AbPsych Reviewer 4 PDF

Abnormal Psychology
Phase 4: Substance Related, Addictive, and Impulse-Control

Disorder, Personality Disorders
Source: Barlow, Durand & Hofmann (2018), Comer & Comer (2017), DSM-V, DSM-V-TR
Substance-Related and Addictive Disorders o First ep of alcohol intoxication is likely to occur
o Substance – chemical compounds that are during mid-teens
ingested to alter mood or behavior o Onset peak in the later teens or early to mid 20s
o Psychoactive substances – alter mood, o Remission and relapse
behavior, or both o Among adolescents, conduct disorder and
o Substance Use – ingestion of psychoactive repeat antisocial behavior often co-occur with
substances in moderate amounts that does not alcohol- and with other substance-related
significantly interfere with social, educational, disorders
or occupational functioning o The key element is the use of heavy doses of
o Substance Intoxication – physiological reaction alcohol with resulting repeated and significant
to ingested substances distress or impaired functioning
o Substance Use Disorders – how much of a o Describes problematic pattern of alcohol use
substance is ingested is problematic that involves impaired control over alcohol use,
o Physiological Dependence – meaning the use of social impairment due to alcohol use, risky
increasingly greater amounts of the drug to alcohol use, and pharmacological symptoms
experience the same effect (tolerance) and a
negative physical response when the
substance is no longer ingested (withdrawal)
Alcohol
o Usually occurs as an episode developing over

minutes to hours and typically lasting several
hours
o Frequency and intensity usually decrease with
further advancing age
o The earlier onset of regular intoxication, the
greater the likelihood the individual will go on
to develop AUD
o Specifiers:
▪ In Early Remission – after meeting full
criteria, none of the criteria was met for at
least 3 months but less than 12 months
▪ Sustained Remission – none of the criteria
have been met again at any time during a
period of 12 months or longer
▪ Controlled Environment
▪ Current Severity/Remission
Abnormal Psychology
o Specifiers: With Perceptual Disturbances
o When hallucinations occur in the absence of
delirium, a diagnosis of substance/medication-
induced psychotic disorder should be
considered
o Acute alcohol withdrawal occurs as an episode
usually lasting 4-5 days and only after
extended periods of heavy drinking
o Withdrawal is rare for individuals younger than
30 years
o Consistent with a half-life of caffeine of
o The symptoms of an alcohol-induced mental
approximately 4-6 hours, usually remit with the
disorder are likely to remain clinically relevant
first day or so and do not have any known long-
as long as the individual continues to
lasting consequences
experience severe intoxication or withdrawal
o Symptoms must not be associated with another
o Breathalyzer – measures levels of intoxication
medical condition or another mental disorder
o GABA seems to be particularly sensitive to
that could better explain them
alcohol
o The Glutamate system is involve why alcohol
affects our cognitive abilities
o Two types of organic brain syndromes may
result from long-term alcohol use: Dementia
and Wernicke-Korsakoff Syndrome (Confusion,
loss of muscle coordination, and unintelligible
speech, believed to be cause by a deficiency of
thiamine)
o Fetal Alcohol Syndrome
o Alcohol Dehydrogenase – metabolize alcohol
o Korsakoff syndrome is a chronic memory
disorder caused by severe deficiency of o Usually begin 12-24 hours after the last caffeine
thiamine (vitamin B-1). dose and peak after 1-2 days of abstinence
o Korsakoff syndrome is most caused by alcohol o Symptoms last for 2-9 days with the possibility
misuse, but certain other conditions also can of withdrawal headaches occurring for up to 21
cause the syndrome. days
o The final determination of caffeine withdrawal
Caffeine should rest on a determination of the pattern
and amount consumed, the time interval
between caffeine abstinence and onset of
symptoms, and the particular clinical feature
presented by the individual
Abnormal Psychology
Cannabis
o When hallucinations occur in the absence of

intact reality testing, a diagnosis of
substance/medication-induced psychotic
disorder should be considered
o Specifiers:
▪ In early remission
▪ In sustained remission
▪ In controlled environment
▪ Current severity/remission
o Most commo during adolescence or young
adulthood
o Progression may be more rapid in adolescents,
particularly those with conduct problems
o CUD among adults typically involves well-
established patterns of daily cannabis use that
continue despite clear psychosocial or medical
problems
o Early onset of cannabis use is a robust o Withdrawal onset typically occurs within 24-48
predictor of the development of CUD and other hours after cessation of use
types of substance use disorders and mental o Peaks within 2-5 days and resolves within 1-2
disorders during young adulthood weeks, although sleep disturbance can persist
longer
Abnormal Psychology
o Women can experience more severe
withdrawal symptoms
Hallucinogens
o The disorder is not often persistent and is

concentrated in young adults
o Phencyclidine can be an additive to other
substances
o Describes problematic pattern of phencyclidine
use that involves impaired control, social
impairment, and pharmacological symptoms
o In particular, in the absence of intact reality

testing, an additional diagnosis of
phencyclidine-induced psychotic disorder
should be considered
Abnormal Psychology
Inhalant
o Toxicological tests are useful in making this

distinction, and determining the route of
administration may also be useful
o Specifiers:
▪ Particular Inhalant
o Usually remits in early adulthood
o Rare in prepubertal children, most common in
adolescents and young adults, uncommon in
older adults
o Those with inhalant use disorder extending into
o Conditions to be ruled out include
adulthood demonstrate earlier onset of
schizophrenia, other drug effects,
inhalant use, use of multiple inhalants, and
neurodegenerative disorders, stroke, brain
more frequent inhalant use
tumors, infections, and head trauma
o A diagnosis if the inhalant exposure is
o Neuroimaging results in hallucinogen
intentional
persisting perception disorder cases are
typically negative
o Reality testing remains intact
Abnormal Psychology
▪ On maintenance therapy
▪ In a controlled environment
o First observed in the late teens or early 20s
o Early use reflect a desire for relief from life
stressors or psychological pain
o Can continue over many years, with brief
periods of abstinence in some individuals
o Intoxication attributable to other intoxicants

may be identified via toxicology screen
o May be suggested by possession or lingering o Can occur in an individual who is opioid naïve,
odors of inhalant substances an individual who uses opioids sporadically,
Opioid and an individual who is physically dependent
on opioids
o Speed and severity of withdrawal associated

with opioids depend on the half-life of the
opioid used
o Specifiers:
Abnormal Psychology
o Most individuals begin to have withdrawal o Barbiturates – prescribed to help people sleep
symptoms within 6-12 hours and replaced such drugs and alcohol
o Symptoms may take 2-4 days to emerge in the o Benzodiazepines – antidepressant, cure for
case of longer-acting drugs anxieties
o More chronic symptoms can last for weeks to o Low doses of barbiturates relaxes the muscles,
months larger does can have results similar to those of
o Among those with OUD, opioid withdrawal and heavy drinking
attempts to relieve withdrawal are typical
o Also accompanied by rhinorrhea, lacrimation,
and pupillary dilation
Sedative-, Hypnotic-, or Anxiolytic-
o Many individuals who misuse sedatives,

hypnotics, or anxiolytics may also misuse
alcohol and other substances, and so multiple
intoxication diagnoses are possible
o Involves individuals in their tends or 20s who

escalate their occasional use of sedative, o Differential diagnosis with Alcohol withdrawal
hypnotic, or anxiolytic agents to the point at may be determined through clinical history
which they develop problems that meet the
criteria for a diagnosis
o Generally, has an onset during adolescence or
early adult life
Abnormal Psychology
Stimulant
o Salient mental disturbances associated with

stimulant intoxication should be distinguished
from the symptoms of schizophrenia, bipolar
and depressive disorders, GAD, and PD
o Specifiers:
o More common among individuals ages 18-25
years old
o Caffeine, Nicotine, Amphetamines, and Cocaine
o Amphetamines – induce feelings of elation and
vigor and can reduce fatigue
o Caffeine – most common of the psychoactive
substances
o First regular use among individuals in
treatment occurs at approximately age 23 yrs
o Stimulant smoking and intravenous use are
associated with rapid progression to severe-
level stimulant use disorder, often occurring
over weeks to months
o Intranasal use and oral use of substances
result in more gradual progression occurring
over months to years
Abnormal Psychology
Tobacco o Prolonged symptoms beyond 1 month can occur
but are uncommon
o Reduction in symptoms with the use of nicotine
confirms the diagnosis
Other (Unknown) Substance
o Specifiers:
▪ On maintenance therapy
▪ In a controlled environment
▪ Current Severity/Remission
o Usually begins within 24 hours of stopping or

cutting down tobacco use, peaks at 2-3 days
after abstinence, and usually lasts 2-3 weeks
o Can occur among adolescent tobacco users,
even prior to daily tobacco use
Abnormal Psychology
Non-Substance-Related
o Genetic factors may affect how people

experience and metabolize certain drugs
o Positive and Negative Reinforcement
o Opponent-Process Theory – an increase in
positive feelings will be followed shortly by an o Specifiers:
increase in negative feelings and vice versa ▪ Episodic – meeting criteria at more than 1
o Expectancy Effect – expectancies develop time point, with symptoms subsiding
before people actually use drugs, perhaps as a between periods of gambling disorder for at
result of loved one’s use, advertising, etc. least several months
o Treatment: Nicotine replacement therapy, ▪ Persistent – experiencing continuous
Bupropion, Naltrexone, Acamprosate, symptoms, to meet diagnostic criteria for
Disulfiram, Methadone, Buprenorphine, multiple years
Aversion Therapy, In-patient treatments, ▪ In early remission
Aversion Therapy, etc. ▪ In sustained remission
o Cross-Tolerance – tolerance for a substance ▪ Current Severity
has not taken before as a result of using o Onset can occur during adolescence or young
another substance similar to it adulthood but in other individuals it manifests
o Synergistic Effect – an increase of effects that during middle or even older adulthood
occurs when more than one substance is acting o Progression appears to be more rapid in
on the body at the same time women than in men
o An additional diagnosis of gambling disorder
should be given only if the gambling behavior is
not better explained by manic episodes
Abnormal Psychology
Disruptive, Impulse-Control, and Conduct Disorder the resolution of the stressor may help
Oppositional Defiant Disorder, Intermittent distinguish adjustment from ODD
Explosive Disorder, Conduct Disorder o ADHD is often co-morbid with ODD
o Diagnosis of ODD should not be made if the
symptoms occur exclusively during the course
of a mood disorder
o If the irritable mood and other symptoms meet
the criteria of DMDD, a diagnosis of ODD is not
given, even if all criteria for ODD are met
o Usually appear during preschool years and

rarely later than adolescence
o Often precedes the development of Conduct
Disorder
o Also conveys risk for the development of
anxiety disorders and major depressive o Onset is most common in late childhood or
disorders adolescence and rarely begins for the first time
o Increased risk for a number of problems in after age 40 years
adjustment as adults o Chronic and persistent course
o It is especially critical during the o Quite common regardless of the presence of
developmental periods that the frequency and ADHD or other disruptive, impulse-control, and
intensity of these behaviors be evaluated conduct disorders
against normative levels before it is decided o A diagnosis should not be made when criteria
that they are symptoms of ODD A1 and/or A2 are only met during an episode of
o Behaviors of ODD are less severe than CD and another mental disorder, or when impulsive
do not include aggression towards people or outburst are attributable to another medical
animals, destruction of property, or pattern of condition or to the physiological effects of a
the theft or deceit substance
o Includes problems of emotional dysregulation o Also should not be made in children and
that are not included in CD adolescents ages 6-18 years, when the
o Temporal association with a stressor and impulsive aggressive outbursts occur in the
symptom duration of less than 6 months after context of an adjustment disorder
Abnormal Psychology
o A diagnosis of DMDD can only be given when o Onset may occur as early as the preschool
the onset of recurrent, problematic, impulsive years, but the first significant symptoms
aggressive outburst is before age of 10 years usually emerge during the period from middle
o A diagnosis of DMDD should be made for the childhood through middle adolescence
first time after 18 years o ODD is the most common precursor to the
o Aggression in ODD is typically characterized by childhood-onset type
temper tantrums and verbal arguments with o Physically aggressive symptoms = childhood
authority figures, whereas IED are in response o Nonaggressive symptoms = adolescence
to a broader array of provocation and include o May be diagnosed in adults, though onset is
physical assault rare after age 16 years
o Childhood-onset type predicts a worse
prognosis and an increased risk of criminal
behavior in adulthood
o When criteria for both ODD and CD are met,
both diagnoses can be given
o When criteria for both ADHD and CD are met,
both diagnoses can be given
o Individuals with conduct disorder will display
substantial levels of aggressive or
nonaggressive conduct problems during
periods in which there is no mood disturbance,
either historically or concurrently
o If criteria for both IED and CD has been met, the
diagnosis of IED should be given only when the
recurrent impulsive aggressive outbursts
warrant independent clinical attention
o CD is diagnosed only when the conduct
problems represent a repetitive and persistent
pattern that is associated with impairment in
social, academic, or occupational functioning
Pyromania & Kleptomania
o Subtypes:
a. Childhood-Onset: prior to age 10 years
b. Adolescent-Onset: no symptom
characteristic prior to age 10 years
c. Unspecified: there is not enough information
available to determine whether the onset
was before or after age 10
o Specifiers:
▪ With limited prosocial emotions o Late adolescence may be the typical age at
▪ Lack of remorse or guilt onset of pyromania
▪ Callous-lack of empathy o Usually associated with CD, ADHD or
▪ Unconcerned about performance adjustment disorder
▪ Shallow or Deficient affect
▪ Severity
Abnormal Psychology
o It is important to rule out other causes of fire
setting before giving diagnosis
o A separate diagnosis is NOT given when fire
setting occurs as part of conduct disorder,
manic episode, or antisocial personality
disorder, or if it occurs during a delusion or
hallucination
o Recognizable during adolescence or early adult

o Disorder often begins in adolescence, but may life
begin in childhood, adolescence, or adulthood, o For PD to be diagnosed in an individual younger
and in rare cases, in late adulthood than 18 years old, it has to be present for at
o 3 typical courses: least 1 year
a. Sporadic with brief episodes and long o When an individual has a persistent mental
periods of remission disorder that was preceded by a preexisting PD,
b. Episodic with protracted periods of stealing the PD must also be recorded, followed by
and periods of remission “premorbid”
c. Chronic with some degree of fluctuation o When personality changes after exposure to
Personality Disorders extreme stress, PTSD should be considered
o Personality Disorder – persistent pattern of Cluster A
emotions, cognitions, and behavior that results
in enduring emotional distress for the person
affected and/or for others and may cause
difficulties with work and relationships
o Personality Traits – enduring patterns of
perceiving, relating to, and thinking about the
environment and oneself that are exhibited in a
wide range of social and personal contexts
o Personality Disorder-Trait Specified (PDTS) –
currently undergoing study for possible
inclusion in a future revision of DSM-V
a. Negative Affectivity – display negative
emotions frequently and intensely
b. Detachment – people who manifest
detachment tend to withdraw from other
people and social interactions
o Excessively mistrustful and suspicious of
c. Antagonism – behave in ways that put them
others, without any justification
at odds with other people
o Slightly more common among the relatives of
d. Disinhibition – behave impulsively, without
people who have schizophrenia
reflecting on potential future consequences
o Early mistreatment or traumatic childhood
e. Psychoticism – have unusual and bizarre
experiences may play a role in the development
experiences
Abnormal Psychology
o May be first apparent in childhood and
adolescence with solitariness, poor peer
relationships, social anxiety,
underachievement in school, and interpersonal
hypersensitivity
o Associated with prior history of childhood
mistreatment, externalizing symptoms,
bullying, and adult appearance of interpersonal
aggression
o For an additional diagnosis of paranoid
personality disorder to be given, the personality
disorder must have been present before the
onset of psychotic symptoms and must persist
when the psychotic symptoms are in remission
(“premorbid”)
o Treatment: CBT
o Typically socially isolated and behave in ways

that would seem unusual to many of us, and
they tend to be suspicious and to have odd
beliefs
o Have “ideas of reference”
o Have odd beliefs or engage in “magical
thinking”
o Clinicians must be aware that different cultural
beliefs or practices may lead to a mistaken
diagnosis of this disorder
o Increased prevalence of schizotypal
personality disorder among relatives of people
o Show pattern of detachment from social with schizophrenia who do not also have
relationships and a limited range of emotions schizophrenia themselves
o Schizoid – describe people who have the o Also associated with childhood mistreatment
tendency to turn inward and away from the among men, and this childhood maltreatment
outside world seems to result in PTSD symptoms among
o Childhood Shyness is reported as a precursor women
to later adult schizoid personality disorder o Has relatively stable course, with only a small
o Abuse and neglect in childhood are also proportion of individuals going on to develop
reported among individuals schizophrenia or another psychotic disorder
o First apparent in childhood and adolescence
o Treatment: Social Skills Training
Abnormal Psychology
Cluster B
o Moods and relationships are unstable, and

o Characterized as having history of failing to usually they have poor self-image
comply with social norms o Often feel empty and are at a great risk of dying
o Tend to be irresponsible, impulsive, and by their own hands
deceitful o Often engage to suicidal behaviors
o Completely lacking in conscience and empathy, o Tend to have turbulent relationships, fearing
they selfishly take what they want and do as abandonment but lacking control over their
they please, violating social norms and emotions
expectations without the slightest guilt or o Often intense, going from anger to deep
regret depression in a short time
o Has chronic course but may become less o Dysfunction in the area of emotion is
evident or remit as the individual grows older, sometimes considered one of the core features
often by age 40 of borderline personality disorder
o Cannot be diagnosed before age 18 years old o Prevalent in families who have history of mood
o Given only if there is evidence of conduct disorders
disorder before age 15 years o Adolescents as young as 12 or 13 years can
o For individuals older than 18 years, a diagnosis meet full criteria
of CD is given only if the criteria for antisocial o Impulsive symptoms remit the most rapidly,
personality disorder are not met while affective symptoms remit at a
o When substance use and antisocial behavior substantially slower rate
both began in childhood and continued into o Recovery is more difficult to achieve and less
adulthood, both disorders should be diagnosed stable over time
if both are met, even though some antisocial o Often co-occurs with mood disorders, so if both
acts may be consequences of substance use criteria are met, both are diagnosed
disorder o Treatment: Dialectical Behavior Therapy
o Antisocial behavior that occurs exclusively
during schizophrenia or bipolar disorder
should not be diagnosed
o Underarousal Hypothesis – psychopaths have
abnormally low levels of cortical arousal
o Fearlessness Hypothesis – psychopaths
possess a higher threshold for experiencing
fear than most other individuals
o Treatment: Parent Training
Abnormal Psychology
Cluster C
o Tend to be overly dramatic and often seem

almost to be acting
o Express emotions in an exaggerated manner o Extremely sensitive of the opinion of others and
o Histrionic PD and Antisocial PD co-occur more although they desire social relationships, their
often anxiety leads them to avoid
o Extremely low self-esteem causes them to be
limited in their friendships and dependent on
those who they feel comfortable with
o Feel chronically rejected by others and are
pessimistic about their future
o Often starts in infancy or childhood with
shyness, isolation, and fear of strangers and
new situations
o Avoidant PD frequently occurs in the absence
of SAD
o Shows negative self-concept; SAD – negative
evaluation of others
o Treatment: Behavioral Intervention Techniques
o They consider themselves different from others
and deserve a special treatment
o Unreasonable sense of self-importance and
are so preoccupied with themselves that they
lack sensitivity and compassion for other
people
o Grandiosity – exaggerated feelings and their
fantasies of greatness
o Child may be fixated at self-centered,
grandiose stage of development
o Common in adolescents but do not necessarily
indicate that the individual will develop
narcissistic PD in adulthood
o Rely on others to make ordinary decisions as
well as important ones, which results in an
unreasonable fear of abandonment
o Agree with other people’s opinion just for them
to be not rejected
Abnormal Psychology
o Feel uncomfortable or helpless when alone Obsessive- People should do better, try
cause of exaggerated fears of being unable to Compulsive harder; I am perfectionist,
take care of themselves everything should be under my
control and my liking
end
o Fixation on things being done “the right way”

o This preoccupation with details prevents them
from completing much of anything
o Need to control all aspects of their life
o When criteria for both OCD and OCPD are met,
both diagnoses should be recorded
o Treatment: CBT
Summary of Personality Disorders
Cluster A
Paranoid I cannot trust people
Schizoid Relationships are messy and
undesirable
Schizotypal It’s better to be isolated from
others
Cluster B
Antisocial I am entitled to break rules
Borderline I deserve this suffering; sad gorl
iz me
Histrionic People are there to serve me or
admire me; Ako ang bida
Narcissistic I am special; You are all below
me; Pa-pangit nyo lahat, ako ang
pinaka powerful sa lahat
Cluster C
Avoidant If people knew the “real me”, they
will reject me
Dependent I need people to survive and be
happy

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Abnormal Psychology

Phase 4: Substance Related, Addictive, and Impulse-Control

o Usually occurs as an episode developing over

o When hallucinations occur in the absence of

o The disorder is not often persistent and is

o In particular, in the absence of intact reality

o Toxicological tests are useful in making this

o Intoxication attributable to other intoxicants

o Speed and severity of withdrawal associated

o Many individuals who misuse sedatives,

o Involves individuals in their tends or 20s who

o Salient mental disturbances associated with

o Usually begins within 24 hours of stopping or

o Genetic factors may affect how people

o Usually appear during preschool years and

o Recognizable during adolescence or early adult

o Typically socially isolated and behave in ways

o Moods and relationships are unstable, and

o Tend to be overly dramatic and often seem

o Fixation on things being done “the right way”

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