Lesson 1: Abnormal Behavior in Historical Context

 Psychological Disorder /Problematic Abnormal Behavior- a psychological

dysfunction within an individual associated with distress or impairment in
functioning and a response that is not typical or culturally expected.

4-5main criteria for Abnormality

Psychological dysfunction- refers to a breakdown in cognitive, emotional, or

behavioral functioning.
Distress- refers to emotional or psychological suffering, discomfort, or anguish that an
individual experiences because of their mental or emotional state, life circumstances, or
a specific event.
-may nagtrigger
Impairment - how a condition or symptom interferes with a person's ability to work,
maintain relationships, perform self-care tasks, and participate in social and recreational
activities.
-interferes routine
Deviance/Atypical/Not culturally expected - describes actions or conduct that deviate
from the expected or socially accepted norms.
Danger - when the behaviors pose a threat or danger towards themselves and the
people surrounding them.

Psychopathology - the scientific study of psychological disorders.

o Scientists-practitioners - mental health professionals take a scientific approach
to their clinical work
o Consumer of Service - Enhancing the practice.
o Evaluator of Science - Determining the effectiveness of the practice.
o Creator of Science - Conducting research that leads to new procedures
useful in practice.
o Counseling Psychologists - study and treat adjustment and vocational issues
encountered by healthy individuals.
o Clinical Psychologists - concentrate on more severe psychological disorders.
o Psy.D. - focus on clinical training and de-emphasize or eliminate research
training.
o Ph.D. - integrate clinical and research training.
o Psychiatrists - investigate the nature and causes of psychological disorders,
often from a biological point of view; make diagnoses; and offer treatments. Must
earn an M.D. degree in medical school and then specialize in psychiatry during
residency training that lasts 3 to 4 years.
o Psychiatric social workers - Must earn a master’s degree in social work as they
develop expertise in collecting information relevant to the social and family
situation of the individual with a psychological disorder. Social workers also treat
disorders, often concentrating on family problems associated with them.
o Psychiatric nurses - Specialize in the care and treatment of patients with
psychological disorders, usually in hospitals as part of a treatment team. Have
advanced degrees, such as a master’s or even a Ph.D.
o Marriage and Family Therapists and Mental Health Counselors - spend 1–2
years earning a master’s degree and are employed to provide clinical services by
hospitals or clinics, usually under the supervision of a doctoral-level clinician.

 Clinical Descriptions - represents the unique combination of behaviors,

thoughts, and feelings that make up a specific disorder. Describing symptoms in
a clinical format.
o Prevalence - refers to the total number of existing cases (both old
and new) of a particular disease or health condition within a specific
population at a given point in time.
o Incidence - refers to the number of new cases of a disease or health
condition that occur within a specific population during a defined period,
such as year.
o Course - refers to the pattern and progression of a disease, condition, or
symptom over time. (Acute, Chronic, Relapse, Recurrent, Intermittent,
Progressive, etc)
 Chronic course - disorders that tend to last a long time,
sometimes a lifetime. E.g. Schizophrenia.
 Episodic course - the individual is likely to recover within a few
months only to suffer a recurrence of the disorder at a later time
(regular interval). E.g. mood disorders
 Time-limited course- the disorder will improve without treatment in
a relatively short period. E.g. acute stress
 Acute course - generally develops suddenly and lasts a short time,
often only a few days or weeks.
 Relapse - return or worsening of symptoms after a period of
improvement or recovery.
 Recurrent course - The return of a sign, symptom, or disease after
a remission.
 Intermittent course - symptoms come and go in an irregular
interval.
 Progressive course - a condition where the symptoms and
severity tend to worsen over time.
o Prognosis - is the anticipated course of a disorder. So, we might say, “the
prognosis is good”, meaning the individual will probably recover, or “the
prognosis is guarded”, meaning the probable outcome doesn’t look good.
o Causation or Etiology - the study of origins, has to do with why a
disorder begins (what causes it) and includes biological, psychological,
and social dimensions.
o Treatment - refers to the interventions, therapies, procedures, or
measures taken to alleviate or manage a health condition, injury, or
illness.
Supernatural Traditions

 Demons and Witches- exorcism

o Deviant behaviors have been considered a reflection of the battle between
good and evil.
 Stress and Melancholy
o During the historical period discussed, there were two contrasting views
on the causes and treatment of mental disorders.
o Some symptoms, such as despair and lethargy, were associated with the
sin of acedia or sloth by the church.
o Nicholas Oresme, a bishop and philosopher, suggested that the disease
of melancholy (depression) was a source of some abnormal behavior,
rather than demonic influences.
 Mass Hysteria
o Mass hysteria is a phenomenon characterized by large-scale outbreaks
of bizarre behavior that has puzzled historians and mental health
practitioners.

 The Moon and the Stars

o Paracelsus, a Swiss physician (1493-1541), rejected the idea of
possession by the devil and proposed that the movements of the moon
and stars had a profound impact on people's psychological
functioning.
o This theory led to the word "lunatic," derived from the Latin word "luna"
(meaning "moon"), and it remains a part of everyday language when
people jokingly attribute their unusual behavior to a full moon.
o The belief that celestial bodies influence human behavior still exists,
particularly among astrology enthusiasts, who think that the positions of
planets affect their lives and behavior.
 The Biological Tradition
o Hippocrates, a Greek physician (460-377 B.C.), is known as the Father
of Modern Western Medicine and proposed that psychological disorders
could be treated like any other disease.
o Hippocrates considered the brain as the seat of wisdom, consciousness,
intelligence, and emotion, suggesting that disorders involving these
functions would be located in the brain.
o The Roman physician Galen (A.D. 129-198) adopted and expanded on
Hippocrates' ideas, creating an influential school of thought that lasted into
the 19th century.
o The Humoral Theory of Disorders emerged from this tradition,
associating normal brain functioning with four bodily fluids or
humors: blood, black bile, yellow bile, and phlegm.
o Treatments in this tradition aimed to restore the proper flow of wind, often
involving acupuncture.
  Syphilis
o sexually transmitted disease involving a bacterial microorganism that
enters the brain, leads to behavioral and cognitive symptoms.
o Ultimately, clinical investigators discovered that penicillin effectively
cures syphilis.
o This discovery highlighted that "madness" and related behavioral and
cognitive symptoms could be directly linked to a curable infection,
challenging prevailing beliefs about the causes and cures of psychological
disorders.

Development of Biological Treatments

 Insulin was given to stimulate appetite in psychotic patients, and it had
calming effects.
o Insulin shock therapy, involves increasing insulin dosages until
patients convulsed, was used but abandoned due to its danger.
 John P. Grey’s position was that the causes of insanity were always physical.
o Under Grey’s leadership, the conditions in hospitals greatly improved and
they became more humane, livable institutions
 Benjamin Franklin discovered that a mild electric shock to the head caused
brief convulsions and memory loss but little harm, leading to thoughts of using
it as a treatment for depression.
 In the 1920s, Hungarian psychiatrist Joseph von Meduna suggested that
induced brain seizures might cure schizophrenia.
 Electroconvulsive therapy (ECT), introduced by two Italian physicians, was
modified and is still used today.
 The 1950s saw the development of the first effective drugs for severe
psychotic disorders, including neuroleptics and benzodiazepines, which
controlled hallucinatory and delusional thought processes and reduced anxiety.
 Emil Kraepelin was one of the founding fathers of modern psychiatry.
o His lasting contribution was in the area of diagnosis and classification.

The Psychological Tradition

 Moral Therapy
o In the first half of the 19th century, a psychosocial approach known as
moral therapy gained influence in the treatment of mental disorders.
o The term "moral" referred more to emotional and psychological
factors rather than a code of conduct.
o Moral therapy aimed to treat institutionalized patients as normally as
possible in a supportive setting that encouraged and reinforced normal
social interaction.
o The roots of moral therapy can be traced back to historical practices such
as those in Greek Asclepiad Temples and in Muslim countries in the
Middle East.
o The systematic application of moral therapy originated with French
psychiatrist Philippe Pinel and his associate Jean-Baptiste
Pussin, who made remarkable reforms in Parisian hospitals.
 o William Tuke followed Pinel's lead in England, and Benjamin
Rush introduced moral therapy in the United States, making it
the treatment of choice in leading hospitals.
o Moral therapy transformed asylums from prison-like institutions into
habitable and therapeutic places.
o In 1833, Horace Mann reported remarkable outcomes from moral therapy
treatment at the Worcester State Hospital, including the cure and release
of previously considered incurable patients and a significant reduction in
violent and disruptive behaviors.

 Asylum Reform and Decline of Moral Therapy

o After the mid-19th century, humane treatment and moral therapy declined
o Dorothea Dix's mental hygiene movement aimed to reform the
treatment of insanity and improve care standards.
o Another factor in the decline of moral therapy was the belief that mental
illness was caused by brain pathology and therefore incurable.
o The psychological tradition went dormant for a time and reemerged in the
20th century through different schools of thought, including
psychoanalysis based on Sigmund Freud's theories and behaviorism,
which focused on learning and adaptation in psychopathology.
 The Present
o Psychological disorders are influenced by a continuous interaction
of these factors.
o Adolf Meyer emphasized the equal contributions of biological,
psychological, and sociocultural factors to psychopathology, but it
took years for this perspective to gain recognition in the field.
o The National Institute of Mental Health (NIMH) initiated a strategic plan
in 2010 to promote research on these interrelationships and translate
findings into treatment settings.
o The current valid model of psychopathology is described as
multidimensional and integrative, taking into account the reciprocal
influences of neuroscience, cognitive science, behavior science, and
developmental science.

Lesson 2: An Integrative Approach to Psychopathology

 Paradigm/Perspectives - a conceptual framework or approach within which a

scientist works—that is, a set of basic assumptions, a general perspective, that
defines how to conceptualize and study a subject, how to gather and interpret
relevant data, even how to think about a particular subject.

An Integrative Approach to Psychopathology

 One Dimensional Model

 o The one-dimensional model simplifies psychopathology by suggesting that
all mental disorders can be explained by a single underlying cause,
often referred to as a "general factor" or a "common pathway.“
o This model assumes that there is a single factor that influences the
development of various mental disorders. It is akin to searching for one
root cause for all psychological problems.

 Multidimensional Model
o The multidimensional model recognizes that psychopathology is complex
and multifaceted. It posits that mental disorders can result from
multiple interacting factors.
 Biological- Genetics
 Psychological-Trauma Experience
 Social- Family upbringing/community
 Developmental- Growing up
o This model incorporates various dimensions or factors, such as
biological, psychological, social, and environmental, to explain the
development and expression of different mental disorders.
o By considering multiple dimensions, the multidimensional model allows for
a more personalized understanding of psychopathology. It acknowledges
that each individual may have a unique combination of factors
contributing to their condition.
o Multidimensional models are often favored in clinical practice because
they can guide comprehensive assessments and more targeted
interventions. They consider the various factors that need to be addressed
in treatment planning.
 Huntington’s disease - a degenerative brain disease that has been traced to a
genetic defect that causes deterioration in a specific area of the brain, the basal
ganglia. It causes broad changes in personality, cognitive functioning, and,
particularly, motor behavior, including involuntary shaking or jerkiness throughout
the body.
 Phenylketonuria (PKU) - results in intellectual disability (mental retardation).
This disorder, present at birth, is caused by the inability of the body to metabolize
(break down) phenylalanine, a chemical compound found in many foods that is
caused by a defect in a single gene, with little contribution from other genes or
the environmental background.

The Nature of Genes

 Polygenic Nature of Most Traits:

o Most human development, behavior, personality, and intelligence are
polygenic, influenced by many genes, each contributing a small effect.
o Psychiatric disorders are also polygenic.
 The human genome consists of over 20,000 genes.
To study the nature of genes:
o Quantitative Genetics- hereditary genes
  Quantitative genetics is primarily concerned with understanding the
heritability of complex traits or characteristics, which are influenced
by multiple genes and environmental factors. These traits often
have a continuous range of variation (e.g., height, intelligence, and
personality).
 Ex: Twin studies, Family studies
o Molecular Genetics- uses machines, identifies individual genes
 delves into the specific genes and genetic variations that underlie
traits and characteristics. It aims to identify the individual genes,
their variations, and the mechanisms by which they influence traits.
 Ex: DNA sequencing, GWAS
 Gene Activation and Environmental Factors
o Genes influence the body and behavior by producing proteins.
o Environmental factors, such as social and cultural influences, can
determine whether genes are activated or "turned on."
o We can be susceptible to disorders
o May kinalaman ang genes at environment sa vulnerability ng tao sa
disorder
 Diathesis-Stress Model
o Diathesis refers to the genetic vulnerability (namana) to a disorder,
which may be dormant until activated by stress or life events.
o The diathesis is genetically based, while stress is environmental, and
their interaction leads to the development of a disorder.
 Gene-Environment Correlation Model
o Genetic endowment may increase the likelihood of experiencing stressful
life events.
o Genetic endowment-characteristics na meron ka, traits ng tao mismo ang
nagawa ng paraan para maexpose sa vulnerability
o Individuals with a genetic predisposition to a specific disorder may also
possess personality traits that lead them to create environmental risk
factors.
o This gene-environment correlation model, also known as the reciprocal
gene-environment model, highlights the bidirectional influence between
genes and the environment.

Neuroscience and its contribution to Psychopathology

The Central Nervous System

o Central Nervous System- processes sensory information, identifies relevance,

and coordinates appropriate reactions.
o Neurons and Their Structure- consist of a central cell body with dendrites,
which receive chemical impulses from other neurons and convert them into
electrical impulses.
 o Axons- transmit these impulses to other neurons via synapses, small
gaps between neurons.
o Synaptic cleft- space between the terminal button of one neuron and the
dendrite of another.
o Neurotransmitters- which are chemicals stored in vesicles in terminal buttons.
Neurotransmitters are released into the synaptic cleft and bind to dendrite
receptors on other neurons. They are key in transmitting impulses, and many
types of neurotransmitters exist.
o Neuro-Glia Interaction- Glia cells, which outnumber neurons, were once
thought to serve insulating roles. However, more recent research has uncovered
their active roles, including modulating neurotransmitter activity.
o Neurotransmitters and Psychopathology- Excesses or insufficiencies in
certain neurotransmitters are associated with different psychological disorders.

Structure of the Brain

o 2 Main Parts of the Brain

o Brain Stem- manages automatic functions like breathing and
coordination.
 Hindbrain- regulates essential activities like heartbeat and
digestion.
 Cerebellum- controls motor coordination
 Midbrain- coordinates movement and processes arousal and
tension
o Forebrain- is the largest and most anterior part of the brain. It plays a
central role in various complex functions, including sensory perception,
motor function, emotion, and cognitive processes.
 Thalamus and hypothalamus- relay information between the
forebrain and lower brain areas.
o Limbic system- influences emotional experiences, learning, and basic drives.
o Basal ganglia- controls motor activity
o Cerebral cortex- largest part of forebrain. Divided in two hemispheres:
o Left Hemisphere- verbal and cognitive processes
o Right Hemisphere- perceiving the world and creating images

Peripheral Nervous System

o Peripheral Nervous System- collaborates with the brain stem to regulate bodily
functions.
o Two Major Divisions:
 Somatic Nervous System- controls muscles and voluntary
movement
 Autonomic Nervous System- consisting of the sympathetic and
parasympathetic nervous systems. Regulating the cardiovascular
and endocrine systems, digestion, and body temperature.
 o Endocrine System- operates differently from other bodily systems.
 Psychoneuroendocrinology- examines the interplay between
hormones and psychological disorders.
o Sympathetic Division- mobilizes the body during times of stress. Plays a
role in the “emergency” or “alarm” response.
o Parasympathetic Division- normalizing arousal and aiding digestion after
a period of sympathetic activation.
o Hypothalamus and Endocrine System- connects to the pituitary gland,
which coordinates the endocrine system. This connection can stimulate
the adrenal glands, leading to the release of epinephrine and cortisol,
associated with the "fight or flight" response.

Neurotransmitters
o Glutamate & GABA- play significant roles in regulating brain functions.
o Glutamate- excitatory and triggers action
o GABA- inhibitory, tempering emotional responses, reducing anxiety
o Serotonin- influences mood, behavior, and information processing and is
involved in various psychological disorders.
o Norepinephrine- related to panic states. Fight-or-flight response.
o Dopamine- has a complex role in influencing behavior. Brain’s reward system.

Behavioral and Cognitive Science

 Conditioning and Cognitive Process

o Conditioning- involves more than simple temporal associations
o Cognitive Processes- play a role in determining the outcome of learning
o The extent and nature of conditioning can vary between animals
depending on their prior exposure to the conditioned stimulus
o This type of learning allows the development of working ideas about the
world and informs appropriate judgments and responses
 Learned Helplessness
o occurs in animals when they face uncontrollable conditions and give up trying to
cope
o Applied to humans when they perceive life stress as uncontrollable,
leading to depression
 Uncontrollable- refers to a condition in which an individual
perceives a lack of control over a situation, leading to a sense of
powerlessness and a belief that one's actions have little or no
impact on the outcome of events.
o Martin Seligman- introduced the concept of learned optimism
 Learned optimism- suggesting that people with an optimistic attitude
tend to fare better psychologically and physically.
Social Learning
 Albert Bandura- observational learning
o integration of others' experiences with judgments about one's own potential
experiences
Social, Cultural, and Interpersonal Factors
 Gender
o Gender roles significantly affect psychopathology
o Phobias- more prevalent among females
o Males- alcohol consumption to cope with panic attacks, which may lead to
alcoholism
o Bulimia nervosa- severe eating disorder, commonly affects young
females due to societal pressure
o Females- “tend and befriend” mechanism, nurturing behavior and forming
alliances

Social Effects on Health and Behavior

 Interpersonal relationships- provide meaning to life, allowing individuals to
overcome physical deficiencies and extend life
 Social relationships- facilitate health-promoting behaviors
 Living in urban areas may be associated with an increased risk of developing
schizophrenia compared to rural areas, beyond other influences

Social Stigma
 Remains a significant concern in society regarding psychological disorders
 Often viewed as signs of weakness
 The lack of social support for psychological illness can impede recovery and
increase the risk of suicide, particularly among veterans returning from war zones

Lesson 3: Anxiety, Trauma-and Stressor-Related, and Obsessive-Compulsive and

Related Disorders

 Anxiety- is a negative mood state characterized by bodily symptoms of physical

tension and by apprehension about the future. It is also closely related to
depression.
 Howard Liddell- first proposed this idea when he called anxiety the “shadow of
intelligence.”
 Anxiety- future-oriented mood state, - is a future-oriented mood state,
characterized by apprehension because we cannot predict or control upcoming
events.
 Fear- is an immediate emotional reaction to current danger characterized by
strong escapist action tendencies and, often, a surge in the sympathetic branch
of the autonomic nervous system.
 Panic attack- is defined as an abrupt experience of intense fear or acute
discomfort, accompanied by physical symptoms that usually include heart
palpitations, chest pain, shortness of breath, and, possibly, dizziness.
o Expected (cued) Panic Attack - triggered by a specific situation or
stimulus.
o Unexpected (uncued) Panic Attack - occur without any apparent trigger
or specific cause.
 Causes of Anxiety and Related Disorders
o Biological Contribution
 Limbic System- most often associated with anxiety
 Behavioral Inhibition System (BIS)- activated by signals from the
brain stem of unexpected events, such as major changes in body
functioning that might signal danger.
 BIS circuit- distinct from the circuit involved in panic.
o Psychological Contributions
 In childhood, we may acquire an awareness that events are not
always in our control.
 Interestingly, the actions of parents in early childhood seem to do a
lot to foster this sense of control or uncontrollability.
 Anxiety sensitivity, which appears to be an important personality
trait that determines who will and who will not experience problems
with anxiety under certain stressful conditions.
o Social Contributions
 Stressful life events trigger our biological and psychological
vulnerabilities to anxiety.
 Most are social and interpersonal in nature—marriage, divorce,
difficulties at work, death of a loved one, pressures to excel in
school, and so on. Some might be physical, such as an injury or
illness.
 Anxiety sensitivity-which appears to be an important personality trait that
determines who will and who will not experience problems with anxiety under
certain stressful conditions
 triple vulnerability theory- proposes that anxiety disorders result from the
interaction of generalized biological vulnerability (genetic inheritance),
generalized psychological vulnerability (beliefs that make the person vulnerable
to anxiety in general), and specific psychological vulnerability (specific beliefs
that make the person vulnerable to a particular anxiety disorder).
 55%- percent of the patients who received a principal diagnosis of an anxiety or
depressive disorder had at least one additional anxiety or depressive disorder at
the time of the assessment.
 major depression- the most common additional diagnosis for all anxiety
disorder
  An important study indicated that the presence of any anxiety disorder was
uniquely and significantly associated with thyroid disease, respiratory disease,
gastrointestinal disease, arthritis, migraine headaches, and allergic conditions
 DSM-5 now makes it explicit that panic attacks often co-occur with certain
medical conditions, particularly cardio, respiratory, gastrointestinal, and vestibular
(inner ear) disorders, even though the majority of these patients would not meet
criteria for panic disorder (Kessler et al., 2006).

Lesson 4: Somatic Symptom and Related Disorders and Dissociative Disorders

 Somatic Symptom Disorder

o Soma-body
o excessive or maladaptive response to physical symptoms or to associated
health concerns.
o medically unexplained physical symptoms
o they feel like they will not overcome and thins that it will lead to serious
illness
o hysterical neurosis
o Criteria for Somatic Symptom Disorder
 A. One or more somatic symptoms that are distressing and/or result
in significant disruption of daily life.
 B. Excessive thoughts, feelings, and behaviors related to the
somatic symptoms or associated health concerns as manifested by
at least one of the following:
 Disproportionate and persistent thoughts about the
seriousness of one’s symptoms.
 Example: umubo lang ng isang beses, iisipin na may lung
cancer na
 High level of health-related anxiety.
 Example: gugugulin ang oras to go to hospitals, seeking
medical help
 Excessive time and energy devoted to these symptoms or
health concerns.
 Example: combination of the first two
 C. Although any one symptom may not be continuously present,
the state of being symptomatic is persistent (typically more than 6
months).
o Specify if: With predominant pain (previously pain disorder): This specifier
is for individuals whose somatic complaints predominantly involve pain.
o Specify current severity:
 Mild: Only one of the symptoms in Criterion B is fulfilled.
  Moderate: Two or more of the symptoms specified in Criterion B
are fulfilled.
 Severe: Two or more of the symptoms specified in Criterion B are
fulfilled, plus there are multiple somatic complaints (or one very
severe somatic symptom).
 Illness Anxiety Disorder
o Formerly known as “hypochondriasis”.
o Physical symptoms are either not experienced at the present time or are
very mild, but severe anxiety is focused on the possibility of having or
developing a serious disease.
o Has mild pain, thinking it will lead to chronic illnesses
o Focused on having chronic illness
o Criteria for Illness Anxiety Disorder
 Fear of having a serious illness
 Somatic symptoms are not present or, if present, are only mild in
intensity.
 There is a high level of anxiety about health, and the individual is
easily alarmed about personal health status.
 The individual performs excessive health-related behaviors (e.g.,
repeatedly checks his or her body for signs of illness) or exhibits
maladaptive avoidance (e.g., avoids doctors’ appointments and
hospitals).
 Illness preoccupation has been present for at least 6 months, but
the specific illness that is feared may change over that period of
time.
 The illness-related preoccupation is not better explained by another
mental disorder, such as somatic symptom disorder, generalized
anxiety disorder, or obsessive-compulsive disorder.
o Specify whether:
 Care-seeking type: Medical care, including physician visits or
undergoing tests and procedures, is frequently used.
 Care-avoidant type: Medical care is rarely used
 Psychological Factors Affecting Medical Condition
o Presence of a diagnosed medical condition such as asthma, diabetes, or
severe pain clearly caused by a known medical condition such as cancer
that is adversely affected (increased in frequency or severity) by one or
more psychological or behavioral factors.
o The pattern would have to be consistent in the neglect of appropriate
monitoring and intervention, but the neglect is clearly a behavioral or
psychological factor that is adversely affecting the medical condition.
o Criteria for Psychological Factors Affecting Medical Condition
 A medical symptom or condition (other than a mental disorder) is
present.
 Psychological or behavioral factors adversely affect the medical
condition in 1 of the following ways:
  The factors have influenced the course of the medical condition as
shown by a close temporal association between the psychological
factors and the development or exacerbation of, or delayed
recovery from, the medical condition.
 The factors interfere with the treatment of the medical condition
(e.g. - poor adherence).
 The factors constitute additional well-established health risks for the
individual.
 The factors influence the underlying pathophysiology, precipitating
or exacerbating symptoms or necessitating medical attention
 The psychological and behavioral factors in criterion B are not
better explained by another mental disorder (Panic Disorder, MDD,
or PTSD)
 Specify if:
 Mild: Increases medical risk (e.g. - inconsistent adherence with
antihypertension treatment).
 Moderate: Aggravates underlying medical condition (e.g. - anxiety
aggravating asthma).
 Severe: Results in medical hospitalization or emergency room visit.
 Extreme: Results in severe, life-threatening risk (e.g. - ignoring
heart attack symptoms
 Conversion Disorder (Functional Neurological Symptom Disorder
o Physical malfunctioning, such as paralysis, blindness, or difficulty in
speaking, without any physical or organic pathology to account for
malfunction.
o Stress takes the form of a physical injury.
o (parang sa case ni Chin-TTW)
o Criteria for Conversion Disorder
 One or more symptoms of altered voluntary motor or sensory
function.
 Clinical findings provide evidence of incompatibility between the
symptom and recognized neurological or medical conditions.
 The symptom or deficit is not better explained by another medical
or mental disorder.
 The symptom or deficit causes clinically significant distress or
impairment in social, occupational, or other important areas of
functioning or warrants medical evaluation
 Factitious Disorder
o The symptoms are under voluntary control, as with malingering, but there
is no obvious reason for voluntarily producing the symptoms except,
possibly, to assume the sick role and receive increased attention.
o When an individual deliberately makes someone else sick, the condition is
called factitious disorder imposed on another (Munchausen syndrome by
proxy).
o Criteria for Factitious Disorder
  Falsification of physical or psychological signs or symptoms, or
induction of injury or disease, associated with identified deception.
 The individual presents himself or herself to others as ill, impaired
or injured.
 The deceptive behavior is evident even in the absence of obvious
external rewards.
 The behavior is not better accounted for by another mental disorder
such as delusional belief system or acute psychosis.
 Specify if:
 Single episode
 Recurrent episodes: Two or more events of falsification of illness
and/ or induction of injury

Dissociative Disorders

 When individuals feel detached from themselves or their surroundings, almost as

if they are dreaming or living in slow motion, they are having dissociative
experiences.
 May happen after an extreme stressful event like accident.
 It also is more likely to happen when you’re tired or sleep deprived from staying
up all night cramming for an exam.
o Depersonalization- your perception alters so that you temporarily lose
the sense of your own reality, as if you were in a dream and you were
watching yourself.
o Derealization- your sense of the reality of the external world is lost.
Things may seem to change shape or size; people may seem dead or
mechanical.
 Depersonalization-Derealization Disorder
o When feelings of unreality are so severe and frightening that they
dominate an individual’s life and prevent normal functioning.
o Anxiety, mood, and personality disorders are also commonly found in
these individuals
o Tunnel visions (perceptual distortions) and Mind emptiness (difficulty
absorbing new information)
o Criteria for Depersonalization-Derealization Disorder
 The presence of persistent or recurrent experiences of
depersonalization, derealization, or both: Depersonalization:
Experiences of unreality, detachment, or being an outside observer
with respect to one’s thoughts, feelings, sensations, body or actions
(e.g., perceptual alterations, distorted sense of time, unreal or
absent self, emotional and/or physical numbing). Derealization:
Experiences of unreality or detachment with respect to
 surroundings (e.g., individuals or objects are experienced as
unreal, dreamlike, foggy, lifeless, or visually distorted).
 During the depersonalization or derealization experience, reality
testing remains intact.
 The symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
 The disturbance is not attributable to the physiological effects of a
substance (e.g., a drug of abuse, medication) or another medical
condition (e.g., seizures).
 The disturbance is not better explained by another mental disorder,
such as schizophrenia or panic disorder
 Dissociative Amnesia
o Generalized Amnesia- people who are unable to remember anything,
including who they are. May be lifelong or may extend from a period in the
more recent past, such as 6 months or a year previously.
o Localized or selective Amnesia- a failure to recall specific events,
usually traumatic, that occur during a specific period
o Dissociative Fugue- individuals just take off and later find themselves in
a new place, unable to remember why or how they got there.
o Amok- Individuals in this trancelike state often brutally assault and
sometimes kill people or animals.
o Criteria for Dissociative Amnesia
 An inability to recall important autobiographical information, usually
of a traumatic or stressful nature, that is inconsistent with ordinary
forgetting. Note: Dissociative amnesia most often consists of
localized or selective amnesia for a specific event or events; or
generalized amnesia for identity and life history.
 The symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
 The disturbance is not attributable to the physiological effects of a
substance (e.g., alcohol or other drug of abuse, a medication) or a
neurological or other medical condition (e.g., partial complex
seizures, transient global amnesia, sequelae of a closed head
injury/traumatic brain injury, or other neurological condition).
 The disturbance is not better explained by dissociative identity
disorder, posttraumatic stress disorder, acute stress disorder,
somatic symptom disorder, or major or mild neurocognitive
disorder.
 Specify if:
 With dissociative fugue: Apparently purposeful travel or bewildered
wandering that is associated with amnesia for identity or for other
important autobiographical information
 Dissociative Identity Disorder
o May adopt as many as 100 new identities, all simultaneously coexisting,
although the average number is closer to 15.
o In some cases, the identities are complete, each with its own behavior,
tone of voice, and physical gestures. But in many cases, only a few
characteristics are distinct, because the identities are only partially
independent, so it is not true that there are “multiple” complete
personalities.
o Different personalities are called alters.
o Host, the person who becomes the patient and asks for treatment.
o The transition from one personality to another is called a switch.