Psychopathology Flashcards
psychopathology
study of the diseases of the mind
abnormal psychology
Incorporates all other areas of psychology (development, cognitive, etc.)
disease
A morbid entity ordinarily characterized by two or more of the following criteria: recognized etiologic agent(s), identifiable group of signs and symptoms, or consistent anatomic alterations
syndrome
A group of symptoms that collectively indicate or characterize a disease, a psychological disorder, or another abnormal condition
disorder
A disturbance or derangement that affects the function of mind or body
diagnosis
the art or act of identifying a disease from its signs and symptoms
symptom
Subjective indication of a disorder; May or may not be directly observable
sign
Objective indication of disorder (Especially as observed and interpreted by an expert rather than by the patient or lay observer); May or may not be expressed by patient
prototypical
description of a disease; way of defining a disorder; PDM description of BPD
polytheic
diagnosis is satisfaction of certain number of criteria; Makes for qualitatively different experiences given same diagnosis
Ex: DSM- here are 9…pick 5
categorical
have or have not
dimensional
exists on continuum- high or low- how psychologists view things
prevalence
how many people have over a certain time (lifetime)
incidence
how many people get it in a given period
criteria
Standards by which to evaluate or test membership (i.e. intensity, frequency, developmental status, duration, pervasiveness, external circumstances)
different prevelances?
Relevant differences by sex, age, culture
-Sex differences: Genetic or biological differences
-Gender differences: Socialization of what is expected
cultural idiom of distress
Way of expressing distress
Experience of fatigue in depression
cultural syndrome
Syndrome found uniquely in cultural group
Koro – genital retraction syndrome
cultural explanation or cause
Understanding why a symptom occurs unique to a culture
other specified disorder
-Not meeting full criteria but clinically significant
-Uncharacteristic presentation
-Reason given why
unspecified disorder
-Not meeting full criteria
-No reason given why
provisional diagnosis
Not enough information, but strong assumption
-Differential diagnosis
-Often noted as “r/o” rule out or “e/f” evaluate for
specifiers for all disorders in DSM
-Mild: mild to moderate distress, little interference
-Moderate: moderate distress, not getting some things accomplished
-Severe: severe distress, unable to function
-In Partial Remission
-In Full Remission
-Prior History
intellectual disability
Deficits in intellectual functions, confirmed by both
-Clinical assessment and
-Individualized, standardized intelligence testing
Deficits in at least 1 area of adaptive functioning across multiple environments
Onset during the developmental period
Associated features:
-Deficits in adaptive functioning (determined by age norms)
-communication, self care, home living, social, self direction, work, leisure, health, safety
IQ levels for ID
Mild: 50-55 - 70
Moderate: 35-40 to 50-55
Severe: 20-25 to 35-40
Profound: < 20-25
diseases and environmental factors that can contribute to ID
Disease
Prenatal: rubella, syphillis, toxoplasmosis, herpes, HIV
Postnatal: encephalitis, meningitis
Environment
Prenatal: High blood pressure, diabetes, drug and alcohol use
Postnatal: birth complications, heavy metals, malnutrition
specific learning disorder
Difficulties learning and using academic skills despite the provision of interventions
-At least 6 months
-At least 1 symptom
-Abilities substantially and quantifiably below expected for chronological age AND cause significant interference
-Confirmed by: clinical assessment OR individually administered standardized achievement measures
-For older than 17 years, documented history of impairing learning difficulties may be substituted for standardized assessment (!)
-Begins during school-age years
-May not be observed until demands exceed the individual’s limited capacity
three kinds of SLD
Reading: inaccurate or slow and effortful word reading, comprehension
Writing: spelling, written expression, grammer
Math: number sense, number facts, calculation, mathematical reasoning
achievement vs aptitude
achievement: knowledge or gained ability, sometimes represented as age or grade level, SAT, GRE, WIAT, Woodcock Johnson
aptitude: potential to learn or gain, IQ, GRE, WAIS, WISC, WIPSI
Autism spectrum disorder
Persistent deficits in social communication and social interaction across multiple contexts
-Social-emotional reciprocity
-Nonverbal communicative behaviors
-Developing, maintaining, and understanding relationships
At least 2 restricted, repetitive patterns of behavior, interests
-Stereotyped or repetitive motor movements, use of objects, or speech
-Insistence on sameness or routines
-Highly restricted, fixated interests abnormal in intensity or focus
-Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects
Begin in the early developmental period
-May not be observed until social demands exceed limited capacities
-May be masked by learned strategies in later life
Associated features:
-4 times more likely in boys; Girls when have Autism Spectrum Disorder more likely to also have Intellectual Disability
level 3 autism
Requiring very substantial support
social communication: Severe deficits in verbal & nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, & minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction, and when they do, makes unusual approaches to meet needs only & responses to only very direct social approaches.
restricted, repetitive behaviors: Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action.
level 2 autism
Requiring substantial support
social communication: Marked deficits in verbal & nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; reduced or abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited to narrow special interests, & who has markedly odd nonverbal communication.
restricted, repetitive behaviors: Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors occur frequently enough to be obvious to the casual observer & interfere with functioning in a variety of contexts. Distress/difficulty changing focus or action.
level 1 autism
Requiring support
social communication: Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences & engages in communication but whose to-and-fro conversation with others fails, and whose attempts to make friends are odd & typically unsuccessful.
restricted, repetitive behaviors: Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching b/w activities. Problems of organization & planning hamper independence.
attention deficit/ hyperactivity disorder
Inattention or Hyperactivity-Impulsivity
-At least 6 months
-Can have either/or
-Symptoms and impairment present before 12 years
-Impairment in at least 2 settings
-Clear evidence of clinically significant impairment in functioning
inattentive type (at least 6, if over 17 5): difficulty with attention or careless mistakes, difficulty sustaining attention, not listening when spoken to, poor follow through, difficulty organizing, avoids sustained mental effort, loses necessary objects, easily distracted, forgetful
hyperactivity (at least 6): fidgets, leaves seat, restless, difficulty playing quietly, difficulty organizing, on the go, excessive talking, blurts out answers, difficulty waiting turn, interrupts or intrudes
delirium
Disturbance of attention and awareness
-Inattention, somnolence
-Distractibility
-Requiring restatement of questions and directions
-Vague/unsatisfactory or bizarrely incorrect answers
-Inability to solve problems due to attention
Develops over a short period of time, represents a change from baseline, and tends to fluctuate during the day
-Develops within hours or days
-Changes during the day
-Often alert, normal in AM; symptomatic in PM
-Sundowning
-Sensory deprivation at nighttime
how delirium impacts other aspects of cognition
Memory
-Often for recent events
Orientation
-Time, place, person (x3)
Language (not just slurred)
-Difficulty naming objects
-Rambling or incoherent speech
Perception
-Misinterpretations, illusions, hallucinations
-Most often visual
-Sometimes accompanied by disorganized delusions
Emotion regulation
-Apathy, fearful, depressed, irritable, euphoric
evidence that delirium is physiological
infection/fever, metabolic disorder, electrolyte imbalance, anesthesia/postoperative state, cardiopulmonary disorders, vitamin deficiency, head trauma, brain lesion or stroke
how to code delirium
-Code medical condition first
Substance Intoxication Delirium
-In excess of effects of intoxication
-Prescribed medications
-Toxins
-Illicit drugs
Substance Withdrawal Delirium
1. Especially with rapid withdrawal from short-acting medications (e.g., alcohol, benzodiazepine)
2. Delirium tremens
-Tremor, agitation, disorientation, hallucination
-Toxin
-Multiple etiologies
Other:
3. Cultural factors may influence detection
4. Most common mental d/o
common causes of delirium across ages
children: fever, infection
young adults: drugs, accidents
adults: not common
older adults: metabolic problems, multiple health conditions, surgery conditions
other facts about delirium
-Male > Female
-Rapid onset
-Wax/waning symptoms
-Generally, resolves few hours to days
-Treat underlying condition
-Poorer prognosis (brain is not functioning)
neurocognitive disorder
Evidence of significant (modest) decline in one or more cognitive domains
-Memory impairment most common
-Widespread
-recognition
-Recall
Declarative
-Semantic and episodic, not procedural
Anterograde (new) or retrograde (previous)
-Cognitive deficits (do not) interfere with independence
-Even persons with mental retardation, delirium (if separate courses)
-Generally, diagnosis only given after 6 months
-Not exclusively in the context of a delirium
-Associated features: motor or gait disturbance; personality change; disinhibited behavior; mood changes and anxiety; sleep disturbance; delusions; poor insight into condition
-Cultural factors may influence detection: reverent treatment of elderly; less emphasis on cognitive demands; explanations for cognitive and behavioral changes
-More frequently observed in older and/or medically unwell individuals
aphasia
language disturbance (speech vague, circumstantial, extensive)
-Pronoun use, stereotyped phrases
-Cannot explain meaning of common phrases
apraxia
inability to coordinate motor movement (despite intact physical ability)
-Cannot perform simple actions on request
agnosia
inability to recognize objects (despite intact sensory ability)
-Cannot identify/name common objects
disturbance in executive function
problems planning, organizing, or abstracting information
-Cannot switch mental sets (serial 7’s)
-Cannot find similarities/differences
-Cannot generate novel information
neurocognitive disorder due to alzheimers disease
Insidious onset and gradual progression
-Typically unaware of cognitive deficits
-Onset to death typically 8-10 years
Evidence of Alzheimer’s disease
-Genetic mutation (rare)
-Decline in memory and learning and one other domain
-Steadily progressive, gradual decline, without plateaus
-No evidence of mixed etiology
problems for recent memory: forgetting, 50% first symptom, repeating things
further cognitive declines: three A’s, frontal release signs, personality changes, lose ability to live independently, delusions, hallucinations
final stages: lose vocabulary, lose self care, unable to coordinate movement, death
Associated features
-20% patients with Alzheimer’s show depressive symptoms
-20% will show pronounced delusions
vascular neurocognitive disease
Symptoms consistent with vascular etiology
-Temporally related to cerebrovascular events
-Decline is prominent in
-Complex attention
-Executive function
Presence of cerebrovascular disease
-Large vessel changes
-Ischemic
-Thrombosis, embolism, hypoperfusion
-Hemorrhagic
-Intra- or extraaxial (inside or outside the brain)
Small vessel changes
-Subcortical ischemic changes
-Also ischemic, but different symptoms, course
Evidence of TBI with one or more of
-Loss of consciousness
-Posttraumatic amnesia
-Disorientation and confusion
-Neurological signs
-Neuroimaging, seizures, change in functions
NCD presents immediately after and persists
Stepwise progression
substance induced neurocognitive disorder
Deficits persist beyond the usual duration of intoxication and withdrawal
-Substance, duration, and extent of use capable of producing neurocognitive impairment
-Temporal course consistent with use and abstinence
Associated features
-Previous substance dependence
-Consistent exposure to toxins
alcohol, cocaine, opioids, amphetamines, cannabis, inhalants, sedatives/anxiolytics, anticonvulsants, heavy metals, industrial chemicals, insecticides, carbon monoxide
mental disorders due to a general medical condition
-Presence of significant psychiatric symptoms
-Evidence of direct physiological consequence of GMC
-NBAFB other mental disorder
-Not exclusively during Delirium
short term, long term, and withdrawal effects of depressants
short term: Relief from anxiety
Euphoria
Lowered inhibition
Poor motor coordination
Impaired concentration/judgment
Slurred speech blurred vision
sedation
long term effects: Depression
Chronic fatigue
Respiratory impairments
Impaired sexual function
Decreased attention span
Poor memory/judgment
Chronic sleep problems
withdrawal: Tremors
Insomnia
Irritability/restlessness
Hallucinations
Convulsions
short term, long term, and withdrawal effects of stimulants
short term: Euphoria
Dilated pupils
Feeling of energy
Increased activity/speech
Decreased appetite
Wakefulness
long term: Chronic sleep problems
Poor appetite
Rapid/irregular heartbeat
Mood swings
withdrawal: Dysphoria
Extreme fatigue
Sleep disturbance
Increased appetite/weight gain
short term, long term, and withdrawal effects of perception distorting
short term: Bloodshot eyes (THC)
Increased appetite (THC)
Mood alterations
Disorientation
Hallucinations
Synesthesia
Impaired cognitive abilities
long term: Flashbacks (LSD)
Low motivation
Decreased cognitive abilities
withdrawal: Sleep disturbance
Loss of appetite
Irritability
Tremors
Depression
short term, long term, and withdrawal effects of opioids
short term: Euphoria
Drowsiness
Apathy
Impaired cognitive ability
Reduced pain sensitivity
long term: Mood instability
Constipation
Respiratory impairments
Physical deterioration
withdrawal: Dysphoria
Aches, pains
Diarrhea/nausea/vomiting
Pupil dilation
Fever
Insomnia
short term, long term, and withdrawal effects of steroids
short term: Euphoria
Muscle growth
long term: Reversal of 2°sex characteristics
Irritability
Reduced energy
Liver/heart disease
withdrawal: Mood swings
Depression
Weakness/fatigue
Weight loss
substance use disorders
Problematic pattern of substance use leading to clinically significant impairment or distress
At least 2 symptoms in a 12-month period
-Limit setting and breaking (impaired control) – using more than intended or over longer period of time; unsuccessful attempts to cut down; great deal of time spent using; craving
-Social impairment – failure to fulfill obligations; use despite interpersonal problems; activities given up
-Consequences (risky use) – use in physically dangerous situations; use despite knowledge of physical or psychological problem
-Physiological dependence (pharmacological) – tolerance; withdrawal
Not a prescribed substance used correctly
Specify if:
-Mild: 2-3 substances present
-Moderate: 4-5 substances present
-Severe: 6+ substances present
-In early remission: 3 consecutive months with no symptoms, but not more than 12 consecutive months; cravings can be present
-In full remission: 12 consecutive months with no symptoms; cravings can be present
substance intoxication vs. withdrawal
Substance Intoxication
-Development of a reversible syndrome due to substance use/exposure
-Problematic behavioral or psychological changes due to the effects on the CNS
-Symptoms should stop with no more usage
Substance Withdrawal
-Cessation of heavy or prolonged substance use
-Development of substance-specific syndrome
-Clinically significant impairment or distress
-Short-acting substances more likely to have prominent withdrawal symptoms
gambling disorder
Grouped with substance disorders due to similar reward pathways, behaviors
Problematic patterns of gambling
-Clinically significant distress or impairment
Four or more symptoms in a 12-month period
-Gambles with more in order to achieve excitement (tolerance)
-Restless or irritable when attempting to cut down (withdrawal)
-Repeated unsuccessful attempts to cut back
-Preoccupied with gambling
-Gambles when distressed
-After losing, returns to get even
-Lies to conceal gambling
-Jeopardized or lost relationship or opportunity
-Relies on other to relieve finances
Specify if:
-Episodic: symptoms subside for several months
-Persistent: continuous symptoms over years
-In early remission; in full remission
-Mild (4-5 symptoms); Moderate (6-7); Severe (8-9)
3x higher among Asian individuals
schizophrenia
Two or more following symptoms
-Delusions
-Hallucinations
-Disorganized speech
-Disorganized behavior
-Negative symptoms: lack of emotional expression, decreased speech, decreased social contact, decreased motivation, decreased self care, slow movement, low sex drive
Present for significant proportion of 1-month period
-Less time if treated
One or more major areas of functioning markedly below normal
Continuous signs of disturbance at least 6 months
Earliest point at which can give diagnosis of Schizophrenia
-5 months DEFINITE prodromal symptoms
-1-month active symptoms
-Can also give Schizophrenia 5 months after active symptoms if some residual symptoms present (and uncertain if prodromal symptoms present)
-Must give Schizophrenia if multiple episodes (without exclusionary diagnoses)
Culture
-Influences belief systems, experiences
-Higher prevalence among African-Americans
-vs. Bipolar in European Americans
-Higher prevalence in developed countries
-Not different urban vs. rural
Age
-Onset late adolescence to early 30s
-Men onset = 18-25
-Women onset = 25-30
schizoaffective disorder
Uninterrupted period of positive or negative symptoms with
-Major depressive episode - With depressed mood (not just anhedonia)
-Manic episode
-At least 2 weeks during lifetime when delusions or hallucinations without mood disturbance
-Mood episode present for the majority of active and residual period
schizophreniform disorder
At least 1 month of psychotic symptoms
-Defined same as Schizophrenia criteria
-Less than 6 months total duration
Impairment not necessary
Presumably better prognosis
-Not “locked in” to Schizophrenia
Diagnosing
-Can also give conservative diagnosis of Schizophreniform Disorder
- 1-month active symptoms
-UNCERTAIN 5 months prior
-6 months not past since break
brief psychotic disorder
Need only 1 positive symptom
-No negative symptoms
-Less than 1-month active symptoms
delusional
-At least 1 month of non-bizarre delusions
-No other positive or negative symptoms
-Except hallucinations in service of delusion
-Functioning not otherwise impaired
manic episode
-Elevated, expansive or irritable mood AND increased goal-directed activity or energy lasting at least 1 week (or any duration if hospitalized)
o-3 or more symptoms (4 if only irritable): grandiosity, decreased need for sleep, pressured speech/more talkative, flight of ideas or racing thoughts, distractibility, increase in goal directed activity or psychomotor agitation, risky behaviors
-causes marked impairment, hospitalization, or psychosis
major depressive episode
At least five depressive symptoms, present most of the day, nearly every day for same 2 weeks
-Depressed mood
-Anhedonia: loss of interest of pleasure
-Weight change –
-Appetite disturbance OR
-Hypophagia: 1 out of 3 meals
-Hyperphagia: More than 4 meals
-Weight change: 5% in 1 month
-Insomnia OR Hypersomnia
-Psychomotor agitation OR retardation
-Low physical energy, fatigue
-Feelings of worthlessness OR guilt
-Problems concentrating OR indecisiveness
-Recurrent thoughts of death or suicide without a specific plan or attempt
Clinically significant distress
hypomanic episode
-Distinct period of abnormally and persistently elevated, expansive, or irritable mood AND activity or energy lasting at least 4 consecutive days for most of the day
-Three or more of the following symptoms: grandiosity, decreased need for sleep, pressured speech/more talkative, flight of ideas or racing thoughts, distractibility, increase in goal directed activity or psychomotor agitation, risky behaviors
-Change in functioning
-Observable to others
-Not causing marked impairment, hospitalization, or psychosis
bipolar 1
If any current or past Manic or Mixed Episodes
-Code for current or most recent episode, severity
Associated features
-Abrupt onset/offset of Manic Episode
-Psychosocial stressor
-Depression immediately proceeds/follows in 50-60% Manic Episodes
-Low insight into mania as a problem
-Depression often viewed as problem
-Regret from manic activities
Bipolar diathesis: Will become manic if put on antidepressant treatments
Men first episode more often Manic
-Higher proportion Manic Episodes
Women first episode more often MDE
-Higher proportion MDEs
-Women 3x more likely Rapid Cycling
bipolar 2
At least 1 Hypomanic Episode and MDE
-If never MDE, then Other Specified Bipolar or Cyclothymia
Never a Manic Episode
-Clinically significant distress or impairment
By definition a recurrent disorder
-Specify Hypomanic or Depressed for most recent episode
Associated features
-More mood episodes than Bipolar I; less hypomanic symptoms than Bipolar I
-Similar suicide attempts as Bipolar I; more completed attempts
major depressive disorder
Major Depressive Episode(s)
-Single
-Recurrent
At least 2 months not meeting criteria in between
Clinical significant distress or impairment
Never Manic or Hypomanic Episode
Code for episodic nature, severity
Associated features:
-10-15% have pre-existing Dysthymia
-“Double depression”
-5-15% die from suicide
-20% lifetime for women, 10% for men
-Expressed more as: Somatic features (weakness) in Asian cultures; “Nerves” and headaches in Latin cultures
persistent depressive disorder (dysthymia)
-Depressed mood for most of the day; more days than not
-2 years (1 year for children, can be irritable mood)
-At least 2 of the following while depressed
-Appetite disturbance
-Sleep disturbance
-Low energy, fatigue
-Low self-esteem
-Poor concentration or indecision
-Hopelessness
-Never 2 months normal mood
-Can be in MDE
-Never Manic or Hypomanic Episode
Associated features:
-75% develop MDE in lifetime
-10% spontaneously remit within 1 year
-Higher comorbidity
subtypes of PDD
with pure dysthymic syndrome: no MDEs
with persistent MDE: continuous MDE
with intermittent MDEs, with current episode: current MDE, but at least 2 months < 5 symptoms
with intermittent MDEs, without current episode: not current MDE, but at least 1 MDE
with anxious distress
At least 2 of the following the majority of the disorder
- Feeling keyed up or on edge
- Feeling unusually restless
- Difficulty concentrating because of worry
- Fear that something awful may happen
- Feeling that might lose control
with mixed features
At least 3 of the following nearly every day of the mood episode
If also in MDE:
- Prominent depressed mood
- Diminished interest or pleasure
- Psychomotor retardation
- Fatigue or loss of energy
- Worthlessness or guilt
- Recurrent thoughts of death
If also manic or hypomanic:
- Elevated, expansive mood
- Inflated self-esteem or grandiosity
- More talkative
- Racing thoughts
- Increased energy, activity
- Increase in risky activities
- Decreased need for sleep
with rapid cycling (bipolar disorder only)
4 or more episode in 1 year
- 2 months between episodes, or
- Switch to opposite pole
with melancholic features (endogenous/typical/anaclitic)
At least 1 of the following during most severe period:
- Anhedonia
- Lack of reactivity
At least 3 of the following:
- Distinct quality of depressed mood
- Depression worse in the morning (diurnal variation)
- Early morning awakening (late insomnia)
- Psychomotor disturbance
- Anorexia or weight loss
- Guilt
More common in more severe MDE’s
with atypical features (exogenous/reactive/introjective)
Mood reactivity
At least 2 of the following:
- Weight gain or increase in appetite
- Hypersomnia
- Leaden paralysis
- Long-standing pattern of interpersonal rejection sensitivity
o Not just while depressed
o Results in significant impairment
Criteria not met during same mood episode
- With Melancholic Features
- With Catatonic Features
with psychotic features
Delusions or hallucinations present at any time during mood episode
- With mood-congruent features
- With mood-incongruent features
with peripartum onset
Symptoms beginning during pregnancy or within 4 weeks postpartum
- Mood disturbance or lability
- Preoccupation with infant well-being
o Fear of being alone with infant
o Disruption in caregiving
Childbirth and infant care associated with
- Sleep disruption
- Withdrawal of social support
- Hormonal changes
with seasonal pattern
Regular temporal relationship between the onset of episodes and a particular time of the year
- Not seasonal-related psychosocial stressors
Full remissions at a characteristic time of the year
- Or change to mania or hypomania
In the last 2 years,
- 2 seasonal episodes
- No nonseasonal episodes
Lifetime seasonal episodes > nonseasonal
cyclothymia
o At least 2 years (1 year for children) with numerous periods of
▪ Hypomanic symptoms
▪ Depressive symptoms
o Symptoms 50% of time; not normal for more than 2 months
o No Mood Episodes
disruptive mood dysregulation disorder
o Severe recurrent temper outbursts
o Inconsistent with developmental level
o Three or more per week
o Mood persistently irritable
▪ Most of the day; nearly every day
o Present for at least 1 year
▪ No more the 3 months without
o Present in 2 settings
o Occurring between 6 and 18
o Onset before 10yo
o Never manic or hypomanic episode
o Never oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder
Associated features:
▪ Reactivity and poor affect regulation
● Not necessarily violent or antisocial anger, but difficulty controlling mood
▪ Distinguish from Bipolar Disorder in children
● Capture chronic reactivity and outbursts that do not represent episodic mania symptoms
▪ Highest in childhood, decrease adolescence
▪ Conversion into internalizing disorders
what class of disorders is highest prevalence
anxiety disorders
separation anxiety disorder
Developmentally inappropriate and excessive fear or anxiety concerning separation to attached
o At least 3 repetitive and excessive symptoms: distress anticipating or experiencing separation; worry about loss or harm to attachment figures; worry about event leading to separation; refusal to go out b/c of fear of separation; fear or refusal about being alone; refusal to sleep; nightmares about separation; complaints about somatic symptoms
o Lasting 4 weeks in children, 6 months in adults
o Associated features: Neediness, intrusiveness, clinginess in children; Frequent accommodation by caregivers; School absences; Homesickness; Demandingness, overprotectiveness in adults (attached to other adults or to children)
o Prevalence
▪ 1.6% in children (similar in adults)
▪ Most prevalent anxiety disorder under 12yo
● Prevalence decreases in adolescence, adulthood
generalized anxiety disorder
o Excessive anxiety or worry in at least 2 areas; more days than not for at least 6 months
o Difficulty controlling worry
▪ At least 3 physiological symptoms: restlessness keyed up, difficulty concentrating, early or middle insomnia, fatigue, irritability, muscle tension
o Prevalence
▪ Women only slightly more prevalent
▪ More common in Euroamerican, developed nations
panic disorder
recurrent unexpected panic attacks
o Panic attacks: Discrete period of intense fear or discomfort with sudden onset (peak within minutes); At least 4 of the following (Limited symptom attack if less than 4): heart papiltations, sweating, trembling or shaking, shortness of breath, choking, chest pain or discomfort, nausea or stomach distress, dizziness or lightheadedness, derealization or depersonalization, fear of losing control, fear of dying, numbness or tingling, chills or hot flashed
▪ Unexpected - Not associated with external or internal cues
▪ Situationally bound - Occur due to cue; Always; Immediate » not panic disorder
▪ Situationally predisposed - Likely to occur due to cue; Variable
o 1 month of anticipatory anxiety (Either or both)
▪ Persistent worry about additional attacks or worry about the implications
▪ Significant change in behavior related to attacks
agoraphobia
o Marked fear or anxiety about 2 or more: Public transit; Open spaces; Enclosed spaces; Lines or crowds; Being outside home
o Fears or avoids: Escape; Help not available; Embarrassment or incapacitation
o Situations always provoke fear or anxiety
o Situations avoided, require companion, or endured
o Fear or anxiety out of proportion to danger
o Fear, anxiety, or avoidance at least 6 months
social anxiety disorder
o Marked fear of social situations with possible scrutiny
▪ In children, must also be with peers
o Fears that will show anxiety
▪ Humiliation or embarrassment
o Always provoke fear or anxiety
o Situations avoided or endured with fear or anxiety
o Out of proportion to actual threat
o Lasting for at least 6 months
o Culture
▪ Highly specific to cultural interactions
▪ In Asian cultures, fear of offending others, fear of using public restrooms
▪ Collectivism = higher social anxiety, but lower social phobia rates
specific phobia
o Marked fear of object or situation
o Always provokes immediate fear or anxiety
o Avoided or endured with fear or anxiety
o Out of proportion to actual danger
o Lasting at least 6 months
obsessive compulsive disorder
o Presence of obsessions and/or compulsions
o Person recognizes obsessions or compulsions excessive or unreasonable
o Obsessions or compulsions
▪ Cause marked distress
▪ Consume at least 1 hour per day, or
o Significantly impair functioning
obsessions:
Recurrent intrusive thoughts, impulses, or images
Cause marked anxiety or distress
Not excessive worry
Attempt to suppress or neutralize thoughts, impulses, or images
Recognizes obsessional thoughts, impulses, or images product of own mind
compulsions:
Repetitive behaviors or mental acts must perform
In response to obsession, or
According to rigid rules
Behaviors or mental acts reduce distress or prevent event
Not realistically connected
Clearly excessive
body dysmorphic disorder
o Preoccupation with defect in appearance
o Repetitive behaviors or mental acts in response to appearance concerns
o Equally common in men (2.1%) and women (2.4%)
hoarding disorder
o Persistent difficulty discarding possessions
▪ Regardless of value or sentimentality
o Perceived need to save, distress in discarding
o Possessions congest and clutter living areas, compromise use
trichotillomania
o Recurrent pulling out of one’s hair, resulting in hair loss
o Repeated attempts to decrease or stop hair pulling
o Higher for females
excoriation (skin picking) disorder
o Recurrent skin picking resulting in skin lesions
o Repeated attempts to decrease or stop skin picking
o Higher for females
reactive attachment disorder
o Consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:
▪ Rarely or minimally seeks comfort when distressed
▪ Rarely or minimally responds to comfort when distressed
o Persistent social and emotional disturbance characterized by at least 2:
▪ Minimal social and emotional responsiveness to others
▪ Limited positive affect
▪ Episodes of unexplained irritability, sadness, or fearfulness that are evident even during non-threatening interactions with adult caregivers
o The child has experienced a pattern of extremes of insufficient care as evidenced by at least 1:
▪ Social neglect or deprivation (persistent lack of having basic emotional needs met)
▪ Repeated changes of primary caregivers that limited stable attachments
▪ Rearing in unusual settings that limited attachments
o Evident before age 5 and developmental age of at least 9 months
disinhibited social engagement disorder
o A pattern of behavior in which a child actively approaches and engages with unfamiliar adults and has 2:
▪ Reduced or absent reticence in approaching unfamiliar adults
▪ Overly familiar verbal or physical behavior
▪ Diminished or absent checking back with caregiver
▪ Willingness to go with unfamiliar adults
o Not limited to impulsivity
o Has experienced a pattern of extremes in insufficient care as evidenced by at least 1:
▪ Social neglect or deprivation (persistent lack of having basic emotional needs met)
▪ Repeated changes of primary caregivers that limited stable attachments
▪ Rearing in unusual settings
o Caregiver is presumed to be responsible
o Developmental age of at least 9 months
post traumatic stress disorder
o Exposure to actual or threatened death, serious injury, or sexual violence (at least 1)
▪ Direct experience
▪ Witnessing in person
▪ Learning about violent or accidental death
▪ Experiencing repeated or extreme exposure
Reexperiencing (at least 1)
▪ Recurrent distressing intrusive recollections
▪ Recurrent distressing dreams
▪ Dissociative reactions (flashbacks)
▪ Intense distress to external or internal cues
▪ Physiological reactivity to external or internal cues
Avoidance (at least 1)
▪ Efforts to avoid thoughts, feelings
▪ Efforts to avoid activities, places, or people
Negative alterations in cognition and mood (at least 2)
▪ Inability to recall important parts of trauma
▪ Negative beliefs about self, others, world
▪ Distorted cognitions about causes or consequences of trauma
▪ Negative emotional state
▪ Markedly diminish interest or participation
▪ Detachment or estrangement feelings
▪ Restricted range of affect
Hyperarousal (at least 2)
▪ Irritability
▪ Self-destructive behavior
▪ Hypervigilance
▪ Easily startled
▪ Problems concentrating
▪ Sleep disturbance
Disturbance at least 1 month
Culture
▪ Higher rates in African Americans, Latino/as, Native Americans
▪ Lowest in Asian Americans
▪ Lower rates in other countries
Gender
▪ Higher among women
Age
▪ Lower among children, older adults
acute stress disorder
Exposure to actual or threatened death, serious injury, or sexual violence (at least 1)
▪ Direct experience
▪ Witnessing in person
▪ Learning about violent or accidental death
▪ Experiencing repeated or extreme exposure
Presence of 9 or more
▪ Recurrent distressing intrusive recollections
▪ Recurrent distressing dreams
▪ Dissociative reactions (flashbacks)
▪ Intense distress to external or internal cues
▪ Physiological reactivity to external or internal cues
▪ Efforts to avoid thoughts, feelings
▪ Efforts to avoid activities, places, or people
▪ Inability to recall important parts of trauma
▪ Negative beliefs about self, others, world
▪ Distorted cognitions about causes or consequences of trauma
▪ Negative emotional state
▪ Markedly diminish interest or participation
▪ Detachment or estrangement feelings
▪ Restricted range of affect
▪ Irritability
▪ Self-destructive behavior
▪ Hypervigilance
▪ Easily startled
▪ Problems concentrating
▪ Sleep disturbance
Duration of disturbance is 3 days to 1 month after trauma
adjustment disorder
o Development of emotional or behavioral symptoms in response to identifiable stressor(s)
▪ Occurring within 3 months of the onset of stressor(s)
Clinically significance
▪ Marked distress in excess of what would be expected from exposure to the stressor
▪ Significant impairment in functioning
o Not meet criteria for, not related to another mental disorder
o Not bereavement
o Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months.
somatic symptom disorder
Multiple physical complaints
▪ Beginning before age 30
▪ Occurring over a period of several years
▪ Result in treatment seeking or in impairment
Variety of complaints
▪ 4 Pain
▪ 2 Gastrointestinal
▪ 1 Sexual
▪ 1 Pseudoneurological
Each physical complaint either
▪ Not fully explained by examination
▪ Impairment in excess of any findings
Not intentionally produced or feigned
General information: 9x healthcare costs
▪ Somatization: Tendency to experience psychological distress as physical symptoms; Frequent, acceptable route of expression in many cultures
▪ Presence of physical symptoms not fully explained by GMC, substance, or other Axis I
● Not under voluntary control
▪ Only feel distress through body
▪ Have both physical and psychological symptoms but physical symptoms are more salient
● When trust, more able to reveal psychological
▪ Vague, ill-defined symptoms
▪ Life circumscribed around medical problems
▪ Unwillingness to consider psychological components/treatments to physical problems
Very associated with culture (“idioms of distress”)
● In US, fashionable medical disorders, disability status
● Weakness – Asian cultures
● Nerves, headaches – Latino cultures
● Virility – preindustrial cultures
undifferentiated somatization disorder
o At least 1 physical complaint
o Each physical complaint either
▪ Not fully explained by examination
▪ Impairment in excess of any findings
o Clinically significant distress or impairment
o At least 6 months duration
o Not intentionally produced or feigned
illness anxiety disorder (hypochondriasis)
o Preoccupation with having a serious illness
o Based on misinterpretation of bodily symptoms
o Persists despite reassurance
o Not delusion intensity (bizarreness); not physical appearance
o Associated features
▪ Afraid to have disease
▪ Believe have it already
● As opposed to Somatization Disorder, in which collect diagnoses
● As opposed to Specific Phobia, in which afraid of contracting
▪ Dependency in relationships
● Reassurance seeking, entitlement
▪ Not believe negative test results
▪ Doctor shopping
o Biological
▪ Modest heritability
▪ “Overactive” nerve transmission
conversion disorder
At least 1 pseudoneurological symptom (paralysis, seizures, tremors, inability to speak, blindness)
o Proceeded by psychosocial stressor
o Not intentionally produced or feigned
o NBAFB GMC, substance use, or culturally sanctioned experience
Specify if:
▪ With Motor Symptom or Deficit
▪ With Sensory Symptom or Deficit
▪ With Seizures or Convulsions
▪ With Mixed Presentation
Associated features
▪ La belle indifference or histrionic features
▪ Suggestibility
▪ Psychosocial stressor
▪ Idiosyncratic symptom presentation
▪ Acute onset
▪ More common in preindustrial cultures
body dysmorphic diosrder
o Preoccupation with defect in appearance
o Clinically significant distress or impairment
o Excessive checking/reassurance seeking
o Often to exacerbation of any defect
o Equally common in men and women
pain disorder
o Disorder where clinical focus is pain
o Psychological factors in
▪ Onset
▪ Severity
▪ Exacerbation
▪ Maintenance
o High potential for Substance-Related, Mood, and Anxiety Disorders
factitious disorder
o Intentional production of symptoms
o Motivation to assume sick role
o External incentives absent
malingering
o Intentional production of symptoms
o Motivation for external incentives
o Associated features
▪ Legal reasons for consult
▪ Discrepancy between findings vs. distress and impairment
▪ Antisocial Personality
▪ Pressure to diagnose
dissociative amnesia
o Inability to recall important personal information
▪ Usually traumatic or stressful information
▪ Inconsistent with ordinary forgetting
dissociative fugue
o Sudden, unexpected travel
▪ Inability to recall past
o Confusion about identity or assumption of new identity
depersonalization disorder
Persistent or recurrent experience of
Depersonalization
● Unreality, detachment, or being an outside observer with respect to self
Derealization
● Unreality or detachment with respect to surroundings
Reality testing intact
o Often distressed over depersonalization: Living in a dream; Watching self from the outside; Not able to feel anything; Not having a sense of own body part; Change in perceptual size of objects; Disturbance in time perception
dissociative identity disorder
o Two or more distinct personality states
▪ Marked discontinuity in sense of self and agency
-affect, consciousness, perception, sensory function, behavior, memory, cognition, motor function
▪ Observed or self-reported
o Recurrent gaps in recall, important personal information, traumatic events
▪ Inconsistent with ordinary forgetting
o Not part of cultural practice
▪ Not fantasy in children
o In addition: History of childhood trauma
sexual dysfunction
disruption in the sexual response
Specific psychophysiological impairment
▪ Persistent or recurrent
● Generally, 75-100% of sexual encounters
At least 6 months
o Clinical significant distress in the individual
Onset
▪ Lifelong Type (primary)
● More difficult to treat
▪ Acquired Type
Situation
▪ Generalized Type
▪ Situational Type
female interest arousal disorder
at least 3 – absent/reduced interest in sexual activity; absent/reduced sexual/erotic thoughts or fantasies; no/reduced initiation of sexual activity (typically unreceptive to partner’s attempts); absent/reduced sexual excitement/pleasure in almost all occasions; absent/reduced interest/arousal in response to cues; absent/reduced genital or nongenital sensations during sexual activity; at least 6 months
male hypoactive sexual desire
persistently or recurrent deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity. Judgment of deficiency is made by clinician; at least 6 months
male erectile disorder
marked difficulty in obtaining or maintaining an erection or decrease in erectile rigidity on almost all occasions of sexual activity; at least 6 months
female orgasmic disorder
marked delay in, marked infrequency of, or absence of orgasm OR markedly reduced intensity of orgasmic sensations on almost all occasions; at least 6 months
male delayed ejaculation or premature ejaculation
marked delay or infrequency of ejaculation experienced almost all occasions of partnered sexual activity; at least 6 months
female genito pelvic pain/penetration disorder
persistent/recurrent difficulties with at least 1: vaginal penetration during intercourse, pain during penetration, fear or anxiety about pain, tensing or tightening of pelvic floor muscles during penetration; at least 6 months
factors related to sexual dysfunction
Partner, Relationship, Individual, Cultural/religious, Medical
paraphilias
sexual interest or behaviors involving unusual objects, situations, or non-consenting personal
Recurrent and intense sexual arousal from
▪ Objects or nonhuman animals
▪ Humiliation or suffering
▪ Nonconsenting persons
▪ At least 6 months
Clinically significant distress or impairment
Specify if:
▪ In a controlled environment: primarily applicable to people living in institutional or other settings where opportunities to engage in behavior is restricted.
▪ In full remission: has not acted on the urges with a nonconsenting person and no distress/impairment for at least 5 years while in an uncontrolled environment.
fetishism
Over at least 6 months, recurrent & intense sexual arousal from either the use of nonliving objects or a highly specific focus on nongenital body parts
The fetish objects are not limited to articles of clothing used in cross-dressing or devices specifically designed for tactile genital stimulation
- Specify if:
o Body parts
o Nonliving objects
o Other
transvestic fetishism
- Over at least 6 months, recurrent & intense sexual arousal from cross-dressing
- Specify if:
- With fetishism: sexually aroused by fabrics, materials, or garments
- With autogynephilla: sexually aroused by thoughts or images of self as female
sexual sadism
- Over at least 6 months, recurrent & intense sexual arousal from the physical or psychological suffering of another person
- Has acted on these sexual urges with nonconsenting person, or the sexual urges or fantasies cause clinically significant distress
sexual masochism
- Over at least 6 months, recurrent & intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer
- Specify if:
- With asphyxiophillia: achieve sexual arousal through the restriction of breathing
pedophilia
- Over at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally 13 or younger)
- Has acted on these sexual urges with nonconsenting person, or the sexual urges or fantasies cause clinically significant distress
- At least 16 years old and at least 5 years older than the child or children (do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12 or 13 y/o)
Specify if:
o Exclusive type (attracted only to children)
o Nonexclusive type
o Sexually attracted to males, females, or both
o Limited to incest
vouyerism
- Over at least 6 months, recurrent & intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, as manifested by fantasies, urges or behaviors.
- Has acted on these sexual urges with nonconsenting person, or the sexual urges or fantasies cause clinically significant distress
- At least 18 years old
exhibitionism
- Over at least 6 months, recurrent & intense sexual arousal from the exposure of one’s genitals to an unsuspecting person, as manifested by fantasies, urges or behaviors.
- Has acted on these sexual urges with nonconsenting person, or the sexual urges or fantasies cause clinically significant distress
- Specify if: Sexually aroused by exposing genitals to prepubertal children, physically mature individuals, or both.
frotteurism
- Over at least 6 months, recurrent & intense sexual arousal from touching or rubbing against a nonconsenting person
- Has acted on these sexual urges with nonconsenting person, or the sexual urges or fantasies cause clinically significant distress
gender dysphoria
Marked incongruence between experienced and assigned gender
-At least 6 months
At least 6 of the following in children: desire or insistence that other gender, preference for cross dressing, preference for cross gender roles, preference for activities typical of other gender, preference for other gender playmates, rejection or typical assigned gender activities, dislike of own anatomy, desire for sex characteristics that match experienced gender
At least 2 of the following in adults: incongruence between experienced gender and sex characteristics, desire to be rid of sex characteristics, desire for sex characteristics of other gender, desire to be of other gender, desire to be treated as the other gender, conviction that have the typical feelings/reactions of other gender
anorexia nervosa
o Restriction of intake, leading to significantly low weight
▪ Typically 85% expected weight, given age, height,
o development, and health
o Intense fear of gaining weight or interference in weight gain
o Disturbance in body image
o Subtypes
▪ Restricting: Dieting, fasting, exercise
▪ Binge-eating/purging: consumption sometimes bingeing; vomiting, laxatives, diurectics, enemas
o Associated features
▪ Reinforcement, attention for dieting behaviors
● Not self-reassured when lose weight
▪ Lack of emotional attunement in family
▪ Conflicts around autonomy and control
● Obsessional traits in childhood
▪ Concerns about eating in public
▪ Amenorrhea
▪ Mortality from medical problems (starvation, electrolyte imbalance) or suicide 3-18% (Herzog et al., 2000)
bulimia nervosa
Recurrent episodes of binge eating
▪ Eating larger amount of food in less than 2 hrs
▪ Sense of lack of control
o Recurrent compensatory behaviors
o Binge-eating/compensatory cycle 1x week for 3 months
o Self-evaluation unduly influenced by body shape and weight
o NBEB Anorexia Nervosa
Severity
▪ Mild: An average of 1–3 episodes of inappropriate compensatory behaviors per week.
▪ Moderate: An average of 4–7 episodes of inappropriate compensatory behaviors per week.
▪ Severe: An average of 8–13 episodes of inappropriate compensatory behaviors per week.
▪ Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per week.
Subtypes
▪ Purging (92-94%)
● Vomiting most common (80-90%)
● Purging “unsuccessful”
o Vomiting reduces 40-70% calories consumed
o Laxatives/enemas reduce 10%
▪ Nonpurging (6-8%)
Associated features
▪ Normal to overweight
● 19% of bulimics undereat, 37% of bulimics eat normal amount, and 44% overeat
▪ Greater history of overweight compared to controls, anorexics
▪ Similar family problems, interpersonal dynamics to anorexics
▪ Early pubertal maturation
▪ Physical damage, medical problems due to purging
● Russel’s signs
● Dental erosion
● Esophageal, gastric damage
● Chronic bowel problems
● Electrolyte imbalance
● Amennorrhea in 20%
binge eating disorder
Recurrent episodes of binge eating
▪ Eating larger amount of food in less than 2 hrs
▪ Sense of lack of control
Binge-eating episodes associated with at least 3 of the following
▪ Eating much more rapidly
▪ Eating until feeling uncomfortably full
▪ Eating large amounts of food when not feeling physically hungry
▪ Eating alone because of feeling embarrassed
▪ Feeling disgusted, depressed, or guilty
o Marked distress regarding binge eating
o Occurs, on average, at least 1x a week for 3 months.
o Not associated with the recurrent use of inappropriate compensatory behavior; not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
Severity
▪ Mild: 1–3 binge-eating episodes per week.
▪ Moderate: 4–7 binge-eating episodes per week.
▪ Severe: 8–13 binge-eating episodes per week.
▪ Extreme: 14 or more binge-eating episodes per week.
oppositional defiant disorder
pattern of at least 4 symptoms:
angry irritable mood: loses temper, touchy or easily annoyed, angry and resentful
argumentative/defiant behavior: argue with adults, defies or refuses to comply, deliberately annoys, blames others
vindictiveness: spiteful or vindictive
▪ At least 6 months
● Most days for younger than 5 years
● Once a week for older than 5 years
▪ Symptoms outside normative range for development
▪ Exhibited with more than a sibling
o Distress in individual or others or negative impact in functioning
▪ Severity is dependent on number of context OD displayed
conduct disorder
o Repetitive and persistent pattern of
▪ violating basic rights of others or
▪ major age-appropriate societal norms or rules
▪ At least 3 behaviors in past year (1 in past 6 months): aggression to people and animals, destruction of property, deceitfulness or theft, serious violations of rules
With limited prosocial emotions (at least 2)
▪ Lack of remorse or guilt
▪ Callous—lack of empathy
▪ Unconcerned about performance
▪ Shallow or deficient affect
conduct disorder course (life course persistent or adolescence limited)
life course persistent: Starts at an early age
Continues into adulthood
More extreme behaviors
Consistent across settings
More linked to neurological signs
40% lead to Antisocial Personality Disorder
adolescence limited: Starts around puberty and continues into adolescence
Stopping in young adulthood
Not consistent across situations
More related to situational factors
intermittent explosive disorder
o Recurrent behavioral outbursts of failure to resist aggressive impulses
▪ Verbal or physical aggression
● Twice weekly for 3 months
▪ Outbursts involving damage, destruction, or injury
● At least 3 in 12 months
o Out of proportion to provocation or stressors
o Not premeditated, not for objective
o Marked distress or impairment or consequences
o At least 6 years old
general personality disorders (3 Ps)
o Persistent
o Pervasive
o Pathological
cluster A personality disorders
Odd-eccentric
▪ Schizotypal: schizophrenia like positive symptoms, magical beliefs
▪ Schizoid: negative symptoms of schizophrenia
▪ Paranoid: judgmental, jealousy, counteract
cluster B personality disorders
dramatic-erratic
i. Antisocial: disregard safety, illegal actions, absence of conscious, deceitful, no remorse
ii. Histrionic: attention, approval seeking, dramatic, center of attention
iii. Narcissistic: no empathy, no self-esteem, grandiosity
iv. Borderline: poor modulation of affect, relationship, self-esteem
cluster C personality disorders
Anxious-Fearful
i. Avoidant: Social inhibition, feelings of inadequacy, hypersensitivity
ii. Dependent: rely on others
iii. Obsessive-compulsive: highly rigid, perfectionist
schizotypal personality disorder
Social and interpersonal deficits
● Peculiar or eccentric behavior and appearance
● Lack of close friends
● Social anxiety that doesn’t diminish with familiarity
Cognitive or perceptual distortions
● Ideas of reference
● Odd or magical thinking
● Unusual perceptual experiences
● Odd thinking or speech
● Suspicious or paranoid ideation
● Inappropriate or restricted affect
schizoid personality disorder
▪ Detachment from social relationships
● Not desire or enjoy others close relationships
o Most time alone
o Indifferent to sex, praise/criticism
▪ Restricted range of emotions
● Detached or flattened affect
paranoid personality disorder
▪ Distrust and suspiciousness
▪ Suspects others exploiting, harming, deceiving
● Preoccupied with loyalty, trustworthiness
o Sexual partner
● Reluctant to confide, others will use against
▪ Reads hidden insults or threat
▪ Reacts angrily, counterattacks, bears grudges
borderline personality disorder
instability in interpersonal relationships
● Frantic efforts to avoid abandonment
o Real or imagined
● Unstable and intense relationships
o Idealization and devaluation
● Transient, stress-related paranoia
Instability in self-image
● Identity disturbance
● Chronic feelings of emptiness
● Severe dissociation
Instability in affect
● Affective instability
● Inappropriate, intense anger
● Impulsivity in at least 2 areas that are self-damaging
Self-harming behaviors or gestures
Kernberg explanation of borderline personality disorder
o Absence of psychosis
o Impaired ego integration
o Primitive defenses
▪ Splitting
▪ Projective identification
Linehan explanation of borderline personality disorder
o Biological vulnerability
▪ More intense reactions, longer duration
o Emotionally invalidating environments
narcissistic personality disorder
Grandiosity
● Exaggerated accomplishments
● Entitlement
● Only understood by high status individuals
Need for admiration
Lack of empathy
● Exploitative
● Envious of others of believes others envy them
Kohut explanation of narcissitc personality disorder
● Early self is bipolar structure
o Immature grandiosity vs. dependent over-idealization
● Caregiver not respond to child’s displays of competency
● Fragile self, use defense of idealization
histrionic personality disorder
Attention seeking
● Uncomfortable when not the center of attention
● Physical appearance to draw attention
● Provocative or sexually inappropriate
● Suggestible
● Impressionistic speech/lacking in detail
Excessive emotionality
● Rapidly shifting shallow emotions
● Dramatization of emotional expression
● Considers relationships more intimate then are
antisocial personality disorder
Inadequately motivated behavior
● Repeatedly performing illegal behaviors
● Impulsivity
● Disregard for safety
Absence of conscious or responsibility
● Consistent irresponsibility
● Deceitfulness
● Lack of remorse
● Aggressiveness/irritability
At least 18
Conduct disorder before age 15
Emotional poverty
● Passive Avoidance Learning
Sociopathy vs. psychopathy
avoidant personality disorder
▪ Social inhibition, feelings of inadequacy, and hypersensitivity
● Avoid occupations with interpersonal contact b/c fears criticism, disapproval, or rejection
● Requires certainty of being liked
● Restraint in relationships b/c of fear of being shamed
● Unwilling to try new things
● Views self as socially inept, unappealing
dependent personality disorder
Pervasive and excessive need to be taken care of
● Difficulty making decisions, initiating projects, handling responsibilities
● Submissive and clinging behavior
● Urgently seeks new relationships
● Fears of separation
● Unrealistic fear of being left alone to take care of self
obsessive compulsive personality disorder
Preoccupation with orderliness, perfectionism, mental and physical control
● Excessively devoted to work and productivity
● Caught up in details
● Refuse to delegate
● Not complete tasks because not perfect
● Unable to discard worthless items
● Miserly
● Rigidity and stubbornness
● Inflexible about morality
