Abnormal Psychology

PSY 3102
Module 5: Trauma and Stressor-Related Disorders and Dissociative Disorders
Trauma is a type of damage to the psyche that occurs as a result of a severely distressing event.
It is a result of an overwhelming amount of stress that exceeds one’s ability to cope or integrate
the emotions involved with that experience

A traumatic event can involve one experience or repeated events or experiences over time.

Posttraumatic Stress Disorder

Anxiety develops in relation to an event that created psychological trauma in response to actual
or threatened death, serious injury, or sexual violation. The exposure must involve directly
experiencing the event, witnessing the event in person, and learning of actual or threatened
death, serious injury, or sexual violation.

Traumas experienced may involve war, natural disasters, car accidents, sexual abuse, and/or
domestic abuse.

A formal diagnosis of PTSD is made when the symptoms cause clinically significant distress or
impairment in social/occupational dysfunction for a period of at least 1 month. The trauma
experienced is severe enough to cause stress responses for months or even years after the
initial incident. The trauma overwhelms the victim’s ability to cope psychologically and
memories of the event trigger anxiety and physical stress responses, including the release of
cortisol.

People with PTSD may experience flashbacks panic attacks and anxiety and hypervigilance.

Complex PTSD
It is a psychological injury that results from exposure to prolonged social and/or interpersonal
trauma in the context of dependence, captivity, or entrapment, which results in the lack or loss
of control, helplessness, and deformations of identity and sense of self.
It was first described in 1992 by Judith Herman in her book Trauma & Recovery.

6 clusters of Symptoms for Diagnosis of C-Ptsd

1. Alterations in regulation affect and impulses;
2. Alterations in attention or consciousness;
3. Alterations in relation with others;
4. Somatizations
;
Alterations in systems of meaning.

Acute Stress Disorder

Individulas with acute stress disorder experience intrusive thoughts or memories of the
traumatic event.
Distressing dreams about the trauma and general sleep disturbances are also common
Many patients avoid external reminders, such as places or people related to the traumatic event.
The patient may have unrealistic feelings or beliefs about the event.
Physical symptoms may occur even without injury.

Adjustment Disorders
Adjustment disorder is a group of symptoms, such as stress, feeling sad, or hopelessness, and
physical symptoms that can occur after you go through a stressful life event. Diagnosis is based
on the identification of major life stressors, your symptoms, and how they impact your ability to
function.

Dissociative Disorders
Dissociation- occurs in a continuum
Most individuals have experienced a dissociative state at some point in their lives.
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Dissociative Identity Disorder

It is a rare mental disorder characterized by at least two distinct and relatively enduring
identities or dissociated personality states that recurrently control a person’s behavior; it is
accompanied by memory impairment for important information
Amnesia in DID is understood to mean amnesia between two or more distinct identities. Each of
the distinct identities or personalities has its own way of perceiving thinking about, and relating
to itself and the environment.

It is previously known as multiple personality disorder

DID became popularized in 1974 with the publication of the highly influential book Sybil.

Depersonalization/Derealization Disorder
Depersonalization
Individuals who experience depersonalization might believe their thoughts and feeling are not
their own.
Derealization
A person who experiences derealization might feel as though they are in a fog or a dream that
the surrounding world is somehow artificial and unreal.

Cluster A Personality Disorders

Personality disorders
1. Differs significantly from the norms and the expectations of their culture in two or more
of the ff areas: cognition, affect, interpersonal functioning, or impulse control.
2. Causes them and/or others around them “clinically significant” distress and impairment
in important areas of functioning.
3. Pervasive and enduring
4. Cannot be better explained by another mental disorder due to direct physiological
effects of a substance or gen medical condition.

The DSM-5 Grouping Personality Disorders

Cluster A (odd or eccentric)
Paranoid PD
Schizophoid PD
Schizotypal PD
Cluster B (dramatic, emotional, or erratic)
Antisocial PD
Borderline PD
Histrionic PD
Narcissistic PD
Cluster C (anxious or fearful)
Avoidant PD
Dependent PD
Obsessive-Compulsive PD

Challenges of Personality Disorders

1. They are the most challenging to manage
2. Individuals with PD may not even recognize that their personality is causing distress or
issues with other people.
3. Social stigma and discrimination related to the diagnosis of PD

Cluster A Personality Disorders

1. Odd or eccentric
2. Paranoid PD
3. Schizoid PD
4. Schizotypal PD
5. Cluster A disorders are likely determined in part by genetics; early childhood experiences
and parenting styles play a role.
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Paranoid PD
- characterized by paranoia and a pervasive, long-standing suspicion and general
mistrust of others.
- They may be hypersensitive, easily feel slighted, and habitually relate to the world by
vigilantly scanning the environment for clues or suggestions that might validate their
fears and biases.
Scizoid PD
- Characterized by a lack of interest in social relationships as well as a tendency toward a
solitary lifestyle, secrecy, emotional coldness, and apathy.
- People with SPD may demonstrate a rich and an elaborate internal fantasy world.
Schizotypal Personality Disorder
- Characterized by a need for social isolation, anxiety in social situations, odd behavior
and thinking, and unconventional beliefs.
- They feel extreme discomfort maintaining close relationships with people, so generally
avoid forming them all together.
- Peculiar speech mannerisms and odd modes of dress
- May react oddly in conversations, not respond or talk to themselves.
- They experience “ideas of reference”

Cluster B Personality Disorders

- Impulsive, overly dramatic, highly emotional, and erratic
- Anti Social PD
- Borderline PD
- Histrionic PD
- Narcissistic PD

ANtisocial Personality Disorder

- Characterized by a pervasive pattern of disregard for (or violation of) the rights of
others
- The individual lack remorse or guilt for the acts they have committed
- Sometimes referred to psychopathy or sociopathy
Borerline Personality Disorder
- Central features of BPD are pattern of impulsitivity and instability in mood, interpersonal
relationships and self image
- Patterns emerge in early adulthood and persist throughout the lifetime
- One tell-tale symptom is intense of abadonment
- People with BPD octen engage in idealization and devaluation of others; alternating
between high positive regard and great disappointment.
- Other symptoms may include intense ander and irritability, self-mutilation, and suicidal
behaviors.
Histrionic Personality Disorder
- Characterized by a pattern of excessive attention-seeking emotions, usually beginning in
early adulthood, including inappropriately seductive behavior and excessive need for
approval.
- Histrionic people are lively, dramatic, vivacious, enthusiastic, and flirtatious.
- People with HPD have a high need for attention, make loud and inappropriate
appearances, exaggerate their behaviors and emotions, and crave stimulation
- They may exhibit sexually provocative behavior,l express strong emotions with an
impressionistic style and can be influenced by others
- HPD is diagnosedfour times more often in women as it is in men.
Narcissistic Personality Disorder
- A person is excessively preoccupied with personal adequacy, power, prestige, and vanity
and is unable to see the destructive damage they are causing to themselves and to
others.
- People with NPD are characterized by exaggerated feelings of self-importance
- It is estimated that one percent of the population with rates greater for men.
- First formulated in 1968, NPD was historically called megalomania and is a form of
severe egocentrism.

Cluster C Personality Disorders

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● Often appear to be nervous or anxious
● Avoidant PD
● Dependent PD
● Obsessive-Compulsive PD

Avoidant Personality Disorder

-chracterized by pervasive pattern of social inhibition, feeling of inadequacy, extreme
sensitivity to negative evaluation, and avoidance of social interactions
- tend to describe themselves as ill at case, anxious, lonely and generally feel unwanted
and isolated from others
- they consider themselves socially inept or personally unappealing
- there is a controversy as to whether avoidant personality disorder is a distinct disorder
from generalized social phobia

Dependent Personality Disorder

- Characterized by a pervasive psychological dependence on other people
- This is a long term (chronic) condition in which people depend on others to meet their
emotional and physical needs

Obsessive-Compulsive Personality Disorder

- Characterized by a general pattern of concern with orderliness, perfectionism, excessive
attention to details, and a need of control over one’s environment, at the expense of
flexibility, openness and efficiency.
- Workaholism and miserliness are also seen often in those with this personality disorder.
- OCPD is distinct from OCD which is an anxiety disorder but some studies found high
comorbidity rates between the two disorders
- Attitudes between people with OCD and OCPD differ

OCD OCPD

Obsessions, Compulsions or both Orderliness, Mental and interpersonal control,

Rigidity, Perfectionism, Preoccupation with
rules, lists, organization, schedule

Inherently distressing Distress not present as preoccupations seen

as desirable

Excessive time taken up due to compulsions Perfectionism interferes with task completion

Happy for others to take over Reluctant to delegate

Not features of OCD Overconscientious, inflexible about morality,

ethics, values

Not features of OCD Miserly, unable to discard

Module 6: Schizophrenia Spectrum Disorders

Schizophrenia
● Characterized by disordered thinking, in which ideas are not logically related; faulty
perceptions and attention; a lack of emotional expressiveness; and disturbances in
behavior e.g disheveled appearance
● Withdraw from other people and everyday reality, experience delusions and
hallucinations
● Substance use rates are high; suicide rates are high 12x more likely to die of suicide
● 1% life prevalence, affects men more than women
● Diagnosed more frequently among some groups
● Sometimes begin in childhood, usually appears in late adolescence/early adulthood,
earlier in men than women
● Late onset (30s)=more severe
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Symptoms of Schizophrenia

Positive Symptoms Negative Symptoms Cognitive Symptoms

- Disorders of - Disorders of omission, - Prevent the

commission, meaning meaning they are individuals effectively
they are something things that the in the workplace or in
that individuals do or individual does not society
think do. - These are subtle
- Behavior that - Some individuals difference in cognitive
indicated loss of experience a ability that are
contact with the catatonic stupor, or a normally only
external reality state in which they discovered after
experienced by are immobile and neuropsychological
non-psychotic mute yet conscious tests are given.
individuals
- Positive symptoms
tend to be the easiest
to recognize
- Hallucinations
- Delusions

Motor Disturbances
● Include disorders of mobility, activity and volition
● Stereotypy
● Mannerisms
● Mitgehen
● Ecopraxia
● Automatic obedience
Behavioral Disturbances
● These may involve deterioration of social functioning
● Involve behaviors that are considered socially inappropriate
● Substance abuse is another disorder of behavior
Mood Disturbances
● Disorders of mood and affect include affective flattening
● Typically, one sees unchanging facial expression, decreased spontaneous movements, a
lack of vocal inflections and slowed speech
● Anhedonia

The Schizophrenia Spectrum

● The spectrum of psychotic disorders include schizophrenia, schizoaffective disorder,
delusional disorder and catatonia
● In the previous version (DSM-IV-TR), schizophrenia was divided into five subtypes:
catatonic, disorganized, paranoid, undifferentiated, and residual.
● However, these are removed in the new DSM-V. Instead, schizophrenia is now understood
as existing along a spectrum of psychotic disorders that include schizoaffective disorder,
delusional disorder, and catatonia.

Schizoaffective Disorder
● Characterized by abnormal thought processes and dysregulated emotions. A person with
this disorder has features of both schizophrenia and a mood disorder by does not strictly
meet the diagnostic criteria for either
● Bipolar type, Depressive type, or Mixed type.
● Common symptoms of schizoaffective disorder include hallucinations, paranoid
delusions and disorganized speed and thinking

Delusional Disorder
● A psychiatric condition in which the person presents with delusions but no accompanying
hallucinations, thought disorder, mood disorder or significant flattening of affect.
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● Apart from delusions people with delusional disorder may continue to socialize and
function normally their behavior does not stand out as odd or bizarre. However, their
preoccupation with delusional ideas can disrupt their lives.

7 types of delusional disorder:

1. Erotomanic type (Erotomania)
2. Grandiose type
3. Jealous type
4. Persecutory type
5. Somatic type
6. Mixed type
7. Unspecified type

Catatonia
● It is any condition of abnormal motor activity thought to be caused by a psychiatric
disorder.
● In the DSM-V, catatonia is not recognized as its own disorder but rather is listed as a
symptom of other psychiatric conditions, such as schizophrenia, bipolar disorder,
post-traumatic stress disorder, and depression

Sexual Dysfunction, Gender Dysphoria and Paraphilic Disorders

Sexual Dysfunctions
● Refers to a problem occurring during any phase of the sexual response cycle that
prevents the individual or couple from experiencing satisfaction from sexual activity
● The sexual response cycle traditionally includes excitement, plateau, orgasm and
resolution. Desire and arousal are both parts of the excitement phase of the sexual
response.

Male Sexual Dysfunction

● Delayed Ejaculation
● Erectile Disorder
● Male Hypoactive Sexual Desire Disorder
● Premature (Early) Ejaculation

Female Sexual Dysfunction

● Female Orgasmic Disorder
● Female Sexual Interest/Arousal Disorder
● Genito-Pelvic Pain/Penetration Disorder

Each of the sexual dysfunctions could be lifelong or acquired, generalized or situational and
clinicians could specify whether distress over symptoms is mild, moderate or severe. Note that
not everyone agrees on the diagnostic criteria for all of these sexual dysfunctions. There is a
variety of ways that people can experience a distressing sexual problem.

Gender Dysphoria
● Formerly classified as gender identity disorder (GID) in the previous version of the DSM,
is the formal diagnosis used by psychologists and physicians to describe people who
experience significant dysphoria (discontent) with the sex and gender they were in.
● Many people who are diagnosed with GID identify as transgender, gender fluid, or
otherwise gender non-conforming experiences of gender dysphoria
● Gender dysphoria is a controversial diagnosis characterized by a person’s discontent
with the sex and gender they were assigned at birth
● Symptoms of gender dysphoria in children include discomfort with their genitalia, feeling
that they were assigned, social isolation, from their peers, anxiety, loneliness, and
depression.

Controversy Suuronding the Diagnosis

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● Many transgender people and researchers suppported the declassification of GID,
arguing that the diagnosis pathologizes a natural form of gender variance, reinforces
the binary model of gender, and can result in stigmatization of transgender individuals.
● Advantages andd disadvantages exist to classifying gender dysphoria as a disorder.
However, many people argue tha tthe distress associated with gender dysphoria is not
caused by any disorder within the individual, but by difficulties encountered from social
disapproval of transgender identities and alternative genders.
● Without the classification of gender dysphoria as a medical disorder, sex-reassignment
therapy may be viewed as cosmetic treatment– rather than medically necessary
treatment for many transgender individuals– and thus may not be covered.

Paraphilic Disorder
● Paraphilia from the Greek; para means around or beside and philia means love.
● It is any emotional disorder characterized by sexually arousiing fantasies, urges or
behaviors that are recurrent, intense, occur over a period of atleast six months, and
cause significant distress or interfere with the sufferer’s work, social function or other
areas of functioning.
● In DSM-V the term paraphilia is defined as “any intense and persistent sexual interest
other than sexual interest in genital stimulation or prepatory fondling with
phenotypically normal, physiologically mature, consenting human partners.”
● Paraphilias, however, may not necessarily classify as “intense and persistent” but rather
preferential sexual interests that are greater than nonparaphilic sexual interests.

Types of Paraphilia
1. Voyeurism
2. Exhibitionism
3. Frotteurism
4. Sexual masochism
5. Sexual sadism
6. Pedophilia
7. Fetishism
8. Transvetism
9. Autogynephilia

Neurodevelopmental Disorder
- Divided into 6 disorder groups

Intellectual Disabilities
- These are neurodevelopmental disorders characterized by significantly impaired
intellectual and adaptive functioning.
- Intellectual disabilities can either be syndromic or non syndromic
- It is defined by an intelligence quotient (IQ) score below 70 in addition to deficits in two
or more adaptive behaviors that affect an individual’s everyday life.
- It was known as “mental retardation” until the end of the 20th century. However, this
term is now widely seen as disparaging.

Global Developmental Delay

- Previously known in DSM-IV as “Mental Retardation Severity Unspecified” the term
global developmental delay (GDD) in DSM-V is used to explain developmental disability
in children who are under five years of age.
- It refers to an important developmental milestone delay in regards to motor, speech, and
language; cognition; social functioning; and activities of daily living.
- GDD is seen in about 15% of children below the age of five.

Diagnosis of GDD
- Genetic, molecular and metabolic tests
- Chromosome testing
- Neuroimaging tests
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Autism Spectrum Disorder
- Redefined the autism spectrum to encompass the previous (DSM-IV-TR) diagnoses of
autism, Asperger syndrome, pervasive developmental disorder not otherwise specified
(PPD-NOS) and childhood disintegrative disorder.
- These disorders are characterized by social deficits and communication difficulties,
repetitive behaviors and interests, sensory issues and in some cases, cognitive delays.
- ASD’s are considered to be on a spectrum because each individual with ASD expresses
the disorder uniquely and has varying degrees of fucntionality.
- Formerly referred to as autism, is a disorder of neural development characterized by a
broad spectrum of social, communication and behavior symptoms, evident in early
childhood.
- ASD is considered to exist along a spectrum because each individual with ASD expresses
the disorder uniquely and has a varying degrees of functionality
- Social impairments in children with ASD can be characterized by a distinctive lack of
intuition about others. Infants with ASD show less attention to social stimuli and smile
and look at others less often.
- Children may exhibit repetitive or restricted behavior and self injurious behaviors.
- ASD affects information processing in the brain by altering how nerve cells and synapses
connect and organize.

Attention Deficit/Hyperactivity Disorder

- It is a neurodevelopmental psychiatric disorder characterized by a constant pattern of
inattention and/or hyperactive and impulsice behavior that interferes with normal
functioning
- The first person to describe a version of ADHD was physician Heinrich Hoffman , in the
1920s
- The first official recognition of the disorder was “attention deficit disorder without
hyperactivity,” in the DSM III (1980)
- WHO estimates that it affected about 39 million people as of 2013
- It affects about 6-7% of children when diagnosed using the earlier DSM-IV criteria; the
incidence is about 3 times higher than in boys than in girls.
- Approximately 30-50% of children diagnosed with ADHD continue to experience
symptoms in adolescents and adults.
- Many children with ADHD are unable to pay attention at school, leading to poor
academic performance and sometimes isolation from peers
- The cause of ADHD is unknown, but most researchers agree that it is an interaction
between genetic and environmental factors.

Subtypes of ADHD:
1. ADHD, Predominantly Inattentive Type
2. ADHD, Predominantly Hyperactive Impulsive Type
3. ADHD, Combined Type

General symptoms:
● Impulsivity
● Forgetfulness
● Inability to concentrate
● Impatience
● Thrill-seeking
● Excessive daydreaming
● Restlessness
● Unusual/Disruptive sleep patterns

Specific Learning Disorder

- Is a classification of disorders in which a person has a difficulty learning in a typical
manner within one of several domains
- Often referred to as learning disabilities, learning disorders are characterized by
inadequate development of specific academic, language and speech skills
- Types of learning disorders include difficulties in reading, mathematics and writing
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- Depending on the type and the severity of the disability, interventions and technology
may be used to help the individual learn strategies that will foster future success

Dyslexia
- Sometimes called reading disorder, is the most common learning disability of all students
with specific learning disabilities, 70-80% have deficits in reading
- The term “developmental dyslexia” is often used as a catch-all term, but researchers
assert that dyslexia is just on of several types of reading disabilities.
- A reading disability can affect any part of the reading process, including word
recognition, word decoding, reading speed, prosody (oral reading with expression), and
reading comprehension.

Dyscalculia
- Is a form of math-related disability that involves difficulties with learning math-related
concepts, memorizing math-related facts, organizing numbers, and understanding how
problems are organized on the page.
- Dyscalculics are often referred to as having poor “number sense”

Dysgraphia
- The term graphia is often used an overarching term for all disorders of written
expression.
- Individuals with dysgraphia typically show multiple writing-related deficiencie, such as
grammatical and punctuation errors within sentences, poor paragraph organization,
multiple spelling errors, and excessively poor penmanship.