1. Introduction: Understanding Psychological Disorders Pathological Eating disorders Psychological disorder Personality disorders Anxiety disorder Dissociative disorders Generalized anxiety disorder DSM-5 Panic attacks Schizophrenia & types Phobias Suicide Behavioral perspective in psychological disorders Post traumatic stress disorder Sexual disorders Obsessive-compulsive disorder Paraphilia Mood disorders

2. Psychopathology is the scientific study of the origins, symptoms, and development of psychological disorders. Psychological disorder is “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress…or disability…or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom…” (DSM-iV-TR,2000)…disabilities include loss of ability to function in an important area of functioning, such as home, social settings, work or school. Like medical disorders, psychological disorders are out of the patient’s control, they may in some cases be treated by drugs…may have both biological (nature) as well as environmental (nurture) influences. These causal influences are reflected in the bio- psycho-social model of illness (Engel, 19770). Dispelling Mental Disorder Myths There are many myths and misconceptions surrounding abnormal behavior; abnormal behavior is always bizarre, normal and abnormal behavior are unique to normal and abnormal persons, and once someone has a mental disorder, they will always have it. Former mental patients do not have a higher rate of violence than the general public. People with severe mental disorders who are experiencing bizarre delusional ideas and hallucinated voices have a slightly higher level of violent and illegal behavior than do “normal” people. There is very little risk of violence or harm to a stranger from casual contact with an individual who has a mental disorder.

3. What Is a Psychological Disorder? A psychological disorder or mental disorder is a pattern of behavioral and psychological symptoms that causes significant personal distress, impairs the ability to function in one or more important areas of daily life, or both. There are five axes of the DSM-5 Axis I- All diagnostic categories except personality disorders and mental retardation…mood, anxiety, or learning disorder Axis II- Personality disorders and specific developmental disorders Axis III- General medical conditions…heart disease, cancer, diabetes Axis IV-Psychosocial and environmental problems…homelessness, divorce, school problems Axis V-Current level functioning…in danger of hurting oneself or others

4. DSM * Diagnostic and Statistical Manual American Psychiatric Association Currently DSM-5 Common language and standard criteria for classifying mental disorders Controversies include: Cultural bias (e.g. sexual disorders) Medical rather than behavioral model Diagnosing, e.g. ADHD, autism.

5. Categories of Disorders include: Obsessive Compulsive and Related Disorders Neurodevelopmental Disorders Dissociative disorders Substance Related and Addictive Disorders Depressive Disorders Bipolar and related disorders Schizophrenia spectrum and other psychotic disorders Anxiety Disorders Somatic Symptom and Related Disorders Trauma and Stressor-Related Disorders Feeding and Eating Disorders Sexual Dysfunction Personality Disorders Autism Spectrum Disorders Neurocognitive Disorders

6. Diagnosing Disorder: The DSM The DSM organizes disorders by category. Within a diagnostic category, clinicians may also identify specifiers and rate severity.

7. Biopsychosocial Model * biological factors come from the body e.g., genes; neurotransmitters psychological factors come from the individual e.g., patterns of negative thinking; stress responses social factors come from society and culture e.g., socioeconomic status, homelessness, abuse Key concept is Interaction.

8. What is Abnormal behavior? A psychological disorder, causing distress, disability, or dysfunction. Defined symptomatically by the DSM 1 in 4 affected each year Each year prevalence: 18.1% anxiety disorders; 1% schizophrenia; 4.4% alcohol use disorder More lower SES Mentally ill stigmatized Many disorders comorbid. Comorbid = more than one disorder at a time Most severe disorders in a small group of people 6% of population have 3 or more disorders

9. DSM-5 Cluster A (odd or eccentric disorders) Not to be confused with Type A personality.Type A personality Paranoid personality disorder: characterized by irrational suspicions and mistrust of others. Paranoid personality disorder Schizoid personality disorder: lack of interest in social relationships, seeing no point in sharing time with others, anhedonia, introspection. Schizoid personality disorder Schizotypal personality disorder: characterized by odd behavior or thinking. Schizotypal personality disorder

10. Cluster B (dramatic, emotional or erratic disorders) Not to be confused with Type B personality.Type B personality Antisocial personality disorder: a pervasive disregard for the rights of others, lack of empathy, and (generally) a pattern of regular criminal activity. Antisocial personality disorder Borderline personality disorder: extreme "black and white" thinking, instability in relationships, self-image, identity and behavior often leading to self-harm and impulsivity. Borderline personality disorder Histrionic personality disorder: pervasive attention seeking behavior including inappropriately seductive behavior and shallow or exaggerated emotions. Histrionic personality disorder Narcissistic personality disorder: a pervasive pattern of grandiosity, need for admiration, and a lack of empathy. Characterized by self- importance, preoccupations with fantasies, belief that they are special, including a sense of entitlement and a need for excessive admiration, and extreme levels of jealousy and arrogance. Narcissistic personality disorder Cluster C (anxious or fearful disorders) Avoidant personality disorder: pervasive feelings of social inhibition and social inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction. Avoidant personality disorder Dependent personality disorder: pervasive psychological dependence on other people. Dependent personality disorder Obsessive-compulsive personality disorder (not the same as obsessive-compulsive disorder): characterized by rigid conformity to rules, moral codes and excessive orderliness. Obsessive-compulsive personality disorder Appendix B: Criteria Sets and Axes Provided for Further Study Appendix B contains the following disorders Depressive personality disorder – is a pervasive pattern of depressive cognitions and behaviors beginning by early adulthood. Depressive personality disorder Passive-aggressive (negativistic) personality disorder – is a pattern of negative attitudes and passive resistance in interpersonal situations. Passive-aggressive (negativistic) personality disorder

11. Anxiety Disorders: Intense Apprehension and Worry Anxiety is an unpleasant emotional state characterized by physical arousal and feelings of tension, apprehension, and worry. People who have anxiety are in a perpetual state of “fight-or-flight”. How do you know if you suffer from an anxiety disorder? Three features distinguish normal anxiety from pathological anxiety. Pathological anxiety is: a. irrational—it is provoked by perceived threats that are exaggerated or nonexistent, and the anxiety response is out of proportion to the actual importance of the situation. b. uncontrollable—the person can’t shut off the alarm reaction even when he or she knows it’s unrealistic. c. disruptive—it interferes with relationships, job or academic performance, or everyday activities. Generalized Anxiety Disorder: Worrying About Anything and Everything Generalized anxiety disorder (GAD) is characterized by excessive, global, and persistent symptoms of anxiety; it is sometimes referred to as free-floating anxiety.

12. Panic Attacks and Panic Disorder: Sudden Episodes of Extreme Anxiety A panic attack is a sudden episode of extreme anxiety that rapidly escalates in intensity. Panic disorder is an anxiety disorder in which the person experiences frequent and unexpected panic attacks. People who suffer from panic disorders tend to feel safer at home and therefore develop agoraphobia, a condition in which the fear is so intense, that the person becomes homebound. Explaining panic disorder a. Panic disorder tends to run in families. b. People with panic disorder are unusually sensitive to the signs of physical arousal. c. According to the cognitive-behavioral theory of panic disorder, people with panic disorder tend to misinterpret the physical signs of arousal as catastrophic and dangerous. After their first panic attack, they become even more attuned to physical changes, increasing the likelihood of future panic attacks

13. The Phobias: Fear and Loathing Phobic disorder is an anxiety disorder and is characterized by an irrational, overwhelming, and intense fear that is directed at a particular object or situation. Specific phobias are an exaggerated fear of a particular thing, such as a phobia of spiders, lizards, or a fear of riding in an elevator. Situational anxiety is usually self-limiting and dissipates as the stressful event recedes into the past. Ie is an overly anxious reaction to a situation Social phobias are the most common of the phobias, and refer to an intense anxiety about a social situation. The anxiety is experienced when the person is in a social or interpersonal setting such as public speaking, or asking someone out for a date. Explaining phobias: Learning theories Classical conditioning may be involved in the development of a specific phobia Operant conditioning can be involved in the avoidance behavior that characterizes phobias. Observational learning can be involved in the development of phobias. Humans seem biologically prepared to acquire fears of certain animals and situations that were survival threats in human evolutionary history. How might these perspectives explain Ms. Jones’s situation? Posttraumatic Stress Disorder Natural disasters, catastrophic illnesses, incest, rape, and assault are a few of the life experiences that can unleash a wave of intense emotional stress. Distressing, intrusive recollections of the event are experienced as “flashbacks”. Very early, severe, recurring child abuse often results in symptoms of PTSD Characteristics of PTSD include: a. Frequent, intrusive recall of the event b. Avoidance of stimuli or situations that tend to trigger memories of the experience and a general numbing of emotional responsiveness c. Increased physical arousal associated with anxiety Several factors influence the likelihood of a person’s developing PTSD: a. A personal or family history of psychological disorders b. The magnitude of the trauma c. Experiencing multiple traumas

14. Obsessive–Compulsive Disorder Obsessive-compulsive disorder (OCD) is characterized by obsessional thoughts and/or compulsive behaviors. Obsessional thoughts are intrusive thoughts that are very distressing to the person thinking them. They evoke a great deal of anxiety, or fear about oneself or loved ones becoming ill, infected with a deadly virus of dying. Obsessions are the thoughts and compulsions are the behaviors (1) Overt physical behaviors, such as repeatedly washing your hands. (2) Covert mental behaviors, such as counting or reciting certain phrases to yourself. 66% -are plagued by obsessions regarding dirtiness, contamination, and germs, with the corresponding compulsions such as cleaning and hand washing. 20%- are worried about safety issues and engage in repetitive checking rituals. 15%-are concerned with a sense of incompleteness. There are two key reasons for OCD Excessive self-doubt Intense worry regarding the safety of oneself and others Depletion of the neurotransmitter serotonin is thought to be involved in the presentation of OCD. Serotonin antidepressants are the most effective treatment used for OCD; they include SSRIs (Prozac, Paxil, Zoloft, Celexa, and Lexapro).

15. Mood Disorders Jenny is a 12 year old girl. She has been described as moody. Jenny has started to sleep late, to the point where she is frequently late for school, and she is becoming sexually curious. She had been a very quiet child, but in the last few months she has become loud, demanding, and visibly unhappy. Teachers have noted that she is no longer hanging around her friends, and when questioned, Jenny has no definitive answer, but responds in a very defensive manner. The friends who Jenny has started to associate with are also sexually curious and rebellious. Jenny’s attitude has changed at home as well. She has started to yell at her mother, and she can be heard crying in her room at night. What once was an uneventful chore, has now become a battle. Jenny has also begun to keep her door closed and has become very secretive, especially in the bathroom. Jenny’s mother has made an appointment with the pediatrician at Jenny’s urging because of complaints from Jenny of joint pains and frequent injuries as a result of Jenny’s recent clumsiness, perhaps because of recent weight gain. Jenny can also be heard yelling and throwing items around in her room.

16. The broad category of mood disorders (aka affective disorders) includes depressive disorders, bipolar disorders, mood disorder due to a general medical condition, and substance-induced mood disorder. Depressive disorders are mood disorders in which the individual suffers depressions without experiencing mania. Mood disorders are psychological disorders characterized by a disturbance of mood; mood or emotions cause impaired cognitive, behavioral, and physical functioning. The DSM-5 lists the following depressive disorders: Major Depressive Disorder, Single Episode Major Depressive Disorder, Recurrent Dysthymic Disorder Depressive Disorder not otherwise specified These symptoms define a major depressive episode (at least five must be present during a 2 week period). *Appetite disturbance with accompanying weight loss or weight gain *Fatigue *Decreased sex drive *Restlessness, agitation, or psychomotor retardation *Diurnal variations in mood (usually feeling worse in the morning) *red flag *Impaired concentrations and forgetfulness *Pronounced anhedonia (total loss of the ability to experience pleasure) *Sleep disturbance Major depression is often triggered by traumatic and stressful events. Chronic stress can also produce major depression.

17. Mood disorders, cont. Dysthymic disorder is generally more chronic and has fewer symptoms than major depressive disorder. Women’s lifetime risk of major depression is one in four; men’s lifetime risk is one in eight. Why? because women experience a greater degree of chronic stress, have a lesser sense of personal control, and are more prone to ruminate about their problems. In seasonal affective disorder (SAD), episodes of depression typically occur during the autumn and winter and subside during the spring and summer. Explaining Mood Disorders Family, twin, and adoption studies suggest that some people inherit a genetic predisposition to mood disorders. Disruption of the neurotransmitters norepinephrine and serotonin has been implicated in the development of major depression.

18. Bipolar Disorder Bipolar disorder involves periods of incapacitating depression alternating with periods of extreme euphoria and excitement; formerly called manic depression. A manic episode is a sudden, rapidly escalating emotional state characterized by extreme euphoria, excitement, physical energy, and rapid thoughts and speech. Treatment for the disorder follows a 3 tier formula: *Rx *Psychotherapy *Education on the disorder

19. Eating Disorders: Anorexia and Bulimia Eating disorders involve serious and maladaptive disturbances in eating behavior and usually develop in adolescence. People with anorexia have an extreme fear of gaining weight or becoming fat, have a distorted perception about their body size, and are denial of how serious their weight loss is. The disorder causes changes in their body due to the severe loss of weight and malnutrition. People with bulimia are within a normal weight range or may even be slightly overweight; however, people with bulimia experience extreme episodes of binge eating.

20. Paraphilias What are paraphilias? Paraphilias are an “abnormal” way in which people achieve sexual gratification. These fantasies, urges, or behaviors must occur for a significant period of time and must interfere with either satisfactory sexual relations or everyday functioning if the diagnosis is to be made. There is also a sense of distress within these individuals. In other words, they typically recognize the symptoms as negatively impacting their life but feel as if they are unable to control them.

21. Common Paraphilias Exhibitionism This disorder is characterized by either intense sexually arousing fantasies, urges, or behaviors in which the individual exposes his or her genitals to an unsuspecting stranger. To be considered diagnosable, the fantasies, urges, or behaviors must cause significant distress in the individual or be disruptive to his or her everyday functioning. Treatment Treatment typically involves psychotherapy aimed at uncovering and working through the underlying cause of the behavior. Medications can at times be helpful to assist the client in resisting urges, but are typically not utilized in treatment. Fetishism Fetishism is characterized by either intense sexually arousing fantasies, urges, or behaviors in which the individual uses a nonliving object (e.g., woman’s high heeled shoe, stockings) in a sexual manner. Typically, the individual requires this object to become sexually aroused and is therefore unable to be aroused without it. To be considered diagnosable, the fantasies, urges, or behaviors must cause significant distress in the individual or be disruptive to his or her everyday functioning. Treatment Treatment typically involves psychotherapy aimed at uncovering and working through the underlying cause of the behavior. Frotteurism This disorder is characterized by either intense sexually arousing fantasies, urges, or behaviors in which the individual touches or rubs against an non-consenting person in a sexual manner. This often occurs in somewhat conspicuous situations such as on a crowded bus or subway. To be considered diagnosable, the fantasies, urges, or behaviors must cause significant distress in the individual or be disruptive to his or her everyday functioning. Treatment Treatment typically involves psychotherapy aimed at uncovering and working through the underlying cause of the behavior.

22. Pedophilia This disorder is characterized by either intense sexually arousing fantasies, urges, or behaviors involving sexual activity with a prepubescent child (typically age 13 or younger). To be considered for this diagnosis, the individual must be at least 16 years old and at least 5 years older than the child. Treatment Treatment typically involves intensive psychotherapy to work on deep rooted issues concerning sexuality, feelings of self, and often childhood abuse. Medical treatments such as ‘chemical castration’ (which is actually a hormone medication which reduces testosterone and therefore sexual urges) have been investigated with very mixed results. Sexual Masochism Sexually masochistic behaviors are typically evident by early adulthood, and often start with masochistic or sadistic play in childhood. The disorder is characterized by either intense sexually arousing fantasies, urges, or behaviors in which the individual is humiliated, beaten, bound, or made to suffer in some way. Treatment Treatment typically involves psychotherapy aimed at uncovering and working through the underlying cause of the behavior. Sexual Sadism Sexually sadistic behaviors are typically evident by early adulthood, and often start with masochistic or sadistic play in childhood. The disorder is characterized by either intense sexually arousing fantasies, urges, or behaviors in which the individual is sexually aroused by causing humiliation or physical suffering of another person. Treatment Treatment typically involves psychotherapy aimed at uncovering and working through the underlying cause of the behavior.

23. Transvestic Fetishism This diagnosis is used for heterosexual males who have sexually arousing fantasies, urges, or behaviors involving cross-dressing (wearing female clothing). To be considered diagnosable, the fantasies, urges, or behaviors must cause significant distress in the individual or be disruptive to his or her everyday functioning. Treatment Treatment typically involves psychotherapy aimed at uncovering and working through the underlying cause of the behavior. Voyeurism This disorder is characterized by either intense sexually arousing fantasies, urges, or behaviors in which the individual observes an unsuspecting stranger who is naked, disrobing, or engaging in sexual activity. To be considered diagnosable, the fantasies, urges, or behaviors must cause significant distress in the individual or be disruptive to his or her everyday functioning. Treatment Treatment typically involves psychotherapy aimed at uncovering and working through the underlying cause of the behavior.

24. Sexual Disorders Dyspareunia Recurrent or persistent genital pain associated with sexual intercourse. Can be diagnosed in males or females, is not better accounted for by another diagnosis (psychiatric or physical) and is not the direct effect of substance use. Treatment Resolving underlying sexual and relationship issues can be helpful in many cases. Female Orgasmic Disorder Delay of orgasm following normal excitement and sexual activity. Due to the widely varied sexual response in women, it must be judged by a clinician to be significant taking into account the person’s age and situation. The condition is persistent or occurs frequently and causes significant distress. Is not a direct effect of substance use. Treatment Typical treatment would involve discovering and resolving underlying conflict or life difficulties. Female Sexual Arousal Disorder Inability to attain or maintain until completion of sexual activity adequate lubrication in response to sexual excitement. Must result in significant distress and not better accounted for by another disorder or the use of a substance. Treatment Typical treatment would involve discovering and resolving underlying conflict or life difficulties.

25. Gender Identity Disorder A strong and persistent identification with the opposite gender. There is a sense of discomfort in their own gender and may feel they were ‘born the wrong sex.’ This has been confused with cross-dressing or Transvestic Fetishism, but all are distinct diagnoses. Treatment Other disorders may be present with this one, including depression, anxiety, relationship difficulties, and personality disorders, and homosexuality is present in a majority of the cases. Treatment is likely to be long-term with small gains made on underlying issues as treatment progresses.

26. Hypoactive Sexual Desire Disorder Deficient or absent sexual fantasies and desire for sexual activity. This judgment must be made by a clinician taking into account the individual’s age and life circumstances. The lack of desire must result in significant distress for the individual and is not better accounted for by another disorder or physical diagnosis. Treatment Typical treatment would involve discovering and resolving underlying conflict or life difficulties. Male Erectile Disorder Recurring inability to achieve or maintain an erection until completion of the sexual activity. Must result in significant distress for the individual and is not better accounted for by another disorder (e.g. drug abuse) or physical diagnosis. Treatment The most commonly applied treatment for non-medical related impotence is ‘Sensate Focus,’ which involves a progression of sexual intimacy, typically over the course of several weeks, and eventually leading to penetration and orgasm. Male Orgasmic Disorder Delay or absence of orgasm following normal excitement and sexual activity. Due to the widely varied sexual response in men, it must be judged by a clinician to be significant, taking into account the person’s age and situation. The condition is persistent or occurs frequently and causes significant distress. Is not a direct effect of substance use. Treatment Typically once a medical cause is ruled out, working through the underlying issues is very helpful. Some therapists also use behavioral techniques such as sensate focus which is a more direct approach if underlying issues are not significant.

27. Premature Ejaculation Ejaculation with minimal sexual stimulation before or shortly after penetration and before the person wishes it. The condition is persistent or occurs frequently and causes significant distress. Is not a direct effect of substance use. Treatment Relaxation training, education, and working through underlying issues are treatment options. If the relationship is new, often the difficulties will resolve as the relationship matures. Sexual Aversion Disorder Persistent or recurring aversion to or avoidance of sexual activity. The aversion must result in significant distress for the individual and is not better accounted for by another disorder or physical diagnosis. When presented with a sexual opportunity, the individual may experience panic attacks or extreme anxiety. Treatment Typical treatment would involve discovering and resolving underlying conflict or life difficulties. Vagismus Recurrent or persistent involuntary spasm of the vaginal muscles that interferes with sexual intercourse. It must cause significant distress and not due to a medical condition or another disorder. Treatment Psychological treatment involves working through underlying issues, while other treatments can involve progressively larger dilators and therapy to help relax muscles which prevent intercourse

28. Clinical Vignette Mr. Rodriguez, a 52-year old, Cuban born president of a successful family business in Miami, was brought to a hospital by his wife after he told her that he had suddenly remembered setting several major fires when he was a child and murdering a man 30 years ago. Mr. Rodríguez tells the following story. He has been “on edge” recently because of a lot of financial problems in his business. A few weeks ago he became enraged with a long-time employee of whom he had been very fond. He yelled at him for misspending a considerable amount of the firm’s money and almost threw an ashtray at him. He was stunned by the violence of his impulses and began to realize how angry and hateful he has always been, particularly in relation to his wife and children. Later, at home, when thinking about the events of the day, “the curtains were opened and I was flooded with memories of acts that had previously been cut off from my conscious mind.” He recalled having set fire to a woman’s house while she was inside. This occurred when he was 5 years old, at his father’s urging. He also recalled having set fires in doctor’s offices and libraries. In addition, he was convinced that, at age 19, he had shot a man for having assaulted his wife. There were many other similar “memories” of violent acts, which he had never had before. For two weeks, Mr. Rodriguez stayed home from work. He sat, inactive, sometimes tearful about the damage he thought he had done, ruminating about what a terrible father he had been. Although his thoughts were painful, he actually “enjoyed the pleasure of knowing and discovering” and denied being persistently depressed. He also denied having experienced any change in weight, appetite, sleep, or psychomotor activity. He admitted to poor concentration, beginning about one month previously, when financial pressures to work had begun to escalate. Sometimes he thought of killing himself. The day before, he had had another “revelation.” He “remembered” for the first time that his father had beaten and sodomized him. He now understood that his destructiveness was caused by his father’s abuse. With this realization, he no longer felt guilty about the terrible things that he had done. Nevertheless, he had agreed today to his wife’s request that he come to the hospital. Mr. Rodriguez is a tall, slender, neatly dressed man with a piercing gaze, poised demeanor, and polished manners. He smokes constantly throughout the session. He is quick witted and playful, even when talking about the serious crimes he claims to have committed. He does well on tests of cognitive functioning. When told that his wife and others maintain that his memories cannot be accurate, he remarks, “Their facts do contradict my recollections. I can’t explain the discrepancy. All I know is I set those fires.” When asked to explain how he could have no police record, he replies that this is because he was so “quick and wily” that no one could catch him. He accounts for his wife’s refusal to believe his stories by asserting that “she must have blocked the memories of the events because they are so upsetting to her.” On admission, physical examination of Mr. Rodriguez, including a neurological evaluation revealed no abnormality. All laboratory tests were also negative.

29. Schizophrenia Nearly 1 in every 100 people will develop schizophrenia; almost 24 million people suffer from schizophrenia Schizophrenia is a serious debilitating disorder in which the mind seems “split’. Drug therapy is the main source of treatment for persons suffering from schizophrenia. Schizophrenia is the chief example of a psychotic disorder, a disorder marked by irrationality and lost contact with reality symptoms excesses or distortions of normal functioning include delusions, hallucinations, and severely disorganized thought processes, speech, and behavior. Negative symptoms reflect defects or deficits in normal functioning including flat affect, alogia (greatly reduced production of speech), and avolition (the inability to initiate or persist in goal-directed behaviors, catatonic state). )…the absence of appropriate behaviors Types of schizophrenia Disorganized schizophrenia-the individual has delusions and hallucinations and the person tends to withdraw, disorganized speech and flat affect; a general disruption of behavior Disorganized thoughts may result from a breakdown in selective attention, a break down in the filter such that minute details may distract attention from bigger, more significant details Catatonic-prolonged states of motor immobility so much so that the individual can be manipulated physically, that alternate with periods of excitability Persons with schizophrenia think in fragmented, bizarre, and often distorted beliefs called delusions Paranoid-the presence of prominent delusions including persecution and grandiosity The jumbled ideas form a word salad, jumbled up sentences Undifferentiated- when an individual displays some combination of positive and negative symptoms that does not clearly fit the criteria for the paranoid, catatonic, or disorganized types. Residual-withdrawal, after hallucinations and delusion have disappeared Disturbed perceptions A person diagnosed with schizophrenia may also have hallucinations…sensory experiences without sensory stimulation, hearing, seeing, feeling, tasting, or smelling things that are not there The emotions of a person diagnosed with schizophrenia are inappropriate, split off from reality Some persons may laugh when others cry or vice versa, still others exhibit no emotions...flat affect…make it hard to have a normal life Biological Factors in Schizophrenia-Ventricles in the brain tend to be larger and widened cortical sulci which means that in some types of schizophrenia, there has been abnormal brain development. Individuals with schizophrenia produce higher than normal levels of the neurotransmitter dopamine and that the excess dopamine causes schizophrenia. The onset of schizophrenia typically occurs during young adulthood.

30. Onset and development of Schizophrenia Schizophrenia manifests in emerging adulthood Schizophrenia may strike suddenly as a response to stress, or a stressor Schizophrenia may be gradual, for those who have experienced a gradual onset of schizophrenia they may be homeless and may be in the lower socioeconomic bracket Schizophrenia affects both males and females, men tend to be struck earlier Schizophrenia is a cluster of disorders and as such, there exists a variety of symptoms

31. The causes of schizophrenia seem to be extremely complex. Evidence from family, twin, and adoption studies has firmly established the role of genetic factors in many cases of schizophrenia. Biological Factors in Schizophrenia-Ventricles in the brain tend to be larger and widened cortical sulci which means that in some types of schizophrenia, there has been abnormal brain development. Midpregnancy viral infections may impair fetal brain development and are an additional consideration in the cause of schizophrenia and increase the probability that a child will develop schizophrenia (flu)…but only 2% of women who contract the flu during their second trimester develop trimester For identical twins who share a placenta, if one twin develops schizophrenia, there is a 6 in 10 chances that the other twin will also develop schizophrenia Children adopted by someone who develops schizophrenia seldom develop schizophrenia the disorder Approximately 10% of people with schizophrenia commit suicide Women outnumber men by three to one in the number of suicide attempts. Men outnumber women by better than four to one in suicide deaths.

32. How can you help prevent suicide? 1. Actively listen as the person talks and vents her feelings. 2. Don’t deny or minimize the person’s suicidal intentions. 3. Identify other potential solutions. 4. Ask the person to delay his decision. 5. Encourage the person to seek professional help.

33. Somatoform Disorders Somatoform disorders are now referred to as somatic disorders Individuals with somatic symptoms plus abnormal thoughts, feelings, and behaviors may or may not have a diagnosed medical condition. The relationship between somatic symptoms and psychopathology exists along a spectrum. Somatic symptom disorder (SSD) is characterized by somatic symptoms that are either very distressing or result in significant disruption of functioning, as well as excessive and disproportionate thoughts, feelings and behaviors regarding those symptoms. To be diagnosed with SSD, the individual must be persistently symptomatic (typically at least for 6 months). TheDSM-5 does not require that the sufferer have a medically unexplained condition. The diagnosis of somatization disorder was essentially based on a long and complex symptom count of medically unexplained symptoms. Individuals previously diagnosed with somatization disorder will usually meet DSM-5 criteria for somatic symptom disorder, but only if they have the maladaptive thoughts, feelings, and behaviors that define the disorder, in addition to their somatic symptoms.”

34. The Dissociative Disorders Dissociative disorders are psychological disorders that involve a sudden loss of memory or change in identity. People with dissociative disorders escape their reality in involuntary and unhealthy ways. Dissociative disorders most often form in children who have been subjected to chronic physical, sexual, and/or emotional abuse. Dissociative disorders come in many forms; the most famous is Dissociative Identity Disorder (DID). Dissociative amnesia is characterized by blocking out of critical personal information, usually of a traumatic or stressful nature. Memory loss is more extensive than normal forgetfulness and cannot be explained by a physical or neurological condition, such as a head injury.

35. DID, cont. Dissociative fuge is a very rare disorder. An individual with dissociative fuge suddenly and unexpectedly takes physical leave of his or her surrounding and sets off on a journey of sorts. An individual in a fugue state is unaware of or is confused about his identity, and in some cases will assume a new identity. Dissociative fugue typically ends as abruptly as it begins. Psychotherapy with a combination of medication treatment is the primary treatment for dissociative disorders. The therapist works with the patient to help the individual understand the cause of the condition and to form new ways of coping with stressful circumstance. DID represents an extreme form of dissociative coping brought on by suffering trauma in childhood— often extreme physical or sexual abuse.

36. Additional disorders as listed in the DSM- 5 Motor Disorders Communication Disorders Body Dysmorphic Disorder Hoarding Disorder

37. Additional disorders as listed in the DSM- 5 Trichotillomania (Hair-Pulling Disorder) Excoriation (Skin-Picking) Disorder Adjustment Disorders Pain Disorder