I.Overview
II. Anxiety Disorders
A. Panic disorder
1. Recurrent unexpected panic attacks
a.unexpected
b.not while the person was the focus of others' attention
2. followed by 1+ month by at least one of:
a. persistent concern of having another attack
b. worry about the implications of the attack
c. Significant change in behavior
3. The usual rule-outs: symptoms not better accounted for by substance, general medical condition, or other mental disorder
4. Two subtypes
a. w/ agoraphobia
b. w/o agoraphobia
B. Agoraphobia without history of panic disorder
C. Specific Phobias
1. Marked and persistent fear that is excessive or unreasonable
2. Exposure to the object/situation almost invariably evokes the phobic response
3. phobics realize that their fear is excessive or unreasonable
4. Situation avoided or endured with intense anxiety or distress
5. Interferes with person's functioning
6. The usual rule-outs
D. Social Phobia : criteria are essentially the same as specific phobia, except that the fear is of situations where one is likely to be:
1. exposed to unfamiliar people,
2. or to be observed and evaluated (possible scrutiny).
E. Obsessive-Compulsive disorder
1. Two components!
a. Obsessions:
(1) recurrent and persistent
(a) ideas
(b) thoughts
(c) impulses
(d) images
that are experienced as intrusive and senseless
(2) not mere exacerbations of real-life problems
(3) persons knows that they are the product of his/her own mind
(4) person attempts to neutralize thoughts somehow, often through compulsions
b. Compulsions
(1) repetitive, purposeful, intentional behaviors or mental acts performed in response to obsession, or in very stereotyped fashion
(2) the behavior is designed to neutralize or prevent discomfort or some dreaded situation 2. ego-dystonic; persons realizes excessive or absu
3. O's or C's must cause marked distress, are time consuming, or significantly interfere
4. The usual rule outs: mental disorder, substance, general medical condition
5. Most common types: cleaners and checkers
F. Post-Traumatic Stress Disorder (PTSD)
Essential feature is recurrent experiencing of a traumatic stressful event that previously evoked intense anxiety.
1. Person has been exposed to a traumatic event
2. The person's response involved intense fear, helplessness, or horror.
3. Three types of symptoms (All necessary)
a. Intrusive symptoms
(1) recollections
(2) dreams
(3) feel as if re-living it
(4) intense distress at events/persons that symbolize trauma
(5) intense physiological reactivity on exposure to some cue
b. Avoidance symptoms
(1) can involve avoidance of thoughts, feelings, stimuli associated with trauma
(2) Can involve amnesia
(3) diminished involvement with others
(4) foreshortened sense of future
c. Hyperarousal
(1) sleep disturbance
(2) irritability, outbursts of anger
(3) Difficulty concentrating
(4) hypervigilance
(5) exaggerated startle response
4. Duration at least one month
5. Delayed onset if onset of symptoms was at least 6 months after the trauma.
G. Acute stress disorder (New to DSM-IV)
1. Again exposed to a trauma
2. presence of dissociative symptoms
3. Intrusive, avoidance, arousal symptoms
4. Causes clinically significant distress or impairment
5. lasts 2 days to 4 weeks, and onset is within 4 weeks of the trauma (if longer than 4 weeks, PTSD)
6. The usual rule-outs: other mental disorders, substance, general medical condition
H. Generalized Anxiety Disorder:
1. unrealistic or excessive worry in at least two arenas
2. 3 of 6 symptoms involving restlessness, fatigue, tension, irritability, sleep difficulties
III. Dissociative disorders--fairly uncommon. Essential feature of these disorders is a disturbance or alteration in the normally integrative functions of identity, memory, or consciousness.
A. Dissociative Identity Disorder (formerly Multiple Personality Disorder)
1. Criteria:
a. Existence within the person of 2+ distinct identities or personality states
b. At least two of these personalities take full control of the person's behavior.
c. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness
d. The usual ruleouts
2. Awareness by other personalities may be:
a. Mutually cognizant
b. Mutually amnesic
c. One-way amnesic
B. Dissociative fugue
1. Sudden, unexpected travel away from home or one's customary place of work, with inability to recall one's past.
2. Confusion about personal identity or assumption of a new identity
3. The usual ruleouts; causes distress
C. Dissociative amnesia
1. One or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature, that is too excessive to be explained by ordinary forgetfulness
2. The usual ruleouts: Not only in DID, Fugue, Not due to organic factors
3. Subtypes:
a. local/circumscribed
b. Selective
c. Generalized
d. Continuous
e. Systematized
4. Differential diagnosis vs. organic
D. Depersonalization Disorder: persistent or recurrent episodes of depersonalization!