modeling communication, family sculpting, self-mandala, parts party, transforming rules
Satir Theory
(under family systems umbrella) considered more of an insight approach because it focuses on past familial patterns in order to avoid repeating current ones; model can be used with families or individuals, promotes insight before action, often very time consuming
Bowen Family Systems Theory
Process other therapy → (1) genogram: therapist and family construct genogram (2) assessment: information from genogram is evaluated in terms of family projection process, sibling position, emotional cutoff, etc; history and background of problem issues are explored, including each member’s perspective of what causes and maintains the presenting problem; therapist assesses the broader context of the extended family system (like impact of substance abuse) (3) differentiation: therapist uses process questions, detriangulation techniques and activities to help members successfully differentiate from each other; coaching is used to reinforce gains made during the process
Bowen Family Systems Theory
Central Constructs: family projection process, differentiation of self, triangles, togetherness/individuality, sibling position, emotional cutoff
(1) family projection process → a) parents transmit or project their immaturity and lack of differentiation onto their children b) often involves the replication of one’s FOO dynamics and so behavioral patterns may be passed down from generation to generation
(2) differentiation of self → a) lifelong process of maintaining balance through movement towards individuation and away from fusion (absence of boundaries)
Differentiation is the capacity to better manage one’s own connection to (and independence from) one’s FOO and other close relationships. A higher level of differentiation would make one less apt to get drawn into others’ emotional issues (being triangulated) and to be less emotionally reactive in close relationships. Lower levels of differentiation are generally accompanied by higher levels of anxiety
(3) triangles → 3rd person involved to diffuse tension of dyad; the basic building blocks of an emotional system; a) when relationships become distant and our anxiety increases, a third person or thing, is introduced to stabilize the relationship b) triangles reduce immediate anxiety but decrease the chance of resolving the problem within the original dyad
(4) togetherness/individuality → a) togetherness - ability to engage in meaningful connection with others b) individuality - a person’s ability to maintain a clear sense of self and identity c) need to balance togetherness and individuality d) if a person within their family system is unable to balance togetherness and individuality, the relationship may become polarized
(5) sibling position → a) fixed personality characteristics based on sibling position, which can be helpful in determining a child’s role in the family’s emotional process (first born - tend to be characterized by power, authority, and self-confidence // later born - tend to identify with the oppressed, rebellious explorers and iconoclasts (attacking or ridiculing traditional or venerated institutions))
First - natural leader, high achiever, organized, on-time, know-it-all, bossy, responsible, adult-pleaser, obeys the rules
Middle - flexibile, easy-going, social, peacemakers, independent, secretive, may feel life is unfair, strong negotiator, generous
Last - risk taker, outgoing, creative, self-centered, financially irresponsible, competitive, bored easily, likes to be pampered, sense of humor
Only - close to parents, self control, leader, mature, dependable, demanding, unforgiving, private, sensitive
(6) emotional cutoff → a) people cut off from their FOO to reduce the discomfort generated by being in emotional contact with them b) individuals are often undifferentiated and may manage emotional intensity by cutting themselves off from their FOO
Bowen Family Systems Theory
Interventions → genogram, process questions, detriangulation, “going home again” exercise, displacement stories, coaching
Bowen Family Systems Theory
Process of therapy → (3-5 sessions average) (1) first session emphasizes: discourse on change (therapist communicates the importance of change talk from problem talk to solution talk), solution discourse (formation of a collaborative relationship), strategy discourse (identifying strategies to help reach client goals), identify exceptions and what has worked in the past (2) establish goals: solutions evolve out of conversations, language is our reality, adopt the client’s lingo, focus on client’s strengths and use compliments
Solution-Focused Brief Therapy
Key concepts: solution and future focused, strengths and resources, beginner’s mind, change is constant, language and meaning, hope
Solution-Focused Brief Therapy
Central Constructs → exceptions, change talk, solutions, strengths and resources, simplicity “complex problems do not need complex solutions”
Solution-Focused Brief Therapy
Exceptions: always a time when the problem does not happen; requires that the therapist develops a detective-like ability to discover even the minutest exceptions to the problem
Change talk: bringing about change and focus on the future; outset of treatment therapists expresses a belief that change is already taking place and asks the client if any changes have occured between the time the appointment was made and the first session; therapists talks to the client about doing something, no matter how small, that will make a difference in their life
Solutions: concentrate on acceptable solutions to the problem; traditional empiricist-based therapy is filled with myths about symptoms, pathology and change; acclimating client’s to scaling questions; use of reframing to help the client find another way of looking at the problem
Strengths and resources: accessibility to the strengths, resources and the client’s own value system; identify their strengths in different areas
Simplicity: simple steps towards solutions include taking a walk, keeping a journal, or going on a short vacation
Solution-Focused Brief Therapy
Case conceptualization: future focus, solution-generating, exceptions and previous solutions
Future focus: focus on where to go from here rather than where the client has been
Solution-generating: solutions are the focus of assessment, find out what they desire
Exceptions and previous solutions: times you may have felt at peace, or describing a good and supportive friend you have
Solution-Focused Brief Therapy
Therapist should → develop working counseling relationship and be attentive to diversity issues; build rapport by identifying strengths, resources, and channeling language to highlight problem, identify areas of functioning and generate hope; assess individual, systemic, and broader cultural dynamics; interventions
Solution-Focused Brief Therapy
general classification for psychotherapy models that focus on dysfunctional emotions, maladaptive behaviors and cognitive processes
Cognitive behavioral therapy
Process of therapy → Assessment, target behaviors, psychoeducation, replace and practice → treatment plan
Cognitive behavioral therapy
Assessment: counseling begins by obtaining a detailed behavioral and cognitive assessment of baseline functioning, including frequency, duration, and context of problematic behaviors and thoughts
Target behaviors/thoughts for change: therapists identify specific behaviors and thoughts for intervention (rather than general goal of “improve mood” the therapist would target “increasing engagement in pleasurable activities”, “initiating social contact”, etc.)
Psychoeducation: therapists educate clients about their irrational thoughts and help motivate them to change
Replace and practice: specific interventions are designed to replace dysfunctional behaviors and thoughts with more productive ones (once symptoms have dissipated client is ready for termination)
Cognitive behavioral therapy
Central Constructs: Automatic thoughts, Beliefs, Schemas
Automatic Thoughts: distorted thoughts that are contrary to objective evidence, swift evaluative statements or internal images, often dysfunctional
Beliefs: core beliefs → deep seated, focus on feelings of helplessness, unlovability, and worthlessness // immediate beliefs → assumptions or conditional beliefs that lie between our core beliefs and automatic thoughts // core beliefs impact our immediate beliefs which affects our automatic thoughts along with being impacted by the situation → leading to our reactions, emotional, behavioral, psychological
Schemas: cognitive structures that organize information // our internal representations of the world; based on organization of concepts and actions that can be revised by new information about our environment, reflect our underlying cognitive organization, helps us create meaning, directly impacts our core beliefs // cognitive distortions: faulty schemas result in our misconceptions about our environment
Cognitive Distortions Ex: blaming oneself, not giving oneself credit, mind reading, negative fortune telling, “Shoulding” yourself, all or nothing thinking, negative filter (ignoring the positive), pessimism, exaggerating, overgeneralization, labeling
Cognitive behavioral therapy
Interventions: Cognitive Restructuring, Questioning, Thought Recording, Relaxation & Breathing techniques, ABC Theory
Cognitive behavioral therapy
Therapist should → develop working counseling relationship and be attentive to cultural norms; use warmth and empathy to build rapport, establish credibility, demonstrate respect and ensure client feels sense of dignity; obtain baseline of client’s problem behavior (including DSM diagnosis); identify specific schemas and cognitive distortions related to the presenting problem; educate client regarding symptoms; help create sense of hope; identify one behavior for the client to engage in throughout the week that helps client move towards their goals;
Cognitive behavioral therapy
Life is a process of storytelling; a social constructivist approach in which reality is constructed by social interactions and processes (Michael White and David Epston)
Narrative Therapy
Overarching goal: unique outcomes → contributor to dysfunction: ongoing conflict → therapeutic process: problem recast as an affliction, client lives preferred story → intervention/technique: deconstructive questions
Narrative Therapy
Process → (1) problem is recast as an affliction through collaborative process of narrating, listening and deconstructive questions; problem is described and given a new name (2) unique outcomes are generated and explored through landscape of actions questioning; the new or preferred story through re-authorizing, re-storying, re-remembering; new outcome is something the problem would not like (3) client lives the story outside the therapy room; continue exploring relationship between person and the problem, use scaling questions to measure success, examine the cultural truths
Narrative Therapy
Central constructs: stories, unique outcomes, language
Stories → life is a series of stories that follow a plot created through interactions with others (no essential truths) // dominant discourse - the story they tell, the client follows this plot and takes certain perspectives according to the plot // alternate discourse - one that does not form to the dominant plot; help them understand different discourses so they can coexist with the dominant plot // deconstruction - process of of developing alternate discourses/stories that will allow for creative resolutions to their problems // cultural discourse - culturally-based truths that influence our lives
Unique outcomes → not a part of the dominant discourse, they are the exceptions; stories or subplots in which the problem-saturated story does not play out in its typical way; helps client create the lives they prefer and develop a more accurate account of their own self and others identities
Language → plays critical role in the way meaning is attached to the self and to one’s lived and future experiences - reality is constructed and given meaning through language
Narrative Therapy
Case conceptualization → problem-saturated story, dominant and alternate discourse, unique outcomes
Problem-saturated story - client’s narrative of the problems they experience; “main plot event”
Narrative Therapy
Goals and interventions → deconstructive questions, landscape of action questions, other techniques
Narrative Therapy
__________: understanding, establishing and maintaining the therapeutic relationship, knowledge and applications of interventions within a theoretical model, impact of value differences between therapist and client on the therapeutic relationship
Treatment
The emotional reaction of the therapist to the client’s contribution/material; can be + or -; can be based off of explicit characteristics (physical resemblance of someone), or subtle unconscious provocations by the client (they are irritating and resistant but complain about being lonely and isolated); we may over-identify with them (they seem similar to us in someway)l we feel parental toward them, or a sexual attraction.
Countertransference
Redirection of client’s feelings for a significant person to the therapist; comes from Freud → how they “transfer” feelings from important persons in their early lives onto the therapist; the client will naturally make assumptions about the therapists likes and dislikes, attitude toward the client, and life outside the office; these assumptions are based off their experiences with and assumptions regarding other important early relationships; so client’s formative dynamics are re-created in the therapy office for both people to observe
Transference
