Mrs. Mileo's Psychology



Psychopathology Case StudiesPractice PacketDSM-5Study Guide and ReviewNEURODEVELOPMENTAL DISORDERSIntellectual Disability or Intellectual Developmental Disorder (formerly Mental Retardation)Autism Spectrum Disorder (incorporates Asperger disorder, childhood disintegrative disorder, pervasive developmental disorder not otherwise specified)Learning Disorders (Academic Skills Disorders)Reading Disorder (Developmental Reading Disorder)/Mathematics Disorder (Developmental Arithmetic Disorder)/ Disorder of Written Expression (Developmental Expressive Writing Disorder)Motor DisordersDevelopmental Coordination Disorder/ Tourette’s Disorder/ Chronic Motor or Vocal Tic Disorder/Transient Tic Disorder Stereotypic Movement DisorderAttention-deficit DisordersAttention-deficit/Hyperactivity Disorder Communication DisordersExpressive Language Disorder (Developmental Expressive Language Disorder)/Developmental Receptive Language Disorder/Phonological Disorder (Developmental Articulation Disorder)/StutteringSCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERSSchizophreniaSchizophreniform DisorderSchizoaffective DisorderSchizotypal Personality DisorderDelusional DisorderBrief Psychotic DisorderCatatoniaPsychotic Disorder Due to a General Medical Condition (with delusions/with hallucinations)Substance induced Psychotic DisorderBIPOLAR AND RELATED DISORDERSBipolar DisordersBipolar I Disorder/Bipolar II Disorder (Recurrent Major Depressive Episode with Hypomania)/ Bipolar disorder Not Elsewhere Defined/ Cyclothymic DisorderDEPRESSIVE DISORDERSDepressive DisordersMajor Depressive Disorder/Dysthymic (Persistent Depressive) Disorder/ Disruptive Mood Dysregulation Disorder (for children up to 18)Premenstrual Dysphoric DisorderMood Disorder Due to a General Medical ConditionSubstance induced Mood DisorderANXIETY DISORDERSPanic DisorderAgoraphobiaSpecific Phobia (Simple Phobia)Social Anxiety DisorderSeparation Anxiety DisorderSelective MutismGeneralized Anxiety Disorder (Includes Overanxious Disorder of Childhood)Anxiety Disorder Due to a General Medical ConditionSubstance induced Anxiety DisorderOBSESSIVE-COMPULSIVE AND RELATED DISORDERSObsessive-Compulsive DisorderExcoriation (skin picking) DisorderHoarding DisorderTrichotillomaniaBody Dysmorphic DisorderBody Focused Repetitive Behavior Disorder (nail biting, lip biting, check chewing)Obsessional JealousyTRAUMA AND STRESSOR RELATED DISORDERSPosttraumatic Stress disorderAcute Stress DisorderReactive Attachment DisorderDisinhibited Social Engagement DisorderAdjustment Disorderswith Anxietywith Depressed Moodwith Disturbance of Conductwith Mixed Disturbance of Emotions and Conductwith Mixed Anxiety and Depressed MoodDISSOCIATIVE DISORDERSDissociative Amnesia (including Fugue)Dissociative Identity Disorder (Multiple Personality Disorder)Depersonalization/Derealization DisorderSOMATIC SYMPTOM AND RELATED DISORDERSSomatic Symptom Disorder (can be with predominant pain or psychological factors that affect other medical conditions)Conversion DisorderIllness Anxiety DisorderFactitious DisorderPseudocyesisFEEDING AND EATING DISORDERSAnorexia NervosaBinge Eating DisorderBulimia NervosaPicaRumination DisorderAvoidant/Restrictive Food Intake DisorderELIMINATION DISORDERSEncopresis/EnuresisSLEEP-WAKE DISORDERSInsomnia DisorderNarcolepsyHypersomnolenceBreathing Related Disorders: hypopnea, central sleep apnea, and hypoventilationCircadian rhythm sleep-wake disorders: advanced sleep phase syndrome, irregular sleep-wake type, non-24-hourRapid Eye Movement sleep behavior disorderRestless Legs SyndromeNightmare Disorder (Dream Anxiety Disorder)Sleep Terror DisorderSleep Disorder Due to a General Medical ConditionSubstance induced Sleep DisorderSEXUAL DYSFUNCTIONSSexual DysfunctionsSexual Desire Disorders: Hypoactive Sexual Desire Disorder; Sexual Arousal Disorders: Female Sexual Interest/Arousal Disorder; Male Erectile Disorder; Orgasm Disorders: Female Orgasmic Disorder (Inhibited Female Orgasm); Male Orgasmic Disorder (Inhibited Male Orgasm); Premature Ejaculation/Sexual Pain Disorders: Genito-Pelvic Pain and Penetration Disorder;Substance induced Sexual DysfunctionGENDER DYSPHORIACross-Gender Identification and Aversion toward One’s Gender:ChildrenAdolescentAdultDISRUPTIVE, IMPULSE-CONTROL, and CONDUCT DISORDERSOppositional Defiant Disorderangry/irritable moodargumentative/defiant behaviorvindictiveness Conduct DisorderDisruptive Behavior DisorderAntisocial Personality DisorderIntermittent Explosive DisorderKleptomaniaPyromaniaSUBSTANCE RELATED AND ADDICTIVE DISORDERSAlcohol Use DisordersAmphetamine (or Related Substance) Use DisordersCaffeine Use DisordersCannabis Use DisordersCocaine Use DisordersGambling Use DisordersHallucinogen Use DisordersInhalant Use DisordersNicotine Use DisordersOpioid Use DisordersPhencyclidine (or Related Substances) Use DisordersSedative, Hypnotic, or Anxiolytic Substance Use DisordersPolysubstance Use DisordersNEUROCOGNITIVE DISORDERSDeliriaDelirium Due to a General Medical Condition/Substance Induced Delirium/Delirium Due to Multiple EtiologiesMajor Neurocognitive Disorder (formerly dementia)Dementia of the Alzheimer’s Type; With Early Onset: if onset at age 65 or below; With Late Onset: if onset after age 65/ Vascular Dementia; Dementias Due to Other General Medical Conditions/ Substance induced Persisting Dementia/ Dementia Due to Multiple EtiologiesMild Neurocognitive Disorder (formerly amnesia)Amnestic Disorder Due to a General Medical Condition/ Substance induced Persisting Amnestic Disorder PARAPHILIC DISORDERSExhibition Disorder/Fetish Disorder /Frotteur Disorder/ Pedophilic Disorder/Sexual Masochistic Disorder /Sexual Sadistic Disorder /Voyeuristic Disorder/Transvestic Fetishism DisorderPERSONALITY DISORDERSParanoid Personality DisorderSchizoid Personality DisorderSchizotypal Personality DisorderAntisocial Personality DisorderBorderline Personality DisorderHistrionic Personality DisorderNarcissistic Personality DisorderAvoidant Personality DisorderDependent Personality DisorderObsessive-Compulsive Personality DisorderANXIETY and OBSESSIVE-COMPULSIVE DISORDERS1. Generalized Anxiety DisorderExcessive anxiety and worry that they cannot control a number of events or activities.The anxiety lasts for at least six monthsThe anxiety and worry are associated with at least three of the following symptoms:restlessness or feeling “keyed up” or on edgebeing easily fatigueddifficulty concentrating or mind going blankirritabilitymuscle tensionsleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)2. Panic AttacksA panic attack is a syndrome or reproducible cluster of symptoms that can occur in several different Anxiety Disorders May display diverse characteristics. The essential feature of a panic attack is the occurrence of a period of intense fear or discomfort, usually lasting for several minutes, and accompanied by at least four of the following symptoms, which develop abruptly and reach a peak of intensity within ten minutespalpitations, pounding, or accelerated heart ratesweatingtrembling or shakingsensations of shortness of breath or smotheringfeeling of chokingchest pain or discomfortnausea or abdominal distressfeeling dizzy, unsteady, or faintderealization (feeling of unreality) or depersonalization (being detached from oneself)fear of losing control or going crazyfear of dyingnumbness or tingling sensationschills or hot flushes3. Panic DisorderRecurrent, unexpected panic attacks that are followed by at least a month of worry about having additional attacks, concern about the implications of the attacks, or a change in behavior related to the attacks4. AgoraphobiaAnxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected Panic Attack.Agoraphobic fears typically involve situations that include being outside of the home alone; being in a crowd or standing in line; being on a bridge; and travelling in a bus, train, or automobile. These situations are avoided.5. Specific PhobiasExcessive and unreasonable fear of exposure to a specific object or situation that provokes an immediate anxiety response that may take the form of a panic attack.The object or situation is avoided by the person or endured with intense distress.6. Social Anxiety DisorderFear of one or more social or performance situations in which they are exposed to scrutiny by others and fear they will act in a way that will be humiliating or embarrassing. Exposure to the feared situation almost invariably provokes anxiety that may take the form of a panic attack.The feared situations are avoided or endured with intense anxiety or distress.7. Obsessive-Compulsive DisorderObsessions: recurrent, persistent, and intrusive thoughts that cause anxiety or distress that they try to suppress and neutralize with:Compulsions: repetitive behaviors that they feel driven to perform in an attempt to prevent distress or some dreaded event.The person has recognized that the obsessions or compulsions are excessive and unreasonable.DISSOCIATIVE AND PERSONALITY DISORDERS1. Dissociative AmnesiaOne or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness.Dissociative FugueIndividuals suddenly travel away from their home or place of work. During this period they are unable to recall their past, have confusion about their personal identity, and may assume a partial or complete new identify.3. Dissociative Identity Disorder (formerly Multiple Personality Disorder)Individuals have two or more distinct identities or personality states that have a relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.At least two of these identities recurrently take control of the person’s behavior. During these periods the individual is often unable to recall important personal information.4. Personality DisordersAn enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas: cognition, affect, interpersonal functioning, impulse control.The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.The pattern is stable and of long duration and its onset can be traced back at least to adolescence or early adulthood.The enduring pattern is not due to direct physiological effects of a substance or a general medical condition.Paranoid Personality Disorder: pervasive distrust and suspiciousness of othersSchizoid Personality Disorder: pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings.Schizotypal Personality Disorder: pervasive pattern of deficits marks by discomfort with, and reduced capacity for, close relationships, as well as cognitive or perceptual distortions and eccentricities of behavior.Antisocial Personality Disorder: pervasive pattern of disregard for and violation of the rights of others.Borderline Personality Disorder: pervasive pattern of instability in interpersonal relationships, self-images, affects, and control over impulses.Histrionic Personality Disorder: pervasive pattern of excessive emotionality and attention seeking.Narcissistic Personality Disorder: pervasive pattern of grandiosity, need for admiration, and lack of empathy.Avoidant Personality Disorder: pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.Dependent Personality Disorder: pervasive and excessive need to be taken care of, leading to submissive and clinging behavior and fears of separation.Obsessive-Compulsive Personality Disorder: pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.DEPRESSIVE DISORDERSCriteria for a Major Depressive Episode: Five (or more) of the following symptoms have been present during the same two 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 pleasuredepressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by othersmarkedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every daysignificant weight loss or weight gain when not dieting (e.g. More than 5% of body weight in a month), or decrease or increase in appetite nearly every dayinsomnia or hypersomnia nearly every dayfatigue or loss of energy nearly every dayfeelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every daydiminished ability to think or concentrate, or indecisiveness, nearly every dayrecurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide.(Not due to effects of substance abuse, a general medical condition, and not better accounted for by bereavement; symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning)Criteria for a Manic EpisodeA. a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week.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.inflated self-esteem or grandiositydecreased need for sleep (e.g. feels rested after only three hours of sleep)more talkative than usual or pressure to keep talkingflight of ideas or subjective experiences that thoughts are racingdistractibility (i.e. attention too easily drawn to unimportant or irrelevant stimuli)increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitationexcessive involvement in pleasurable activities that have a high potential for painful consequences.(Not due to substance abuse or general medical condition; cause marked impairment in occupational functioning or in usual social activities or relationships with others)ANXIETY DISORDERSCASE STUDIESCASE AA 35 year old clothing salesman was showing a particularly fussy customer a suit two months ago and suddenly began to sweat profusely. His heart started to pound, he felt dizzy and because fearful that he was about the die. The customer didn’t notice his condition and continued to question him about the suit in minute detail. The patient, feeling faint, abruptly left the customer and went to lie down in the back of the store. The customer became insulted, complained to the manager, and left. When the manager found the patient, he was slumped in a chair in the back room trembling. Approximately ten minutes later the patient’s symptoms began to subside. He saw his physician the next day who found no evidence of any medical problems. Two weeks later he had another similar unexpected attack. Since that time he has worries continuously about having another attack. His friends and colleagues have noticed that he is no longer as spontaneous and outgoing as he had been in the past.CASE B“I wish I could tell you exactly what’s the matter. Sometimes I feel like something terrible has just happened when actually nothing has happened at all. Other time I’m expecting the sky to fall down any minute. Most of the time I can’t point my finger at something specific. Still, I feel tense and jumpy. The fact is that I am tense and jumpy almost all of the time. Sometimes my heart beats so fast, I’m sure it’s a heart attack.”CASE C“I can’t tell you why I am afraid of rats. They fill me with terror. Even if I just see the word “rat,” my heart starts pounding. I worry about rats in the restaurants I go to, in my kitchen cupboard, and anywhere I hear a noise that sounds like a small animal scratching or running.”CASE DA twenty-eight year old woman was walking through her local shopping mall when she began to feel intensely anxious. The anxiety was accompanied by sensations of choking, smothering, and a sudden sense that the people and sores around her were unreal. She began to fear that she was going crazy and the more she worried about this the more anxious she became. A guard, seeing that she was in distress, brought her to the mall office where she was able to lie down. A few minutes later the symptoms began to subside. She went home after leaving the mall but she did not tell her husband what had happened. A week later she had a similar attack while she was walking down the street. She was able to reach her house where she lay down until the attack ended. In the following three weeks, she had two more attacks. Between attacks she was constantly worried about having another attack. The patient was finally forced to tell her husband because she was so fearful of not being able to get help if an attack occurred that she would not leave her house alone or travel on public transportation.CASE EA twenty-eight year old woman is a rising junior executive in her investment company. Her increasing duties require her to make periodic formal presentations to the senior management of the company. However, she becomes intensely anxious at the thought of speaking in public. When she is forced to give a presentation she begins to feel anxious days in advance of the talk and the anxiety increases as the time for the talk approaches. She is concerned that her anxiety will become noticeable during the talk or that she will do something to embarrass herself. CASE FA thirty-eight year old man has been increasing anxious about his job in a large manufacturing company. He feels he has been passed over for promotion several times. The patient is preoccupied with many small events and conversations that have occurred at work during the year and worries how his superiors will interpret them. He finds it difficult to control his worrying. During the day at work he feels restless and edgy. AT home he is irritable and has difficulty sleeping. His wife asks him about work, but he doesn’t want to talk about it.You Are The Therapist: Anxiety DisordersCase ASymptoms of IndividualDSM-5 ClassificationCase BSymptoms of IndividualDSM-5 ClassificationCase CSymptoms of IndividualDSM-5 ClassificationCase DSymptoms of IndividualDSM-5 ClassificationCase ESymptoms of IndividualDSM-5 ClassificationCase FSymptoms of IndividualDSM-5 ClassificationOBSESSIVE-COMPULSIVE, DISSOCIATIVE, and SOMATIC DISORDERSCASE STUDIESCASE ARocky Prater went to college only because of pressure from his older brother. Unfortunately, he got into several courses he hated, so that the entire school day seemed difficult and dull. Shortly before midterms, Rocky developed a thought that he had not set his alarm clock. He would lean out of bed to check, but it was always set. Sometimes he would wake up in the middle of the night with the terrible feeling that the alarm was not set, but it always was. Still he continued to go through this alarm checking ritual at least once every night and often more frequently. Finally, his counselor helped him realize that his recurring thought was based on his unconscious desire to sleep through his morning classes, and that the behavior was his unconscious method of counter-acting these unrecognized feelings. After his talk with the counselor, his behavior began to fade away.CASE BA workman while attempting to throw an electrical switch, was thrown to the ground by a “shock.” Shortly thereafter he discovered that he could not use his right leg. He was bedfast for several months and later could move about only with the aid of crutches and a brace. A suit for a large sum was brought against the company for which he had been working at the time of the accident. In the course of the trial, evidence was presented indicating that the switch had been carrying a much lower voltage than the workman had supposed it carried. Furthermore, the switch was so constructed that it seemed almost impossible for anyone to receive a shock from it. A medical examination showed that there was no nerve injury as the man claimed and that no damage had been done to the muscles of the leg. Nevertheless, the man was unable to use his leg and so was unable to earn a living for his family. The court allowed the man some compensation, though not nearly as much as he had demanded. The case was closed. Within a short time thereafter, all symptoms of paralysis disappeared. The man was able to perform his duties as well as ever.CASE CDonald (age 22) attended college at night while working to support his forty-five year old mother. He was in love with a girl whom he hoped to marry. Donald’s mother, however, did not like the girl and tried to break them up. The girl could see that Donald would never be able to support both her and his mother. She also knew that the three of them could never get along together under the same roof. She gave Donald a month to decide what to do about it. A week before the deadline, he suddenly disappeared. He was found two weeks later in another state, completely unable to say who he was, where he was, or what he was planning to do. He could not recall, or even recognize, the name of either his mother or his girlfriend. Obviously this was his solution to the conflict. This behavior was not inconsistent with his previous history. In his earlier school days, he had frequently forgotten his homework and been absent minded. Forgetting this was already a convenient habit for him.CASE DThis patter in illustrated by the case of a thirteen year old boy who was constantly preoccupied with the thought that he wanted to hurt other people. Whenever he saw someone asleep, he was struck by the thought that he had killed them. In his religious observances he felt compelled to make the sign of the cross three times instead of once as other people did. He refused to watch deaths portrayed in movies and television because he thought they were real. He also was afraid of bumping and hurting other people and for this reason he avoided crowds and all the usual boyhood sports.CASE EA man married against his family’s wishes. He lost his job and was forced to appeal to his family for support. An uncle gave him some money, but warned him he would get no more unless he divorced his wife. On the way home the patient was held up and his money taken from him. He decided to jump into the river. But on the way to the river he forgot who he was and where he lived and that he was married; nor could he account for his being in the locality. He became perplexed and alarmed and asked a policeman for help. He was taken to a hospital and one day later, recovered his memory of these incidents and his identity under hypnosis.CASE FA successful executive who, for various reasons, hated the responsibility of marriage and fatherhood was obsessed many times a day with the idea that his two children were “somehow in danger,” although he knew them to be safe in a well-run private day school to which he himself brought them every morning. As a result, he felt impelled to interrupt his office routine three times a day by personal calls to the school principal who, incidentally, after several months began to question the sincerity of the patient’s fatherly solicitude. Similarly, the patient could not return home at night without misgivings unless he brought some small present to his wife and children, although, significantly, it was always something they did not want.CASE GA woman of fifty, heavily plastered make-up in a useless effort to look thirty, attended one of the author’s lectures. During the question period, she told the following story: “about three years ago, I woke up one morning to find I just couldn’t’ straighten my back. At first I thought I had slept in a draft and that a hot bath would help, but it didn’t. Then I became afraid and called my physician; he took x-rays and did other tests and finally told me that he couldn’t find anything wrong. Well, that really got me—here I couldn’t straighten up and this idiot doctor couldn’t figure out why, so I really told him off. I had seven weeks’ sick leave coming from my company, and I phoned a friend whose brother was a doctor and would certify that I couldn’t work. After about six weeks, I was getting pretty sick of being at home, when a friend dropped in one Sunday. I told him what had been happening, and he just looked at me and laughed. He said “that’s the poorest excuse for staying home I’ve ever heard, you faker. Stand up straight!” When he yelled at me, I was so startled that I guess I stood up straight, and I haven’t had any trouble since.CASE HBetty, a girl of fifteen, was apprehended for stealing dresses from a department store. When her room at home was searched, it contained several dozen dresses, all stolen from the department stores in her city. Every dress was much too large for her to wear. Further investigation disclosed that she came from a well to do family and had ample spending money for her age. She could have just about anything she asked her parents for and had no need to steal anything. Questioned about her thefts, she admitted having no reason to steal. She merely explained that she frequently had an uncontrollable urge to steal large dresses.CASE IA boy in high school was supplied with some second hand books. He began to doubt the accuracy of them, for as they were not new, he thought they might be out of date and what he read might not be the truth. Before long, he would not read a book unless he could satisfy himself that it was new and the writer of it an authority. Even then he was assailed with doubts. For her felt uncertain as to whether he understood what he read. If, for example, he came across a word of which he was not sure of the exact meaning, he could not go on until he had looked up the word in the dictionary. But likely as not, in the definition of the word there would be another word with which he was not entirely familiar and he would have to look that up, so at times a half an hour or more would be taken up in reading a single page, and even then he would feel doubtful as to whether he had gotten the exact truth.CASE JAn extroverted, flirtatious, rather immature twenty one year old married woman, the mother of a young infant, on awakening from the anesthesia after an appendectomy, experienced complete amnesia for the previous five years. At sixteen she had been briefly unconscious following an automobile accident, and she now believed that she was hospitalized because of the accident. Taken home a few days after the appendectomy, she did not recognize her husband or child. When told who they were, she did not challenge their identities and said they were “nice.” While convalescing, she greatly enjoyed reading magazines designed for teenagers. The amnesia and five year regression were responses to an immediate stress situation: her husband was about to graduate from college and take a job in the family business in his native city. She did not want to leave her friends and she feared living under the watchful eye of her mother-in-law, a very dominant and critical woman. Just before the surgery, the mother-in-law had some to stay with the family and help them get ready to move. She had been outspoken and critical of her daughter-in-law’s housekeeping habits and juvenile manner of dress. The amnesia episode psychologically eliminated the mother-in-law’s existence, for the patient had no responsibility and no child to care for. The amnesia cleared up with hypnotic treatment.CASE KJim, a soldier, is in an Army Medical hospital. He complains of a loss of sensation in his fingers. He also complains that he cannot see, although a competent oculist examined his eyes and found nothing wrong. It seems strange that Jim is calm about his disorder even to the point of feeling indifferent about it. Except for this, his personality seems intact.CASE LBill is an extremely orderly, clean, stubborn, and stingy person. He expects everything in the house to be spotless at all times. He insists that every chair, napkin, ashtray, and book be in its proper place. His wife loves him but finds it very difficult to keep the house in the rigid order he demands. He tends to have some time consuming rituals connected with dressing and personal care, such as arranging his toilet articles in a particular order, rinsing his face exactly five times after shaving, laying out all of his clothes in a fixed sequence and making sure that he puts them on in that order.You Are The Therapist: Obsessive-Compulsive, Dissociative, Somatic DisordersCase ASymptoms of IndividualDSM-5 ClassificationCase BSymptoms of IndividualDSM-5 ClassificationCase CSymptoms of IndividualDSM-5 ClassificationCase DSymptoms of IndividualDSM-5 ClassificationCase ESymptoms of IndividualDSM-5 ClassificationCase FSymptoms of IndividualDSM-5 ClassificationCase GSymptoms of IndividualDSM-5 ClassificationCase HSymptoms of IndividualDSM-5 ClassificationCase ISymptoms of IndividualDSM-5 ClassificationCase JSymptoms of IndividualDSM-5 ClassificationCase KSymptoms of IndividualDSM-5 ClassificationCase LSymptoms of IndividualDSM-5 ClassificationBIPOLAR and SCHIZOPHRENIA SPECTRUM DISORDERSCASE STUDIESCASE AThe patient lies in bed hardly moving. He does not look at anyone passing by his bed. His facial expression is empty and unchanging. He is thin and pale and looks physically ill. He refused to eat and has to be fed by a stomach tube. He cannot control urination or defecation. Occasionally he mutters a few words like “Sin….Sinners….Hell” apparently preoccupied completely with his thoughts of sin and punishment. We are quite sure he does not know where he is; he may believe he is in hell.CASE BA young man believed that he was destined to become Emperor of the Unites States. “I could do a lot for the world,” he said, “The US has presidents, will it ever have an emperor? I’ll bet you think I’m nuts to ask about that. I must have the morning paper to keep track of world affairs. If the people of the Unites States want me to rule them, I’m willing to do so; but no one has been to see me and tell me. I’ll be glad to lead them.” Later he spoke of hearing public announcements that he was to be crowned emperor. “It’s been heard all over the country…The world is in chaos. Thousands will be killed. I’m not a god or a devil, but I’m a supernatural being.” All nations will be under his rule but Egypt. Along with these delusional convictions, the patient believed that attempts to kill him were repeatedly being made so that he lived, like Damocles, in constant danger.CASE CHe dressed in flashy pajamas and loud bathrobes, and was otherwise immodest and careless about his personal appearance. He neglected his meals and rest hours, and was highly irregular, impulsive, and distractible in his adaptations to war routine. Without apparent intent to be annoying or disturbing he sang, whistled, told pointless off color stories, visited indiscriminately and flirted crudely with the nurses and female patience. Superficially he appeared to be in high spirits, and yet one day when he was being gently chided over some particularly irresponsible act he suddenly slumped in a chair, covered his face with his hands, began sobbing and cried, “for Pete’s sake, Doc, let me be. Can’t you see that I’ve just got to act happy?” This reversal of mood was transient and his seeming buoyancy returned in a few moments; nevertheless, during treatment his defense euphoria disappeared again when he revealed his fear that his wife was unfaithful to him.CASE DA woman believed that her son-in-law planned to sexually assault and kill her. Her reaction to this idea was expressed in many letters sent to friends and relatives, mailed surreptitiously, and causing the daughter and son-in-law much embarrassment. She believed her daughter’s husband to be a reincarnation of a lover from her youth. She brought out old pictures to verify the resemblance and then launched into longer stories about the man to whom she had been engaged as a girl.CASE ENo, I never was crazy, a little nervous. Look at my teeth. I came here to have my teeth fixed. We’re going to have a strawberry party now. Yesterday, I heard voices…they said. “I ran to the drugstore and I am going home tomorrow.” I heard J.B. Scott’s voice and it came up here in the air. We’ve got 39 banks on Market Street. We’ve got lots of property. Say, take me home and I’ll give you three laundry bags. I’m 29 and a half, 29 and a half. Now I want you to get me ten apples and two dozen lemons. Now listen, if I get some pineapple, will you preserve it?CASE FThe following is a letter written to a radio station by a man not in a mental hospital. The letter is reprinted exactly.Gentlemen:I am writing you for some information. For over three years I have been tormented and tortured by parties using or directing something on me. I think it is something in the television or radio field. I am not a technical man so I can’t figure it out. It is invisible, but I sure can feel it. They can send it mild, medium, and strong. When in building with metal lathing, I can hear a sharp clicking sound in the walls and feel it working on me. They keep it directed mainly at my chest and abdomen. It causes a stiffening and paralyzing of the muscles and there is a stinging, burning pain. It feels just like a ball of fire working on my body. It seems to expand my chest and abdomen so much that I feel as though I were going to explode like a toy balloon. It affects my vision and causes blurring in my sight.One day when I took an automobile trip and was on the road for five hours, there was no sign of the trouble. You see, I had gotten away from where they were operating, but when I returned home it started up again. One night when I went to bed, they sprung a picture of a big audience of people before my eyes.I notified the F.B.I. at Washington D.C. but haven’t heard from them so I thought you people could solve the mystery for me. If you can enlighten me as to what they are using and how to run down or combat it successfully, I will appreciate the same very much, I assure you. I am very anxious to end this torture and continuous misery.CASE GMidge became depressed and asked to return to the hospital where she had been a patient. She then became overactive and exuberant in spirits and visited her friends, to whom she outlined her plans for reestablishing different forms of lucrative businesses. She purchased many clothes, bought furniture, pawned her rings, and wrote checks without funds. For a period thereafter, she was depressed. In a little less than a year, she again became overactive, played her radio until late in the night, smoked excessively, and took out insurance on a car that she had not yet bought. Contrary to her usual habits, she swore frequently and loudly, created a disturbance in a club to which she did not belong, and instituted divorce proceedings. On the day prior to her second admission to the hospital, she purchased fifty-seven hats.You Are The Therapist: Bipolar and Schizophrenia Spectrum DisordersCase ASymptoms of IndividualDSM-5 ClassificationCase BSymptoms of IndividualDSM-5 ClassificationCase CSymptoms of IndividualDSM-5 ClassificationCase DSymptoms of IndividualDSM-5 ClassificationCase ESymptoms of IndividualDSM-5 ClassificationCase FSymptoms of IndividualDSM-5 ClassificationCase GSymptoms of IndividualDSM-5 ClassificationPERSONALITY DISORDERS: CASE STUDIESCASE AA forty year old construction worker believes that his coworkers do not like him and fears that someone might let his scaffolding slip in order to cause him injury on the job. This concern followed a recent disagreement on the lunch line when the patient felt that a coworker was sneaking ahead and complained to him. He began noticing this new “enemy” laughing with the other men and often wondered if he were the butt of their mockery.CASE BPam, a twenty-two year old secretary, was causing numerous problems for her supervisor and coworkers. According to her supervisor, Pam was unable to carry out her duties without constant guidance. Seemingly helpless and dependent, Pam would overreact to minor events and job pressures with irritability and occasional temper tantrums. If others placed unwanted demands on her, she would complain of physical problems, such as nausea or headaches; furthermore, she frequently missed work altogether. To top it off, Pam was flirtatious and often demandingly seductive toward men in the office.CASE CA twenty-six year old unemployed woman was referred for admission to a hospital by her therapist because of intense suicidal preoccupation and urges to mutilate herself by cutting herself with a razor. The patient was apparently well until her junior year in high school, when she became preoccupied with religion and philosophy, avoided friends, and was filled with doubt about who she was…she seems to be searching for a charismatic religious figure with whom to identify. Three years ago she began psychotherapy, and initially idealized her therapist as being incredibly intuitive and empathic. Later she became hostile and demanding of him, requiring more and more sessions, sometimes two in one day. Her life centered on her therapist, by this time to the exclusion of everyone else. Although her hostility toward her therapist was obvious, she could neither see it nor control it. Her difficulties with her therapist culminated in many episodes of her forearm cutting and suicidal threats.CASE DBill D., a highly intelligent but quite introverted and withdrawn thirty-three year old computer analyst, was referred to psychological evaluation by his physician, who was concerned that bill might be depressed…Bill had virtually no contact with other people. He lived alone in his apartment, worked in a small office by himself, and usually saw no one at work except for the occasional visit of his supervisor to give him new work and pick up completed projects. He ate lunch by himself and about once a week, on nice days, went to the zoo for his lunch break. He is happiest when he is alone.CASE EA twenty-five year old, single, graduate student complains to his psychoanalyst of difficulty completing his Ph.D. in English Literature. He believes that his thesis topic may profoundly increase the level of understanding in his discipline and make him famous, but so far he has not been able to get past the third chapter. His mentor does not seem sufficiently impressed with his ideas, and the patient is furious at him, but also self-doubting and ashamed. He blames his mentor for his lack of progress, and thinks that he deserves more help with his grand idea, that his mentor should help with some of the research. The patient brags about his creativity and complains that other people are “jealous” of his insight. He prides himself on the brilliance of his class participation and imagines someday becoming a great professor.CASE FSally, a thirty-five year old librarian, lived a relatively isolated life and had few acquaintances and no close personal friends. From childhood on, she had been very shy and had withdrawn from close ties with others to keep from being hurt or criticized. Two years before she entered therapy, she had a date to go to a party with an acquaintance she had met at the library. The moment they arrived at the party, Sally felt extremely uncomfortable because she was “not dressed properly.” She left in a hurry and refused to see her acquaintance again. It was because of her continuing concern over this incident that—two years later!—Sally decided to go into therapy, even though she dreaded the possibility that the psychologist “would be critical of her.”CASE GSarah D., a thirty-two year old mother of two and a part-time tax accountant, came to a crisis center late one evening after Michael, her husband of a year and a half, abused her physically and then left home. Although he had never physically harmed the children, he frequently threatened to do so when he was drunk. Sarah appeared acutely anxious and worried about the future and “needed to be told what to do.” She wanted her husband to come back and seemed rather unconcerned about his regular pattern of physical abuse. She voiced her concern about being able to make it on her own. Several times in the past few months, Sarah had made up her mind to get out of the marriage but couldn’t bring herself to break away. She would threaten to leave, but when the time came to do so, she would “freeze in the door” with a numbness in her body and a sinking feeling in her stomach at the thought of “not being with Michael.”CASE HMark, a twenty-two year old, came to a psychology clinic on court order. He was awaiting trial for car theft and armed robbery. His case records revealed that he had a long history of arrests beginning at age nine. To date, he had not held a job for more than a few days at a time, even though his generally charming manner enabled him to readily obtain jobs. He is described as a longer, with very few friends. Though initially charming, Mark was generally affable and complimentary during the therapy session. At the end of it, he enthusiastically told the therapist how much he’d benefitted from the counseling and looked forward to future sessions. Mark’s first session was his last. Shortly after it, he skipped bail and presumably left town in order to avoid his trial.CASE IA forty-one year old male was referred to a community mental health center’s activities program for help in improving his social skills. He had a lifelong pattern of social isolation, and spent hours worrying that his angry thoughts about his older brother would cause his brother harm. He described in elaborate and often irrelevant detail his rather uneventful and routine daily life. For two days he had studied the washing instruction on a new pair of jeans—did ‘wash before wearing’ mean that he jeans were to be washed before wearing the first time, or did they need, for some reason, to be washed each time before they were worn? He did not regard concerns such as these as senseless, though he acknowledged that the amount of time spent thinking about them might be excessive.CASE JAlan appeared to be well suited to his work as a train dispatcher. He was quite conscientious, perfectionistic, and attended to minute details. However, he was not close to his coworkers and, reportedly, they thought him “off.” He would get quite upset if even minor variations to his daily routine occurred. For example, he would become tense and irritable if coworkers did not follow exactly his elaborately constructed schedules and plans. If he became tied up in traffic, he would beat the steering wheel and swear at other drivers for holding him up.You Are The Therapist: Personality DisordersCase ASymptoms of IndividualDSM-5 ClassificationCase BSymptoms of IndividualDSM-5 ClassificationCase CSymptoms of IndividualDSM-5 ClassificationCase DSymptoms of IndividualDSM-5 ClassificationCase ESymptoms of IndividualDSM-5 ClassificationCase FSymptoms of IndividualDSM-5 ClassificationCase GSymptoms of IndividualDSM-5 ClassificationCase HSymptoms of IndividualDSM-5 ClassificationCase ISymptoms of IndividualDSM-5 ClassificationCase JSymptoms of IndividualDSM-5 Classification ................
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