Abnormal Psychology: Jeremiah Paul Silvestre, RPM

Abnormal
Psychology
Jeremiah Paul Silvestre, RPm

Current Issues in Psychology
2nd semester, A.Y. 2018-2019
What is
“abnormal?”
Define “abnormality”
using the different
schools of thoughts.
Outcome Weight No. of
items
1. Distinguish between pathological and non- 20% 20
pathological manifestations of behavior.
2. Recognize common psychological disorders 20% 20
given specific symptoms.
3. Use major psychological theories, particularly 30% 30
the commonly recognized ones, in explaining how
psychological problems are caused and how they
develop.
4. Identify the socio-cultural factors that may 15% 15
impact on problem-identification and diagnosis of
abnormal behavior.
5. Apply appropriate ethical principles and 15% 15
standards in diagnosing cases of abnormal
behavior.
100% 100
Topics to be discussed:
• Depressive Disorders
• Bipolar and Related Disorders
• Schizophrenia Spectrum and Other
Psychotic Disorders
• Substance-Related and Addictive
Disorders
• Neurodevelopmental Disorders
• Neurocognitive Disorders
Defining Abnormal Behavior
• Dysfunction
• Distress
• Deviance
• Dangerousness
Assessing and Diagnosing
Abnormality
• Assessment – gathering information

about people’s symptoms/problems
• Diagnosis – labelling a set of symptoms

(i.e. syndrome) that often occur together
•co-morbidity – two or more co-occurring
diagnoses
Perspectives on Abnormal
Behavior
Biological Perspective
heritability of ADHD runs around
80 percent if the father has it.
-Barkley, 2013
Psychological Perspectives
Psychodynamic
Learning/Behaviorism
Humanism
Gestalt
Existential
Cognitive
Sociocultural Perspective
Medical Model
Abnormal Behavior: Treatment:
focus on biological hospitalization and

and physiological drugs
factor
Psychodynamic Model
consequence of identification and

anxiety produced by resolution of the
unresolved, conflicts
unconscious conflicts
Behavior/Learning Model
results from faulty or reshaping disordered

ineffective learning behavior learning
and conditioning new, more
appropriate, and
more adaptive
responses
Cognitive Model
particular thoughts developing new

and behaviors that thought processes
are often based upon and new values from
false assumptions maladaptive ones
Socio-Cultural Model
learned within a integrating of

social context different approaches/
ranging from the perspectives
family, to the
community, to the
culture
DEPRESSIVE
DISORDERS
Depressive Disorders
• Major Depressive Disorder
• Persistent Depressive Disorder
(Dysthymia)
-Feelings of helplessness and
hopelessness
-Loss of interest in daily
activities
-Appetite or weight changes
-Sleep changes
-Anger or irritability
-Loss of energy
-Self-loathing
-Reckless behavior
-Concentration problems
-Unexplained aches and pains
Major Depressive Disorder
Diagnostic Criteria:
A. Five (or more) of the following symptoms have been
present during the same 2-week period and represent
a change from previous functioning; at least one of the
symptoms is either (1) depressed mood or (2) loss of
interest or pleasure.
1. Depressed mood most of the day, nearly every day, as
indicated by either subjective report (e.g., feeling sad,
blue, “down in the dumps,” or empty) or observation
made by others (e.g., appears tearful or about to cry).
(In children and adolescents, this may present as an
irritable or cranky, rather than sad, mood.)
2. Markedly diminished interest or pleasure in all, or almost
all, activities every day, such as no interest in hobbies,
sports, or other things the person used to enjoy doing.
3. Significant weight loss when not dieting or weight gain
(e.g., a change of more than 5 percent of body weight in
a month), or decrease or increase in appetite nearly
every day.
4. Insomnia (inability to get to sleep or difficulty staying
asleep) or hypersomnia (sleeping too much) nearly
every day
5. Psychomotor agitation (e.g., restlessness, inability to sit
still, pacing, pulling at clothes or clothes) or retardation
(e.g., slowed speech, movements, quiet talking) nearly
every day
6. Fatigue, tiredness, or loss of energy nearly every day
(e.g., even the smallest tasks, like dressing or washing,
seem difficult to do and take longer than usual).
7. Feelings of worthlessness or excessive or inappropriate
guilt nearly every day (e.g., ruminating over minor past
failings).
8. Diminished ability to think or concentrate, or
indecisiveness, nearly every day (e.g. appears easily
distracted, complains of memory difficulties).
9. Recurrent thoughts of death (not just fear of dying),
recurrent suicidal ideas without a specific plan, or a
suicide attempt or a specific plan for committing suicide
B. The symptoms cause clinically significant distress or
impairment in social, occupational , or other important
areas of functioning.
C. The episode is not due to the effects of a substance or
to a medical condition.
D. The occurrence is not better explained by
schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional disorder, or
other specified and unspecified schizophrenia
spectrum and other psychotic disorders.
E. There has never been a manic episode or a
hypomanic episode.
Persistent Depressive Disorder
(Dysthymia)
A. Depressed mood for most of the day, for more days
than not, as indicated by either subjective account or
observation by others, for at least 2 years. In children
and adolescents, mood may be irritable and duration
must be at least 1 year.
B. Presence, while depressed, of two (or more) of the
following:
1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration and/or difficulty making decisions
6. Feelings of hopelessness
(Dysthymia)
C. During the 2-year period (1 year for children and
adolescents) of the disturbance, the individual has
never been without symptoms in Criteria A and B for
more than 2 months at a time.
D. Criteria for major depressive disorder may be
continuously present for 2 years.
E. There has never been a manic episode or a
hypomanic episode, and criteria have never been met
for cyclothymic disorder.
(Dysthymia)
F. The disturbance is not better explained by a persistent
schizoaffective disorder, schizophrenia, delusional
disorder, or other specified or unspecified
schizophrenia spectrum and other psychotic
disorders.
G. The symptoms are not attributable to the physiological
effects of a substance (e.g., a drug of abuse, a
medication) or another medical condition (e.g.,
hypothyroidism).
H. The symptoms cause clinically significant distress or
impairment in social, occupational, or other important
The Mood Cycle
BIPOLAR AND RELATED
DISORDERS
Bipolar and Related Disorders
• Bipolar I Disorder
• Bipolar II Disorder
• Cyclothymic Disorder
Mania is the cardinal symptom

of bipolar disorder. Without the
mania, it would be considered
Depressive Disorder.
Manic Episode
A. A distinct period of abnormally and persistently
elevated, expansive, or irritable mood, lasting at least
1 week (or any duration if hospitalization is necessary)
B. During the period of mood disturbance, three (or more) of
the following symptoms have persisted (four if the mood is
only irritable) and have been present to a significant
degree.
1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3 hours of
sleep)
3. more talkative than usual or pressure to keep talking
4. flight of ideas or subjective experience that thoughts are racing
Manic Episode
degree.
5. distractibility (i.e., attention too easily drawn to unimportant or
irrelevant external stimuli)
6. increase in goal-directed activity (either socially, at work or school, or
sexually) or psychomotor agitation
7. excessive involvement in pleasurable activities that have a high
potential for painful consequences (e.g., engaging in unrestrained
buying sprees, sexual indiscretions, or foolish business investments)
Manic Episode
C. The mood disturbance is sufficiently severe to cause
marked impairment in social or occupational
functioning or to necessitate hospitalization to prevent
harm to self or others, or there are psychotic features.
D. The episode is not attributable to the physiological
effects of a substance (eg, a drug of abuse, a
medication, or other treatment).
Hypomanic Episode
A. A distinct period of abnormally and persistently
elevated, expansive, or irritable mood and abnormally
and persistently increased activity or energy, lasting at
least four consecutive days and present most of the
day, nearly every day.
degree.
1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3 hours of
sleep)
3. more talkative than usual or pressure to keep talking
4. flight of ideas or subjective experience that thoughts are racing
Hypomanic Episode
degree.
5. distractibility (i.e., attention too easily drawn to unimportant or
irrelevant external stimuli)
6. increase in goal-directed activity (either socially, at work or school, or
sexually) or psychomotor agitation
7. excessive involvement in pleasurable activities that have a high
potential for painful consequences (e.g., engaging in unrestrained
buying sprees, sexual indiscretions, or foolish business investments)
Hypomanic Episode
C. The episode is associated with an unequivocal
change in functioning that is uncharacteristic of the
individual when not symptomatic.
D. The disturbance in mood and the change in
functioning are observable by others.
E. The episode is not severe enough to cause marked
impairment in social or occupational functioning or to
necessitate hospitalization. If there are psychotic
features, the episode is, by definition, manic.
F. The episode is not attributable to the physiological
effects of a substance (eg, a drug of abuse, a
medication, or other treatment).
Major Depressive Episode
A. Five (or more) of the following symptoms have been
present during the same 2-week period and represent
a change from previous functioning; at least one of the
symptoms is either (1) depressed mood or (2) loss of
interest or pleasure.
1. Depressed mood most of the day, nearly every day, as
indicated by either subjective report (e.g., feeling sad,
blue, “down in the dumps,” or empty) or observation
made by others (e.g., appears tearful or about to cry).
(In children and adolescents, this may present as an
irritable or cranky, rather than sad, mood.)
2. Markedly diminished interest or pleasure in all, or almost
all, activities every day, such as no interest in hobbies,
sports, or other things the person used to enjoy doing.
3. Significant weight loss when not dieting or weight gain
(e.g., a change of more than 5 percent of body weight in
a month), or decrease or increase in appetite nearly
every day.
4. Insomnia (inability to get to sleep or difficulty staying
asleep) or hypersomnia (sleeping too much) nearly
every day
5. Psychomotor agitation (e.g., restlessness, inability to sit
still, pacing, pulling at clothes or clothes) or retardation
(e.g., slowed speech, movements, quiet talking) nearly
every day
6. Fatigue, tiredness, or loss of energy nearly every day
(e.g., even the smallest tasks, like dressing or washing,
seem difficult to do and take longer than usual).
7. Feelings of worthlessness or excessive or inappropriate
guilt nearly every day (e.g., ruminating over minor past
failings).
8. Diminished ability to think or concentrate, or
indecisiveness, nearly every day (e.g. appears easily
distracted, complains of memory difficulties).
9. Recurrent thoughts of death (not just fear of dying),
recurrent suicidal ideas without a specific plan, or a
suicide attempt or a specific plan for committing suicide
B. The symptoms cause clinically significant distress or
C. The episode is not due to the effects of a substance or
to a medical condition.
D. The occurrence is not better explained by
schizoaffective disorder, schizophrenia,
Bipolar I Disorder
A. Criteria have been met for at least one manic episode
(Criteria A-D under “Manic Episode” above).
B. The occurrence of the manic and major depressive
episode (s) is not better explained by schizoaffective
disorder, schizophrenia, schizophreniform disorder,
delusional disorder, or other specified and unspecified
disorders.
C. The symptoms cause clinically significant distress or
Bipolar II Disorder
A. Criteria have been met for at least one hypomanic
episode (Criteria A-F under “Manic Episode” above)
and at least one major depressive episode (Criteria A-
C under “Major Depressive Episode” above.)
B. There has never been a manic episode.
C. The occurrence of the manic and major depressive
episode (s) is not better explained by schizoaffective
disorder, schizophrenia, schizophreniform disorder,
delusional disorder, or other specified and unspecified
disorders.
D. The symptoms cause clinically significant distress or
Cyclothymic Disorder
A. For at least 2 years (at least 1 year in children and
adolescents) there have been numerous periods with
hypomanic symptoms that do not meet criteria for a
hypomanic episode and numerous periods with
depressive symptoms that do not meet criteria for a
Major Depressive Episode.
B. During the above 2-year period (1 year in children and
adolescents), the hypomanic and depressive periods
have been present for at least half the time and the
individual has not been without the symptoms in for
more than 2 months at a time.
Cyclothymic Disorder
C. Criteria for major depressive, manic, or hypomanic
episode have never been met.
D. The symptoms in Criterion A are not better explained
by schizoaffective disorder, schizophrenia,
E. The symptoms are not attributable to physiological
effects of a substance (e.g., a drug of abuse, a
medication) or a general medical condition (e.g.,
hyperthyroidism).
F. The symptoms cause clinically significant distress or
The Mood Cycle
Persistent
Major
Depressive Bipolar I Bipolar II Cyclothymic
Depressive
Disorder Disorder Disorder Disorder
Disorder
(Dysthymia)
2 weeks 2 years 2 years
Major
symptoms
Depressive
Episode
*4 days
 / /  only
Manic
Episode
*1 week
    
Hypomanic symptoms
Episode
*4 days
  /  only
Case Study
Maria is a 19 year old Filipino female from Dumaguete
who moved to Metro Manila for college when she was 17.
Since her move, Maria had been feeling depressed most of the
time, crying frequently. She had difficulty concentrating and
making decisions on her own. She also suffered from low self-
esteem and felt tired most of the time. Sometimes, Maria will
feel better for about two weeks before experiencing sadness
and low self-esteem again.
Maria’s difficulty with concentration has markedly
affected her school performance. As such, she was recently put
on probation status due to her difficulty in passing her subjects.
Maria also chose to stay in her dorm room most of the time and
did not report having any friends.
Her medical report indicated no significant medical
history. There was also no sign of Maria having had either a
manic or hypomanic episode in the past.
SCHIZOPHRENIA
SPECTRUM AND
OTHER PSYCHOTIC
DISORDERS
Schizophrenia Spectrum And Other
Psychotic Disorders
• Delusional Disorder
• Brief Psychotic Disorder
• Schizophreniform Disorder
• Schizophrenia
• Schizoaffective Disorder
Schizophrenia Spectrum And Other
Psychotic Disorders
P
Mood disorders S
Y Substance
C induced
“organic” mental
H disorders
“Functional” O
disorders S
Schizophrenia Delirium
“spectrum” I Dementia
disorders S Amnestic d/o
Key Features That Define the
Psychotic Disorders
• Delusions
• Hallucinations
• Disorganized Thinking (Speech)
• Grossly Disorganized or Abnormal Motor
Behavior
• Negative Symptoms
Delusions
-are fixed beliefs that are not amenable to
change in light of conflicting evidence.
• Persecutory
• Referential
• Grandiose
• Erotomanic
• Nihilistic
• Somatic
• Jealous
Meet the Delusionals!
“bhe, masakit ang ulo

ko. I told you I have
brain tumor eh!”
“mga beshies! It’s the

Zombie Apocalypse
coming!!!”
“O-M-G! That
barista made
lagay some
lason in my
unicorn frappe!”
“gurl, y’know, that Your
Body is a Wonderland
song is written for me
by John Mayer. We are
secretly together na!
hihi.. kilig! <3
“I deserve an
acceptable reason
kung bakit you are
cheating on me.”
“Nagpapa-cute
na naman
‘tong reporter
na ‘to sa akin.”
#GGSS
“I was sent by
the Messiah to
save all of you,
humankind!”
Hallucinations
-are perception-like experiences that occur
without an external stimulus. They are vivid
and clear, with the full force and impact of
normal perceptions, and not under
voluntary control.
“I was diagnosed with Schizophrenia at the
age of 17, so I started drawing my
hallucinations to cope with it..”
-Kate
Disorganized Thinking (Speech)
• Derailment or loose associations
• Tangentiality
• Incoherence/“word salad”
Grossly Disorganized or Abnormal
Motor Behavior
• Catatonic behavior
–Negativism
–Bizarre posture
–Mutism and stupor
–Catatonic excitement
Negative Symptoms
• Diminished emotional expression
• Avolition
• Alogia
• Anhedonia
• Asociality
Case Study
Peter is a married 42-year-old postal worker was brought to the
hospital by his wife because he had been insisting that there was a
contract out on his life. He told the doctors that the problem started
about four months ago when his supervisor accused him of tampering
with a package, an offense that could have cost him his job. Though the
supervisor was exonerated at a formal hearing, he was furious and felt
publicly humiliated. Peter went on to say that his coworkers soon began
avoiding him, turning away from him when he walked by, as if they didn’t
want to see him. He began to think that they were talking about him
behind his back, although he could never clearly make out what they
were saying. He gradually became convinced that his coworkers were
avoiding him because his boss had put a contract on his life.
Peter said he had noticed several large white cars cruising up
and down the street where he lived. He believed there were hit men in
these cars and refused to leave his home without a companion. Other
than reporting that his life was in danger, his thinking and behavior
appeared entirely normal on interview. He denied any hallucinations and
excepting his unusual beliefs about his life being in danger, he showed
no other signs of psychotic behavior.
SUBSTANCE-RELATED AND
ADDICTIVE DISORDERS
Substance-Related and Addictive
Disorders
• Substance Use Disorders

• Substance-Induced Disorders
Substance Use Disorders
-are patterns of maladaptive use of

psychoactive substances that lead to
significant levels of impaired functioning or
personal distress
-specific diagnosis identifies the particular
substance associated with problematic use
(alcohol, caffeine, cannabis, tobacco, etc.)
Substance Use Disorders
Substance Abuse Substance Dependence
Diagnosis given when Diagnosis given when

recurrent substance use substance use leads to
leads to significant physiological
harmful consequences dependence or
(i.e. impairments in significant dependence
functioning) (i.e. persistent use
despite knowledge of
harm)
Substance-Induced Disorders
-are patterns of abnormal behavior induced

by use of psychoactive substances
Substance-Induced Disorders
Substance Intoxication Substance Withdrawal
Involves a pattern of Involves a cluster of

repeated episodes of symptoms that occur when
intoxication brought a person abruptly stops
about by use of a particular using a particular substance
substance (effect to the following a period of
central nervous system like prolonged and heavy use of
drunkenness or being the substance.
“high”)
NEURODEVELOPMENTAL
DISORDERS
Neurodevelopmental Disorders
• Intellectual Disability (Intellectual
Development Disorder)
• Autism Spectrum Disorder
• Attention-Deficit/Hyperactivity Disorder
Onset in the early

developmental period (6 years
old or earlier.)
Intellectual Disability (Intellectual
A. Deficits in intellectual functions, such as reasoning,
problem solving; planning; abstract thinking; judgment;
academic learning (ability to learn in school via
traditional teaching methods) and learning experience
(the ability to learn through experience, trial and error,
and observation), confirmed both by clinical
assessment and individualized, standardized
intelligence testing.
B. Deficits in adaptive functioning that result in failure to
meet developmental and sociocultural standards for
personal independence and social responsibility.
Without ongoing support, the adaptive deficits limit
functioning in one or more activities of daily life, such
as communication, social participation, and
independent living, across multiple environments,
such as home, school, work, and community
C. Onset of intellectual and adaptive deficits during the
developmental period.
Autism Spectrum Disorder
A. Persistent deficits in social communication and social
interaction across multiple contexts, as manifested by
the following, currently or by history (examples are
illustrative, not exhaustive; see text):
1. Deficits in social-emotional reciprocity, ranging, for
example, from abnormal social approach and failure of
normal back-and-forth conversation; to reduced sharing
of interests, emotions, or affect; to failure to initiate or
respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for
social interaction, ranging, for example, from poorly
integrated verbal and nonverbal communication; to
abnormalities in eye contact and body language or
deficits in understanding and use of gestures; to a total
lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understand
relationships, ranging, for example, from difficulties
adjusting behavior to suit various social contexts; to
difficulties in sharing imaginative play or in making
friends; to absence of interest in peers.
Specify current severity:
• Severity is based on social communication impairments and
restricted, repetitive patterns of behavior.
B. Restricted, repetitive patterns of behavior, interests, or
activities, as manifested by at least two of the
following, currently or by history (examples are
illustrative, not exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of
objects, or speech (e.g., simple motor stereotypes, lining
up toys or flipping objects, echolalia, idiosyncratic
phrases).
2. Insistence on sameness, inflexible adherence to
routines, or ritualized patterns of verbal or nonverbal
behavior (e.g., extreme distress at small changes,
difficulties with transitions, rigid thinking patterns,
greeting rituals, need to take same route or eat same
food every day).
3. Highly restricted, fixated interests that are abnormal in
intensity or focus (e.g., strong attachment to or
preoccupation with unusual objects, excessively
circumscribed or perseverative interests).
4. Hyper- or hyporeactivity to sensory input or unusual
interest in sensory aspects of the environment (e.g.
apparent indifference to pain/temperature, adverse
response to specific sounds or textures, excessive
smelling or touching of objects, visual fascination with
lights or movement).
Specify current severity:
• Severity is based on social communication impairments and
restricted, repetitive patterns of behavior.
C. Symptoms must be present in the early developmental
period (but may not become fully manifest until social
demands exceed limited capacities, or may be
masked by learned strategies in later life).
D. Symptoms cause clinically significant impairment in
social, occupational, or other important areas of
current functioning.
E. These disturbances are not better explained by
intellectual disability (intellectual developmental
disorder) or global developmental delay. Intellectual
disability and autism spectrum disorder frequently co-
occur; to make comorbid diagnoses of autism
spectrum disorder and intellectual disability, social
communication should be below that expected for
general developmental level.
Attention-Deficit/Hyperactivity
Disorder
A. A persistent pattern of inattention and/or hyperactivity-
impulsivity that interferes with functioning or
development, as characterized by (1) and/or (2):
1. Inattention: Six or more of the following symptoms of
inattention have persisted for at least 6 months to a
point that is inappropriate for developmental level:
a) Often does not give close attention to details or makes
careless mistakes in schoolwork, work, or other
activities.
b) Often has trouble keeping attention on tasks or play
activities.
c) Often does not seem to listen when spoken to directly.
Disorder
d) Often does not follow through on instructions and fails
to finish schoolwork, chores, or duties in the workplace
(not due to oppositional behavior or failure to
understand instructions).
e) Often has trouble organizing activities.
f) Often avoids, dislikes, or doesn’t want to do things that
take a lot of mental effort for a long period of time
(such as schoolwork or homework).
g) Often loses things needed for tasks and activities (e.g.
toys, school assignments, pencils, books, or tools).
h) Is often easily distracted.
i) Is often forgetful in daily activities.
Disorder
A. A persistent pattern of inattention and/or hyperactivity-
impulsivity that interferes with functioning or
development, as characterized by (1) and/or (2):
2. Hyperactivity and Impulsivity: Six or more of the
following symptoms of inattention have persisted for at
least 6 months to a point that is inappropriate for
developmental level:
a) Often fidgets with hands or feet or squirms in seat
when sitting still is expected.
b) Often gets up from seat when remaining in seat is
expected.
c) Often excessively runs about or climbs when and
where it is not appropriate (adolescents or adults may
feel very restless).
Disorder
d) Often has trouble playing or doing leisure activities
quietly.
e) Is often “on the go” or often acts as if “driven by a
motor”.
f) Often talks excessively.
g) Often blurts out answers before questions have been
finished.
h) Often has trouble waiting one’s turn.
i) Often interrupts or intrudes on others (e.g., butts into
conversations or games).
Disorder
B. Several inattentive or hyperactive-impulsive symptoms
were present prior to age 12 years.
C. Several inattentive or hyperactive-impulsive symptoms
are present in two or more settings (e.g., at home,
school, or work; with friends or relatives; in other
activities.)
D. There is clear evidence that symptoms interfere with,
or reduce the quality of, social, academic, or
occupational functioning.
E. The symptoms do not occur exclusively during the
course of schizophrenia or another psychotic disorder
and are not better explained by another medical
disorder.
Case Study
Alonzo is a 7-year-old boy who was referred for a clinical
consultation. Inside the play room, Alonzo barely made eye contact
with the therapist and was preoccupied with a small blanket he
brought with him. He also did not respond when the therapist asked
him questions. His mother reported that she had begun noticing
years earlier that Alonzo did not interact much with others, either at
home or at preschool, but assumed that when he started 1st grade
things will get better. Mother stated, however, that this was not the
case and that he was significantly less social than his peers. Alonzo’s
academic performance was poor and teachers have noted that it was
hard for him to play with others or to follow the teachers’ instructions.
His teachers have observed that Alonzo engages in tantrums
whenever there are slight changes to the daily school routine. He
would also engage in tantrums whenever the classroom became
noisy. Mother brought in a prior neuropsychological report that
showed Alonzo having significant deficits in reasoning, problem
solving, judgment, and academic learning. Mother also admitted that
she ties his shoe laces for him, gives him baths, and brushes his teeth
for him.
ELIMINATION
DISORDERS
Elimination Disorders
• Enuresis
• Encopresis
Enuresis
The child must be at least 5 years of age or at an equivalent
developmental level and meet the following criteria:
• Repeatedly wetting bedding or clothes (whether intentionally

or involuntarily)
• Wetting occurs at least twice a week for three months or
causes significant distress or impairment in functioning
• There is no medical or organic basis to the disorder; nor is it
caused by use of a drug or medication
Encopresis
The child must be at least 4 years of age or at an equivalent
developmental level and meet the following criteria:
• Repeated passage of feces into inappropriate places, whether

involuntary or intentional
• At least one such event occurs each month for at least 3
months or impairment in functioning
• There is no medical or organic basis to the disorder; nor is it
caused by use of a drug or medication
TRAUMA- AND
STRESSOR-
RELATED
DISORDERS
Trauma- and Stressor-Related
Disorders
• Post-Traumatic Stress Disorder
• Acute Stress Disorder
stressors
• Distress • Eustress
– Death of a family – Examination or graded
member recitation
– Hospitalization – Contest or competition
– Injury or illness – Vacation
– Separation from a – Holiday seasons
committed relationship – New job/hobby
partner
– Money problems
ANXIETY
DISORDERS
Anxiety Disorders
• Panic Disorder
• Agoraphobia
• Social Anxiety Disorder
• Generalized Anxiety Disorder
Anxiety-Biological Mechanisms
• fight or flight response -hypothalamus
• Sympathetic Nervous System
• hormone - cortisol
Panic Disorder
• fight or flight response -hypothalamus
• Sympathetic Nervous System
• hormone - cortisol
Response is out of proportion

Panic Disorder
A. Recurrent unexpected panic attacks- an abrupt surge
of intense fear or intense discomfort that reaches a
peak within minutes., and during which time four (or
more) of the following symptoms occur:
1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating.
3. Trembling or shaking.
4. Sensations of shortness of breath or smothering.
5. Feelings of choking.
6. Chest pain or discomfort.
7. Nausea or abdominal distress.
Panic Disorder
A. Recurrent unexpected panic attacks- an abrupt surge
of intense fear or intense discomfort that reaches a
peak within minutes., and during which time four (or
more) of the following symptoms occur:
8. Feeling dizzy, unsteady, light-headed or faint.
9. Chills or heat sensations.
10. Paresthesias ( numbness or tingling sensations.)
11. Derealization (feelings of unreality) or depersonalization
(being detached from oneself.)
12. Fear of losing control or going crazy.
13. Fear of dying.
Note: Culture specific symptoms should not count as four
required symptoms.
Panic Disorder
B. At least one of the attacks has been followed by 1
month (or more) of one or both of the following:
1. Persistent concern or worry about additional panic
attacks or their consequences
2. A significant maladaptive change in behavior related to
the attacks.
C. The disturbance is not attributable to physiological
effects of a substance or another medical condition.
D. The disturbance is not better explained by another
mental disorder.
Agoraphobia
A. Marked fear or anxiety about two (or more) of the
following five situations:
1. Using public transportations.
2. Being in open spaces.
3. Being in enclosed spaces.
4. Standing in line or being in a crowd.
5. Being outside of the home alone.
B. The individual fears or avoids these situations
because of thoughts that escape might be difficult or
help might not be available in the event of developing
panic-like symptoms or other incapacitating or
embarrassing symtpoms.
Agoraphobia
C. The agoraphobic situations almost always provoke
fear or anxiety.
D. The agoraphobic situations are actively avoided,
require the presence of the companion, or are
endured with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual
danger posed by the agoraphobic situations and to the
sociocultural context.
F. The fear, anxiety or avoidance is persistent, typically
lasting for 6 months or more.
G. The fear, anxiety or avoidance causes clinically
significant distress or impairment in social,
occupational, or other important areas of functioning.
Agoraphobia
H. If another medical condition is present, the fear,
anxiety or avoidance is clearly excessive.
I. The fear, anxiety or avoidance is not better explained
the symptoms of another mental disorder.
Note: Can co-occur with Panic Disorder
Specify with specific phobia
Social Anxiety Disorder (Social
Phobia)
A. Marked fear or anxiety about one or more social
situations in which the individual is exposed to
possible scrutiny by others.
B. The individual fears that he or she will act in a way or
show anxiety symptoms that will be negatively
evaluated.
C. The social situations almost always provoke fear or
anxiety.
D. The social situations are avoided or endured with
intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual
threat posed by the social situation and to the
sociocultural context.
Social Anxiety Disorder (Social
Phobia)
F. The fear, anxiety or avoidance is persistent, typically
lasting for 6 months or more.
G. The fear, anxiety or avoidance causes clinically
H. The fear, anxiety or avoidance is not attributable to
physiological effects of a substance or another
medical condition
I. The fear, anxiety or avoidance is not better explained
by the symptoms of another mental disorder.
J. If another medical condition is present, the fear,
anxiety or avoidance is excessive.
Generalized Anxiety Disorder
A. Excessive anxiety or worry, occurring more days than
not for at least 6 months, about a number of events or
activities.
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or
more) of the following six symptoms:
1. Restlessness or feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance.
Generalized Anxiety Disorder
D. The anxiety worry or physical symptoms causes
clinically significant distress or impairment in social,
E. The disturbance is not attributable to physiological
effects of a substance or another medical condition
F. The disturbance is not better explained by another
mental disorder.
Case Study
Helen is a 59-year-old widow. By the time she came for
treatment, she was accompanied to her evaluation session by
her daughter, Mary. She was a fraillooking woman who entered
the office clutching Mary’s arm and insisted that Mary stay
throughout the interview. Helen recounted that she had lost her
husband and mother within 3 months of one another; her father
had died 20 years earlier. Although she had never experienced
a panic attack, she always considered herself an insecure,
fearful person. Even so, she had been able to function in
meeting the needs of her family until the deaths of her husband
and mother left her feeling abandoned and alone.
She had now become afraid of “just about everything”
and was terrified of being out on her own, lest something bad
would happen and she wouldn’t be able to cope with it. Even at
home, she was fearful that she might lose her daughter and
son. She needed continual reassurance from them that they
too wouldn’t abandon her.
OBSESSIVE-
COMPULSIVE
AND
RELATED
DISORDERS
Obsessive-Compulsive and Related
Disorders
• Obsessive-Compulsive Disorder
OBSESSIONS COMPULSIONS
Germs Cleaning
Unsafe Checking
Something bad will Repeating

happen
Chaotic Arranging
Obsessive-Compulsive Disorder
A. Presence of obsessions, compulsions, or both:
Obsessions, are defined by (1) and (2)
1. Recurrent and persistent thoughts, urges or
images during the disturbance, as intrusive and
unwanted, and that in most individuals cause marked
anxiety or distress.
2. The individual attempts to ignore or suppress
such thoughts, urges or images, or to neutralize them with
some other thought or action.
A. Presence of obsessions, compulsions, or both:
Compulsions, are defined by (1) and (2)
1. Repetitive behaviors or mental acts that the
individual feels driven to perform in response to an
obsession or according to rules that must be applied
rigidly.
2. The behaviors or mental acts are aimed at
preventing or reducing anxiety or distress, or preventing
some dreaded event or situation.; however, these
behaviors or mental acts are not connected in a realistic
way with what they are designed to neutralize or prevent,
or are clearly excessive.
B. The obsessions or compulsions are time-consuming
(e.g. take more than 1 hour per day) or cause clinically
C. The obsessive-compulsive symptoms are not
attributable to physiological effects of a substance or
another medical condition
D. The disturbance is not better explained by another
mental disorder.
Sample Case
Jack, a successful chemical engineer, was urged by his wife, Mary, a
pharmacist, to seek help for “his little behavioral quirks,” which she
had found increasingly annoying. Jack was a compulsive checker.
When they left the apartment, he would insist on returning to check
that the lights or gas jets were off or that the refrigerator doors were
shut. Sometimes he would apologize at the elevator and return to the
apartment to carry out his rituals. Sometimes the compulsion to check
struck him in the garage. He would return to the apartment, leaving
Mary fuming. Going on vacation was especially difficult for Jack. The
rituals occupied the better part of the morning of their departure. Even
then, he remained plagued by doubts. Mary had also tried to adjust to
Jack’s nightly routine of bolting out of bed to recheck the doors and
windows. Her patience was running thin. Jack realized that his
behavior was impairing their relationship as well as causing him
distress. Yet he was reluctant to enter treatment. He gave lip service
to wanting to be rid of his compulsive habits, but he also feared that
surrendering his compulsions would leave him defenseless against
the anxieties they helped to ease.
Sample Case
that the lights or gas jets were off or that the refrigerator doors
were shut. Sometimes he would apologize at the elevator and return
to the apartment to carry out his rituals. Sometimes the compulsion to
check struck him in the garage. He would return to the apartment,
leaving Mary fuming. Going on vacation was especially difficult for
Jack. The rituals occupied the better part of the morning of their
departure. Even then, he remained plagued by doubts. Mary had also
tried to adjust to Jack’s nightly routine of bolting out of bed to recheck
the doors and windows. Her patience was running thin. Jack realized
that his behavior was impairing their relationship as well as causing
him distress. Yet he was reluctant to enter treatment. He gave lip
service to wanting to be rid of his compulsive habits, but he also
feared that surrendering his compulsions would leave him
defenseless against the anxieties they helped to ease.
Sample Case
to the apartment to carry out his rituals. Sometimes the
compulsion to check struck him in the garage. He would return to the
apartment, leaving Mary fuming. Going on vacation was especially
difficult for Jack. The rituals occupied the better part of the morning of
their departure. Even then, he remained plagued by doubts. Mary had
also tried to adjust to Jack’s nightly routine of bolting out of bed to
recheck the doors and windows. Her patience was running thin. Jack
realized that his behavior was impairing their relationship as well as
causing him distress. Yet he was reluctant to enter treatment. He
gave lip service to wanting to be rid of his compulsive habits, but he
also feared that surrendering his compulsions would leave him
defenseless against the anxieties they helped to ease.
Sample Case
difficult for Jack. The rituals occupied the better part of the
morning of their departure. Even then, he remained plagued by
doubts. Mary had also tried to adjust to Jack’s nightly routine of
bolting out of bed to recheck the doors and windows. Her patience
was running thin. Jack realized that his behavior was impairing their
relationship as well as causing him distress. Yet he was reluctant to
enter treatment. He gave lip service to wanting to be rid of his
compulsive habits, but he also feared that surrendering his
compulsions would leave him defenseless against the anxieties they
helped to ease.
Sample Case
bolting out of bed to recheck the doors and windows. Her
patience was running thin. Jack realized that his behavior was
impairing their relationship as well as causing him distress. Yet he
was reluctant to enter treatment. He gave lip service to wanting to be
rid of his compulsive habits, but he also feared that surrendering his
compulsions would leave him defenseless against the anxieties they
helped to ease.
Sample Case
impairing their relationship as well as causing him distress. Yet
he was reluctant to enter treatment. He gave lip service to wanting to
be rid of his compulsive habits, but he also feared that surrendering
his compulsions would leave him defenseless against the anxieties
they helped to ease.
Sample Case
impairing their relationship as well as causing him distress. Yet
he was reluctant to enter treatment. He gave lip service to wanting to
be rid of his compulsive habits, but he also feared that surrendering
his compulsions would leave him defenseless against the
anxieties they helped to ease.

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Abnormal

Jeremiah Paul Silvestre, RPm

• Assessment – gathering information

• Diagnosis – labelling a set of symptoms

Abnormal Behavior: Treatment:

focus on biological hospitalization and

Abnormal Behavior: Treatment:

consequence of identification and

Abnormal Behavior: Treatment:

results from faulty or reshaping disordered

Abnormal Behavior: Treatment:

particular thoughts developing new

Abnormal Behavior: Treatment:

learned within a integrating of

Mania is the cardinal symptom

2 weeks 2 years 2 years

“bhe, masakit ang ulo

“mga beshies! It’s the

• Substance Use Disorders

-are patterns of maladaptive use of

Substance Abuse Substance Dependence

Diagnosis given when Diagnosis given when

-are patterns of abnormal behavior induced

Substance Intoxication Substance Withdrawal

Involves a pattern of Involves a cluster of

Onset in the early

• Repeatedly wetting bedding or clothes (whether intentionally

• Repeated passage of feces into inappropriate places, whether

Response is out of proportion

Something bad will Repeating

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