Psychology

  Developmental Psychology

Margoth's

Abnormal and Normal Psychology

There is no clear distinction that can be drawn between normal and abnormal behaviors. It is a real question as to whether those words can be sensibly used at all, given their tremendous baggage and built-in biases and the general confusion they create. This is not an idle question without real-world consequences. The "treatment" of every single "mental disorder" that mental health professionals "diagnose," from "depression" and "attention deficit disorder" on through "schizophrenia," flows from how society construes "normal" and "abnormal." This matter affects tens of millions of people annually; and affects everyone, really, since a person's mental model of "what is normal?" Depending on how data are gathered and how diagnoses are made, as many as 27% of some population groups may be suffering from depression at any one time (NIMH, 2001; data for older adults). There is evidence that some psychological disorders are more common than was previously thought.  Is a division of psychology that studies people who are "abnormal" or "atypical"   and the criteria to help manifestation of symptom, and how to help a patient with clinical and sub clinical diagnoses to compared to the members of a given society.  

The behavior reflects a dysfunction in psychological, biological or development process. Norm typical standard pattern, average.  Abnormal  means away from the norm. Definition away from the norm. An example would be driving a car after drinking six-pack of beer.

Criteria for example would be if the patient is hurting others or him/herself.  By saying  or moving in ways that people do not understand. The individual’s behavior cannot be socially “deviant” as defined in terms of religion, politics, or sexuality.  Deviation from the norm or departing from usual standard. That would be dysfunction, inadequate adjustment how is the person functioning in a daily life.  How this person hygiene,  is the patient able to hold an employment  how does the relationships in a daily basis are presented, is the patient distress. Meaning under tension,  how much suffering stress or tension is place this person.

            The behavior usually is acclimated with significant distress or disability in important repayment of life. Clinical behavior involves a measurable degree of importance. It may need medical attention to treat a condition level of severity, and that has to be diagnose and that is a validity predict future behavior or response to treatment. Medical attention to treat a condition level of severity. A sub-Clinical is Less serious issues that are non-medical. Just under or blew. Not on issue may or may not need medical attention. For example it may not be a sever issue if a person is not able to sleep  all night. This may not need a medical attention unless this is becoming conically.

Attachment is the way a person relates to an emotional connection with someone like a care giver. This can be the quality of early environment bound. The approach to personality development that assumes people move through a series of stage in which they confront conflicts between biological drives and social  expectations. The way these conflicts are resolve determines the person’s ability to learn, to get along with others, and to cope with anxiety (Berk pg 15) confidence stable sense of self. (I, me, myself) that is called the Ego Strength.

Timing of Experience

http://epaa.asu.edu/ojs/

http://www.dsm5.org/Pages/http://www.dsm5.org/Pages/Default.aspx

Default.aspx

http://apps.who.int/classifications/icd10/browse/2010/en#/V

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Abstract

So Many Mentally Ill Behind Bars

In this documentary called "The New Asylums," Frontline goes deep inside Ohio's state prison system to explore the complex and growing issue of mentally ill prisoners. With unprecedented access to prison therapy sessions, mental health treatment meetings, crisis wards, and prison disciplinary tribunals, the film provides disturbing portrait of the new reality for the mentally ill. Frontline Pbs. Posted May 10, 2005. So Many Mentally Ill Behind Bars An observation at the inheritance, of closing America's mental hospitals the push for mental health diversion courts. "Unfortunately, I do believe that some of the mental health treatment that we provide in prisons is better than what one might get in the community," says Dr. Reginald Wilkinson, the head of the Ohio prison system, in the documentary “The new asylum, Posted May 10, 2005. Mentions that community jails, 25 percent of the jail population is severely mentally ill. If 98% of people return to society, there is a big problem here. That means 98 % can be treated somehow. Only 2 % of this people will need some type of jail service from the Society. A successful system for reentry would coordinate efforts among specialists in a range of services, integrate treatment for mental illness and substance abuse, they need the combine primary healthcare with mental healthcare, When you know the courts are more apt to send a person to prison because they are going to get treated, “there's something disconcerting about that." There is so many mentally ill coming back into jails and prisons after being released with major depression, and bipolar disorder to name a few, according to the documentary "I've actually had a judge mention to me before that, 'We hate to do this, but we know the person will get treated if we send this person to prison. We need to be better citizens and get involved in the community. In part, we as citizen need to educate ourselves that we can make better choices. Many of this people have no education, no support, therefore no voices. Act of 1968 to address the growing need to help ex-offenders return to their communities and be productive and stable members of society. It concentrates on four areas: jobs, housing, mental health and substance abuse treatment, and strengthening families. We need to be more involved in the political issues and let our politicians know that we care about things like so many mentally ill behind bars is wrong. Prevention children are to have education so they can have choices. Why so many mentally ill behind are bars? Because people on the top are greedy and they do not think about people as humans. It's all about money. Injustice, because the less privileged has less help, less education, less health care, and much less then everything that includes the basics needs. In this documentary I understood that the displaying statistics on the mentally ill in state prisons and contact information in each state. He says that 98 percent of the people in prison do return to the society. There is something wrong with this picture. We need to let our voice be heard. Instead of more prisons we need more schools. Kids need to have education that way when they grow up in this society the can choose, not to just be drop in the systems. At the same time now instead of more swats teams coming to forcefully remove the ill people, we need more psychologists and psychiatrists to help the mental ill people incarcerated easy the pain and understand them. Not punished them for been sick. I also notes in this documentary, the sheriffs, swat team and staff in the facility is predominant whites. The people incarcerated most of them are of color, this is kind of information makes me believe that something is not fair. There is no representation of color people in this institution.

There is no structure on discharges in the first time. No instructions, no medication until the patient is referred to a physician or medical service after discharge from this institution. Create and improve housing resources for the mentally ill, involve families and the community with the offender's treatment, and ensure that people with mental illness are accessing the full range of government entitlements for which they are eligible, such as Social Security Disability Insurance. It says that in order to get a better mental treatment you must be in prison or jail. It does not make any sense in my view. We have to be thinking more for treatment and prevention then correctional and institutionalization. So Many Mentally Ill Behind Bars References Funding for Frontline is provided by the Park Foundation and through the support of PBS viewers. Additional funding for "The New Asylums" is provided by the John D. and Catherine T. MacArthur Foundation and the Open Society Institute. Posted May 10, 2005. ssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss Vygotsky's Theories The work of Lev Vygotsky focuses on how culture, the values , beliefs, customs, and skills of social group is transmitted to the next generation. According to Vygotsky’s, Social interaction in particular cooperative dialogues with more knowledgeable members of society. It is necessary for children to acquire the ways of thinking and behaving that make up a community's culture ( Rowe and Wertsch, 2002). Vygotsky's theories stress the fundamental role of social interaction in the development of cognition (Vygotsky, 1978; Wertsch, 1985), as he believed strongly that community plays a central role in the process of "making meaning. Vygotsky's theory suggests that development depends on interaction with people and the tools that the culture provides to help form their own view of the world. There are three ways a cultural tool can be passed from one individual to another. The first one is imitative learning, where one person tries to imitate or copy another. The second way is by instructed learning which involves remembering the instructions of the teacher and then using these instructions to self-regulate. The final way that cultural tools are passed to others is through collaborative learning, which involves a group of peers who strive to understand each other and work together to learn a specific skill. Vygotsky theory combines the social environment and cognition. Children will acquire the ways of thinking and behaving that make up a culture by interacting with a more knowledgeable person, and believed that social interaction will lead to ongoing changes in a child's thought and behavior. Theses thoughts and behaviors would vary between cultures (Berk, 1994). Vygotsky places considerably more emphasis on social factors contributing to cognitive development (Piaget is criticized for underestimating this). Vygotsky states cognitive development stems from social interactions from guided learning within the zone of proximal development as children and their partners co-construct knowledge. In contrast Piaget maintains that cognitive development stems largely from independent explorations in which children construct knowledge of their own. For Vygotsky, the environment in which children grow up will influence how they think and what they think about. Vygotsky places more and different, emphasis on the role of language in cognitive development (again Piaget is criticized for lack of emphasis on this). For Vygotsky, cognitive development results from an internalization of language. Sociocultural Model Sociology: Human relationships &social groups Anthropology: Human cultures & institutions; cultural context that influence people Questions: What are the norms of society? What roles does the person play in the social environment? What family structure is the person a part of? What is the social network of support? Sociocultural Treatments Examine a person’s social surroundings Explanations focus on: Family structure and communications Social Networks Societal Conditions Societal labels and roles Developmental Cognitive Neuroscience Biological psychology, behavioral neuroscience, biopsychology, and psychobiology are all terms encompassing the application of biology, particularly neurobiology, to the study of physiological, genetic, and developmental mechanisms of behavior in human and non-human animals. Biological psychology investigates at the level of nerves, neurotransmitters, brain circuitry and the basic biological processes that underlie normal and abnormal behavior. Most research in behavioral neuroscience involves non-human animal models which have implications for understanding human pathology and contribute to evidence-based practice. Cognitive-Behavioral The way you construe the world has bearing on how you are affected by events in the world. Your thoughts influence your behavior. Attributions: Inferences we make about causes of events Beliefs we hold about our abilities (self-efficacy) Beliefs we hold about the behaviors of others Cognitive Treatments CBT: Cognitive Behavioral Therapy Uncover internal thoughts, beliefs, feelings See how inner beliefs are affecting behavior and conflict in one’s life Overgeneralizations, all-or-none thinking Negative Thinking Illogical Thought Patterns Inflexible Standards of Perfection Become aware of “automatic” self-talk Behavioral Terms Behavioral Reinforcement Positive OR Negative Most effective: Intermittent Reinforcement Punishment Shaping Generalization Extinction Behavioral Treatments Functional Assessment Look at environment and see how person is functioning in the environment. Change environment, change person References (Berk, 1994). Rowe and Wertsch, 2002 Vygotsky, 1978; Wertsch, 1985  SOME WEBSITES YOU MAY FIND HELPFUL & OF INTEREST   College of San Mateo Library: http://www.collegeofsanmateo.edu/library  CSM Cares Website: http://collegeofsanmateo.edu/csmcares/ American Psychological Association (APA): www.apa.org                 OR       www.apa.org/students The Owl at Purdue (Great website about APA format): http://owl.english.purdue.edu/owl/resource/560/01/ Further APA Style Tips:            www.apastyle.org    ALSO  http://www.apastyle.org/faqs.html National Alliance on Mental Illness (NAMI): www.nami.org NAMI San Mateo County: http://www.namisanmateo.org/home.asp NAMI Santa Clara County: http://www.namisantaclara.org/ National Institute of Mental Health (NIMH): http://www.nimh.nih.gov/index.shtml Substance Abuse and Mental Health Services Association (SAMHSA): http://www.samhsa.gov/ National Institute on Drug Abuse: www.nida.nih.gov Network of Care: http://SanMateo.networkofcare.org/mh/home/index.cfm Thomas Szasz: http://www.szasz.com/ The Narcissism Epidemic http://www.narcissismepidemic.com/ The Dictionary of Disorder (Spitzer):  http://www.newyorker.com/archive/2005/01/03/050103fa_fact DSM Multi-Axial System: http://allpsych.com/disorders/dsm.html APA DSM-5 Development: http://www.dsm5.org/Pages/Default.aspx     ANDhttp://www.psych.org/mainmenu/research/dsmiv/dsmv.aspxhttp://www.dsm5.org/about/Pages/faq.aspx PTSD: http://www.ptsd.va.gov/ Hervey Cleckley, MD: The Mask of Sanity: http://www.cassiopaea.org/cass/sanity_1.PdF Theodore Millon, PhD: http://www.millon.net/ Dialectical Behavior Therapy: http://behavioraltech.org/index.cfm

http://dsm.psychiatryonline.org/book.aspx?bookid=644

DSM-5™ Diagnostic and Statistical Manual of Mental Disorders

DSM-IV. As was the case with DSM-IV, the codes within DSM-5 represent valid codes of

The ICD-9-CM (the International Classification of Diseases, 9th

edition, Clinical Modification).

The ICD-9-CM is the coding system that the Department of Health and Human Services has designated for use in all health transactions in the United States. You do not need a “crosswalk” to use the codes found in DSM-5

(GAF) The Global Assessment of Functioning

(WHODAS 2.0)The World Health Organization Disability Assessment Schedule

DSM-5™ Clinical Cases

Edited by John W. Barnhill, M.D.

• Copyright
• Preface
• Chapter 1. Neurodevelopmental Disorders
• Chapter 2. Schizophrenia Spectrum and Other Psychotic Disorders
• Chapter 3. Bipolar and Related Disorders
• Chapter 4. Depressive Disorders
• Chapter 5. Anxiety Disorders
• Chapter 6. Obsessive-Compulsive and Related Disorders
• Chapter 7. Trauma- and Stressor-Related Disorders
• Chapter 8. Dissociative Disorders
• Chapter 9. Somatic Symptom and Related Disorders
• Chapter 10. Feeding and Eating Disorders
• Chapter 11. Elimination Disorders
• Chapter 12. Sleep-Wake Disorders
• Chapter 13. Sexual Dysfunctions
• Chapter 14. Gender Dysphoria
• Chapter 15. Disruptive, Impulse-Control, and Conduct Disorders
• Chapter 16. Substance-Related and Addictive Disorders
• Chapter 17. Neurocognitive Disorders
• Chapter 18. Personality Disorders
• Chapter 19. Paraphilic Disorders

Excerpt

·         Aggressive behavior (2.23)

·  Anxiety (2.13)

·         Appetite changes or unusual eating behavior (2.18)

·         Avoidance behavior (2.15)

·         Behavioral problems in a child or adolescent (2.2)

·         Catatonic symptoms (2.7)

·         Cognitive impairment (2.28)

·         Delusions (2.5)

·         Depressed mood (2.10)

·         Distractibility (2.4)

·         Eating behavior, unusual, or appetite changes (2.18)

·         Elevated or expansive mood (2.8)

·         Etiological medical conditions (2.29)

·         Excessive substance use (2.26)

·         Hallucinations (2.6)

·         Hypersomnolence (2.20)

·         Impulsivity or impulse-control problems (2.24)

·         Insomnia (2.19)

·         Irritable mood (2.9)

·         Medical conditions, etiological (2.29)

·         Memory loss (2.27)

·         Panic attacks (2.14)

·         Poor school performance (2.1)

·         Psychomotor retardation (2.12)

·         School performance, poor (2.1)

·         Self-injury or self-mutilation (2.25)

·         Sexual dysfunction in a female (2.21)

·         Sexual dysfunction in a male (2.22)

·         Somaticcomplaints or illness/appearance anxiety (2.17)

·         Speechdisturbance (2.3)

·         Substanceuse, excessive (2.26)

·         Suicidalideation or behavior (2.11)

·         Traumaor psychosocial stressors involved in the etiology (2.16)

Highlights of Changes from 
DSM-IV-TR to DSM-5
Changes made to the DSM-5 diagnostic criteria and texts are outlined in this chapter in the same order 
in which they appear in the DSM-5 classification. This is not an exhaustive guide; minor changes in text 
or wording made for clarity are not described here. It should also be noted that Section I of DSM-5 contains a description of changes pertaining to the chapter organization in DSM-5, the multiaxial system, 
and the introduction of dimensional assessments (in Section III).
Terminology
The phrase “general medical condition” is replaced in DSM-5 with “another medical condition” where 
relevant across all disorders.
Neurodevelopmental Disorders
Intellectual Disability (Intellectual Developmental Disorder)
Diagnostic criteria for intellectual disability (intellectual developmental disorder) emphasize the need 
for an assessment of both cognitive capacity (IQ) and adaptive functioning. Severity is determined by 
adaptive functioning rather than IQ score. The term mental retardation was used in DSM-IV. However, 
intellectual disability is the term that has come into common use over the past two decades among 
medical, educational, and other professionals, and by the lay public and advocacy groups. Moreover, a 
federal statue in the United States (Public Law 111-256, Rosa’s Law) replaces the term “mental retardation with intellectual disability. Despite the name change, the deficits in cognitive capacity beginning 
in the developmental period, with the accompanying diagnostic criteria, are considered to constitute a 
mental disorder. The term intellectual developmental disorder was placed in parentheses to reflect the 
World Health Organization’s classification system, which lists “disorders” in the International Classification of Diseases (ICD; ICD-11 to be released in 2015) and bases all “disabilities” on the International 
Classification of Functioning, Disability, and Health (ICF). Because the ICD-11 will not be adopted for several years, intellectual disability was chosen as the current preferred term with the bridge term for the future in parentheses.
Communication Disorders
The DSM-5 communication disorders include language disorder (which combines DSM-IV expressive and mixed receptive-expressive language disorders), speech sound disorder (a new name for phonological disorder), and childhood-onset fluency disorder (a new name for stuttering). Also included is social (pragmatic) communication disorder, a new condition for persistent difficulties in the social uses of verbal and nonverbal communication. Because social communication deficits are one component of autism spectrum disorder (ASD), it is important to note that social (pragmatic) communication disorder cannot be diagnosed in the presence of restricted repetitive behaviors, interests, and activities (the other component of ASD). The symptoms of some patients diagnosed with DSM-IV pervasive developmental disorder not otherwise specified may meet the DSM-5 criteria for social communication disorder.
Autism Spectrum Disorder Autism spectrum disorder is a new DSM-5 name that reflects a scientific consensus that four previously 
separate disorders are actually a single condition with different levels of symptom severity in two core 
  2 • Highlights of Changes from DSM-IV-TR to DSM-5
domains. ASD now encompasses the previous DSM-IV autistic disorder (autism), Asperger’s disorder, 
childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified. ASD 
is characterized by 1) deficits in social communication and social interaction and 2) restricted repetitive 
behaviors, interests, and activities (RRBs). Because both components are required for diagnosis of ASD, 
social communication disorder is diagnosed if no RRBs are present.
Attention-Deficit/Hyperactivity Disorder
The diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD) in DSM-5 are similar to those 
in DSM-IV. The same 18 symptoms are used as in DSM-IV, and continue to be divided into two symptom domains (inattention and hyperactivity/impulsivity), of which at least six symptoms in one domain 
are required for diagnosis. However, several changes have been made in DSM-5: 1) examples have 
been added to the criterion items to facilitate application across the life span; 2) the cross-situational 
requirement has been strengthened to “several” symptoms in each setting; 3) the onset criterion has 
been changed from “symptoms that caused impairment were present before age 7 years” to “several 
inattentive or hyperactive-impulsive symptoms were present prior to age 12”; 4) subtypes have been 
replaced with presentation specifiers that map directly to the prior subtypes; 5) a comorbid diagnosis 
with autism spectrum disorder is now allowed; and 6) a symptom threshold change has been made for 
adults, to reflect their substantial evidence of clinically significant ADHD impairment, with the cutoff 
for ADHD of five symptoms, instead of six required for younger persons, both for inattention and for 
hyperactivity and impulsivity. Finally, ADHD was placed in the neurodevelopmental disorders chapter 
to reflect brain developmental correlates with ADHD and the DSM-5 decision to eliminate the DSM-IV 
chapter that includes all diagnoses usually first made in infancy, childhood, or adolescence.
Specific Learning Disorder
Specific learning disorder combines the DSM-IV diagnoses of reading disorder, mathematics disorder, 
disorder of written expression, and learning disorder not otherwise specified. Because learning deficits 
in the areas of reading, written expression, and mathematics commonly occur together, coded specifiers for the deficit types in each area are included. The text acknowledges that specific types of reading deficits are described internationally in various ways as dyslexia and specific types of mathematics 
deficits as dyscalculia.
Motor Disorders
The following motor disorders are included in the DSM-5 neurodevelopmental disorders chapter: developmental coordination disorder, stereotypic movement disorder, Tourette’s disorder, persistent (chronic) motor or vocal tic disorder, provisional tic disorder, other specified tic disorder, and unspecified tic 
disorder. The tic criteria have been standardized across all of these disorders in this chapter. Stereotypic 
movement disorder has been more clearly differentiated from body-focused repetitive behavior disorders that are in the DSM-5 obsessive-compulsive disorder chapter.
Schizophrenia Spectrum and Other Psychotic Disorders
Schizophrenia
Two changes were made to DSM-IV Criterion A for schizophrenia. The first change is the elimination 
of the special attribution of bizarre delusions and Schneiderian first-rank auditory hallucinations (e.g., 
two or more voices conversing). In DSM-IV, only one such symptom was needed to meet the diagnostic 
requirement for Criterion A, instead of two of the other listed symptoms. This special attribution was Highlights of Changes from DSM-IV-TR to DSM-5 • 3
removed due to the nonspecificity of Schneiderian symptoms and the poor reliability in distinguishing 
bizarre from nonbizarre delusions. Therefore, in DSM-5, two Criterion A symptoms are required for any 
diagnosis of schizophrenia. The second change is the addition of a requirement in Criterion A that the 
individual must have at least one of these three symptoms: delusions, hallucinations, and disorganized 
speech. At least one of these core “positive symptoms” is necessary for a reliable diagnosis of schizophrenia.
Schizophrenia subtypes
The DSM-IV subtypes of schizophrenia (i.e., paranoid, disorganized, catatonic, undifferentiated, and 
residual types) are eliminated due to their limited diagnostic stability, low reliability, and poor validity. 
These subtypes also have not been shown to exhibit distinctive patterns of treatment response or longitudinal course. Instead, a dimensional approach to rating severity for the core symptoms of schizophrenia is included in Section III to capture the important heterogeneity in symptom type and severity 
expressed across individuals with psychotic disorders.
Schizoaffective Disorder
The primary change to schizoaffective disorder is the requirement that a major mood episode be present for a majority of the disorder’s total duration after Criterion A has been met. This change was made 
on both conceptual and psychometric grounds. It makes schizoaffective disorder a longitudinal instead 
of a cross-sectional diagnosis—more comparable to schizophrenia, bipolar disorder, and major depressive disorder, which are bridged by this condition. The change was also made to improve the reliability, 
diagnostic stability, and validity of this disorder, while recognizing that the characterization of patients 
with both psychotic and mood symptoms, either concurrently or at different points in their illness, has 
been a clinical challenge.
Delusional Disorder
Criterion A for delusional disorder no longer has the requirement that the delusions must be nonbizarre. A specifier for bizarre type delusions provides continuity with DSM-IV. The demarcation of 
delusional disorder from psychotic variants of obsessive-compulsive disorder and body dysmorphic 
disorder is explicitly noted with a new exclusion criterion, which states that the symptoms must not be 
better explained by conditions such as obsessive-compulsive or body dysmorphic disorder with absent 
insight/delusional beliefs. DSM-5 no longer separates delusional disorder from shared delusional disorder. If criteria are met for delusional disorder then that diagnosis is made. If the diagnosis cannot be 
made but shared beliefs are present, then the diagnosis “other specified schizophrenia spectrum and 
other psychotic disorder” is used.
Catatonia
The same criteria are used to diagnose catatonia whether the context is a psychotic, bipolar, depressive, or other medical disorder, or an unidentified medical condition. In DSM-IV, two out of five symptom clusters were required if the context was a psychotic or mood disorder, whereas only one symptom cluster was needed if the context was a general medical condition. In DSM-5, all contexts require 
three catatonic symptoms (from a total of 12 characteristic symptoms). In DSM-5, catatonia may be 
diagnosed as a specifier for depressive, bipolar, and psychotic disorders; as a separate diagnosis in the context of another medical condition; or as an other specified diagnosis.4 • Highlights of Changes from DSM-IV-TR to DSM-5  Bipolar and Related Disorders
Bipolar Disorders To enhance the accuracy of diagnosis and facilitate earlier detection in clinical settings, Criterion A for manic and hypomanic episodes now includes an emphasis on changes in activity and energy as well as mood. The DSM-IV diagnosis of bipolar I disorder, mixed episode, requiring that the individual simultaneously meet full criteria for both mania and major depressive episode, has been removed. Instead, a new specifier, “with mixed features,” has been added that can be applied to episodes of mania or hypomania when depressive features are present, and to episodes of depression in the context of major depressive disorder or bipolar disorder when features of mania/hypomania are present.
Other Specified Bipolar and Related Disorder DSM-5 allows the specification of particular conditions for other specified bipolar and related disorder, 
including categorization for individuals with a past history of a major depressive disorder who meet all criteria for hypomania except the duration criterion (i.e., at least 4 consecutive days). A second condition constituting an other specified bipolar and related disorder is that too few symptoms of hypomania are present to meet criteria for the full bipolar II syndrome, although the duration is sufficient at 4 or more days.
Anxious Distress Specifier In the chapter on bipolar and related disorders and the chapter on depressive disorders, a specifier for 
anxious distress is delineated. This specifier is intended to identify patients with anxiety symptoms that are not part of the bipolar diagnostic criteria. 
Depressive Disorders
DSM-5 contains several new depressive disorders, including disruptive mood dysregulation disorder 
and premenstrual dysphoric disorder. To address concerns about potential overdiagnosis and overtreatment of bipolar disorder in children, a new diagnosis, disruptive mood dysregulation disorder, is included for children up to age 18 years who exhibit persistent irritability and frequent episodes of extreme 
behavioral dyscontrol. Based on strong scientific evidence, premenstrual dysphoric disorder has been 
moved from DSM-IV Appendix B, “Criteria Sets and Axes Provided for Further Study,” to the main body of DSM-5. Finally, DSM-5 conceptualizes chronic forms of depression in a somewhat modified way. 
What was referred to as dysthymia in DSM-IV now falls under the category of persistent depressive disorder, which includes both chronic major depressive disorder and the previous dysthymic disorder. An inability to find scientifically meaningful differences between these two conditions led to their combination with specifiers included to identify different pathways to the diagnosis and to provide continuity with DSM-IV. 
Major Depressive Disorder Neither the core criterion symptoms applied to the diagnosis of major depressive episode nor the requisite duration of at least 2 weeks has changed from DSM-IV. Criterion A for a major depressive episode in DSM-5 is identical to that of DSM-IV, as is the requirement for clinically significant distress or impairment in social, occupational, or other important areas of life, although this is now listed as Criterion B rather than Criterion C. The coexistence within a major depressive episode of at least three manic symptoms (insufficient to satisfy criteria for a manic episode) is now acknowledged by the specifier “with mixed features.” The presence of mixed features in an episode of major depressive disorder in-Highlights of Changes from DSM-IV-TR to DSM-5 • 5
creases the likelihood that the illness exists in a bipolar spectrum; however, if the individual concerned has never met criteria for a manic or hypomanic episode, the diagnosis of major depressive disorder is retained. 
Bereavement Exclusion In DSM-IV, there was an exclusion criterion for a major depressive episode that was applied to depressive symptoms lasting less than 2 months following the death of a loved one (i.e., the bereavement exclusion). This exclusion is omitted in DSM-5 for several reasons. The first is to remove the implication that bereavement typically lasts only 2 months when both physicians and grief counselors recognize that the duration is more commonly 1–2 years. Second, bereavement is recognized as a severe psychosocial stressor that can precipitate a major depressive episode in a vulnerable individual, generally beginning soon after the loss. When major depressive disorder occurs in the context of bereavement, it adds an additional risk for suffering, feelings of worthlessness, suicidal ideation, poorer somatic health, 
worse interpersonal and work functioning, and an increased risk for persistent complex bereavement 
disorder, which is now described with explicit criteria in Conditions for Further Study in DSM-5 Section III. Third, bereavement-related major depression is most likely to occur in individuals with past personal and family histories of major depressive episodes. It is genetically influenced and is associated with similar personality characteristics, patterns of comorbidity, and risks of chronicity and/or recurrence as non–bereavement-related major depressive episodes. Finally, the depressive symptoms associated with bereavement-related depression respond to the same psychosocial and medication treatments as non–bereavement-related depression. In the criteria for major depressive disorder, a detailed footnote has replaced the more simplistic DSM-IV exclusion to aid clinicians in making the critical distinction between the symptoms characteristic of bereavement and those of a major depressive episode. Thus, although most people experiencing the loss of a loved one experience bereavement without developing a major depressive episode, evidence does not support the separation of loss of a loved one from other stressors in terms of its likelihood of precipitating a major depressive episode or the relative likelihood that the symptoms will remit spontaneously.
Specifiers for Depressive DisordersSuicidality represents a critical concern in psychiatry. Thus, the clinician is given guidance on assessment of suicidal thinking, plans, and the presence of other risk factors in order to make a determination of the prominence of suicide prevention in treatment planning for a given individual. A new specifier to indicate the presence of mixed symptoms has been added across both the bipolar and the depressive disorders, allowing for the possibility of manic features in individuals with a diagnosis of unipolar depression. A substantial body of research conducted over the last two decades points to the importance of anxiety as relevant to prognosis and treatment decision making. The “with anxious distress” specifier gives the clinician an opportunity to rate the severity of anxious distress in all individuals with bipolar or depressive disorders.
Anxiety Disorders The DSM-5 chapter on anxiety disorder no longer includes obsessive-compulsive disorder (which is included with the obsessive-compulsive and related disorders) or posttraumatic stress disorder and acute stress disorder (which is included with the trauma- and stressor-related disorders). However, the sequential order of these chapters in DSM-5 reflects the close relationships among them.6 • Highlights of Changes from DSM-IV-TR to DSM-5
Agoraphobia, Specific Phobia, and Social Anxiety Disorder (Social Phobia)
Changes in criteria for agoraphobia, specific phobia, and social anxiety disorder (social phobia) include deletion of the requirement that individuals over age 18 years recognize that their anxiety is excessive or unreasonable. This change is based on evidence that individuals with such disorders often overestimate the danger in “phobic” situations and that older individuals often misattribute “phobic” fears to aging. Instead, the anxiety must be out of proportion to the actual danger or threat in the situation, after taking cultural contextual factors into account. In addition, the 6-month duration, which was limited 
to individuals under age 18 in DSM-IV, is now extended to all ages. This change is intended to minimize overdiagnosis of transient fears.
Panic AttackThe essential features of panic attacks remain unchanged, although the complicated DSM-IV terminology for describing different types of panic attacks (i.e., situationally bound/cued, situationally predisposed, and unexpected/uncued) is replaced with the terms unexpected and expected panic attacks. 
Panic attacks function as a marker and prognostic factor for severity of diagnosis, course, and comorbidity across an array of disorders, including but not limited to anxiety disorders. Hence, panic attack can be listed as a specifier that is applicable to all DSM-5 disorders. 
Panic Disorder and Agoraphobia Panic disorder and agoraphobia are unlinked in DSM-5. Thus, the former DSM-IV diagnoses of panic disorder with agoraphobia, panic disorder without agoraphobia, and agoraphobia without history of panic disorder are now replaced by two diagnoses, panic disorder and agoraphobia, each with separate criteria. The co-occurrence of panic disorder and agoraphobia is now coded with two diagnoses. This change recognizes that a substantial number of individuals with agoraphobia do not experience panic symptoms. The diagnostic criteria for agoraphobia are derived from the DSM-IV descriptors for agoraphobia, although endorsement of fears from two or more agoraphobia situations is now required, because this is a robust means for distinguishing agoraphobia from specific phobias. Also, the criteria for agoraphobia are extended to be consistent with criteria sets for other anxiety disorders (e.g., clinician judgment of the fears as being out of proportion to the actual danger in the situation, with a typical duration of 6 months or more). 
Specific Phobia
The core features of specific phobia remain the same, but there is no longer a requirement that individuals over age 18 years must recognize that their fear and anxiety are excessive or unreasonable, and 
the duration requirement (“typically lasting for 6 months or more”) now applies to all ages. Although 
they are now referred to as specifiers, the different types of specific phobia have essentially remained 
unchanged. 
Social Anxiety Disorder (Social Phobia)The essential features of social anxiety disorder (social phobia) (formerly called social phobia) remain the same. However, a number of changes have been made, including deletion of the requirement that 
individuals over age 18 years must recognize that their fear or anxiety is excessive or unreasonable, and duration criterion of “typically lasting for 6 months or more” is now required for all ages. A more significant change is that the “generalized” specifier has been deleted and replaced with a “performance only” specifier. The DSM-IV generalized specifier was problematic in that “fears include most social situations” was difficult to operationalize. Individuals who fear only performance situations (i.e., speaking Highlights of Changes from DSM-IV-TR to DSM-5 • 7
or performing in front of an audience) appear to represent a distinct subset of social anxiety disorder in terms of etiology, age at onset, physiological response, and treatment response. 
Separation Anxiety Disorder Although in DSM-IV, separation anxiety disorder was classified in the section “Disorders Usually First 
Diagnosed in Infancy, Childhood, or Adolescence,” it is now classified as an anxiety disorder. The core 
features remain mostly unchanged, although the wording of the criteria has been modified to more 
adequately represent the expression of separation anxiety symptoms in adulthood. For example, attachment figures may include the children of adults with separation anxiety disorder, and avoidance 
behaviors may occur in the workplace as well as at school. Also, in contrast to DSM-IV, the diagnostic 
criteria no longer specify that age at onset must be before 18 years, because a substantial number of 
adults report onset of separation anxiety after age 18. Also, a duration criterion—“typically lasting for 6 
months or more”—has been added for adults to minimize overdiagnosis of transient fears. 
Selective Mutism In DSM-IV, selective mutism was classified in the section “Disorders Usually First Diagnosed in Infancy, 
Childhood, or Adolescence.” It is now classified as an anxiety disorder, given that a large majority of 
children with selective mutism are anxious. The diagnostic criteria are largely unchanged from DSM-IV. 
Obsessive-Compulsive and Related Disorders
The chapter on obsessive-compulsive and related disorders, which is new in DSM-5, reflects the increasing evidence that these disorders are related to one another in terms of a range of diagnostic 
validators, as well as the clinical utility of grouping these disorders in the same chapter. New disorders 
include hoarding disorder, excoriation (skin-picking) disorder, substance-/medication-induced obsessive-compulsive and related disorder, and obsessive-compulsive and related disorder due to another 
medical condition. The DSM-IV diagnosis of trichotillomania is now termed trichotillomania (hair-pulling disorder) and has been moved from a DSM-IV classification of impulse-control disorders not elsewhere classified to obsessive-compulsive and related disorders in DSM-5.
Specifiers for Obsessive-Compulsive and Related Disorders
The “with poor insight” specifier for obsessive-compulsive disorder has been refined in DSM-5 to allow 
a distinction between individuals with good or fair insight, poor insight, and “absent insight/delusional” 
obsessive-compulsive disorder beliefs (i.e., complete conviction that obsessive-compulsive disorder 
beliefs are true). Analogous “insight” specifiers have been included for body dysmorphic disorder and hoarding disorder. These specifiers are intended to improve differential diagnosis by emphasizing that individuals with these two disorders may present with a range of insight into their disorder-related beliefs, including absent insight/delusional symptoms. This change also emphasizes that the presence of absent insight/delusional beliefs warrants a diagnosis of the relevant obsessive-compulsive or related disorder, rather than a schizophrenia spectrum and other psychotic disorder. The “tic-related” specifier for obsessive-compulsive disorder reflects a growing literature on the diagnostic validity and clinical utility of identifying individuals with a current or past comorbid tic disorder, because this comorbidity may have important clinical implications. 
Body Dysmorphic Disorder
For DSM-5 body dysmorphic disorder, a diagnostic criterion describing repetitive behaviors or mental 8 • Highlights of Changes from DSM-IV-TR to DSM-5
acts in response to preoccupations with perceived defects or flaws in physical appearance has been 
added, consistent with data indicating the prevalence and importance of this symptom. A “with muscle 
dysmorphia” specifier has been added to reflect a growing literature on the diagnostic validity and clinical utility of making this distinction in individuals with body dysmorphic disorder. The delusional variant of body dysmorphic disorder (which identifies individuals who are completely convinced that their perceived defects or flaws are truly abnormal appearing) is no longer coded as both delusional disorder, somatic type, and body dysmorphic disorder; in DSM-5 this presentation is designated only as body dysmorphic disorder with the absent insight/delusional beliefs specifier.
Hoarding Disorder Hoarding disorder is a new diagnosis in DSM-5. DSM-IV lists hoarding as one of the possible symptoms 
of obsessive-compulsive personality disorder and notes that extreme hoarding may occur in obsessivecompulsive disorder. However, available data do not indicate that hoarding is a variant of obsessivecompulsive disorder or another mental disorder. Instead, there is evidence for the diagnostic validity and clinical utility of a separate diagnosis of hoarding disorder, which reflects persistent difficulty discarding or parting with possessions due to a perceived need to save the items and distress associated 
with discarding them. Hoarding disorder may have unique neurobiological correlates, is associated with significant impairment, and may respond to clinical intervention.
Trichotillomania (Hair-Pulling Disorder)
Trichotillomania was included in DSM-IV, although “hair-pulling disorder” has been added parenthetically to the disorder’s name in DSM-5.
Excoriation (Skin-Picking) Disorder
Excoriation (skin-picking) disorder is newly added to DSM-5, with strong evidence for its diagnostic 
validity and clinical utility. 
Substance/Medication-Induced Obsessive-Compulsive and Related Disorder and Obsessive-Compulsive and Related Disorder Due to Another Medical Condition
DSM-IV included a specifier “with obsessive-compulsive symptoms” in the diagnoses of anxiety disorders due to a general medical condition and substance-induced anxiety disorders. Given that obsessive-compulsive and related disorders are now a distinct category, DSM-5 includes new categories for substance-/medication-induced obsessive-compulsive and related disorder and for obsessive-compulsive and related disorder due to another medical condition. This change is consistent with the intent of DSM-IV, and it reflects the recognition that substances, medications, and medical conditions can present with symptoms similar to primary obsessive-compulsive and related disorders. Other Specified and Unspecified Obsessive-Compulsive and Related Disorders
DSM-5 includes the diagnoses other specified obsessive-compulsive and related disorder, which can 
include conditions such as body-focused repetitive behavior disorder and obsessional jealousy, or 
unspecified obsessive-compulsive and related disorder. Body-focused repetitive behavior disorder is 
characterized by recurrent behaviors other than hair pulling and skin picking (e.g., nail biting, lip biting, cheek chewing) and repeated attempts to decrease or stop the behaviors. Obsessional jealousy is characterized by nondelusional preoccupation with a partner’s perceived infidelity.Highlights of Changes from DSM-IV-TR to DSM-5 • 9
Trauma- and Stressor-Related Disorders
Acute Stress Disorder
In DSM-5, the stressor criterion (Criterion A) for acute stress disorder is changed from DSM-IV. The criterion requires being explicit as to whether qualifying traumatic events were experienced directly, witnessed, or experienced indirectly. Also, the DSM-IV Criterion A2 regarding the subjective reaction to the traumatic event (e.g., “the person’s response involved intense fear, helplessness, or horror”) has been eliminated. Based on evidence that acute posttraumatic reactions are very heterogeneous and that DSM-IV’s emphasis on dissociative symptoms is overly restrictive, individuals may meet diagnostic criteria in DSM-5 for acute stress disorder if they exhibit any 9 of 14 listed symptoms in these categories: intrusion, negative mood, dissociation, avoidance, and arousal.
Adjustment Disorders. In DSM-5, adjustment disorders are reconceptualized as a heterogeneous array of stress-response 
syndromes that occur after exposure to a distressing (traumatic or nontraumatic) event, rather than as 
a residual category for individuals who exhibit clinically significant distress without meeting criteria for a more discrete disorder (as in DSM-IV ). DSM-IV subtypes marked by depressed mood, anxious symptoms, or disturbances in conduct have been retained, unchanged. 
Posttraumatic Stress Disorder
DSM-5 criteria for posttraumatic stress disorder differ significantly from those in DSM-IV. As described previously for acute stress disorder, the stressor criterion (Criterion A) is more explicit with regard to how an individual experienced “traumatic” events. Also, Criterion A2 (subjective reaction) has been eliminated. Whereas there were three major symptom clusters in DSM-IV—reexperiencing, avoidance/numbing, and arousal—there are now four symptom clusters in DSM-5, because the avoidance/numbing cluster is divided into two distinct clusters: avoidance and persistent negative alterations in cognitions and mood. This latter category, which retains most of the DSM-IV numbing symptoms, also includes new or reconceptualized symptoms, such as persistent negative emotional states. The final cluster—alterations in arousal and reactivity—retains most of the DSM-IV arousal symptoms. It also includes irritable or aggressive behavior and reckless or self-destructive behavior. Posttraumatic stress disorder is now developmentally sensitive in that diagnostic thresholds have been lowered for children and adolescents. Furthermore, separate criteria have been added for children age 6 years or younger with this disorder.
Reactive Attachment Disorder The DSM-IV childhood diagnosis reactive attachment disorder had two subtypes: emotionally withdrawn/inhibited and indiscriminately social/disinhibited. In DSM-5, these subtypes are defined as distinct disorders: reactive attachment disorder and disinhibited social engagement disorder. Both of these disorders are the result of social neglect or other situations that limit a young child’s opportunity to form selective attachments. Although sharing this etiological pathway, the two disorders differ in important ways. Because of dampened positive affect, reactive attachment disorder more closely resembles internalizing disorders; it is essentially equivalent to a lack of or incompletely formed preferred attachments to caregiving adults. In contrast, disinhibited social engagement disorder more closely resembles ADHD; it may occur in children who do not necessarily lack attachments and may have established or even secure attachments. The two disorders differ in other important ways, including correlates, course, and response to intervention, and for these reasons are considered separate disorders. 10 • Highlights of Changes from DSM-IV-TR to DSM-5
Dissociative Disorders
Major changes in dissociative disorders in DSM-5 include the following: 1) derealization is included in the name and symptom structure of what previously was called depersonalization disorder and is now called depersonalization/derealization disorder, 2) dissociative fugue is now a specifier of dissociative amnesia rather than a separate diagnosis, and 3) the criteria for dissociative identity disorder have been changed to indicate that symptoms of disruption of identity may be reported as well as observed, and that gaps in the recall of events may occur for everyday and not just traumatic events. Also, experiences of pathological possession in some cultures are included in the description of identity disruption. Dissociative Identity Disorder
Several changes to the criteria for dissociative identity disorder have been made in DSM-5. First, Criterion A has been expanded to include certain possession-form phenomena and functional neurological symptoms to account for more diverse presentations of the disorder. Second, Criterion A now specifically states that transitions in identity may be observable by others or self-reported. Third, according to Criterion B, individuals with dissociative identity disorder may have recurrent gaps in recall for everyday events, not just for traumatic experiences. Other text modifications clarify the nature and course of identity disruptions.
Somatic Symptom and Related Disorders .In DSM-5, somatoform disorders are now referred to as somatic symptom and related disorders. In 
DSM-IV, there was significant overlap across the somatoform disorders and a lack of clarity about their boundaries. These disorders are primarily seen in medical settings, and nonpsychiatric physicians found the DSM-IV somatoform diagnoses problematic to use. The DSM-5 classification reduces the number of these disorders and subcategories to avoid problematic overlap. Diagnoses of somatization disorder, hypochondriasis, pain disorder, and undifferentiated somatoform disorder have been removed. Somatic Symptom Disorder
DSM-5 better recognizes the complexity of the interface between psychiatry and medicine. Individuals with somatic symptoms plus abnormal thoughts, feelings, and behaviors may or may not have a diagnosed medical condition. The relationship between somatic symptoms and psychopathology exists along a spectrum, and the arbitrarily high symptom count required for DSM-IV somatization disorder did not accommodate this spectrum. The diagnosis of somatization disorder was essentially based on a long and complex symptom count of medically unexplained symptoms. Individuals previously diagnosed with somatization disorder will usually meet DSM-5 criteria for somatic symptom disorder, but only if they have the maladaptive thoughts, feelings, and behaviors that define the disorder, in addition to their somatic symptoms.
In DSM-IV, the diagnosis undifferentiated somatoform disorder had been created in recognition that 
somatization disorder would only describe a small minority of “somatizing” individuals, but this disorder did not prove to be a useful clinical diagnosis. Because the distinction between somatization disorder and undifferentiated somatoform disorder was arbitrary, they are merged in DSM-5 under somatic symptom disorder, and no specific number of somatic symptoms is required.
Medically Unexplained Symptoms DSM-IV criteria overemphasized the importance of an absence of a medical explanation for the somatic symptoms. Unexplained symptoms are present to various degrees, particularly in conversion disorder, Highlights of Changes from DSM-IV-TR to DSM-5 • 11
but somatic symptom disorders can also accompany diagnosed medical disorders. The reliability of 
medically unexplained symptoms is limited, and grounding a diagnosis on the absence of an explanation is problematic and reinforces mind -body dualism. The DSM-5 classification defines disorders on the basis of positive symptoms (i.e., distressing somatic symptoms plus abnormal thoughts, feelings, 
and behaviors in response to these symptoms). Medically unexplained symptoms do remain a key feature in conversion disorder and pseudocyesis because it is possible to demonstrate definitively in such disorders that the symptoms are not consistent with medical pathophysiology.
Hypochondriasis and Illness Anxiety Disorder
Hypochondriasis has been eliminated as a disorder, in part because the name was perceived as pejorative and not conducive to an effective therapeutic relationship. Most individuals who would previously have been diagnosed with hypochondriasis have significant somatic symptoms in addition to their high health anxiety, and would now receive a DSM-5 diagnosis of somatic symptom disorder. In DSM-5, individuals with high health anxiety without somatic symptoms would receive a diagnosis of illness anxiety disorder (unless their health anxiety was better explained by a primary anxiety disorder, such as generalized anxiety disorder). 
Pain Disorder
DSM-5 takes a different approach to the important clinical realm of individuals with pain. In DSM-IV, the 
pain disorder diagnoses assume that some pains are associated solely with psychological factors, some with medical diseases or injuries, and some with both. There is a lack of evidence that such distinctions can be made with reliability and validity, and a large body of research has demonstrated that psychological factors influence all forms of pain. Most individuals with chronic pain attribute their pain to a combination of factors, including somatic, psychological, and environmental influences. In DSM-5, some 
individuals with chronic pain would be appropriately diagnosed as having somatic symptom disorder, with predominant pain. For others, psychological factors affecting other medical conditions or an adjustment disorder would be more appropriate.
Psychological Factors Affecting Other Medical Conditions and Factitious Disorder
Psychological factors affecting other medical conditions is a new mental disorder in DSM-5, having 
formerly been included in the DSM-IV chapter “Other Conditions That May Be a Focus of Clinical Attention.” This disorder and factitious disorder are placed among the somatic symptom and related disorders because somatic symptoms are predominant in both disorders, and both are most often encountered in medical settings. The variants of psychological factors affecting other medical conditions are removed in favor of the stem diagnosis. 
Conversion Disorder (Functional Neurological Symptom Disorder)
Criteria for conversion disorder (functional neurological symptom disorder) are modified to emphasize the essential importance of the neurological examination, and in recognition that relevant psychological factors may not be demonstrable at the time of diagnosis. 
Feeding and Eating Disorders
In DSM-5, the feeding and eating disorders include several disorders included in DSM-IV as feeding and eating disorders of infancy or early childhood in the chapter “Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence.” In addition, brief descriptions and preliminary diagnostic criteria are 
provided for several conditions under other specified feeding and eating disorder; insufficient informa-12 • Highlights of Changes from DSM-IV-TR to DSM-5
tion about these conditions is currently available to document their clinical characteristics and validity 
or to provide definitive diagnostic criteria. 
Pica and Rumination Disorder
The DSM-IV criteria for pica and for rumination disorder have been revised for clarity and to indicate that the diagnoses can be made for individuals of any age. 
Avoidant/Restrictive Food Intake Disorder
DSM-IV feeding disorder of infancy or early childhood has been renamed avoidant/restrictive food 
intake disorder, and the criteria have been significantly expanded. The DSM-IV disorder was rarely used, 
and limited information is available on the characteristics, course, and outcome of children with this 
disorder. Additionally, a large number of individuals, primarily but not exclusively children and adolescents, substantially restrict their food intake and experience significant associated physiological or psychosocial problems but do not meet criteria for any DSM-IV eating disorder. Avoidant/restrictive food 
intake disorder is a broad category intended to capture this range of presentations. 
Anorexia Nervosa
The core diagnostic criteria for anorexia nervosa are conceptually unchanged from DSM-IV with one exception: the requirement for amenorrhea has been eliminated. In DSM-IV, this requirement was waived in a number of situations (e.g., for males, for females taking contraceptives). In addition, the clinical 
characteristics and course of females meeting all DSM-IV criteria for anorexia nervosa except amenorrhea closely resemble those of females meeting all DSM-IV criteria. As in DSM-IV, individuals with this 
disorder are required by Criterion A to be at a significantly low body weight for their developmental 
stage. The wording of the criterion has been changed for clarity, and guidance regarding how to judge 
whether an individual is at or below a significantly low weight is now provided in the text. In DSM-5, Criterion B is expanded to include not only overtly expressed fear of weight gain but also persistent behavior that interferes with weight gain. 
Bulimia Nervosa The only change to the DSM-IV criteria for bulimia nervosa is a reduction in the required minimum 
average frequency of binge eating and inappropriate compensatory behavior frequency from twice to 
once weekly. The clinical characteristics and outcome of individuals meeting this slightly lower threshold are similar to those meeting the DSM-IV criterion.
Binge-Eating Disorder
Extensive research followed the promulgation of preliminary criteria for binge eating disorder in Appendix B of DSM-IV, and findings supported the clinical utility and validity of binge-eating disorder. The 
only significant difference from the preliminary DSM-IV criteria is that the minimum average frequency 
of binge eating required for diagnosis has been changed from at least twice weekly for 6 months to at 
least once weekly over the last 3 months, which is identical to the DSM-5 frequency criterion for bulimia nervosa. 
Elimination Disorders No significant changes have been made to the elimination disorders diagnostic class from DSM-IV to 
DSM-5. The disorders in this chapter were previously classified under disorders usually first diagnosed in infancy, childhood, or adolescence in DSM-IV and exist now as an independent classification in DSM-5.Highlights of Changes from DSM-IV-TR to DSM-5 • 13
Sleep-Wake Disorders Because of the DSM-5 mandate for concurrent specification of coexisting conditions (medical and 
mental), sleep disorders related to another mental disorder and sleep disorder related to a general 
medical condition have been removed from DSM-5, and greater specification of coexisting conditions is provided for each sleep-wake disorder. This change underscores that the individual has a sleep disorder warranting independent clinical attention, in addition to any medical and mental disorders that are also present, and acknowledges the bidirectional and interactive effects between sleep disorders and coexisting medical and mental disorders. This reconceptualization reflects a paradigm shift that is widely accepted in the field of sleep disorders medicine. It moves away from making causal attributions between 
coexisting disorders. Any additional relevant information from the prior diagnostic categories of sleep disorder related to another mental disorder and sleep disorder related to another medical condition 
has been integrated into the other sleep-wake disorders where appropriate.
Consequently, in DSM-5, the diagnosis of primary insomnia has been renamed insomnia disorder to 
avoid the differentiation of primary and secondary insomnia. DSM-5 also distinguishes narcolepsy, 
which is now known to be associated with hypocretin deficiency, from other forms of hypersomnolence. These changes are warranted by neurobiological and genetic evidence validating this reorganization. Finally, throughout the DSM-5 classification of sleep-wake disorders, pediatric and developmental 
criteria and text are integrated where existing science and considerations of clinical utility support such 
integration. This developmental perspective encompasses age-dependent variations in clinical presentation.
Breathing-Related Sleep Disorders
In DSM-5, breathing-related sleep disorders are divided into three relatively distinct disorders: obstructive sleep apnea hypopnea, central sleep apnea, and sleep-related hypoventilation. This change reflects 
the growing understanding of pathophysiology in the genesis of these disorders and, furthermore, has 
relevance to treatment planning. 
Circadian Rhythm Sleep-Wake Disorders
The subtypes of circadian rhythm sleep-wake disorders have been expanded to include advanced sleep 
phase syndrome, irregular sleep-wake type, and non-24-hour sleep-wake type, whereas the jet lag type 
has been removed.
Rapid Eye Movement Sleep Behavior Disorder and Restless Legs Syndrome
The use of DSM-IV “not otherwise specified” diagnoses has been reduced by designating rapid eye 
movement sleep behavior disorder and restless legs syndrome as independent disorders. In DSM-IV, 
both were included under dyssomnia not otherwise specified. Their full diagnostic status is supported 
by research evidence.
Sexual Dysfunctions
In DSM-IV, sexual dysfunctions referred to sexual pain or to a disturbance in one or more phases of the 
sexual response cycle. Research suggests that sexual response is not always a linear, uniform process 
and that the distinction between certain phases (e.g., desire and arousal) may be artificial. In DSM-5, 
gender-specific sexual dysfunctions have been added, and, for females, sexual desire and arousal disorders have been combined into one disorder: female sexual interest/arousal disorder.
To improve precision regarding duration and severity criteria and to reduce the likelihood of overdiag-14 • Highlights of Changes from DSM-IV-TR to DSM-5
nosis, all of the DSM-5 sexual dysfunctions (except substance-/medication-induced sexual dysfunction) 
now require a minimum duration of approximately 6 months and more precise severity criteria. These 
changes provide useful thresholds for making a diagnosis and distinguish transient sexual difficulties 
from more persistent sexual dysfunction.
Genito-Pelvic Pain/Penetration Disorder
Genito-pelvic pain/penetration disorder is new in DSM-5 and represents a merging of the DSM-IV categories of vaginismus and dyspareunia, which were highly comorbid and difficult to distinguish. The diagnosis of sexual aversion disorder has been removed due to rare use and lack of supporting research.
Subtypes
DSM-IV included the following subtypes for all sexual disorders: lifelong versus acquired, generalized 
versus situational, and due to psychological factors versus due to combined factors. DSM-5 includes 
only lifelong versus acquired and generalized versus situational subtypes. Sexual dysfunction due to a general medical condition and the subtype due to psychological versus combined factors have been 
deleted due to findings that the most frequent clinical presentation is one in which both psychological and biological factors contribute. To indicate the presence and degree of medical and other nonmedical correlates, the following associated features are described in the accompanying text: partner factors, relationship factors, individual vulnerability factors, cultural or religious factors, and medical factors.
Gender Dysphoria
Gender dysphoria is a new diagnostic class in DSM-5 and reflects a change in conceptualization of the 
disorder’s defining features by emphasizing the phenomenon of “gender incongruence” rather than 
cross-gender identification per se, as was the case in DSM-IV gender identity disorder. In DSM-IV, the chapter “Sexual and Gender Identity Disorders” included three relatively disparate diagnostic classes: 
gender identity disorders, sexual dysfunctions, and paraphilias. Gender identity disorder, however, is 
neither a sexual dysfunction nor a paraphilia. Gender dysphoria is a unique condition in that it is a diagnosis made by mental health care providers, although a large proportion of the treatment is endocrinological and surgical (at least for some adolescents and most adults). In contrast to the dichotomized 
DSM-IV gender identity disorder diagnosis, the type and severity of gender dysphoria can be inferred 
from the number and type of indicators and from the severity measures.
The experienced gender incongruence and resulting gender dysphoria may take many forms. Gender 
dysphoria thus is considered to be a multicategory concept rather than a dichotomy, and DSM-5 acknowledges the wide variation of gender -incongruent conditions. Separate criteria sets are provided for gender dysphoria in children and in adolescents and adults. The adolescent and adult criteria include a more detailed and specific set of polythetic symptoms. The previous Criterion A (cross-gender 
identification) and Criterion B (aversion toward one’s gender) have been merged, because no supporting evidence from factor analytic studies supported keeping the two separate. In the wording of the 
criteria, “the other sex” is replaced by “some alternative gender.” Gender instead of sex is used systematically because the concept “sex” is inadequate when referring to individuals with a disorder of sex development. 
In the child criteria, “strong desire to be of the other gender” replaces the previous “repeatedly stated 
desire” to capture the situation of some children who, in a coercive environment, may not verbalize the desire to be of another gender. For children, Criterion A1 (“a strong desire to be of the other gender or Highlights of Changes from DSM-IV-TR to DSM-5 • 15
an insistence that he or she is the other gender . . .)” is now necessary (but not sufficient), which makes the diagnosis more restrictive and conservative. 
Subtypes and Specifiers
The subtyping on the basis of sexual orientation has been removed because the distinction is not 
considered clinically useful. A posttransition specifier has been added because many individuals, after 
transition, no longer meet criteria for gender dysphoria; however, they continue to undergo various 
treatments to facilitate life in the desired gender. Although the concept of posttransition is modeled on the concept of full or partial remission, the term remission has implications in terms of symptom reduction that do not apply directly to gender dysphoria. 
Disruptive, Impulse-Control, and Conduct Disorders
The chapter on disruptive, impulse-control, and conduct disorders is new to DSM-5. It brings together disorders that were previously included in the chapter “Disorders Usually First Diagnosed in Infancy, 
Childhood, or Adolescence” (i.e., oppositional defiant disorder; conduct disorder; and disruptive behavior disorder not otherwise specified, now categorized as other specified and unspecified disruptive, 
impulse-control, and conduct disorders) and the chapter “Impulse-Control Disorders Not Otherwise 
Specified” (i.e., intermittent explosive disorder, pyromania, and kleptomania). These disorders are all 
characterized by problems in emotional and behavioral self-control. Because of its close association 
with conduct disorder, antisocial personality disorder has dual listing in this chapter and in the chapter 
on personality disorders. Of note, ADHD is frequently comorbid with the disorders in this chapter but is listed with the neurodevelopmental disorders.
Oppositional Defiant Disorder
Four refinements have been made to the criteria for oppositional defiant disorder. First, symptoms are now grouped into three types: angry/irritable mood, argumentative/defiant behavior, and vindictiveness. This change highlights that the disorder reflects both emotional and behavioral symptomatology. 
Second, the exclusion criterion for conduct disorder has been removed. Third, given that many behaviors associated with symptoms of oppositional defiant disorder occur commonly in normally developing 
children and adolescents, a note has been added to the criteria to provide guidance on the frequency 
typically needed for a behavior to be considered symptomatic of the disorder. Fourth, a severity rating has been added to the criteria to reflect research showing that the degree of pervasiveness of symptoms across settings is an important indicator of severity. 
Conduct Disorder
The criteria for conduct disorder are largely unchanged from DSM-IV. A descriptive features specifier has been added for individuals who meet full criteria for the disorder but also present with limited prosocial emotions. This specifier applies to those with conduct disorder who show a callous and unemotional interpersonal style across multiple settings and relationships. The specifier is based on research 
showing that individuals with conduct disorder who meet criteria for the specifier tend to have a relatively more severe form of the disorder and a different treatment response. 
Intermittent Explosive Disorder
The primary change in DSM-5 intermittent explosive disorder is the type of aggressive outbursts that 
should be considered: physical aggression was required in DSM-IV, whereas verbal aggression and nondestructive/noninjurious physical aggression also meet criteria in DSM-5. DSM-5 also provides more 16 • Highlights of Changes from DSM-IV-TR to DSM-5
specific criteria defining frequency needed to meet criteria and specifies that the aggressive outbursts 
are impulsive and/or anger based in nature, and must cause marked distress, cause impairment in occupational or interpersonal functioning, or be associated with negative financial or legal consequences. 
Furthermore, because of the paucity of research on this disorder in young children and the potential 
difficulty of distinguishing these outbursts from normal temper tantrums in young children, a minimum age of 6 years (or equivalent developmental level) is now required. Finally, especially for youth, the relationship of this disorder to other disorders (e.g., ADHD, disruptive mood dysregulation disorder) has been further clarified.
Substance-Related and Addictive Disorders
Gambling Disorder An important departure from past diagnostic manuals is that the substance-related disorders chapter has been expanded to include gambling disorder. This change reflects the increasing and consistent 
evidence that some behaviors, such as gambling, activate the brain reward system with effects similar  to those of drugs of abuse and that gambling disorder symptoms resemble substance use disorders to a certain extent. 
Criteria and Terminology
DSM-5 does not separate the diagnoses of substance abuse and dependence as in DSM-IV. Rather, criteria are provided for substance use disorder, accompanied by criteria for intoxication, withdrawal, substance/medication-induced disorders, and unspecified substance-induced disorders, where relevant. 
The DSM-5 substance use disorder criteria are nearly identical to the DSM-IV substance abuse and dependence criteria combined into a single list, with two exceptions. The DSM-IV recurrent legal problems criterion for substance abuse has been deleted from DSM-5, and a new criterion, craving or a strong desire or urge to use a substance, has been added. In addition, the threshold for substance use disorder diagnosis in DSM-5 is set at two or more criteria, in contrast to a threshold of one or more criteria for a diagnosis of DSM-IV substance abuse and three or more for DSM-IV substance dependence. Cannabis withdrawal is new for DSM-5, as is caffeine withdrawal (which was in DSM-IV Appendix B, “Criteria Sets and Axes Provided for Further Study”). Of note, the criteria for DSM-5 tobacco use disorder are the same as those for other substance use disorders. By contrast, DSM-IV did not have a category for 
tobacco abuse, so the criteria in DSM-5 that are from DSM-IV abuse are new for tobacco in DSM-5.
Severity of the DSM-5 substance use disorders is based on the number of criteria endorsed: 2–3 criteria 
indicate a mild disorder; 4–5 criteria, a moderate disorder; and 6 or more, a severe disorder. The DSMIV specifier for a physiological subtype has been eliminated in DSM-5, as has the DSM-IV diagnosis of polysubstance dependence. Early remission from a DSM-5 substance use disorder is defined as at least 3 but less than 12 months without substance use disorder criteria (except craving), and sustained remission is defined as at least 12 months without criteria (except craving). Additional new DSM-5 specifiers include “in a controlled environment” and “on maintenance therapy” as the situation warrants.Neurocognitive Disorders
DeliriumThe criteria for delirium have been updated and clarified on the basis of currently available evidence. 
Major and Mild Neurocognitive Disorder
The DSM-IV diagnoses of dementia and amnestic disorder are subsumed under the newly named entity Highlights of Changes from DSM-IV-TR to DSM-5 • 17
major neurocognitive disorder (NCD). The term dementia is not precluded from use in the etiological 
subtypes where that term is standard. Furthermore, DSM-5 now recognizes a less severe level of cognitive impairment, mild NCD, which is a new disorder that permits the diagnosis of less disabling syndromes that may nonetheless be the focus of concern and treatment. Diagnostic criteria are provided 
for both major NCD and mild NCD, followed by diagnostic criteria for the different etiological subtypes. 
An updated listing of neurocognitive domains is also provided in DSM-5, as these are necessary for 
establishing the presence of NCD, distinguishing between the major and mild levels of impairment, and differentiating among etiological subtypes. 
Although the threshold between mild NCD and major NCD is inherently arbitrary, there are important reasons to consider these two levels of impairment separately. The major NCD syndrome provides 
consistency with the rest of medicine and with prior DSM editions and necessarily remains distinct to 
capture the care needs for this group. Although the mild NCD syndrome is new to DSM-5, its presence 
is consistent with its use in other fields of medicine, where it is a significant focus of care and research, 
notably in individuals with Alzheimer’s disease, cerebrovascular disorders, HIV, and traumatic brain 
injury. 
Etiological Subtypes
In DSM-IV, individual criteria sets were designated for dementia of the Alzheimer’s type, vascular 
dementia, and substance-induced dementia, whereas the other neurodegenerative disorders were 
classified as dementia due to another medical condition, with HIV, head trauma, Parkinson’s disease, 
Huntington’s disease, Pick’s disease, Creutzfeldt-Jakob disease, and other medical conditions specified. 
In DSM-5, major or mild vascular NCD and major or mild NCD due to Alzheimer’s disease have been retained, whereas new separate criteria are now presented for major or mild NCD due to frontotemporal 
NCD, Lewy bodies, traumatic brain injury, Parkinson’s disease, HIV infection, Huntington’s disease, prion 
disease, another medical condition, and multiple etiologies. Substance/medication-induced NCD and 
unspecified NCD are also included as diagnoses.
Personality Disorders
The criteria for personality disorders in Section II of DSM-5 have not changed from those in DSM-IV. 
An alternative approach to the diagnosis of personality disorders was developed for DSM-5 for further 
study and can be found in Section III. For the general criteria for personality disorder presented in Section III, a revised personality functioning criterion (Criterion A) has been developed based on a literature review of reliable clinical measures of core impairments central to personality pathology. Furthermore, the moderate level of impairment in personality functioning required for a personality disorder 
diagnosis in DSM-5 Section III was set empirically to maximize the ability of clinicians to identify personality disorder pathology accurately and efficiently. With a single assessment of level of personality 
functioning, a clinician can determine whether a full assessment for personality disorder is necessary. 
The diagnostic criteria for specific DSM-5 personality disorders in the alternative model are consistently defined across disorders by typical impairments in personality functioning and by characteristic 
pathological personality traits that have been empirically determined to be related to the personality 
disorders they represent. Diagnostic thresholds for both Criterion A and Criterion B have been set empirically to minimize change in disorder prevalence and overlap with other personality disorders and to 
maximize relations with psychosocial impairment. A diagnosis of personality disorder—trait specified, 
based on moderate or greater impairment in personality functioning and the presence of pathological personality traits, replaces personality disorder not otherwise specified and provides a much more 18 • Highlights of Changes from DSM-IV-TR to DSM-5
informative diagnosis for patients who are not optimally described as having a specific personality disorder. A greater emphasis on personality functioning and trait-based criteria increases the stability and 
empirical bases of the disorders.
Personality functioning and personality traits also can be assessed whether or not an individual has a 
personality disorder, providing clinically useful information about all patients. The DSM-5 Section III approach provides a clear conceptual basis for all personality disorder pathology and an efficient assessment approach with considerable clinical utility.
Paraphilic Disorders
Specifiers
An overarching change from DSM-IV is the addition of the course specifiers “in a controlled environment” and “in remission” to the diagnostic criteria sets for all the paraphilic disorders. These specifiers 
are added to indicate important changes in an individual’s status. There is no expert consensus about 
whether a long-standing paraphilia can entirely remit, but there is less argument that consequent psychological distress, psychosocial impairment, or the propensity to do harm to others can be reduced to 
acceptable levels. Therefore, the “in remission” specifier has been added to indicate remission from a 
paraphilic disorder. The specifier is silent with regard to changes in the presence of the paraphilic interest per se. The other course specifier, “in a controlled environment,” is included because the propensity 
of an individual to act on paraphilic urges may be more difficult to assess objectively when the individual has no opportunity to act on such urges.
Change to Diagnostic Names
In DSM-5, paraphilias are not ipso facto mental disorders. There is a distinction between paraphilias 
and paraphilic disorders. A paraphilic disorder is a paraphilia that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to 
others. A paraphilia is a necessary but not a sufficient condition for having a paraphilic disorder, and a 
paraphilia by itself does not automatically justify or require clinical intervention.
The distinction between paraphilias and paraphilic disorders was implemented without making any 
changes to the basic structure of the diagnostic criteria as they had existed since DSM-III-R. In the diagnostic criteria set for each of the listed paraphilic disorders, Criterion A specifies the qualitative nature 
of the paraphilia (e.g., an erotic focus on children or on exposing the genitals to strangers), and Criterion B specifies the negative consequences of the paraphilia (distress, impairment, or harm—or risk of 
harm—to others). 
The change for DSM-5 is that individuals who meet both Criterion A and Criterion B would now be 
diagnosed as having a paraphilic disorder. A diagnosis would not be given to individuals whose symptoms meet Criterion A but not Criterion B—that is, to those individuals who have a paraphilia but not a 
paraphilic disorder.
The distinction between paraphilias and paraphilic disorders is one of the changes from DSM-IV that 
applies to all atypical erotic interests. This approach leaves intact the distinction between normative 
and nonnormative sexual behavior, which could be important to researchers or to persons who have 
nonnormative sexual preferences, but without automatically labeling nonnormative sexual behavior as Highlights of Changes from DSM-IV-TR to DSM-5 • 19
psychopathological. This change in viewpoint is reflected in the diagnostic criteria sets by the addition 
of the word disorder to all the paraphilias. Thus, for example, DSM-IV pedophilia has become DSM-5 
pedophilic disorder.
DSM is the manual used by clinicians and researchers to diagnose and classify mental disorders. The American Psychiatric 
Association (APA) will publish DSM-5 in 2013, culminating a 14-year revision process. For more information, go to www.
DSM5.org. 
APA is a national medical specialty society whose more than 36,000 physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org. 
For more information, please contact Eve Herold at 703-907-8640 or press@psych.org.
© 2013 American Psychiatric Association

Abnormal Psychology

What is normal?

TRUE OR FALSE?

Abnormal behaviors are always bizarre

A clear distinction can be drawn between “normal” and “abnormal” behaviors

Geniuses are particularly prone to insanity

Most psychological disorders are not curable

FALSE!

Abnormal behaviors are always bizarre

                                                                                    FALSE

2.   A clear distinction can be drawn between “normal” and “abnormal” behaviors

                                                                                    FALSE            

3.  Geniuses are particularly prone to insanity

                                                                                    FALSE

4.  Most psychological disorders are not treatable

                                                                                    FALSE

Abnormal Psychology

Ab = Away from

Norm = typical standard pattern, average

Abnormal = away from the norm…

Psycho –

Pathos –

Psychopathology –

“The 4 Ds”

DEVIANCE:

Deviation from the norm

Departing from usual standards

DYSFUNCTION:

How is the person functioning in daily life?

Hygiene, Employment, Relationships

More objective

“The 4 Ds”

DISTRESS:

How does the individual feel?

What is the level of suffering experienced?

More subjective

DANGER:

Is the individual a danger to self?

Is the individual a danger to others?

Is the individual gravely disabled?

5150: Involuntary 72-hour hold

OCCUPATIONAL TERMINOLOGY

PSYCHIATRIST MD licensed by state to practice medicine

PSYCHOLOGIST PhD

Can do assessment, research, therapy

SOCIAL WORKER

Licensed Clinical Social Worker

Master’s in Social Work & License MFT

Marriage & Family Therapist

Master’s in Counseling & License

Categories of Disorders

Anxiety Disorders

Dissociative Disorders

Somatoform Disorders

Mood Disorders

Thought Disorders

Sexual Disorders

Theoretical Perspectives

Biological

Psychoanalytic

Behavioral

Cognitive Behavioral

Humanistic (Existential-Humanistic)

Sociocultural

*Timing of the experience in child development refers to the terms critical period, sensitive period, and windows of opportunity.

http://www.youtube.com/watch?feature=player_embedded&v=OinqFgsIbh0

Learning Goals & Objectives Upon completion of this course, students should have accomplished the following goals:

http://www.youtube.com/watch?v=8hLubgpY2_w

An understanding of the research methods used by developmental psychologists.

An appreciation for major developmental changes occurring from birth to adolescence.

Knowledge of various types of atypical development in childhood.

Assessment Criteria What is Developmental Psychology?

http://www.youtube.com/watch?v=dmMXtZhx7io

Developmental psychology focuses on the development of individuals across their lifespan within the context of family, peer groups, child-care and after-school programs, schools, neighborhoods, and larger communities and society. It considers the well-being of children, youth, and adults, vis--vis the cognitive, emotional, social, academic, and health domains. Developmental research often focuses on disparities among groups (for example, gender, resources such as parental income and education, ethnicity, and immigrant status) as well as the ways in which equity among groups may be promoted.

Knowledge of various types of atypical development in childhood.

Assessment Criteria 

What is Developmental Psychology?

https://smccd.mrooms.net/mod/resource/view.php?id=556171

Developmental psychology focuses on the development of individuals across their lifespan within the context of family, peer groups, child-care and after-school programs, schools, neighborhoods, and larger communities and society. It considers the well-being of children, youth, and adults, vis--vis the cognitive, emotional, social, academic, and health domains. Developmental research often focuses on disparities among groups (for example, gender, resources such as parental income and education, ethnicity, and immigrant status) as well as the ways in which equity among groups may be promoted.

Developmental Scienc

Developmental Science: concerns itself with the study of age-related changes in behavior, thinking, emotions, and social relationships.

 Two important questions in the scientific study of child development:Nature vs. Nurture?

Do age related changes occur in important life stages?

Nature vs. Nurture

Nature vs. Nurture Debate: also referred to as heredity vs. environment or nativism vs. empiricism, is one of the oldest and most central theoretical issues within both psychology and philosophy. Rationalists and Idealists: Advocate the viewpoint of nature, stating that at least some knowledge is inborn Empiricists: Advocate the side of the debate of nurture, viewing the child as a blank slate.  

Psychology Pioneers and Child Development

The views of two of psychology’s pioneers illustrate the way early psychologists approached the nature-nurture issue.

 G. Stanley Hall believed that the milestones of childhood were dictated by an inborn developmental plan and were similar to those that had taken place in the evolution of the human species. He believed that developmentalists should identify norms or average ages at which milestones happened.

 John Watson on the other hand, explained development in terms of environmental influence. Watson, therefore, resided on the nurture side of the debate with Hall on the Nature side.

Watson & Behaviorism

“Give me a dozen healthy infants, well-formed, and my own specified world to bring them up in and I’ll guarantee to take any one at random and and train him to become any type of specialist I might select – doctor, lawyer, merchant, chief, and yes even beggar man and thief, regardless of his talents, penchants, abilities, vocations, and the race of his ancestors. (Watson, 1930, p. 104) 

Behaviorism – defines development in terms of behavior chances caused by environmental influences. Behaviorists such as Watson did not believe in an inborn developmental plan of any sort, as previously stated, Watson believed that through environmental manipulation, children could be trained to be or do anything.  

Watson, Behaviorism and Little Albert

http://www.youtube.com/watch?v=Xt0ucxOrPQE

Stages & Sequences

The second “big question” in developmental psychology addresses stages and sequences of development, or the continuity-discontinuity issue. 

In essence, this addresses the question of whether a child’s expanding ability is just “more of the same,” or does it reflect a new kind of activity?

The core of this debate is whether we accept child development as consisting of quantitative or qualitative change.

Quantitative Change

Let’s refer to the issue of childhood play as an example.

A 2 year old child is unlikely to have individual friends among his or her playmates

An 8 year old child is likely to have several.

Viewing this as a quantitative change, we would see this as a change in amount from 0-some # of friends.

This would suggest that there is some sort of fixed number (or range) of friends that are normal for a given age group and therefore friendship attainment is continuous in nature. 

Qualitative Change

Alternatively, we could view these changes as qualitative.

A qualitative change, here would refer to a substantive change in type of socialization/play Moving from interest, to disinterest in peer playmates. 

Influences on Development

Most modern developmental psychologists agree that essentially every facet of a child’s development is a product of some pattern of interaction between BOTH nature and nurture.

Developmentalist Arnold Gesell used the term maturation to describe genetically programmed sequential patterns of change.

According to Gesell, the development of a child is influenced by both environment and maturation.

*·Studies conducted to examine Gesell’s maturational position both support and challenge his position.

*Sometimes distinguished in terms of as a point of “no return” vs. period of greatest sensitivity.

*These can collectively be though of as: before a certain stage in development, embryonic cells are “plastic” --  their final destiny is not fully determined.

 **Key Developmental Moments

*More specifically, a critical period refers to any time during development when an organism is especially responsive to, and learns from a specific type of stimulation. The same stimulation at other points in development has little or no effect 

**A sensitive period refers to a period which particular experiences can best contribute to proper development. It is similar to a critical period, but the effects of deprivation during a sensitive period are not as severe as during a critical period.

**Is Development Predetermined?

*Another kind of internal influence is described by concepts of inborn biases. 

*Elizabeth Spelke among others have concluded that babies come into the world with certain preexisting conceptions about the behavior of objects. 

*Examples cited for this are that very young babies already seem to understand that unsupported objects will move downward and that a moving object will continue to move in the same direction unless it encounters an obstacle. 

*But is this always true? 

*The Visual Cliff

*http://www.youtube.com/watch?v=4OelrPzpQ6Q

*Genetic Predetermination? 

*Behavior Genetics uses two primary research techniques:The study of identical and fraternal twins.The study of adopted children.

Gene x Environment Interactions

A child’s genetic heritage may also affect her environment, a phenomenon that could occur via two routes:

First, the child could inherit her genes from her parents, who also create the environment where she is growing up.

Second, each child’s unique pattern of inherited qualities affects the way she behaves with other people, which in turn, affects the way adults and other children respond to her.

Cultural Context of Development

Until quite recently, most research on environmental influences focused on a child’s family (frequently on the mother).

In the late 1980’s, Developmental Psychologist Ure Brofenbrenner among others, led the push to emphasize the social complexity in which a child grows up.

His approach emphasized the social ecology of how a child grows up, replete with siblings, parents, grandparents, babysitters and the larger social system of culture, neighborhood, and the relationship qualities with which they are exposed.  

Changes & Temporal Influences

Normative Age-Graded Change – Changes that are common to every member of a species.

Normative History-Graded Changes – Changes that occur in most members of a cohort as a result of factors at work during a specific, cultural period.

Cohort Effects – Effects experienced within a group of individuals who share the same historical experiences at the same time in their lives. 

Normative Changes (Individual Differences) – Changes that result from unique, un-shared events. 

Theories of Development:Psychoanalytic

The most distinctive and central function of psychoanalytic theory is that behavior is governed by both unconscious and conscious processes.

 Sexual Impulses (or more generally, life affirming impulses) Libido (or libidinal energy) is the energy source for this impulse. Basic Life impulses are referred to as needs.As an Impulse grows, it becomes more likely that the person will choose an action which will reduce this need.

Theories of Development:

Timing of Experience

Timing of the experience in child development refers to the terms critical period, sensitive period, and windows of opportunity.

Some times distinguished in terms of rapid vs. gradual beginning and end.

Sometimes distinguished in terms of as a point of “no return” vs. period of greatest sensitivity.

These can collectively be though of as: before a certain stage in development, embryonic cells are “plastic” --  their final destiny is not fully determined.

 Key Developmental Moments

More specifically, a critical period refers to any time during development when an organism is especially responsive to, and learns from a specific type of stimulation. The same stimulation at other points in development has little or no effect 

A sensitive period refers to a period which particular experiences can best contribute to proper development. It is similar to a critical period, but the effects of deprivation during a sensitive period are not as severe as during a critical period.

 Is Development Predetermined?

Another kind of internal influence is described by concepts of inborn biases. 

Elizabeth Spelke among others have concluded that babies come into the world with certain preexisting conceptions about the behavior of objects. 

Examples cited for this are that very young babies already seem to understand that unsupported objects will move downward and that a moving object will continue to move in the same direction unless it encounters an obstacle. 

But is this always true? 

The Visual Cliff

http://www.youtube.com/watch?v=4OelrPzpQ6Q

Genetic Predetermination? 

Behavior Genetics uses two primary research techniques:The study of identical and fraternal twins.The study of adopted children.

Gene x Environment Interactions

A child’s genetic heritage may also affect her environment, a phenomenon that could occur via two routes: 

First, the child could inherit her genes from her parents, who also create the environment where she is growing up.

Second, each child’s unique pattern of inherited qualities affects the way she behaves with other people, which in turn, affects the way adults and other children respond to her.

Cultural Context of Development

Until quite recently, most research on environmental influences focused on a child’s family (frequently on the mother).

In the late 1980’s, Developmental Psychologist Ure Brofenbrenner among others, led the push to emphasize the social complexity in which a child grows up.

His approach emphasized the social ecology of how a child grows up, replete with siblings, parents, grandparents, babysitters and the larger social system of culture, neighborhood, and the relationship qualities with which they are exposed.  

Changes & Temporal Influences

Normative Age-Graded Change – Changes that are common to every member of a species.

Normative History-Graded Changes – Changes that occur in most members of a cohort as a result of factors at work during a specific, cultural period.

Cohort Effects – Effects experienced within a group of individuals who share the same historical experiences at the same time in their lives. 

Normative Changes (Individual Differences) – Changes that result from unique, unshared events. 

Theories of Development:Psychoanalytic

The most distinctive and central function of psychoanalytic theory is that behavior is governed by both unconscious and conscious processes.

 Sexual Impulses (or more generally, life affirming impulses) Libido (or libidinal energy) is the energy source for this impulse. Basic Life impulses are referred to as needs.As an Impulse grows, it becomes more likely that the person will choose an action which will reduce this need.Theories of Development:

An 8 year old child is likely to have several.Viewing this as a quantitative change, we would see this as a change in amount from 0-some # of friends.

This would suggest that there is some sort of fixed number (or range) of friends that are normal for a given age group and therefore friendship attainment is continuous in nature.

 Qualitative Change

Alternatively, we could view these changes as qualitative.

A qualitative change, here would refer to a substantive change in type of socialization/playn Moving from interest, to disinterest in peer playmates.

Influences on Development

Most modern developmental psychologists agree that essentially every facet of a child’s development is a product of some pattern of interaction between BOTH nature and nurture.

Developmentalist Arnold Gesell used the term maturation to describe genetically programmed sequential patterns of change.

According to Gesell, the development of a child is influenced by both environment and maturation.

·Studies conducted to examine Gesell’s maturational position both support and challenge his position.

Timing of Experience

Timing of the experience in child development refers to the terms critical period, sensitive period, and windows of opportunity.

Some times distinguished in terms of rapid vs. gradual beginning and end.

Sometimes distinguished in terms of as a point of “no return” vs. period of greatest sensitivity.

*These can collectively be though of as: before a certain stage in development, embryonic cells are “plastic” --  their final destiny is not fully determined. 

**Key Developmental Moments

*More specifically, a critical period refers to any time during development when an organism is especially responsive to, and learns from a specific type of stimulation. The same stimulation at other points in development has little or no effect

**A sensitive period refers to a period which particular experiences can best contribute to proper development. It is similar to a critical period, but the effects of deprivation during a sensitive period are not as severe as during a critical period.

**Is Development Predetermined?

*Another kind of internal influence is described by concepts of inborn biases.

*Elizabeth Spelke among others have concluded that babies come into the world with certain preexisting conceptions about the behavior of objects.

*Examples cited for this are that very young babies already seem to understand that unsupported objects will move downward and that a moving object will continue to move in the same direction unless it encounters an obstacle.*But is this always true?

*The Visual Cliff*http://www.youtube.com/watch?v=4OelrPzpQ6Q

*Genetic Predetermination?

*Behavior Genetics uses two primary research techniques:The study of identical and fraternal twins.The study of adopted children.

*Gene x Environment Interactions

*A child’s genetic heritage may also affect her environment, a phenomenon that could occur via two routes:

*First, the child could inherit her genes from her parents, who also create the environment where she is growing up.

*Second, each child’s unique pattern of inherited qualities affects the way she behaves with other people, which in turn, affects the way adults and other children respond to her.

*Cultural Context of Development

*Until quite recently, most research on environmental influences focused on a child’s family (frequently on the mother).

*In the late 1980’s, Developmental Psychologist Ure Brofenbrenner among others, led the push to emphasize the social complexity in which a child grows up.

*His approach emphasized the social ecology of how a child grows up, replete with siblings, parents, grandparents, babysitters and the larger social system of culture, neighborhood, and the relationship qualities with which they are exposed.*Changes & Temporal Influences

*Normative Age-Graded Change – Changes that are common to every member of a species.

*Normative History-Graded Changes – Changes that occur in most members of a cohort as a result of factors at work during a specific, cultural period.

*Cohort Effects – Effects experienced within a group of individuals who share the same historical experiences at the same time in their lives.

*Normative Changes (Individual Differences) – Changes that result from unique, unshared events.

*Theories of Development:Psychoanalytic

*The most distinctive and central function of psychoanalytic theory is that behavior is governed by both unconscious and conscious processes.

*Sexual Impulses (or more generally, life affirming impulses) Libido (or libidinal energy) is the energy source for this impulse. Basic Life impulses are referred to as needs.As an Impulse grows, it becomes more likely that the person will choose an action which will reduce this need.

***Theories of Development:

*You MUST read for this course. Exams will be based on both lectures, and readings. Failure to read will impact your course grade.Psychoanalytic

*According to Freud, at least 5 stages of human development exist.

*At each stage, there is a crisis which must be worked through.

*If the crisis is not properly worked out, the person could become fixated at that stage of development. 

*Fixations are seen in adulthood as child like approaches to gratifying the basic impulses of the Id.

**Psychosexual Stages of Development

*Oral Stage (infancy to about 18 months)

*Anal Stage (about 18 months to 3 years old)*Phallic Stage (can occur as early as 3 yrs to about 6 years old )Oedipal/Electra Complex (major crisis of this stage)

*Latency (6 years to puberty)

*Genital Stage (Puberty – adulthood)

*Theories of Development: Erikson

*The ego is of utmost importance.

*Part of the ego is able to operate independently of the id and the superego.

*The ego is a powerful agent that can adapt to situations, thereby promoting mental health.

*Social and sexual factors both play a role in personality development.

**Erikson’s Stages of Development

*Stage 1: Basic Trust vs. Mistrust (birth-18 months)

*Stage 2: Autonomy vs. Shame and Doubt (2-3 years old)

*Stage 3: Initiative vs. Guilt (3-5 years old)

*Stage 4: Industry vs. Inferiority (6-11 years old)

*Stage 5: Identity vs. Role Confusion (12-18 years old)

*Stage 6: Intimacy vs. Isolation (19-40 years old)

*Stage 7: Generativity vs. Stagnation (40-65 years old)

*Stage 8: Integrity vs. Despair (65+)

**Psychology 200Developmental Psychology

*  Professor Gavin Ryan Shafron, M.A.*Theories of Development: Cognitive

*Jean Piaget began his career as a biologist

*Began studying the development of thinking: genetic epistemology, meaning the study of the development of knowledge.

**Piaget (Continued)

*Schemas – Skill sets infants have which direct the way an infant can explore his/her environment.

*Assimilation – Utilizing the rules of a previously learned schema and generalizing them to the use of a new object.

*Accommodation- changing a previously learned schema to adapt better to the use of a new object.

*Both assimilation and accommodation are part of learning, or as Piaget referred to it in the developmental context: Adaptation.

*Piaget Stages of Child Development

*The sensorimotor stage (infancy- about 2 yrs old)

*Preoperational stage (2-7 years old)

*Concrete operations stage (7-11 yrs old)

*Formal operations stage (12 yrs +)

*****  Cognitive-Developmental and   Information-Processing Theory

*Information Processing Theory

*ModelsConceptsMemory

*Theories of Development:Behavioral Theories*The majority of the work on behavioral theories of development derives from the work of Russian scientist Ivan Pavlov,  Columbia University Psychology Edward Thorndike, and Behavioral Psychology Legend B.F. Skinner.

*Pavlov – Classical Conditioning

*Thorndike & Skinner – Operant Conditioning

**Classical Conditioning

*Operant Conditioning

*Elaborating on Thorndike’s original theory, B.F. Skinner and his colleagues outlined 4 types of operant conditioning:

*In Positive Reinforcement a particular behavior is strengthened by the consequence of experiencing a positive condition.

  *In Negative Reinforcement a particular behavior is strengthened by the consequence of stopping or avoiding a negative condition.

*In Punishment a particular behavior is weakened by the consequence of experiencing a negative condition.

*In Extinction a particular behavior is weakened by the consequence of not experiencing a positive condition or stopping a negative condition

**Theories of Development: Learning Theory & Bandura

*Albert Bandura – Stanford psychologist who suggested that environment and modeling caused behavior.

*He labeled this concept reciprocal determinism:  The world and a person’s behavior cause each other.

*His work is considered the basis for social learning theory

*Cognitive-Developmental andInformation-Processing Theory

*Lev Vygotsky: Complex forms of thinking have their origins in social interactionsScaffolding Zone of Proximal Development

*Theoretical Applications

*Eclectic Approach: Use of multiple theoretical perspectives to explain and study human development

**Research Methods in Child Psychology

*Four goals for the scientific study of human development:

**Cross-Sectional Designs*Capture one moment in time*Useful for age related changes*Expedient

*Provide indications of possible age differences or age changes*Longitudinal Designs

*This is where several moments in time are captured and analyzed over a period of days, months or even years.*Also useful for age related changes in different ways*Useful for assessing consistencies or changes in behavior across age*Also useful for comparison of individual differences and group differences

**Sequential Designs

*Help in understanding age-related changes through:

*Comparison of cohorts 

*Individual differences

**Positives and Negatives to Each Form of Research Design

*Identifying Relationships Between Variables

*Limits of Correlations§They do not reveal causal relationships§§One variable cannot tell us if one causes the other to occur

**Experimental Design

*Cross-Cultural DesignEthnographyExtensive study of one culture based on observation

**Research Ethics

*Protection of animal rights and human subjects

**Prenatal Development

*Conception and Genetics:*ConceptionOvumSpermZygote

* Chromosomes23 pairsDNAGenes23rd Pair: X and Y chromosomes

* Gametes (Ovum & Sperm)MeiosisOnly 23 chromosomes

**Human Chromosome #20

*Conception & Genetics

*Conception & Genetics (continued)

****Dominant-recessive patternDominant genes always express their characteristicsBoth recessive genes must be present to express their characteristics

**Genetics: Key Terms to Understand

* Polygenic InheritanceMany genes blend together to increasethe genetic outcomes seen in the phenotype

* Multifactorial PatternsExpression of traits that are influenced by both genes and environment

* Genomic ImprintingSome genes are biochemically marked at the time ova and sperm develop

* Mitochondrial InheritanceGenes passed only from mother to child

**Example: Genetics of Hair Type

*Twins

*Infertility & Assisted Reproductive Technology

* The use of assisted reproductive technology to help postmenopausal women get pregnant is controversial.

** What are the arguments for and against this practice?**Development from Conception to Birth

* Stages of Prenatal Development

**Development from Conception to Birth: Zygotic* The Germinal Stage:  Zygote

*From conception to implantation, implantation is complete 10 days to 2 weeks after conception

*Blastocyst divides into two sections

*Specialization of cells needed to support development PlacentaUmbilical cordChorionAmnion

**Migration of the Zygote

*Development from Conception to Birth: Embryonic

* The Embryonic Stage: Embryo

**Development from Conception to Birth: FetalThe Fetal Stage: FetusGrowth statisticsRefinement of all organ systemsSurfactantAge of viabilityNervous System: Neurons* Dendrites

* Axons

* Synapses

**Fetal Stage (continued)

*Sex Differences in Prenatal Development

*Between weeks 4 and 8, males begin to secrete testosterone from primitive testes

** Prenatal hormonal influences

**Prenatal Development Fetuses

•Respond to sound with body movements as early as 25 weeks•

Can distinguish between familiar and novel stimuli by 32 weeks

•Can learning prenatally

•Influenced by prenatally music

**Problems with Prenatal Development

* Genetic Disorders

* Autosomal Disorders

**Problems in Prenatal Development (continued)

* Genetic Disorders

**Problems in Prenatal Development (continued)

* Chromosomal errors

* Trisomies: three copies of autosomeTrisomy 21: Down SyndromeMaternal age influence

**Problems in Prenatal Development (continued)

* Teratogens: Maternal Diseases (first 8 weeks most vulnerable)Each organ system is most vulnerable to harm when its development is most rapid.

•Chronic Illnesses• 

Heart disease, diabetes, lupus, hormone imbalances can all lead to developmental delays

* RubellaVaccinations should be given to all children

* HIV

* Other sexually transmitted diseasesSyphilisGenital herpesGonorrheaCytomegalovirus

**Environmental Hazards

* Environmental Hazards

* Limiting exposure to mercury

* Avoiding possible harmful chemicals

**Psychology 200

Developmental Psychology

*  Professor Gavin Ryan Shafron, M.A.

*Problems in Prenatal Development

* Teratogens: Drugs

**Problems in Prenatal Development (continued)Other Maternal InfluencesAge

* Older mothers

* Teenage mothersPoverty-Related Maternal Influences

* Diet* General adequacy, key nutrients, and caloric needsSubnutritionFolic acid deficiencies

* Malnutrition

***Maternal Stressors and Hormone Imbalance

*High-Tech Monitoring For High-Risk Pregnancies

* At-home monitoring of fetal and maternal health in high-risk pregnancies is convenient and far less expensive than in-patient care, but what are its disadvantages?

* Under what conditions might in-hospital monitoring be preferable to at-home monitoring?

**Birth* Drugs during Labor and Delivery

********Birth

*  Natural Childbirth

*Lamaze method

*Classes and techniques

*BirthLocation

* Traditional hospital maternity unit

* Hospital-based birth center

* Free-standing birth center; midwives

* Home birth

*BirthFathers at Delivery

* Normal in the United States

* Has little effect on fathers’ emotional bonds with infants

*The Process of Birth

* Labor

*The Process of Birth

* Birth Complications  

* Anoxia

* Cesarean Deliveries (C-Sections)*Phases of Labor

*Phases of Delivery

*The Process of BirthAssessing the Newborn

* Apgar ScaleEvaluate at birth and 5 minutes later

* Brazelton Neonatal Behavioral Assessment ScaleTracks development over 2 weeksResponses to stimuli and reflexes are checked

**The Apgar Scale

*Assessing the Newborn*Assessing the Newborn

*Reflexes and Behavioral StatesAdaptive Reflexes: Disappear during first year of life

*Help survivalSuckingSwallowingRooting

*Weak or absent reflexes warn of possible neuronal development problems*Reflexes and Behavioral StatesPrimitive Reflexes*Controlled by the medulla and midbrainMoro ReflexBabinski Reflex

*Disappearance of these reflexes should occur by 6 to 8 months*Persistence indicates neurological problems

*Reflexes and Behavioral States* States of Consciousness

*Daytime and Nighttime Sleep across the First Year*Reflexes and Behavioral StatesStates of Consciousness

*SleepPatternsCultureCosleeping*Crying*Colic

 * Persistent and often inconsolable crying, totaling more than 3 hours per day

* Disappears at 3-4 months

*Variations in Infants’ Cries

* Suppose you did a study showing that the more irritable the infant’s cries are, the more likely parents are to develop hostile attitudes toward their infant

.* What would be the implications of this finding for neurological explanations of the correlation between the quality of infants’ cries and later developmental problems?

* What kind of research would be necessary to establish norms for infant crying?

*Physical and Cognitive AbilitiesMotor Skills

* Emerge gradually in early weeks of life

* Follow two broad patterns

*  Physical and Cognitive Abilities

* Sensory and Perceptual Skills  Newborns can:

*Learning

*LearningSchematic Learning Baby organizes experiences into expectanciesSchemas: built up over many exposures to particular experiencesHabituation

*  Temperament and Social SkillsTemperament: Inborn predispositions that form foundations of personality

* Formulated by Thomas and ChessEasy childDifficult childSlow to warm up childThese Patterns tend to persist into later childhood

*  Temperament and Social SkillsEmergence of Emotional Expression

* Some rudimentary emotions are present at birth

* Emotions differentiate with ageTaking Turns

* Seen in conversations and eye contact

* Present in feeding: burst-pause pattern

* Seen in infants only a few days old

*Health and Wellness in Early Infancy* Nutrition

**Questions to Ponder

* Suppose a friend was thinking of her choices for breastfeeding and bottle-feeding.

* What would you tell her?

** How would a frequently crying baby affect the parents’ reactions and interactions with that child?

*Health and Wellness in Early Infancy

* Nutrition

**Health and Wellness in Early InfancyHealth Care and Immunizations Well Baby Care

*Motor skills assessed by doctor

*Infant Mortality Across Ethnic Groups

*Psychology 200Developmental Psychology

*  Professor Gavin Ryan Shafron, M.A.

*The Brain and Nervous System

*Major Structures of the Brain

*The Brain and Nervous System

*Synaptic Development

*Synaptic DevelopmentBoth processes heavily dependent on experiences

*Follows “use it or lose it” dictum

*Early flexibility allows children to adapt to environment better

*Programmed plasticity is in its height in infancy

*Myelinization

*Formation of myelin sheath

*Cephalocaudal and Proximodistal patterns

*Developmental path

*Reticular Formation – This part of the brain allows us to keep attention on what we are doing. This continues to develop in spurts until a person is in their mid-20’s.

***The Neuron

*Myelinization

*Lateralization

*Corpus callosum growth and maturation

*Left and Right Brain Dominance

*Lateralization 

*Sign language learning

*Lateralization of Brain Functions

*LateralizationSpatial Perception: Ability to identify and act on relationships of objects in space

*Relative right-left orientation

*LateralizationSpatial cognition: ability to infer rules from and make predictions about the movements of objects in space

*Gender differences

*Environmental influences

*LateralizationHandedness

*Prevalence

*Incidences

*Appearance

*Bones, Muscles, and Motor Skills

*Patterns of Change in Size and Shape: Height and Weight Gain

s*Growth Curve Shifts*Bones, Muscles and Motor SkillsBones

*FontanelsSkull soft spots that fuse as bones growFilled in by 12-18 months

*OssificationThe process of bone hardeningOccurs steadily from birth to puberty

*Bones, Muscles, and Motor SkillsMuscles and Fat

*Virtually all muscle fibers are present at birth

*Developmental changes

*Gender differences

*Strength

*Sex Differences in Strength

*Bones, Muscles, and Motor SkillsUsing the Body

*StaminaChanges are linked to growth of the heart and lungs, especially during pubertyBefore puberty, boys and girls are similar in physical strength, speed, and staminaAfter puberty, boys are ahead in all three

*Motor DevelopmentGross motor skills develop earlier than fine motor skillsFine motor skills develop rapidly in the elementary school years

*Stages in Children’s Drawing

*The Endocrine and Reproductive SystemsHormones

*Pituitary gland

*Thyroid and pituitary growth hormones*Adrenal androgen

*Gonadatrophic hormones

*The Endocrine and Reproductive Systems

*Sequence of Changes in Girls and BoysGirls

*Development of pubic hair and breasts

*Growth spurt follows

*Menstruation follows 2 years after other visible signsOccurs between 12 ½ and 13 ½Follows a secular trend—caused by changes in diet and lifestylePossible to conceive shortly after menarche, but irregularity is the norm

*Sequence of Pubertal Changes in Girls

*Sequence of Changes in Girls and BoysBoys

*Growth spurts come later in the stages than in girls

*Development of beard and lowering of voice comes late in the stages

*Boys can attain fertility as early as age 12 or as late as age 16

*Sequence of Pubertal Changes in Boys

*  The Timing of Puberty 

*Timing of Puberty and Body Image

*  The Timing of Puberty 

*Questions to Ponder

*Remembering your own adolescence,Were you an early, normal, or late bloomer?How did your body changes affect your mental image and your behaviors?

*Does the research on sexual behavior match your experiences and that of your friends?  Why or why not?

*  Sexual Behavior in AdolescencePrevalence of Sexual Behavior

*Gender differences

*Multiple partners

*High school sexual experience across ethnic groups

*Sexual Experience among High School Students in the United States

*Explaining Adolescent Sexual Behavior

*Social factors are better predictors of sexual activity than hormones

*Explaining Adolescent Sexual Behavior

*Sexually Transmitted Diseases and Sex Education*Teenage Pregnancy 

*Higher in United States than in any other Western industrialized country

*Ethnic differences

*Older adolescent births are more common

**Teenage Pregnancy .

——What is Language?

—What do you think? What is language? This may seem like a simple question, but what is language to you, what is the meaning of language to our society and society in general, and what do you think is the utility of the understanding of language to psychology?

—

—http://www.youtube.com/watch?v=PZatrvNDOiE

——When we speak to someone, we produce a series of sounds in a continuous stream, punctuated by pauses and modulated by stresses and changes in pitch.

—We speak sentences as a string of sounds emphasizing some and quickly gliding over others.

—

—Analysis of Speech

—Any analysis of speech usually begins with its elements, or phonemes: which are the basic elements of speech.

—Onset Time, is the delay between the initial sound of a consonant and the onset of the vibration of the vocal chords.

—Unvoiced vs.

Voiced Consonants

—

—From Phonemes to Speech

—Phonemes combine together to form the smallest units of a language which convey meaning. These are known as morphemes.

—Continuing to use the word Pin as an example, we can see how the meaning of the word changes when we remove the P  from Pin, changing the word Pin to In.

—We can therefore see that in this example, both P and In are morphemes because they both contain meaning. Removal of either one changes the word. 

—Understanding the Meaning of speech

—If we want a listener to understand our speech, we must follow the conventions or “rules” of language, using words the listener or reader is familiar with, combining them in specific ways. This is referred to as Syntax.

—Consider this as an example: “There is snow in the forecast today.” = Understandable meaning.

vs.

“Forecast the in there today is snow.” = No meaning

—Speech & Understanding (continued)

—Syntactical Rules -certain principles governing any language which makes the language understandable.

—Syntactical rules are learned implicitly.

—

—Our understanding of these rules does not need to be taught and occurs on their own.

—

——Structure of Language

—Semantics refers to the meaning of words. Semantics also provide important cues to the syntax of a sentence.

—Yet sometimes the meaning of words in the sentence alone may not be enough to fully and accurately derive meaning.

—Prosody refers to the varying rhythms, changes, and the way we stress different portions of words and different words in sentences. This aids in communicating the meaning of our sentences.

—Noam Chomsky & Language

—Noted linguist and MIT professor Noam Chomsky theorizes that newly formed sentences are represented in the brain in terms of their meaning, this is referred to as deep structure.

—In order to speak or write a sentence the person must transform the deep structure into an appropriate surface structure, or the particular form the sentence takes. 

——Language and our knowledge of the world

—Scripts specify various kinds of events and the event-related interactions that people have witnessed or have learned about from others. Once the speaker has established which script is being referred to, the listener can fill in the details.

—

—http://www.youtube.com/watch?v=UTbI-G42JoY

—Play from 3:10-7:34

——

—Language Disorders

—Paul Broca: French Neurosurgeon found that when his patient suffered trauma to a specific area of his prefrontal cortex he could neither speak a complete sentence nor express his thoughts in writing.
Broca’s area

—Wernicke's area

—Carl Wernicke, a German neurologist, discovered another part of the brain, this one involved in understanding language, in the posterior portion of the left temporal lobe. People who had a lesion at this location could speak, but their speech was often incoherent and made no sense.

——Language Centers of the brain

——Norman Geschwind formulated a “connectionist” model which drew on the lesion studies done by Wernicke and his successors. Currently this is known as the Geschwind-Wernicke model.

——Geschwind-Wernicke model

—According to this model, each of the various characteristics of language (perception, comprehension, production, etc.) is managed by a distinct functional module in the brain, and each of these modules is linked to the others by a very specific set of serial connections. The central hypothesis of this model is that language disorders arise from breakdowns in this network of connections between these modules.

——Perhaps the most striking anatomical characteristic of the human brain is that it is divided into two hemispheres, so that it has two of almost every structure: one on the left side and one on the right. But these paired structures are not exactly symmetrical and often differ in their size, form, and function. This phenomenon is called Brain Lateralization.

——Lateralization of Brain Function

——When we are talking about language, it is therefore useful to distinguish between verbal language—the literal meaning of the words—and everything that surrounds these words and gives them a particular connotation.

—That is the big difference between denoting and connoting: the message that is perceived never depends solely on what is said, but always on how it is said as well.

—Lateralization & Language

—Comparing Broca’s & Wernikie’s Aphasia

—Broca’s Aphasia: damage to Broca’s area in the frontal lobes which disruption individual’s ability to speak.

——Wernicke’s Aphasia: Brain damage in the left hemisphere that invades Wernicke;s area as well as the surrounding region of the temporal and parietal lobes which consists of poor speech recognition and the production of meaningless speech.

—Psycholinguistics

—Overgeneralization errors which expand past tense inflections in speech which they have learned to apply to all verbs.

—Overextension

—Underextension

— Semantic priming or the presentation of a previously known word which facilitates the recognition of words which have a related meaning.

—Language Acquisition Device: a part of a brain mechanism, theorized by Noam Chomsky and others to contain universal grammatical rules and motivations toward language acquisition.

—Reading and Information Processing

—To understand language use disorders, we must understand how we receive information verbally

—We do not receive information from the visual environment while the eyes are actually moving, but only during brief fixations.

—When we read we typically focus on only 80% of content words (words that have core meaning in a sentence) and only 40% of function words (words such as “and” or “the”).

——The average fixation lasts only about 250 milliseconds but the duration can vary considerably.

—Reading & Information Processing

—Most psychologists who study the reading process believe that readers have two basic ways to recognize words:

—Phonetic Reading involves the decoding of the sounds that letters, or groups of letters make.

—Whole-Word Reading refers to our recognition of the whole word as a unit, rather than the necessity of sounding out each word to understand it. Therefore this relies on some implicit recall of learned word pronunciation and meaning.

—Language Use Disorders

—The best evidence demonstrating that people can read words without sounding them out comes from studies of patients with Dyslexia.

—Dyslexia by definition means faulty reading.

—Acquired dyslexias are those caused by damage to the brains of people who already know how to read.

—But perhaps the most commonly known dyslexias are those which are Developmental in nature. These difficulties become apparent as children learn to read. 

—Types of Developmental Dyslexia

—Surface Dyslexia which is a deficit in whole-word reading. The term surface reflects the fact that people with this disorder make errors related to the visual appearance of words and to phonological rules, not to the meaning of the words.

—Direct Dyslexia resembles forms of aphasia covered in the last lecture. People with this disorder can read words aloud even though they cannot understand what they are saying.

——Prevalence & Causes

—The symptoms of developmental dyslexias resemble those of acquired dyslexias.

—They first manifest in childhood and tend to occur in families suggesting a genetic component.

—Prevalence rates internationally range from 1% in Japan and China to 33% in Venezuala.

—In a cross-nation study the average prevalence rate of developmental dyslexias are at about 7%.

—Perhaps not surprisingly, researchers have implicated deficits in both Broca’s and Wernicke’s area in these disorders

——Developmental Psychology

—Personality Theory Development

—Psychoanalytic Conceptions of Personality

—The most distinctive and central function of psychoanalytic theory is that behavior is governed by both unconscious and conscious processes.

—Sexual Impulses (or more generally, life affirming impulses) Libido (or libidinal energy) is the energy source for this impulse. Basic Life impulses are referred to as needs.

—As an Impulse grows, it becomes more likely that the person will choose an action which will reduce this need.

——Psychoanalytic Structure of the Mind

—The structure of the personality in psychoanalytic theory is threefold. Freud divided it into the id, the ego, and the superego. Only the ego was visible or on the surface, while the id and the superego remains below, but each has its own effects on the personality, nonetheless.

——Psychosexual Stages of Development

—Oral Stage (infancy to about 18 months)

—Anal Stage (about 18 months to 3 years old)

—Phallic Stage (can occur as early as 3 yrs to about 6 years old )

—Oedipal/Electra Complex (major crisis of this stage)

—Latency (6 years to puberty)

—Genital Stage (Puberty – adulthood)

—Other Psychodynamic Personality Theorists

—Carl Jung: was a Swiss psychiatrist who  developed his own psychodynamic theory – analytical (Jungian) psychology.

—Jung, like Freud was intrigued by unconscious processes. He believed that we not only have a Personal Unconscious that contains repressed memories and impulses, but also an inherited Collective Unconscious. The collective unconscious contains primitive images, or Archetypes, that reflect the history of our species.

——Jung & the Myers- Briggs

—One aspect of Jung’s  theory concerned traits that Jung felt were inborn.  These inborn, genetically determined traits are usually called temperaments.

—Later, two students of Jung's theory named Myers and Briggs - mother and daughter - developed a personality test based on Jung's temperaments called the Myers-Briggs Type Inventory, or MBTI.  It has gone on the become the most famous personality test of all time.

——Other Psychodynamic Personality Theorists

—Alfred Adler – Another follower of Freud, also felt that Freud had placed too much emphasis on sexual impulses. Adler believed that people are basically motivated by an inferiority complex.

—Drive  for Superiority

—Creative Self

—Individual Psychology

——Other Psychodynamic Personality Theorists

—Karen Horney – Neo-psychoanalyst who argued argued that little girls do not feel inferior to boys and that these views were founded on western cultural prejudice, not scientific evidence.

—She asserted that unconscious sexual and aggressive impulses are less important than social relationships in children’s development. She also believed that genuine and consistent love can alleviate the effects of even the most traumatic childhood.

—Other Psychodynamic Personality Theorists

—Erik Erikson - proposed stages of psychosocial development. Rather than label stages for various erogenous zones as Freud did, Erikson labeled them for the traits that might be developed according to its possible outcomes.

——Evaluation of Psychodynamic Perspective

—They involve many concepts and explain many varieties of human behavior and traits.  

—Although today concepts such as the id and libido strike many psychologists as unscientific,

— Freud fought for the idea that human personality and behavior are subject to scientific analysis.

—Personality Theory & Development

—Trait Theories of Personality

—Gordon Allport proposed that an individual's conscious motives and traits better describe personality than does that person's unconscious motivation. He identified three types of traits:

—Cardinal traits

—

—Central traits

—

—Secondary traits

—Allport’s Trait Theory

—Cardinal traits, such as a tendency to seek out the truth, govern the direction of one's life.

—

—Central traits operate in daily interactions, as illustrated by a tendency to always try to control a situation.

—

—Secondary traits, such as a tendency to discriminate against older people, involve response to a specific situation.

——Cattell’s Trait Theory

—Raymond Cattell, by means of a statistical technique called factor analysis, organized the huge number of words used generally to describe personality (over 17,000) and reduced them to 16 basic factors.

——Cattell’s Personality Factors

—emotional, easily upset vs. calm, stable

—intelligent vs. unintelligent

—suspicious vs. trusting

—reserved, unfriendly vs. outgoing, friendly

—assertive, dominant vs. not assertive, humble

—sober, serious vs. happy-go-lucky

—conscientious vs. expedient

—shy, timid vs. venturesome

Among others….

—— Eysenck’s Trait Theory

—Hans Eysenck was, along with Cattell, among the first psychologist to make this traits and temperament into something more mathematical.

—Instead of making these traits either-or, like Jung did, he saw them as dimensions.

——The 5 Factor Model

—More recently, a number of researchers have been using the latest in computer technology to redo the work that Eysenck and other earlier researchers did in far more laborious ways.  This has lead to what is known as the "big five" or the "five factor" theory.

——The 5 Factor Model

—OCEAN

—Openness

—

—Contentiousness

—— Extroversion-Introversion

——Agreeableness

——Neuroticism

——Genetics & the 5 Factor Model

—Evaluation of Trait Theories

—These five have stood up so well to research that I suspect most psychologists today accept them, at least until something even better comes along.

— It is also becoming clear that these are in fact strongly influenced by genetics.  In other words, you are born with at least the general outline of your personality traits already laid out for you.  That doesn't mean you can't change - it just means that it is less likely and more difficult.

——Behaviorism & Learning Theory

—Learning can be defined as the process leading to relatively permanent behavioral change or potential behavioral change.

—John B. Watson

——B.F. Skinner

——Albert Bandura

——Social Learning Theory

—Social-Cognitive theories of personality

—Social Cognitive Theory

—The social cognitive theory explains how people acquire and maintain certain behavioral patterns, while also providing the basis for intervention strategies

—Evaluating behavioral change depends on the factors environment, people and behavior.

—Social Cognitive Theory  provides a framework for designing, implementing and evaluating programs.

——Humanistic-Existential Perspective of Personality

—For the humanist/existentialist the prime focus on a psychology and personality of humans must acknowledge factors that are specifically human, such as choice, responsibility, freedom, and how humans create meaning in their lives.

—Human behavior is not seen as determined in some mechanistic way, either by inner psychological forces, schedules of external reinforcement, or genetic endowments, but rather as a result of what we choose and how we create meaning from among those choices.

——Maslow’s Hierarchy of Needs

—Characteristics of Self-Actualizers:

—1) Realistically oriented

—2) Accept self & others for what they are

—3) Spontaneous

—4) Problem-Centered vs. Self-Centered

—5)Somewhat Detached, need privacy

—6) Autonomous/Independent

—7) Appreciate People & Things

—8) Appreciate the mystery of life

—9) Identify with humanity (feel connected)

—10) Able to have deeply emotional relationships

—11) Believe in Democratic Values

—12) Does not confuse means with ends

—https://smccd.mrooms.net/file.php/50893/Online_Lecture_3.mov

https://smccd.mrooms.net/file.php/50893/Online_Lecture_3.mov

http://www.youtube.com/watch?v=1PGDpSp5CyI&feature=youtu.be

http://youtu.be/zHZVbcJrUsg

http://youtu.be/rnkuKyKOKxs

http://youtu.be/zHZVbcJrUsg

https://smccd.mrooms.net/file.php/50893/Online_Lecture_3.mov

http://video.pbs.org/video/1841157252/

http://www.youtube.com/watch?v=PZatrvNDOiE

http://www.youtube.com/watch?v=UTbI-G42JoY

https://www.youtube.com/watch?v=OuTZJi2xjmk

http://www.youtube.com/watch?v=IUsID-TjNGw

http://www.youtube.com/watch?v=QJ2h8TZ-38Q

http://www.youtube.com/watch?v=dmMXtZhx7io

http://www.youtube.com/watch?v=8hLubgpY2_w

QuestiThe Visual Cliff

Gene x Environment Interactions

Critical period,

Sensitive period

Sexual impulses/ Libido

Stages and sequences

Freud’s 5 stages of human development

Erikson’s 8 Stages of Human Development

Behaviorism

Little Albert Experiment

Qualitative changes vs Quantitative Changes

John Piaget, his stages of development

Genetic Epistemology

Schemas

Assimilation

Accommodation

Adaptation

Health Care and Immunizations

Illnesses in infancy:

•           Diarrhea

•           Upper Respiratory Infections

•           Ear Infections

Infant Mortality

Temperament

Taking Turns, eye contact and breast feeding

Colic

Variations in Infants’ Cries

Teratogens

Problems in Prenatal Development

Prenatal effects of Maternal Stress

Role of Father’s presence during delivery

Homosexuality: Biological Basis Hypothesis vs.  Programmed at Birth Hypothesis

Nutrition in Childhood

Obesity in Childhood

Dieting in Childhood and Adolescence

Cycle of Poverty & Health

Sensation Seeking

            Relationship to Alcohol Use

Smoking in Adolescence: Peer and parental influecnes

Sensation

Perception

Nativism

Empiricism

Maintenance

Attunement

Siegler’s Wave Theory

Intelligence Tests vs. Achievement Tests

Stanford-Binet

Influences to IQ scores: maturational vs experiential variables

Flynn Effect

Reliability

Validity

What IQ Scores Predict : High Intelligence vs. Low Intelligence (Slide 239)

What IQ Scores Do NOT predict 

Question: Is development more due to genes or environment? Do you think that the answer varies depending on what type of development we are referring to? Are there any other variables that might account for development?

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3091813/pdf/nihms219498.pdf

https://www.childwelfare.gov/pubs/issue_briefs/brain_development/effects.cfm#impact

 Question: Is development more due to genes or environment? Do you think that the answer varies depending on what type of development we are referring to? Are there any other variables that might account for development?

Answer:

Development is due to both, genes and environment. It depends of the resources such as parental income and education, ethnicity, and immigrant status as well as the ways in which equity among groups may be promoted, and these are just a few examples of variables that may cause the development. According Two important questions in the scientific study of child development: Of Nature vs. Nurture, by (G. Stanley Hall.) he believed that the milestones of childhood were dictated by an inborn developmental plan and were similar to those that had taken place in the evolution of the human species. He believed that norms or average ages at which milestones happened, and by (John Watson) explained development in terms of environmental.

Esther Barros Garcia.

Veronica,

I agree in this issue, the developments are a product of the interaction of both nurture and nature.  The evidence of how each factor impacts development and in what ways, and to what extent (the more I think the less I understand this issue lol) Is very complex, and has more to do with variety of components like, society with economy or the economic position of the family, social capital, and culture, and of course where in the world you are.

Thank you,

Esther

Cephalocaudal: Development proceeds from head to toe.Proximodistal: Development proceeds from the trunk out towards the fingers.Automatic reduction in the strength of a response to a repeated stimulusBuilt in at birthHelps to learn familiar from unfamiliar experiences
*Vaccinations

*Health and Wellness in Early InfancyIllnesses
* Diarrhea
* Upper Respiratory Infections
* Ear infections (Otitis Media)
*Health and Wellness in Early InfancyInfant Mortality
* Definition
* Incidence
* RisksSudden Infant Death Syndrome (SIDS)
* Definition
* Risks and relationships

Heavy Metal Music and Reckless Behavior

Among Adolescents

Jeffrey Arnett t

Received July 14, 1990; accepted Janua O, 10, 1991

Adolescents who liked heavy metal music were compared to those who did not

on a variety of outcome variables, particularly focusing on reckle,s:~ behavior. Boys

who liked heavy metal music reported a higher rate of a wide range of reckless

behavior, including driving behavior, sexual behavior, and drug use. They were

also less satL~fied with their family relationships. GMs who liked heavy metal music

were more reckless in the areas of shoplifting, vandalism, sexual behavior, and

drug use, and reported lower self-esteem. Both boys and girls who liked heavy

metal music were higher in sensation seekbTg and more self assured with regard

to sexuality and dating. In regression analyses, the relation between reckless behavior

and liking heavy metal music was sustained Jbr five out of twelve variables

concerning reckless behavior, including three of four among girls, when sensation

seeking and family relationships were entered into the equation beJbre liking or

not liking heavy metal music.

INTRODUCTION

Heavy metal music achieved considerable popularity during the 1980s

among American adolescents. Characterized by heavily distorted electric

guitars, pounding rhythms, and raucous raw vocals, all typically played at

an extremely loud volume, it had been only a fringe movement in popular

music until the past decade. However, by the end of the decade the top

heavy metal bands such as Metallica and Ozzy Ozbourne were selling mili

Postdoctoral Fellow, Committee, on Human Devclopmenl, University of Chicago, 5730

South Woodlawn Avenue, Chicago, Illinois 60637. Received Ph.D. from University of

Virginia. Research interests include adolescent musical preferences, reckless behavior, and

socialization. To whom correspondence should be addressed.

573

iXM7-289)//91/1200-O573506.50/D ~) 1991 P[CI1LII11P ul~lishingC orporatioll

Journal of Youth and Adolescence, VoL 20, No. 6, 1991

Heavy Metal Music and Reckless Behavior

Among Adolescents

Jeffrey Arnett t

Received July 14, 1990; accepted Janua O, 10, 1991

Adolescents who liked heavy metal music were compared to those who did not

on a variety of outcome variables, particularly focusing on reckle,s:~ behavior. Boys

who liked heavy metal music reported a higher rate of a wide range of reckless

behavior, including driving behavior, sexual behavior, and drug use. They were

also less satL~fied with their family relationships. GMs who liked heavy metal music

were more reckless in the areas of shoplifting, vandalism, sexual behavior, and

drug use, and reported lower self-esteem. Both boys and girls who liked heavy

metal music were higher in sensation seekbTg and more self assured with regard

to sexuality and dating. In regression analyses, the relation between reckless behavior

and liking heavy metal music was sustained Jbr five out of twelve variables

concerning reckless behavior, including three of four among girls, when sensation

seeking and family relationships were entered into the equation beJbre liking or

not liking heavy metal music.

INTRODUCTION

Heavy metal music achieved considerable popularity during the 1980s

among American adolescents. Characterized by heavily distorted electric

guitars, pounding rhythms, and raucous raw vocals, all typically played at

an extremely loud volume, it had been only a fringe movement in popular

music until the past decade. However, by the end of the decade the top

heavy metal bands such as Metallica and Ozzy Ozbourne were selling mili

Postdoctoral Fellow, Committee, on Human Devclopmenl, University of Chicago, 5730

South Woodlawn Avenue, Chicago, Illinois 60637. Received Ph.D. from University of

Virginia. Research interests include adolescent musical preferences, reckless behavior, and

socialization. To whom correspondence should be addressed.

573 iXM7-289)//91/1200-O573506.50/D ~) 1991 P[CI1LII11P ul~lishingC orporatioll

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Workshop module

A Graded Peer Assignment

Adding a Comment

Anonymous Grading

Assessment of Teacher's Examples

Assignment Elements

Display of Teacher's Grades

Editing a Comment

Grading of Peer Assignments

Grading Strategy

Grading of Student Submissions

Grading the Student Assessments

Hiding the Display of Grades

Including Self in the Assignment

Managing a Workshop Assignment

Number of Assessments of Student submissions

Number of Assessments of Teacher's Examples

Number of Comments, Elements, Bands or Criteria

Number of Peer Assessors

Peer Graded Assignment Type

Resubmitting assignments

Self Assessment

Specimen Assessment Form

Submission of Teacher's Examples

The Breakdown of the Final Grade

The Calculation of the Final Grade

The Final Grades

UnGraded Assessments (Student Submissions)

UnGraded Assessments (Teacher Submissions)

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wwwbdashboard

wwwbdashboard General Info

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wpAssessments

wpAssessment types

Comment inline

Email teachers

Page size

Quick Grade

Re-submit

Allow deleting

Maximum number of uploaded files

Allow notes

Hide description before available date

Does the conclusion bring the writer’s main idea to a logical close? Does the conclusion sum up the main idea without simply repeating the thesis or topic sentences?

Communication :

We all have the right to our opinion, but when we take the step to speak out in public, we also have the responsibility to speak ethically. Persuasion is the art of argument, and ethical persuasion demands that we critically examine our argument and evidence AND that we are willing to share, review, reflect and critique our argument and evidence with our peers. In this unit, we'll practice the fine art of argument, taking a close look at major pitfalls of persuasion--preaching to the choir, faulty evidence, and fallacies.

The Art of Losing Is Not Hard To Master

      The art of losing is not hard to master. On the poem, “One Art” by Elizabeth Bishop, is presented with emotion, comparison symbolism, and irony. It illustrates chronologically the progression of losing something. It has six stanzas and all the stanzas are about losing something. She sets up the progression of loss in the poem, going from the loss of insignificant things to the major loss of a person in a relationship at the end. She shows through her writing that in order to triumph over loss, one must learn the attributes of, realistic expectations of acceptance, and participation are important in order to achieve the potential for triumph and growth.

Bishop explains that you can lose a key to a door or a relationship of another person in your life, one must be aware and accept, in order to triumph, first to small things not a big deal, and it increases to be everything. Love is compare to be a big loss, the writer is telling her readers that it is good to begin gradually feeling comfortable with loss, as it is inevitable experiences in life. The repetition the writer chooses in her stanzas gives a reader the sense of actually encouraging those to accept loss , even with all the losses that life can bring, many times those losses have the appearance of something much worse than the reality; this is why realistic expectations are important for defeating loss. For example in the first, and second stanzas of “One Art” E.B. Introduces some of the minor things that people often lose, saying, “accept the fluster/of lost door keys, the hours badly spent (1.4-5). She says that we lose gradually something and we can lose everything and that is not something that you need to have a skill or be educated to lose anything.

Bishop encourages the reader to show acceptance and compassion to loss. She is trying to convince herself that losing things is not hard and she should not worry. With the repetition of loss, Bishop provides opportunities for the reader to interpret what is important to our lives. The fact of losing things should not have any problem she says. Gradually in the next stanzas of, “One Art” E. B. Gives examples of some of the large things that people next-to-last, of three loved houses went. She lost two immense lovely cities as well, some realms she owned, two rivers, a continent, kingdoms that she owned, and one of the large landmasses of the earth. I miss them, but it was not a disaster, the phrase “isn’t hard to master” (1.6.1-19). There is a positive message made out of loss, even with all of the loss detailed in the writing. This is relatable to young individuals, during the first decade or two of life, everything seems new and exciting, but as they age, they lose interest and excitement on new experiences. So many things seem filled with the intent many staff seems to be missing without intentions to loss. Then practice losing farther, losing faster:  If she would have the skills to loose, she would lose things at a faster rate. She explains to the reader the numerous losses she has taken, such as vast realms of property once owned. The faith stanza of “One Art” EB. Gives examples of some of the large things that people often lose, saying ““. . . two rivers, a continent” “I miss them, but it was not a disaster” (5.13-14). For example, the housing market of 2006 to 2011 here in Unites states, the stock market in 2008-2009. Some people that had save money in cash in the banks or at home, now own outright their properties, or got a very low interest for their properties. The last stanza of “One Art” E.B. Introduces some of the minor things that people often lose, saying “not too hard to master,” her understatement suggests the opposite, as the poem concludes that the loss, Bishop is trying to say that losing something is not something you need to have skills.

       This is why realistic expectations are important; so many things seem filled with the intent to be lost that their loss is no disaster. In the poem, the writer is telling her readers that it is good, to gradually feel comfortable with loss, as it is inevitable experiences in life. She seems to accept already to loss something every day. With all the six stanzas, the writer as she continues to use the same phrase, she is trying to pass her message in her poem. She seems to accept already to loss something every day. Embracing loss can be a wonderful thing when you accept it, being that not all loss will lead to disaster and have potential to grow into something healthy and beautiful once again. Next time you are dealing with a loss, remember embracing the losses, because it could be a wonderful thing. It may not be a disaster, and could very well be the start of a new beginning, a learning lesson that will save your life. This practice of learning to loss is achieve over time and is something everyone must accept eventually at some point in our lives.  

                                           

Poem “One Art” by Elizabeth Bishop

 https://www.youtube.com/watch?v=8VqNoLzZRkI&feature=youtube_gdata_player

Psychology

Question: What Is Psychology?

What exactly is psychology? Popular television programs, books, and films have contributed to a a number of misconceptions about this subject. The diverse careers paths of those holding psychology degrees also contributes to this confusion.
Early Psychology
Psychology evolved out of both philosophy and biology. Discussions of these two subjects date as far back as the early Greek thinkers including Aristotle and Socrates. The word psychology is derived from the Greek word psyche, meaning 'soul' or 'mind.'
A Separate Science
The emergence of psychology as a separate and independent field of study was truly born when Wilhelm Wundt established the first experimental psychology lab in Leipzig, Germany in 1879.
Wundt's work was focused on describing the structures that compose the mind. This perspective relied heavily on the analysis of sensations and feelings through the use of introspection, a highly subjective process. Wundt believed that properly trained individuals would be able to accurately identify the mental processes that accompanied feelings, sensations and thoughts.
Schools of Thought
Throughout psychology's history, a number of different schools of thought have thought have formed to explain human thought and behavior. These schools of thought often rise to dominance for a period of time. While these schools of thought are sometimes perceived as competing forces, each perspective has contributed to our understanding of psychology. The following are some of the major schools of thought in psychology.

• Structuralism

• Functionalism

• Psychoanalysis

• Behaviorism

• Humanism

• Cognitivism

Psychology Today
Today, psychologists prefer to use more objective scientific methods to understand, explain, and predict human behavior. Psychological studies are highly structured, beginning with a hypothesis that is then empirically tested. The discipline has two major areas of focus: academic psychology and applied psychology. Academic psychology focuses on the study of different sub-topics within psychology including personality, social behavior and human development. These psychologists conduct basic research that seeks to expand our theoretical knowledge, while other researchers conduct applied research that seeks to solve everyday problems.
Applied psychology focuses on the use of different psychological principles to solve real world problems. Examples of applied areas of psychology include forensic psychology, ergonomics, and industrial-organizational psychology. Many other psychologists work as therapists, helping people overcome mental, behavioral, and emotional disorders.
Psychology Research Methods
As psychology moved away from its philosophical roots, psychologists began to employ more and more scientific methods to study human behavior. Contemporary researchers employ a variety of scientific techniques including experiments, correlational studies longitudinal research, and others to test, explain, and predict behavior.
Areas of Psychology

• Abnormal Psychology is the study of abnormal behavior and psychopathology. This specialty area is focused on research and treatment of a variety of mental disorders and is linked to psychotherapy, and clinical psychology.

• Biological Psychology, also known as biopsychology, studies how biological processes influence the mind and behavior. This area is closely linked to neuroscience and utilizes tools such as MRI and PET scans to look at brain injury or brain abnormalities.

• Clinical Psychology is focused on the assessment, diagnosis, and treatment of mental disorders. It is also considered the largest employment area within psychology.

• Cognitive Psychology is the study of human thought processes and cognitions. Cognitive psychologists study topics such as attention, memory, perception, decision-making, problem-solving, and language acquisition.

• Comparative Psychology is the branch of psychology concerned with the study of animal behavior. This type of research can lead to a deeper and broader understanding of human psychology.

• Developmental Psychology is an area that looks at human growth and development over the lifespan. Theories often focus on the development of cognitive abilities, morality, social functioning, identity, and other life areas.

• Forensic Psychology is an applied field focused on using psychological research and principles in the legal and criminal justice system.

• Industrial-Organizational Psychology is a field that uses psychological research to enhance work performance, select employee, improve product design, and enhance usability.

• Personality Psychology looks at the various elements that make up individual personalities. Well-known personality theories include Freud's structural model of personality and the "Big Five" theory of personality.

• School Psychology is the branch of psychology that works within the educational system to help children with emotional, social, and academic issues.

• Social Psychology is a discipline that uses scientific methods to study social influence, social perception and social interaction. Social psychology studies diverse subjects including group behavior, social perception, leadership, nonverbal behavior, conformity, aggression, and prejudice.

Early Psychology
Psychology evolved out of both philosophy and biology. Discussions of these two subjects date as far back as the early Greek thinkers including Aristotle and Socrates. The word psychology is derived from the Greek word psyche, meaning 'soul' or 'mind.'
A Separate Science
The emergence of psychology as a separate and independent field of study was truly born when Wilhelm Wundt established the first experimental psychology lab in Leipzig, Germany in 1879.
Wundt's work was focused on describing the structures that compose the mind. This perspective relied heavily on the analysis of sensations and feelings through the use of introspection, a highly subjective process. Wundt believed that properly trained individuals would be able to accurately identify the mental processes that accompanied feelings, sensations and thoughts.
Schools of Thought
Throughout psychology's history, a number of different schools of thought have thought have formed to explain human thought and behavior. These schools of thought often rise to dominance for a period of time. While these schools of thought are sometimes perceived as competing forces, each perspective has contributed to our understanding of psychology. The following are some of the major schools of thought in psychology.

• Structuralism

• Functionalism

• Psychoanalysis

• Behaviorism

• Humanism

• Cognitivism

Psychology Today
Today, psychologists prefer to use more objective scientific methods to understand, explain, and predict human behavior. Psychological studies are highly structured, beginning with a hypothesis that is then empirically tested. The discipline has two major areas of focus: academic psychology and applied psychology. Academic psychology focuses on the study of different sub-topics within psychology including personality, social behavior and human development. These psychologists conduct basic research that seeks to expand our theoretical knowledge, while other researchers conduct applied research that seeks to solve everyday problems.
Applied psychology focuses on the use of different psychological principles to solve real world problems. Examples of applied areas of psychology include forensic psychology, ergonomics, and industrial-organizational psychology. Many other psychologists work as therapists, helping people overcome mental, behavioral, and emotional disorders.
Psychology Research Methods
As psychology moved away from its philosophical roots, psychologists began to employ more and more scientific methods to study human behavior. Contemporary researchers employ a variety of scientific techniques including experiments, correlational studies longitudinal research, and others to test, explain, and predict behavior.
Areas of Psychology

• Abnormal Psychology is the study of abnormal behavior and psychopathology. This specialty area is focused on research and treatment of a variety of mental disorders and is linked to psychotherapy, and clinical psychology.

• Biological Psychology, also known as biopsychology, studies how biological processes influence the mind and behavior. This area is closely linked to neuroscience and utilizes tools such as MRI and PET scans to look at brain injury or brain abnormalities.

Psychology is both an applied and academic field that studies the human mind and behavior. Research in psychology seeks to understand and explain how we think, act and feel. As most people already realize, a large part of psychology is devoted to the diagnosis and treatment of mental health issues, but that's just the tip of the iceberg when it comes to applications for psychology. In addition to mental health, psychology can be applied to a variety of issues that impact health and daily life including performance enhancement, self-help, ergonomics, motivation, productivity, and much more.

Answer:

Psychology is a broad and diverse field. A number of different subfields and specialty areas have emerged. The following are some of the major areas of research and application within psychology:
Like this article? Sign up for the Psychology Newsletter to get the latest psychology updates and to learn more about diverse topics including social behavior, personality, development, memory, creativity and much more.

Question: What Is Psychology?

What exactly is psychology? Popular television programs, books, and films have contributed to a a number of misconceptions about this subject. The diverse careers paths of those holding psychology degrees also contributes to this confusion.
Psychology is both an applied and academic field that studies the human mind and behavior. Research in psychology seeks to understand and explain how we think, act and feel. As most people already realize, a large part of psychology is devoted to the diagnosis and treatment of mental health issues, but that's just the tip of the iceberg when it comes to applications for psychology. In addition to mental health, psychology can be applied to a variety of issues that impact health and daily life including performance enhancement, self-help, ergonomics, motivation, productivity, and much more.

Answer:

Psychology is a broad and diverse field. A number of different subfields and specialty areas have emerged. The following are some of the major areas of research and application within psychology:

• Clinical Psychology is focused on the assessment, diagnosis, and treatment of mental disorders. It is also considered the largest employment area within psychology.

• Cognitive Psychology is the study of human thought processes and cognitions. Cognitive psychologists study topics such as attention, memory, perception, decision-making, problem-solving, and language acquisition.

• Comparative Psychology is the branch of psychology concerned with the study of animal behavior. This type of research can lead to a deeper and broader understanding of human psychology.

• Developmental Psychology is an area that looks at human growth and development over the lifespan. Theories often focus on the development of cognitive abilities, morality, social functioning, identity, and other life areas.

• Forensic Psychology is an applied field focused on using psychological research and principles in the legal and criminal justice system.

• Industrial-Organizational Psychology is a field that uses psychological research to enhance work performance, select employee, improve product design, and enhance usability.

• Personality Psychology looks at the various elements that make up individual personalities. Well-known personality theories include Freud's structural model of personality and the "Big Five" theory of personality.

• School Psychology is the branch of psychology that works within the educational system to help children with emotional, social, and academic issues.

• Social Psychology is a discipline that uses scientific methods to study social influence, social perception and social interaction. Social psychology studies diverse subjects including group behavior, social perception, leadership, nonverbal behavior, conformity, aggression, and prejudice.

OBJECTIVE 2.1 – Name the basic unit that makes up the nervous system, state what it is specifically designed to do, and list and describe its four parts.
OBJECTIVE 2.2 – Explain how a nerve impulse (action potential) occurs and how it is an all-or-nothing event and include the terms resting potential, threshold, ion channels, and negative after-potential.OBJECTIVE 2.3 – Describe how nerve impulses are carried from one neuron to another, contrast
         this communication with a action potential, and include an explanation of receptor sites, types
         of neurotransmitters, neural networks, plasticity, neurogenesis, and the types and functions of
         neuropeptides.

OBJECTIVE 2.4 – Differentiate a nerve from a neuron and explain the functions of myelin and neurilemma.   

OBJECTIVE 2.5 – Chart the various subparts of the human nervous system and explain their functions, describe the progress being made in repairing neurons in the central nervous system (CNS), and ways to prevent injury to the CNS.

OBJECTIVE 2.6 – Describe the spinal cord and explain the mechanism of the reflex arc, including the types of neurons involved.
OBJECTIVE 2.7 – Define biopsychology, describe techniques used to map brain structures and brain functions, and discuss how these techniques have been used to detect and undestand brain disorders, brain efficiency, and even behaviors, such as lying,
OBJECTIVE 2.8–Describe the main differences between the brains of lower and higher animals and include a description of the cerebrum, cerebral cortex,  gray matter, and corticalization.

OBJECTIVE 2.9 – Discuss hemispheric specialization, including the work of Roger Sperry,  how and why the brain is “split” and the resulting effects, the functions of the right and left hemisphere, the function of the corpus collosum, and how a person would be affected by damage to each hemisphere (such as the condition known as “spatial neglect” and neurological “soft signs”).

OBJECTIVE 2.10 – Describe the functions of each of the lobes of the brain and of the association areas, including Broca’s and Wernicke’s areas; explain the effects of damage to each of these brain regions, including the conditions of aphasia, agnosia, and facial agnosia; and discuss the findings of the studies on the differences in brain structure and brain specialization in women and men.
OBJECTIVE 2.11 – List the three areas of the subcortex and explain the function of each of the following parts of the subcortex: a. the midbrain; b. the hindbrain (brainstem) including: 1. the medulla; 2. the pons; 3. the cerebellum, and 4. the reticular formation; and c. the forebrain including: 1. the thalamus and 2. the hypothalamus.
OBJECTIVE 2.12 – List the structures that comprise the limbic system and explain its overall function as well as the specific functions of the amygdala and the hippocampus; describe the significance of “pleasure” and “aversive” areas in the limbic system; and summarize the brain’s basic functions and the latest brain research to aid paralyzed patients.

OBJECTIVE 2.13 –Explain the purpose of the endocrine system, the action of hormones, and the effects that the following glands have on the body and behavior: a. pituitary (include a description of giantism, dwarfism, and acromegaly); b. pineal; c. thyroid (include a description of hyperthyroidism and hypothyroidism); d. adrenal medulla; and e. adrenal cortex (include a description of virilism, premature puberty, and the problem of anabolic steroids).

OBJECTIVE 2.14 – Discuss brain dominance, late hology, A Journey 3e Objectives     

Psychology, A Journey 3e Objectives      Chapter 4

​OBJECTIVE 4.1 – Describe how our senses act as a data reduction system and biological transducers; explain the concepts of perceptual features, feature detectors, phosphenes, sensory analysis, sensory coding, and sensory localization; and differentiate between the processes of sensation and perception.

​OBJECTIVE 4.2 – Define the concepts of hue, saturation, and brightness; describe the functions of the lens, photoreceptors, and the retina; explain how the eye focuses and the process of accommodation; and describe the four vision problems of hyperopia, myopia, astigmatism, and presbyopia.

​OBJECTIVE 4.3 – Describe the functions of the rods and cones; explain how the brain compensates for the blind spot; describe the relationship between the fovea and visual acuity and the structures responsible for peripheral vision; and discuss night vision and how it can be improved.

​OBJECTIVE 4.4 – Compare and contrast the trichromatic and opponent-process theories of color vision, including a description of afterimages, color blindness, color weakness, and the IshiharaTest and describe the process of dark adaptation.

​OBJECTIVE 4.5 – Explain the stimulus for hearing using the terms compression, rarefaction, frequency, and amplitude and describe the location and function(s) of the following parts of the ear: a. pinna; b. eardrum (tympanic membrane); c. auditory ossicles; d. oval window; e. cochlea; f. hair cells g. stereocilia; h. organ of Corti.

​OBJECTIVE 4.6 – Describe the frequency theory and the place theory of hearing, the three general types of deafness, the decibel levels of sounds that can cause temporary and permanent hearing loss, and the methods of artificial hearing. 

​OBJECTIVE 4.7 – Describe the sense of smell, including the condition anosmia and the lock and key theory; and describe the sense of taste, including the five taste sensations, the sensitivity of humans to these tastes, the location and functions of the taste buds, and how taste is affected by smell, texture, temperature, and pain.

​OBJECTIVE 4.8 – List the three somesthetic senses and describe the function of each; list the five sensations produced by the skin receptors, explain why certain areas of the body are more sensitive to touch, differentiate between the warning and reminding systems regarding pain messages; discuss factors that influence pain and three ways to reduce pain; and describe the vestibular system including the parts of the inner ear involved and how the sensory conflict theroy explains motion sickness.

​OBJECTIVE 4.9 – Describe how sensory adaptation, sensory gating, and selective attention prevent many sensory events from ever reaching conscious awareness and include in your discuss, the concepts of counterirritation, acupuncture, phantom limb pain, the neuromatrix, and inattentional blindness.
​OBJECTIVE 4.10 – Describe the perceptual constancies of size, shape, and brightness:  define and give examples of the Gestalt organizing principles of figure-ground (include the concept of reversible figures and camouflage), nearness, similarity, continuity, closure, contiguity, and common region; and explain the concepts of perceptual hypothesis, ambiguous stimuli, and impossible figures.

​OBJECTIVE 4.11 – Describe depth perception; discuss the research regarding this perceptual ability; and describe the following depth cues and indicate whether each cue is monocular or binocular: a. retinal disparity (include the term stereoscopic vision); b. convergence; c. accommodation.
​OBJECTIVE 4.12 – Describe and give examples of the following monocular, pictorial depth cues: a. linear perspective; b. relative size; c. height in the picture plane; d. light and shadow; e. overlap; f. texture gradients; g. aerial perspective; h. relative motion or motion parallax (include a discussion of the moon illusion and the apparent-distance hypothesis).

​OBJECTIVE 4.13 – Describe the following concepts that influence a person’s view of the world:  perceptual constructions, “boiled frog syndrome,” bottom-up and top-down processing,  perceptual expectancy (set), “other-race effect,” perceptual learning, perceptual habits, illusions, hallucinations, reality testing, the Charles Bonnet syndrome, the Ames room, and the Müller-Lyer illusion. 

​OBJECTIVE 4.14 – Define the terms extrasensory perception, parapsychology, and psi phenomenon; describe the purported psychic abilities of clairvoyance, telepathy, precognition, and psychokinesis, including the research  with Zener cards; and explain what most psychologists believe regarding psi abilities and stage ESP.

​OBJECTIVE 4.15 – Explain why most eyewitness testimony is inaccurate and describe how a person can more accurately perceive the world and become a better eyewitness to life.

Chapter 5
​OBJECTIVE 5.1 – Define consciousness, waking consciousness, the first-person experience, and altered state of consciousness (ASC) and  list causes of an ASC.

​OBJECTIVE 5.2 – Describe the basic characteristics of sleep; what skills can be performed when asleep; sleep as a biological rhythm; the concept of microsleep; the symptoms of sleep deprivation and temporary sleep deprivation psychosis; hypersomnia in teenagers; the sleep patterns of short and long sleepers; and the relationship between age and sleep needs. 
​OBJECTIVE 5.3 – Explain what physiologically controls sleep; describe the characteristics of the four stages of sleep, including the different brain wave patterns in each; differentiate between the two basic states of sleep (REM and NREM); and describe the symptoms of REM behavior disorder and hypnopompic hallucinations.

​OBJECTIVE 5.4—List factors that contribute to sleep problems in American society and describe the following sleep disturbances (Table 5.1):  a. hypersomnia; b. narcolepsy; c. periodic limb movement syndrome; d. restless legs syndrome; e. sleep drunkenness;  f. sleep terror disorder; and  g. sleep-wake schedule disorder.

​OBJECTIVE 5.5—Describe the three types of insomnia, what causes each type, the effectiveness of prescription and nonprescription sleeping pills, and the six behavioral remedies used to treat chronic insomnia.

​OBJECTIVE 5.6– Describe sleepwalking and sleeptalking; differentiate between nightmares vs. night terrors; state three steps that can be used to eliminate nightmares; and discuss sleep apnea, its causes, its treatments, and its connection to SIDS, including the risk factors and preventative measures for SIDS.

​OBJECTIVE 5.7 – Discuss REM sleep and dreaming, including when REM sleep was discovered, the average length and spacing of dreams per night, the research of William Dement, the causes and symptoms of REM rebound, and the functions of REM sleep.

​OBJECTIVE 5.8 – Explain the current research on dream content, Freud’s psychodynamic dream theory, and the activation-synthesis hypothesis.

​OBJECTIVE 5.9 – Define hypnosis and describe its history from Mesmer through its use today; discuss the state and the nonstate theories  of hypnosis and the view of hypnosis as autosuggestion; describe how stage hypnotists perform their “acts”; and discuss how “true” hypnosis is conducted, including the basic suggestion effect, hypnotic susceptibility, and what can and canot be achieved with hypnosis. 
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​OBJECTIVE 5.10 – Describe the two major forms of meditation and their benefits; explain the relaxation response; and discuss sensory deprivation and the beneficial uses of  sensory restriction (REST).

​OBJECTIVE 5.11 – Define the term psychoactive drug; describe how various drugs affect the nervous system; and differentiate physical dependence from psychological dependence.

​OBJECTIVE 5.12 – Discuss the medical uses (if any), symptoms of abuse, organic damage potential, withdrawal symptoms, and treatment options for: a. amphetamines; b. cocaine; c. MDMA (ecstasy); d. caffeine; e. nicotine. f. barbiturates; g. GHB; h. tranquilizers (include the concept of drug interaction); i. alcohol; and j. hallucinogens (including marijuana) and explain why drug abuse is such a common problem.
​OBJECTIVE 5.13 – Explain the procedure for “catching a dream”; the effect that various drugs have on REM sleep;  how Freud, Hall, Cartwright, and Perls analyzed dreams, including Freud’s four dream processes; how dreams can be used to improve creativity; and lucid dreaming. ralization, and handness, including their relationship to language processing; how and when the dominant hemisphere is determined; and the incidence, advantages, and disadvantages of being right-or left-handed, or inconsistent in dominance

Psychology, A Journey 3e Objectives      Chapter 6
​OBJECTIVE 6.1 – Define learning, response, reinforcement, antecedents, and consequences and explain how these terms are related to classical and operant conditioning.
​OBJECTIVE 6.2 – Briefly describe the history of classical conditioning and give examples of how classical conditioning takes place, utilizing the following terms: a. neutral stimulus (NS); b. conditioned stimulus (CS); c. unconditioned stimulus  (UCS); d. unconditioned response (UCR); e. conditioned response (CR).
​OBJECTIVE 6.3 – Explain how reinforcement occurs during the acquisition of a classically conditioned response; describe higher-order conditioning; and discuss the informational view of classical conditioning.
​OBJECTIVE 6.4 – Describe and give examples of the following concepts as they relate to classical conditioning: a. extinction; b. spontaneous recovery; c. stimulus generalization; and d. stimulus discrimination.

​OBJECTIVE 6.5 – Describe the relationship between classical conditioning and reflex responses,  explain what a conditioned emotional response (CER) is and how it is it is acquired, and discuss the therapy techniques of desensitization and virtual reality exposure and the concept of vicarious classical conditioning.

​OBJECTIVE 6.6 – Briefly describe the history of operant conditioning, including Thorndike’s law of effect and the work of  B.F. Skinner;  contrast the two types of conditioning; and differentiate between the terms reward and reinforcement.

​OBJECTIVE 6.7 – Explain operant conditioning in terms of the informational view; define response-contingent reinforcement; and describe the deterimental effect of delaying reinforcement and how response chaining can counteract this effect.

​OBJECTIVE 6.8 – Explain why superstitious behavior develops and why it persists; describe the process of shaping; and explain how extinction and spontanous recovery occur in operant conditioning and how reinforcement and extinction are involved in negative attention-seeking behavior.

​OBJECTIVE 6.9 – Compare and contrast positive reinforcement, negative reinforcement, and the two types of punishment and give examples of each.
​OBJECTIVE 6.10 – Define and give examples of primary reinforcers, secondary reinforcers, tokens, social reinforcers, and feedback (knowledge of results); and explain how conditioning techniques can be applied to energy conservation and learning aids, such as programmed instruction, computer-assisted instruction, and interactive simulations.
​OBJECTIVE 6.11 – Compare and contrast the effects of continuous and partial reinforcement and describe, give an example of, and explain the effects of the following schedules of partial reinforcement: a. fixed ratio (FR); b. variable ratio (VR); c. fixed interval (FI); and d. variable interval (VI).

​OBJECTIVE 6.12 – Explain the concept of stimulus control and describe the processes of generalization and discrimination as they relate to operant conditioning.

​OBJECTIVE 6.13 – Explain how punishers can be defined by their effects on behavior;           discuss the three factors that influence the effectiveness of punishment; and differentiate the effects of severe punishment from mild punishment.

Psychology, A Journey 3e Objectives      Chapter 7
​OBJECTIVE 7.1 — Define memory; explain the three processes of memory—encoding, storage, and retrieval; and list the three stages of memory—sensory, short-term, and long-term.

​OBJECTIVE 7.2 — Describe sensory memory, including icons and echoes and how information is transferred from sensory memory to short-term memory.

​OBJECTIVE 7.3  — Describe short-term memory, including its capacity, how information is encoded, the permanence of short-term memory and its susceptibility to interference, and the concept of working memory.
​OBJECTIVE 7.4 — Describe long-term memory in terms of permanence, capacity and the basis on which information is stored; define dual memory; and explain how one’s culture affects memory.
​OBJECTIVE 7.5 — Explain the “magic number” seven; describe chunking; and explain how the two types of rehearsal affect memory.

​OBJECTIVE 7.6 — Discuss the permanence of memory, including the work of Penfield and the Loftuses; explain constructive processing and pseudo-memories; and describe the effects of hypnosis on memory and how a cognitive interview can improve eyewitness memories.

​OBJECTIVE 7.7 — Briefly describe how long-term memories are organized, including the network model and redintegrative memories.

​OBJECTIVE 7.8 — Differentiate procedural (skill) memory from declarative (fact) memory and define and give examples of the two kinds of declarative memory (semantic and episodic).
​OBJECTIVE 7.9 — Explain the tip-of-the tongue state and the feeling of knowing; and describe and give examples of each of the following ways of measuring memory: a. recall, including the serial position effect; b. recognition, including a comparison to recall and the concept of distractors; and c. relearning, including the concept of savings score.

​OBJECTIVE 7.10 — Distinguish between explicit and implicit memories and describe priming.

​OBJECTIVE 7.11 — Differentiate the concepts of internal mental images and eidetic imagery; and explain how these abilities are different from having an exceptional memory.
​OBJECTIVE 7.12 — Explain Ebbinghaus’ curve of forgetting; and discuss the following           explanations of forgetting: a. encoding failure; b. decay of memory traces;           c. disuse, including why this explanation is questioned; d. cue-dependent forgetting; e. state-dependent learning; f. retroactive and proactive interference; and g. repression, including the recovered memory/false memory debate and how repression differs from suppression.
​OBJECTIVE 7.13 — Describe flashbulb memories,  retrograde and anterograde amnesia, and the role of consolidation in memory, including the effects of ECS.
​OBJECTIVE 7.14 — Name the structure in the brain that is responsible for switching information from STM to LTM; and discuss the research on where in the brain different types of memories are stored and the relationship between learning and transmitter chemicals.

​OBJECTIVE 7.15 — Describe each of the following in terms of how it can improve memory: a. knowledge of results; b. recitation; c. rehearsal; d. selection;           e. organization; f. whole versus part learning; g. serial position effect; h. cues;           i. spaced practice; j. sleep; k. hunger; m. extension of memory intervals; l. review; and m. strategies to aid recall, including the cognitive interview.
​OBJECTIVE 7.16 — Define mnemonic; explain the four basic principles of using mnemonics; and describe three techniques for using mnemonics to remember things in order.
Psychology, A Journey 3e Objectives      Chapter 8
​OBJECTIVE 8.1 — Describe what it means to be a savant.
​OBJECTIVE 8.2 — Describe Binet’s role in intelligence testing; give a general definition of intelligence; and explain the g-factor, what an operational definition of intelligence is, and how other cultures view intelligence.
​OBJECTIVE 8.3 — Describe the development of the original Stanford-Binet and the five cognitive factors measured by the Stanford-Binet Intelligence Scales, Fifth Edition (SB5).
​OBJECTIVE 8.4 — Define mental age and chronological age; use examples to show how they are used to compute an intelligence quotient (IQ); differentiate between this IQ (MA/CA x 100) and deviation IQs; and explain how percentiles are interpreted.
​OBJECTIVE 8.5 — Distinguish the Wechsler tests from the Stanford-Binet tests and between group and individual tests; and describe the distribution of IQ scores observed in the general population.

​OBJECTIVE 8.6 — Differentiate between the terms gifted and genius; describe Terman’s study of his gifted subjects, including how the successful ones differed from the less successful ones as adults; and explain how gifted children are identified.

​OBJECTIVE 8.7 — Define mental retardation (developmental disabiled) and state the dividing line between normal intelligence and retardation; describe the degrees of retardation, and differentiate between familial and organic retardation.


​OBJECTIVE 8.8 — Explain why psychologists are developing broader definitions of intelligence; and describe Howard Gardner’s theory of multiple intelligences.
​OBJECTIVE 8.9 — Define the term artificial intelligence (AI); explain what AI is based on; list its advantages and limitations; and describe how computer simulations and expert systems are being used.

​OBJECTIVE 8.10 — Describe the studies that provide evidence for the hereditary view and for the environmental view of intelligence, including the twin studies, the adoption studies,  Skeels’ study, IQ gains in Westernized nations, and the effects of video games, the Internet, and television.


​OBJECTIVE 8.11 — Define cognition and list the three basic units of though

​OBJECTIVE 8.12 — Describe the uses and properties of mental images; explain how  stored and created images are used and how the size of a mental image may be important; and describe how kinesthetic imagery aids thinking.

​OBJECTIVE 8.13 — Define the terms concept, concept formation, conceptual rule, and prototype;  explain  how children and adults learn concepts; differentiate among the three types of concepts (conjunctive, relational, and disjunctive); explain the difference between the denotative and the connotative meanings of a word; describe how the connotative meaning is measured; and discuss problems associated with social stereotypes and all-or-nothing thinking.

​OBJECTIVE 8.14 — Explain how language aids thought; define semantics; and discuss           bilingual education, including the concepts of additive and subtractive bilingualism and two-way bilingual education.

​OBJECTIVE 8.15 — Briefly explain the following three requirements of a language and their related concepts:  a. symbols (phonemes and morphemes); b. grammar           (syntax and transformation rules); c. productivity; describe the characteristics of gestural languages; and discuss the extent to which primates have been taught to use language, including criticisms.

​OBJECTIVE 8.16 — Define and explain how each of the following terms are related to problem-solving: (a) mechanical solutions, including trial-and-error and rote;           (b) algorithms; (c) solutions by understanding, including a general solution and functional solutions; (d) a random search strategy; (e) heuristics, including the differences in experts and novices; and (f) insight, including selective encoding, selective selective combination, and selective comparison.

​OBJECTIVE 8.17 — Explain and give examples of how fixation and functional fixedness block problem-solving; and describe the four common barriers to creative thinking.

​OBJECTIVE 8.18 — Describe and give examples of the four kinds of thought (inductive, deductive, logical, and illogical); define the creative processes of fluency, flexibility, and originality; differentiate between convergent and divergent thinking; explain how creativity can be measured and why creativity is more than divergent thinking; discuss the five stages of creative problem-solving and the typical  characteristics of creative persons; and list Csikszentmihalyi’s recommendations for developing one’s creativity.

​OBJECTIVE 8.19 — Define intuition; describe the process of “thin-slicing”; explain the following three common intuitive thinking errors: a. representativeness (include representativeness heuristic); b. underlying odds (base rate); c. framing; and include a brief description of what it means to have wisdom.

​OBJECTIVE 8.20 — Describe how IQ tests may be unfair to certain groups and what a           culture-fair test is; explain how group differences in IQ scores are related to           cultural and environmental differences rather than race; and list the advantages           and disadvantages of using standardized testing in schools.

Psychology, A Journey 3e Objectives      Chapter 9

​OBJECTIVE 9.1 — Define motivation and what factors influence motivation and emotions; describe the condition known as alexithymia; and explain the need reduction model and how the incentive value of a goal can affect motivation.

​OBJECTIVE 9.2 — Describe and give an example of each of the three types of motives; and define homeostasis.

​OBJECTIVE 9.3 — Describe how circadian rhythms affect energy levels, motivation, and performance; and explain how and why shift work and jet lag may adversely affect a person and how to minimize the effects of shifting one’s rhythms.

​OBJECTIVE 9.4 — Discuss why hunger cannot be fully explained by the contractions of an empty stomach and describe the relationship of each of the following to hunger:  a. blood sugar; b. liver; c. hypothalamus: 1) feeding system (lateral hypothalamus), 2) satiety system (ventromedial hypothalamus), 3) blood sugar regulator (paraventricular nucleus); d. GLP-1.

​OBJECTIVE 9.5 — Explain how each of the following is related to overeating and obesity: a.
a person’s set point;
b. the release of leptin;  c. external eating cues;
d. variety and taste,
e. emotions,
f. cultural factors, and g. dietary content.


​OBJECTIVE 9.6 — Explain the paradox of  “yo-yo” dieting and describe what is meant by behavioral dieting and how these techniques can enable you to control your weight
​OBJECTIVE 9.7 — Describe the essential features of the eating disorders of anorexia nervosa and bulimia nervosa; explain what causes them; and what treatments are available for these eating disorders.
​OBJECTIVE 9.8 — Name the brain structure that appears to control thirst; and differentiate extracellular and intracellular thirst.
​OBJECTIVE 9.9 — Explain how the drive to avoid pain and the sex drive differ from other primary drives; describe how the sex drive in humans differs from that of lower animals; and how alcohol and various other drugs affect one’s sex drive.

​OBJECTIVE 9.10 — Describe the erogenous zones and the similarities and differences in the male and female sexual response cycle, including the four phases of sexual response identified by Masters and Johnson; and define the terms aphrodisiacs and sexual script.
​OBJECTIVE 9.11 — Define the term sexual orientation; describe the various types of sexual orientation; explain the combination of influences that appears to produce homosexuality; and discuss the four types of sexual dysfunctions and treatments for them, such as drugs and sensate focus.

​OBJECTIVE 9.12 — Discuss the importance of  the stimulus drives; describe the arousal theory, the inverted U function, and the Yerkes-Dodson law; explain how one can cope with test anxiety; and list the characteristics of high and low sensation-seekers.
​OBJECTIVE 9.13 — Describe social motives and explain how they are acquired; define the need for achievement (nAch) and differentiate it from the need for power; relate this need for achievement to risk taking; explain the influences of drive and determination in the success of high achievers; and list seven steps to enhance self-confidence.
​OBJECTIVE 9.14 — List (in order) the needs found in Maslow’s hierarchy of motives; distinguish between basic needs and growth needs; explain why Maslow’s lower (physiological) needs are considered prepotent; and define and give examples of meta-needs.

​OBJECTIVE 9.15 — Distinguish between intrinsic and extrinsic motivation, and explain how each type of motivation may affect a person’s interest in work, leisure activities, and creativity.
​OBJECTIVE 9.16 — Define the terms emotions and moods, explain how emotions aid survival; describe the three major elements of emotions; list the eight primary emotions proposed by Plutchik; and explain the role played by the brain hemispheres when a person experiences two opposite emotions simultaneously.

​OBJECTIVE 9.17 — Describethe roles of the sympathetic and parasympathetic branches of the ANS in emotional arousal; explain how the parasympathetic rebound may be involved in cases of sudden death; and discuss the use and limitations of the lie detector (polygraph) and future techniques to be used in airport security for detecting lies.
​OBJECTIVE 9.18 — Discuss Darwin’s view of human emotion and which facial expressions appear to be universal and most recognizeable; describe cultural and gender differences in emotional expression; and discuss kinesics, including the emotional messages conveyed by facial expressions and body language.

​OBJECTIVE 9.19 —Describe and give examples of the following theories of emotion: a. James-Lange theory; b. Cannon-Bard theory; c. Schachter’s cognitive theory; d. the effects of attribution on emotion; e. the facial feedback hypothesis, including the dangers of suppressing emotions; f.  emotional appraisal; and g. the contemporary model of emotion.

​OBJECTIVE 9.20 — Describe the concept of emotional intelligence and its five  skills; and briefly discuss the benefits of positive emotions.

The Study on Obedience

In 1963, Stanley Milgram, a Yale psychologist, conducted an experiment on obedience. Milgram describe several experiments which establish to prove his point that people follow instructions without questioning the authority figure. In order to demonstrate that participants carried out orders without question, Milgram shows: “When the very first experiments were carried out, Yale undergraduates were used as subjects, and about sixty percent of them were fully obedient (696)”. The participants obey the authority under the complex circumstances.  A lab director, a perceived authority figure, ordered participants to administer increasingly painful shocks to “subjects”, who were all strangers, which escalated to a lethal voltage.  The participants were unaware that the shocks were not real and that “the subjects” were actually actors hired to pretend to be shocked.  The majority of participants were willing to administer deadly shocks and only a minority refused to obey when asked by the lab director.  In this controversial study, the participants were able to act without guilt because the lab director, the perceived authority figure, could be blamed for the harmful consequences of their actions. 

People follow instructions without questioning the morality of the orders. “The point of the experiment is to see how far a person will proceed in concrete and measurable situation, in which he is ordered to inflict increasing pain on a protesting victim (694)”.This experiment powerfully demonstrates real-world behavior; people may act in ways that may be labeled as immoral if executed on an individual basis.  However, these same actions may seem acceptable if they can be justified as “just following orders.”  For example, many former Nazi officers used the defense of “just following orders” when tried for war crimes against the Jewish people, yet this defense rarely proved successful.  Milgram’s experiment suggests that the desire to obey perceived authority strongly influences social behavior.  It indicates that most people are unable to withstand social pressure and only a few successfully resist conformity when confronted with a perceived authority.  Interesting future research might explore finding out what helped individuals resist harming others even when pressured by a perceived authority.

At present, Religious obedience is that general submission which religious vow to God, and voluntarily promised to their superiors.  The person allowing him to be governed throughout his life by others for the sake of God, religious have taken a far greater part than formerly in civil and public life, personally fulfilling all the conditions required of citizens, in order to exercise their right of voting and other functions compatible with their profession. No political system rejects the votes of persons in dependent positions, and all freely permits the use of any legitimate influence, which corrects to some extent the vicious tendency of equalitarianism. The moral significance religious is bound morally to obey on all occasions.  A member of a religious order has often compared to a dead body, but in truth, the religious vow by vanity and self-love and all their fatal opposition to the Divine will kill nothing. If superiors and subjects have sometimes failed to understand the practice of religious obedience, if direction has sometimes been indiscreet, human institution is not free from these accidental imperfections. The expression "blind obedience” (the catholic encyclopedia on CD-ROM ) signifies a keen appreciation of the rights of authority, the reasonableness of submission, and blindness only to such selfish or worldly considerations as would lessen regard for authority.

This article demonstrate that the problem of obedience is part psychological, social, and learned. The behaviors of these individuals in the study are patterns of society. The essence of obedience for some people seems to be that they feel no responsibility for their actions that the authority gives to the person in the study. The breaking up of society into people carrying out narrow and specific jobs takes away the human quality, says Milgram. The importance of this lesson is that ordinary people simply doing their jobs and can become agents in  terrible destruction. People’s willingness to go almost any length to please the authority figure is demanding explanations.

Sources:

THE CATHOLIC ENCYCLOPEDIA ON CD-ROM Includes the Catholic Encyclopedia, Church Fathers, Summa, and Bible.

Elliot, Life of Father Heckler ,New York, 1896.

In 1963, Stanley Milgram, a Yale psychologist

 Que Es tener exito personal?

Para mi, Es la realizacion progresiva de mis metas.

Que Es la felizidad?

Es un estado mental, un subproducto en el prosseso.

 De una actitud mental Positiva

 La felizidad consiste en hacer el

 bien. Donde encontrar el exito personal y la felicidad?

Los  Exitos Personales estan  en la jente con mente organizada. Con verdaderos deseos de actuar!
Deseo (un ardente, intenso, passion, obsession que te motiva a actuar).

Motivacion: crea un ambiente propicio para que la persona interesada pueda ver el camino para la realisacion de tus metas.
Las metas, correctible Es importante
La vida Es un juego, que nesecitas accion, con planiamiento diario.

Perseverancia
Persistencia
Receptividad
Actitud positiva
Ser Decisiva
Accion!Actuar: Poner en practica tus ideas. Ejecutar tus ideas. As desidido lograr, y a desidido  pagar el precio que sea nesesario para alcansar tus metas.
Metas de toma de compromiso.
 metas, planamiento de su objetivo en la vida.
NOTA:
El que sabe y no actua Es un fracasado!,
La accion es el USO del Conosimiento

2.) Decision: el poder de decision  Es algo que desarollamos

 paulativamente  durante  nurstras vidas.

Nadies puede encontrar loque no puede visualizar. Es el procceso de aprendisaje. (tiempo)

El exito no Es estatico, es dinamico
Nadies puede definir tus exito!!! No lo permitas, estarian anulando tu libertada interior,  "el libre albedrio"!!
Es personal, y de disfrutar cada paso, Durante el trayeto al realisacion de mis METAS!
1.) Las alternativas: son una Consecuenia directa de tu libertad.
El subproducto en el procceso, de una accion que ejecutastes.
2.) Como eliminar el odio por experiences del  pasado.
Los 4 elementos de la humanidad.
Consiste en:
Physico
Emocional
Espiritual
Mental
El ser "YO"

5 instrumentos
Formula de situacion mental  5 instrumentos para comunicar con el mundo exterior (fuera de una persona)

Visual
Auditivo
Olfato
Sentido
Tactico

Technica de Los disparadores

1.) Despues del ser (YO) la palabra, Es mas importante.

La palabra: comunicasion, el que tiene la informacion y la communica al mundo exterior Es un triunfador!
La communicasion COMO nos communicamos a nosotros mismo, Es muy importante, Si nos communicamos bien,

Tipos de mecanismos de orientacion
para la communicasion.

1.) Duplicasion   Physiologica
2.) Asercamiento alejamiento
3.) Interal y external
4.) Igualdad diferencia
5.) lenguaje NO verbal lleva un porcentaje alto
 (90%) (movimiento del cuerpo.
7.) Nesesida Posibilidad*

La Communicasion correcta es importante!*

Solamente nesecitamos comunicar lo que la persona puede entender. Debemos pensar  mucho en loque desimos, para que nunca digamos todo lo que entendemos/sabemos.

Solamente debemos comunicar loque la persona puede entender de acurdo a su situacion MENTAL.

2.) Education

You are not your thoughts
Be careful what you feed your mind

3.) Creencias:
Solo puedes  hacer si tu crees que puedes hacer!

*Nuestro ambiente
*Educasion
*Eventos passados

4.) Resultados de nuestro pasado 

•Nunca le tengas miedo al fracaso y nunca fracasaras!

• NOTA:   En la vida NADA ES GRATIS!!!

Todo cosa, causa, y efecto:
Todo absolutamente todo.
la vida tiene un precio!!

No aceptes nada GRATIS

Paga el precio!   No aceptes algo que no te Pertenece.
Si recibes algo gratis, realmente pagastes un precio mas alto. Talves pagastes, con humillaacion, con tu autoestima rebajada.
 La palabra gratis, Es la palabra mas cara del diccionario.

Todo en la vida tiene un valor (un precio).
 Esta Es La ley universal de causa y efecto.

Tips:
La formula para alcansar el exito.
*Deside con presicion que es loque deseas en la vida?

*Deside cuanto y que Es el precio?
* Cuanto Es loque vas a sacrificar,  
* mentalmente antes de que empieses el proceso visualisa los pasos las cosas que pudueran pasar y  resuelve el percance en la trayectora del camino, disfrutando el proceso con optimismo, haciendo todo con sabiduria y buenas intenciones.

El optimismo: Modifica tus pensamientos  en tu mente. El consepto de ti mismo, de nuestra conducta.
Tu no eres loque piensas que eres.  Loque piensa, eso Es loque tu eres!

La realisad esta en nuestra mente, y eso Es subjectivo, dependiendo como persivimos el mundo externo.

Your brain needs down time

Step one
Mega to do list:

everything you need to do in long and short term.
All things that needs to do down.
This will empty your mind.
Then take a break for an hour or so

Step two
Defining your Desires

Write all the things that you ever wanted.

Everything that desire!!!! Imagine that ideal life that you want!!!
Take a break and go away.

Step three.
The Fear Factor

Write it down what ever fear you have, and write down so you can empty hour mind. This will bring the fears on to the surfa.
Take a break and them comeback. Read out loud all beginning from the first list. Exam your fear enteries and think of solutions.

Find your solutions  Think on ways to yo solve.

EXITOS PERSONAL   Y SUPERACION PERSONAL PARA LLEGAR HACER  LOMEJOR QUE PUEDAN SER.

PARA DEJAR ESTE  MUNDO MEJOR QUE DELOQUE ENCONTRASTES CUANDO LLEGASTES A QUI!

• Para Mi Es El Logro Progressive  De Mis Metas Y Disfrutando El Proseso.   Es Dinaminco No Estatico.

La Mente Humana Es Lo Mas Complejo Y Asombroso De Toda La Creacion  De Este Planeta Asta La Fecha.

El Exito No Tiene Correlacion Entré El Nivel De Inteligencia.

***Solamente Ser Parctica Y Poner Tiempo, Porque Es Un Processo De Aprendisaje Para Tener Exito, Tienes Que Estar Listo Para Entender El Pensaje.

Superacion Personal?

**Que Quieres  Ser Lo Mas Eficas Posible

El Exito  Es Creado Por Uno Mismo: Es Una Cadena De Cosas Bien Hechas En Una Cadena De Tiempo  nadie puede definir tu exito. No es forsado, Es deseado. El procceso del exito es muy intimo del ser humano, Es personal el ser humano es libre por naturaleza.  El y solo El deside que hacer con su vida. El ser humano puede decidir que alguien desida por el, pero aun en ese caso El (tu)deside que desidan por El.(por ti). 

La jente no logra loque quiere  sino loque espera lograr! "Mucha differncia" quieres triumfar pero esperas fracasar, y por  so fracasa.

Toda persona que realmente quiere vivie una vida exitosa, vive una vida exitosa;  independientemente de todas las cosas malas que le pasa.
 Porque a desidido ser exitosa, a desidido triumfar.  Decidio, motivado, creando el ambiente propicio para que tu te motives, tu desidas a desarrollar, y tomar el camino de su eleccion. solo la emocion puede crear la passion nessecaria y desarrollar un ardiente deseo y toma una decicion.  Es tu decision loque te motiva,  intensamente emociona, para  solo una emosion: es tu decision loque te motiva.

Crea el ambiente propisio para que la persona interesada pueda ver la situacion claramente el camino pasaso y el nuevo camino desidiendo pagar el precion.
 Solo la emocion crea la passion nessesaia para convertir un simple deseo en  una obsersion que se vivie minuto a minuto.

El poder de decision es persistencia.
Perseverancia: persistencia es uno de los factores para cual quier exito en la vida.
Resceptible: una actitud positiva no aceptes nada gratis! para tener exito: nesesitas tener un ardiente deseo para poder alcansar tu proposito a culminar tu proposito)  
Exito personal: depende a la persona que preguntes

To: MARGOTH BARROS

FEBRERO, 2, 2002

 Faith is the "external elixir which gives life, power and action to the impulse of THOUGHTS.

Para DIOS  NO HAY NADA IMPOSIBLE! No hay nada imposible para DIOS! Todo es posible!

IDEAS AND CREATIONS AN IDEA FORMED IN YOUR MIND "FORMS IN THE INSIDE of your mind, self, the invisible elixir.  

My gift to you: The fastest way to create a life on your terms

In Think and Grow Rich, Napoleon Hill gives us a simple yet powerful statement: “The great leaders of business, industry, and finance, and the great artists, poets, musicians and writers all became great because they developed the power of self-motivation.”

Take a Steve Jobs or a Walt Disney or a Henry Ford. All titans of their industries, they all understood that learning can’t be confined to the schoolyard. For these men, and the pioneers before them, personal growth is closely tied to learning how your mind works, and conditioning your psychology for success.

So many of us believe that after a college education the learning stops. But as Jim Rohn once said:
“Formal education will make you a living; self education will make you a fortune.”

From: Books of Napolion Hill.

http://www.youtube.com/user/sirdannyaxl#p/u/0/mE3WSEEymqg

http://www.youtube.com/user/sirdannyaxl#p/u/1/23NKF4ubmxo

Faith is the "external elixir which gives life, power and action to the impulse of THOUGHTS

http://www.mindislife.com/category/subconscious

There are a few things you can do each day to improve your control of your mind. It will help you improve your ability to concentrate. Besides that, it will also put you in a state of wellbeing for you to think good thoughts and influence your subconscious mind to manifest your goals.

1. Avoid caffeine. Both coffee and tea puts caffeine into your body. So you think caffeine will give you a mental and physical ‘boost’ and make you more awake. Do you know why? According to Dr Robert Young a microbiologist who is an expert of the blood, he says our body identifies caffeine as a poison in our bloodstream. It then wakes up the immune system to work faster to get rid of the caffeine from our bloodstream. When our immune system wakes up and works on red alert mode, we feel the rush which we think is giving us a boost.

But in fact, caffeine tends to create hypertension, hyperactivity and most importantly it creates restlessness. If you are not used to taking caffeine, and you drink a cup of coffee right before bedtime, you will know what I mean. It makes the conscious mind restless and reduces concentration. And concentration and a state of calm are they keys to influencing your subconscious mind.

2. Build Up And Accumulate A High Level Of Life Energy. When your energy is low, you are vibrating at a lower frequency that aligns you with negative thoughts and emotions. Think of someone who is happy and optimistic, do they have a high or low level of energy? Think of someone who is depressed and pessimistic, do they have high or low energy?

3. Reduce stress in your daily life. I think we all know by now that stress is never good for our mental and physical health. Stress drains away a huge amount of mental and physical energy that we could instead use for our manifesting work. The brain needs a certain level of energy reserve to be able to think clearly. Depression is often a symptom of prolonged mental or physical stress, ie, the symptom of low energy reserve.

4. Get adequate sleep each night. Sleep deprivation can diminish your ability to think clearly. If you lose 2 hours of sleep, you will need more than 2 hours more sleep the next day to make up for it. Lack of sleep causes sluggishness of thought and physiology.

5. Spend quiet time meditating or doing ‘mental work’. Practising meditation and doing mental work especially at night before you go to bed is the best habit you can have to improve your manifesting skills. When the brain is working on Beta mode, we are in a state of normal waking hour thinking. In Beta, our Conscious Mind is very active and we create a lot of ‘mental noise’. We need to train ourselves to go into another state of mind in order to do mental work for manifesting. We can either go to Alpha or Delta. In my ebook “Secrets Techniques Of Manifesting And Creating With Imagination”, I teach a very simple technique you can train daily to go into Alpha state of mind. If you have read my books, you will notice that I have used the Alpha state to help me achieve many of my goals and desires in the past.

The difference between ordinary state of Beta versus Alpha is this. For example, you can think a positive thought or give an instruction to your subconscious mind 20 times in Beta, and it will not compare to giving that same instruction to your subconscious mind JUST ONCE in Alpha.

If you would like to learn to go into a deeper state than Alpha, you can learn to go into Delta, which is even more powerful. I have been training myself to go into Delta state by using a very powerful training program which I highly recommend to anyone who wishes to improve their manifesting skills. You can learn more about it here

Faith is the "external elixir which gives life, power and action to the impulse of THOUGHTS http://www.youtube.com/watch?v=2p7BX9TBaeg&feature=youtube_gdata_player liberar la mente del flujo constante de pensamientos que la confunden.

 http://www.pideloqueseteantoje.com/ NAVE espacial magner

SELF POWER: links

http://www.quantumjumping.com/lp/supernatural-1?

http://www.getabstract.com/

http://www.sevenessentiallaws.com/essentiallaws1.php

 http://www.getabstract.com/

www.poynter.org

www.spj.org   ttp://library.thinkquest.org/J003358F/trivia.html

Question: What Is Psychology?

What exactly is psychology? Popular television programs, books, and films have contributed to a a number of misconceptions about this subject. The diverse careers paths of those holding psychology degrees also contributes to this confusion. Psychology is both an applied and academic field that studies the human mind and behavior. Research in psychology seeks to understand and explain how we think, act and feel. As most people already realize, a large part of psychology is devoted to the diagnosis and treatment of mental health issues, but that's just the tip of the iceberg when it comes to applications for psychology. In addition to mental health, psychology can be applied to a variety of issues that impact health and daily life including performance enhancement, self-help, ergonomics, motivation, productivity, and much more.

Answer:

Early Psychology

Psychology evolved out of both philosophy and biology. Discussions of these two subjects date as far back as the early Greek thinkers including Aristotle and Socrates. The word psychology is derived from the Greek word psyche, meaning 'soul' or 'mind.'

A Separate Science

The emergence of psychology as a separate and independent field of study was truly born when Wilhelm Wundt established the first experimental psychology lab in Leipzig, Germany in 1879. Wundt's work was focused on describing the structures that compose the mind. This perspective relied heavily on the analysis of sensations and feelings through the use of introspection, a highly subjective process. Wundt believed that properly trained individuals would be able to accurately identify the mental processes that accompanied feelings, sensations and thoughts.

Schools of Thought

Throughout psychology's history, a number of different schools of thought have thought have formed to explain human thought and behavior. These schools of thought often rise to dominance for a period of time. While these schools of thought are sometimes perceived as competing forces, each perspective has contributed to our understanding of psychology. The following are some of the major schools of thought in psychology.

• Structuralism
• Functionalism
• Psychoanalysis
• Behaviorism
• Humanism
• Cognitivism

Psychology Today

http://med.stanford.edu

Today, psychologists prefer to use more objective scientific methods to understand, explain, and predict human behavior. Psychological studies are highly structured, beginning with a hypothesis that is then empirically tested. The discipline has two major areas of focus: academic psychology and applied psychology. Academic psychology focuses on the study of different sub-topics within psychology including personality, social behavior and human development. These psychologists conduct basic research that seeks to expand our theoretical knowledge, while other researchers conduct applied research that seeks to solve everyday problems.

Applied psychology focuses on the use of different psychological principles to solve real world problems. Examples of applied areas of psychology include forensic psychology, ergonomics, and industrial-organizational psychology. Many other psychologists work as therapists, helping people overcome mental, behavioral, and emotional disorders.

Psychology Research Methods

As psychology moved away from its philosophical roots, psychologists began to employ more and more scientific methods to study human behavior. Contemporary researchers employ a variety of scientific techniques including experiments, correlational studies longitudinal research, and others to test, explain, and predict behavior.

Areas of Psychology

Psychology is a broad and diverse field. A number of different subfields and specialty areas have emerged. The following are some of the major areas of research and application within psychology:

• Abnormal Psychology is the study of abnormal behavior and psychopathology. This specialty area is focused on research and treatment of a variety of mental disorders and is linked to psychotherapy, and clinical psychology.
• Biological Psychology, also known as biopsychology, studies how biological processes influence the mind and behavior. This area is closely linked to neuroscience and utilizes tools such as MRI and PET scans to look at brain injury or brain abnormalities.
• Clinical Psychology is focused on the assessment, diagnosis, and treatment of mental disorders. It is also considered the largest employment area within psychology.
• Cognitive Psychology is the study of human thought processes and cognitions. Cognitive psychologists study topics such as attention, memory, perception, decision-making, problem-solving, and language acquisition.
• Comparative Psychology is the branch of psychology concerned with the study of animal behavior. This type of research can lead to a deeper and broader understanding of human psychology.
• Developmental Psychology is an area that looks at human growth and development over the lifespan. Theories often focus on the development of cognitive abilities, morality, social functioning, identity, and other life areas.
• Forensic Psychology is an applied field focused on using psychological research and principles in the legal and criminal justice system.
• Industrial-Organizational Psychology is a field that uses psychological research to enhance work performance, select employee, improve product design, and enhance usability.
• Personality Psychology looks at the various elements that make up individual personalities. Well-known personality theories include Freud's structural model of personality and the "Big Five" theory of personality.
• School Psychology is the branch of psychology that works within the educational system to help children with emotional, social, and academic issues.
• Social Psychology is a discipline that uses scientific methods to study social influence, social perception and social interaction. Social psychology studies diverse subjects including group behavior, social perception, leadership, nonverbal behavior, conformity, aggression, and prejudice.

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Sign up for the Psychology Newsletter to get the latest psychology updates and to learn more about diverse topics including social behavior, personality, development, memory, creativity and much more. Produced by the Centre for Genetics Education. Internet:  http://www.genetics.edu.au 888 www.genetics.edu.au © Centre for Genetics Education 1 ENVIRONMENTAL AND GENETIC INTERACTIONS—Complex Patterns of Inheritance 1 FACT SHEETFACT SHEET Produced by the Centre for Genetics Education. Internet: http://www.genetics.edu.auProduced au 11 Important points Multifactorial inheritance refers to the pattern of inheritance of common health problems and rarer conditions caused by a combination of both genetic and other factors that may include internal factors such as ageing and exposure to external environmental factors such as diet, lifestyle, and exposure to chemicals or other toxins Multifactorial conditions have in common that they do not always develop despite the suggested presence of a faulty gene(s) The inherited faulty gene(s) make the person at increased risk for developing the condition (predisposed or susceptible) but unless other factors are present, the condition may never develop at all It may be possible to determine if family members are at risk for a particular multifactorial condition by examining their family health history and discussing it with their doctor Having one or more blood relatives who have been affected by a condition, particularly at a younger than expected age, is an indication that family members may be at risk of also developing that condition or passing it on to the next generation Knowing that a person is at increased risk can lead to the use of early detection tests and preventative strategies. (See Genetics Fact Sheet 9) For a very few conditions, triggers have been identified, for example lack of the vitamin folate in the developing baby’s environment is linked to the chance that the baby will have a neural tube defect such as spina bifida. Supplementation of a woman’s diet with folate in pre-pregnancy and in early pregnancy can significantly reduce the chance of a baby born with this condition. Such a preventative approach is only possible for those few conditions where the environmental trigger, or some of the triggers, have been identified Research is continuing to better understand the process that lead to a build-up of faulty genes in a person’s body over their lifetime, causing the condition to develop. For those who are at increased risk for conditions due to an inherited predisposition, this may provide the means by which the condition is avoided altogether Understanding the patterns of inheritance of genetic conditions in families is becoming increasingly complex (See Genetics Fact Sheet 2). Complex patterns of inheritance As shown in Figure 11.1, the contribution from inherited genetic information to conditions that affect a person’s growth, development and health is variable and ranges from conditions that: Are directly due to changes, present from birth, in the genetic information either in one or more of the 20,000 or so genes located in the nucleus (see Genetics Fact Sheet 1) - There are four ‘traditional’ patterns of inheritance that apply to the inheritance of the faulty gene(s) involved (see Genetics Fact Sheets 8, 9 & 10) - Risk for the development of these genetic conditions in current or future family members can generally be estimated - Other unknown factors impact on the severity, or age of onset of the expression of their symptoms as often there is variability even between family members Are due to external factors in the person’s physical and chemical environment and where genetic factors are not involved; eg. due to shared exposure to the same environmental factor such as poor quality air or water or poor nutrition Tend to ‘run in the family’ and an inherited faulty gene appears to be involved, but the patterns of inheritance are less predictable than expected. In these conditions the person’s genetic make-up makes them susceptible (predisposed) to develop the condition but other factors need to be present for the condition to develop at all Risk estimation for these genetic conditions to develop for blood relatives, is complex. Complex patterns of inheritance also result from: The faulty gene is not present in all the egg or sperm cells Faulty mitochondrial genes (See Genetics Fact Sheet 12) The parent has a mixture of faulty and working gene copies (Mosaicism) in the egg or sperm cells (See Genetics Fact Sheet 13). Figure 11.1: A diagrammatic representation of the interaction between genetic and environmental factors. This Fact Sheet discusses conditions arising from the interaction of inherited changes in one or more genes with other factors in their internal or external environment. Produced by the Centre for Genetics Education. Internet: http://www.genetics.edu.au 888 www.genetics.edu.au © Centre for Genetics Education 2 ENVIRONMENTAL AND GENETIC INTERACTIONS—Complex Patterns of Inheritance 1 FACT SHEETFACT SHEET Produced by the Centre for Genetics Education. Internet: http://www.genetics.edu.auProduced au 11 A pattern of multifactorial inheritance Multifactorial inheritance refers to the pattern of inheritance, of certain conditions due to a combination of both genetic and other factors that may include internal factors such as ageing, and exposure to external environmental factors such as diet, lifestyle, and exposure to chemicals or other toxins (Table 11.1). Common health problems include some forms of cancer, some forms of cardiac disease, diabetes and mental illness such as schizophrenia and manic depression (see Genetics Fact Sheets: 47-51, 53-56, 57 & 58). These conditions have in common that they do not always develop despite the suggested presence of a faulty gene: the ‘penetrance’ of the condition is not complete. For example, not all women who have inherited a faulty breast cancer gene will develop breast cancer. The faulty gene is not completely `penetrant‘. The reason for this ‘incomplete penetrance’ of the condition is most likely due to the interaction between the information in the faulty gene with the information in one or more other genes and with other ‘environmental’ factors including physical and chemical elements as well as ageing Table 11.l: The conditions listed are some of the health problems in which genetics plays a role How can a person determine if they or their blood relatives are at risk for developing a multifactorial condition? It may be possible to determine if blood relatives are at risk for developing a particular multifactorial condition by examining family health history and discussing it with their doctor. A person’s family health history can be an indication that a condition due to a faulty gene is running in the family (See “Tips on collecting your family health history” http://www.genetics.edu.au/Information/Your-Family-Health-History/fhh#Tips on talking to your fam FHH) Having one or more blood relatives who have been affected by a condition, particularly at a younger than expected age, is an indication that family members may be at risk of also developing that condition or passing it on to the next generation This can lead to the use of early detection tests and preventative strategies. Triggering factors, if known, can be avoided Recent advances in technology have also made it possible to determine, in some cases for some multifactorial conditions, if an individual has inherited a particular faulty gene that has predisposed him/her to a condition ie. they are at increased risk for a condition such as those listed in Table 11.1 (also see Genetics Fact Sheet 21). The inheritance of the predisposing faulty gene involved will follow a traditional pattern of inheritance. In the majority of cases, the pattern is autosomal dominant inheritance (See Genetics Fact Sheet 9) eg. inherited predisposition to breast and ovarian cancer (see Genetics Fact Sheet 48) This pattern is often suggested by the family history but inheriting the faulty gene simply makes a woman predisposed or at increased risk of developing breast cancer and ovarian cancer Despite inheriting a faulty gene, breast or ovarian cancer will not develop unless other genes are made faulty over the woman’s lifetime Possible triggers for other genes to become faulty include factors in our internal and external environments as well as the impact of ageing. The variability of these genetic and environmental factors influence the number of blood relatives who develop the condition, affecting the ‘penetrance’ of the condition in the family Often fewer family members have the condition than would be expected according to traditional patterns of inheritance A condition that runs in the family may be due to shared exposure to the same environmental factor such as poor quality air or water or poor nutrition; eg. having a number of family members who smoke can lead to exposure to toxins from passive smoking with its established health impact. In some cases, exposure to an environmental factor will be the only reason for a condition to run in a family; ie. genetic factors may not be involved at all The estimation of the risk for developing a particular multifactorial condition in a family is dependent on a number of factors. These include: Whether there is a significant contribution by the inherited genetic information to the condition How closely related the person is to an affected relative Whether there are many affected family members In some cases, how early the symptoms of the condition first occurred It is not currently feasible to screen everyone for every faulty gene and the number of conditions for which genetic testing is available is limited. Looking at their family health history in consultation with their doctor will therefore remain the most important tool in determining if a person is at risk for developing particular genetic conditions. Discussion of an individual’s family health tree with their doctor or a genetic counsellor can lead to an estimation of the particular risk for a condition that is present in the family. Birth Defects: cleft palate/lip, neural tube defects such as spina bifida Cancer: bowel, breast, ovarian, bowel, melanoma and prostate Cardiovascular conditions: high blood pressure, some causes of heart disease, high cholesterol Metabolic: diabetes Neurological/psychiatric conditions: Alzheimer disease in later life, schizophrenia, bipolar disorder Muscular/skeletal: arthritis, rheumatic disorders, osteoporosis Skin conditions: psoriasis, moles, eczema Respiratory: asthma, allergies, emphysema Produced by the Centre for Genetics Education. Internet: http://www.genetics.edu.au 888 www.genetics.edu.au © Centre for Genetics Education 3 ENVIRONMENTAL AND GENETIC INTERACTIONS—Complex Patterns of Inheritance 1 FACT SHEETFACT SHEET Produced by the Centre for Genetics Education. Internet: http://www.genetics.edu.auProduced au 11 Can some genetic conditions due to multifactorial inheritance be prevented? As multifactorial conditions involve an inherited predisposition with an environmental trigger, an obvious preventive approach is to modify the known triggers in those individuals who are susceptible due to their family history. For a very few conditions, these triggers have been identified. Lack of the vitamin folate in the developing baby’s environment has been linked to the chance that the baby will have a neural tube defect such as spina bifida. Supplementation by folate in women pre-pregnancy and in early pregnancy can significantly reduce the number of babies born with this condition (see Genetic Fact Sheets 19 & 59) High dietary cholesterol is a factor in increased risk for cardiovascular disease (see Genetics Fact Sheet 54) and obesity has also been linked to increased risk for diabetes type 2 (see Genetics Fact Sheet 57) with exercise as an effective intervention This approach is only possible for those few conditions where the environmental trigger, or some of the triggers, have been identified. Understanding the process of the interaction between genetic predisposition and developing a condition It is clear that for many common and rare conditions such as those listed in Table 11.1, simply inheriting one or more faulty genes associated with a particular condition is not enough for that condition to develop. The person’s inherited genetic information may make them susceptible (predisposed) to the condition but if other steps do not occur during their life then the condition will never develop. The field of cancer genetics has provided some clues as to how the pathway works for some cancers to develop and this may be the model for other multifactorial conditions. Knudson’s `2-Hit Hypothesis’ In 1971, Alfred Knudson, a scientist, hypothesised that there was a relationship between inherited and new or sporadic cancers (not inherited). Knudson was aware that cancers arose because of genetic variations, and that these caused the genes critical for controlling cell growth and the division of cells to become faulty. Another way of looking at it is that these are normal ‘cancer protection’ genes that become faulty and can no longer do their usual job in the body (Figure 11.2 and Genetics Fact Sheet 47). The example of retinoblastoma Dr Knudson proposed that the first cell of a rare tumour that developed in the eyes of children (retinoblastoma) underwent two different `hits’ that changed the information in both copies of a gene so that both gene copies were faulty (mutations). Everyone has a gene (called the RB gene) that contains the information for the cells to produce a protein whose role is to prevent tumour growth (tumour suppressor protein) in the nerve-rich layers that line the back of the eyes (retina). In retinoblastoma a malignant tumour develops when both copies of the RB gene become faulty so that the tumour in the retina is not prevented. Figure 11.2: The child inherits one of the RB gene copies already faulty. A change occurs in the other copy of the RB gene (the second ‘hit’) so now both RB gene copies are faulty and can no longer prevent the cancer developing in the retina RB occurs most commonly in children under the age of three and may be inherited or sporadic. He noted that RB could result from tumours (primary tumours) occurring in both eyes (bilateral) or only in one eye (unilateral), but the sporadic (non-inherited) forms of RB were always unilateral. Most individuals with bilateral retinoblastomas had the familial form. In other words, if two or more primary tumours occurred in the same person, it was more likely that all of the cells of the body had received the first ‘hit’ making the RB gene copy faulty at the time of conception. The child inherited one faulty copy of the RB gene and one working copy from each parent. As shown in Figure 11.2, the child is born with one of their RB gene copies faulty and then, over the first few years of their life, the other partner gene copy is also made faulty by some other unknown factor It was also very unlikely that each of these tumours arose independently at the same time due to independent chance ‘hits’ in the same gene out of the 20,000 or so genes in the human cells. Remarkably, this hypothesis was proposed in the early 1970s but it was not until 1987 that the identification of the retinoblastoma gene occurred and completely confirmed Knudson’s hypothesis. Knudson’s theory is thought to not only apply to the development of inherited cancer in children, but to be one of the systems leading to other cancers that develop in later life. (See Fact Sheets 47). It is likely that other complex conditions will be due to genetic and environmental interactions that lead to changes in the genetic information building up over the person’s lifetime. Other Genetics Fact Sheets referred to in this Fact Sheet: 1, 2, 8, 9, 10, 12, 13, 19, 21, 47, 48, 49, 50, 51, 53, 54, 55, 56, 57, 58, 59 Produced by the Centre for Genetics Education. Internet: http://www.genetics.edu.au 888 www.genetics.edu.au © Centre for Genetics Education 4 ENVIRONMENTAL AND GENETIC INTERACTIONS—Complex Patterns of Inheritance 1 FACT SHEETFACT SHEET Produced by the Centre for Genetics Education. Internet: http://www.genetics.edu.auProduced au 11 Information in this Fact Sheet is sourced from: Harper P. (2010). Practical Genetic Counseling (7th Edition). London: Arnold Knudson AG Jr. (1971). Mutation and cancer: statistical study of retinoblastoma. Proc. Natl. Acad. Sci. USA 68-4: 820-823 Online Mendelian Inheritance in Man, OMIM. McKusick-Nathans Institute for Genetic Medicine, Johns Hopkins University (Baltimore, and National Center for Biotechnology Information, National Library of Medicine (Bethesda, MD) [online].Available from: http://www.ncbi.nlm.nih.gov/omim/ [Accessed April 2012] Read A and Donnai D. (2010). New Cinical Genetics (2nd edition). Bloxham, Oxfordshire: Scion Publishing Ltd Trent R. (1997). Molecular medicine. 2nd ed. New York: Churchill Livingstone Ltd Edit history April 2012 Author/s: A/Prof Kristine Barlow-Stewart Previous editions: 2007, 2004, 2002, 2000, 1998, 1996, 1994, 1993 Acknowledgements previous editions: Bronwyn Butler; Prof Eric Haan; Prof Graeme Morgan; Gayathri Parasivam; Mona Saleh

Existential-Humanistic Theory An “Interactionist” Approach

1. DEVIANCE:

2. DYSFUNCTION:

3.  DISTRESS: 

4. DANGER:

---

• Removing patients from hospitals and into normal living conditions, caused by successful use of medication but has resulted in a high rate of homelessness for people with mental disorders.

• The policy when the hospital has to send some patients home after their treatments, even if the patient might become homeless, or they don't have family that can give them the proper care.

• Removal of patients, even those still in chronic states, to take in more patients and decrease overcrowding, with the hopes that the patients could survive on their own and keep up with their medical agendas alone.

• Releasing mental patients from the hospitals and back into the public.

• Patients may have a hard time assimilating into everyday life, especially if their families are not helping to support them. It may be difficult finding a job,

• causing homelessness to be a potential issue of deinstitutionalization in the cases where medication is at a price unattainable to the released patients and/or they are unable to adapt from a controlled environment to an uncontrolled environment.

• Patients who are successfully deinstitutionalized may be able to maintain relatively normal lifestyles as they continue therapy and treatment for their condition.

• Allowing patients with psychological disorders to be placed, ideally, in the hands of a relative to resume treatment outside of a mental hospital.

Frequently Asked Questions about DSM-5 Implementation- For Clinicians

UPDATED 9/20/13

How can I purchase DSM-5?

When should I begin using DSM-5, and is there a date when use of DSM-IV will be discontinued?

How do I use the codes that are listed in DSM-5, and how are DSM and ICD related?

Sometimes different disorders or subtypes share the same diagnostic code. Is this an error?

How will the previous Axis I, II, and III conditions be recorded?

With the removal of the multiaxial system in DSM-5, how will disability and functioning be

assessed?

How do I code “diagnosis deferred” or report “no diagnosis given”?

How should specifiers and subtypes be recorded using DSM-5?

I found a possible error in DSM-5.  How do I report this?

Is it normal for a manual such as this to contain errors?

I see that “Not Otherwise Specified” (NOS) diagnoses from DSM-5 have been replaced with

“Other” and “Unspecified” conditions.  How will this change impact diagnoses?

How do I correctly reference the DSM-5 in papers?

How do I attain permission to use DSM-5 criteria or content in publications, lectures, or other

formats?

Is DSM-5 available in any languages besides English?

How can I purchase DSM-5?

For ordering information or to purchase DSM-5 and related products (including the DSM-5 eBook

and DSM-5 Diagnostic Criteria Mobile App), please visit our website,

http://www.appi.org/Pages/DSM.aspx. The online version of the manual is available through

subscription to PsychiatryOnline: http://dsm.psychiatryonline.org/store/home.aspx.

When can I begin using DSM-5, and is there a date when use of DSM-IV will be discontinued?

You can begin using DSM-5 immediately. Insurers and other agencies may require use of DSMIV diagnostic names or the multiaxial system for a short period of time while forms and data

systems are updated to reflect DSM-5. We expect the transition from DSM-IV to DSM-5 will be

complete by January 1

st

, 2014.

How do I use the codes that are listed in DSM-5, and how are DSM and ICD related?

The way you will record DSM-5 diagnosis codes is no different from how these were recorded

using DSM-IV. As was the case with DSM-IV, the codes within DSM-5 represent valid codes of

the ICD-9-CM (the International Classification of Diseases, 9

thedition, Clinical Modification). The ICD-9-CM is the coding system that the Department of Health and Human Services has designated for use in all health transactions in the United States. You do not need a “crosswalk” to use the codes found in DSM-5.

Note that on October 1st

, 2014, the United States will no longer use ICD-9-CM as its official

coding system.  Effective on that date, the ICD-10-CM (the International Classification of

Diseases, 10th edition, Clinical Modification) will be the official system that must be used. The

ICD-10-CM codes are already included in the DSM-5.  You will not need to purchase a new

DSM-5 when the United States switches to this system. The ICD-10-CM codes are listed in

parentheses next to each disorder title.  On October 1st , 2014, simply begin using the codes listed

in parentheses to code your diagnoses.  Because we anticipated US adoption of ICD-10-CM, and have already included the codes in this manual, we believe it will greatly ease the transition to the new system for clinicians and other health care personnel. Sometimes different disorders or subtypes share the same diagnostic code. Is this an error? Frequently Asked Questions about DSM-5 Implementation- For Clinicians

UPDATED 9/20/13

No. It is occasionally necessary to use the same code for more than one disorder. Because the

DSM-5 diagnostic codes are limited to those contained in the ICD, some disorders must share

codes for recording and billing purposes. For example, hoarding disorder and obsessivecompulsive disorder share the same codes (ICD-9-CM 300.3 and ICD-10-CM F42). We will be

working with the ICD-10-CM revision conferences supported by CMS and NCHS to recommend

separate codes for these new disorders as soon as possible.

Because there may be multiple disorders associated with a given ICD-9-CM or ICD-10-CM code,

the DSM-5 diagnosis, whenever possible, should be recorded by name in the medical record in

addition to listing the code. See our “Insurance Implications of DSM-5” FAQ for additional

information.  How will the previous Axes I, II, and III conditions be recorded?

Although a single axis recording procedure was previously used for Medicare and Medicaid

reporting, some insurance companies required clinicians to report on the status of all five DSMIV-TR axes. However, only Axes I, II, and III contained codable information.

DSM-5 combines the first three DSM-IV-TR axes into one list that contains all mental disorders,

including personality disorders and intellectual disability, as well as other medical diagnoses.

Other conditions that are a focus of the current visit or help to explain the need for a treatment or

test may also be coded, usually as ICD-9-CM V-codes or, starting on October 1, 2014 as ICD-10-

CM Z-codes. A list of these other conditions can be found on pp. 715-727 of DSM-5.

With the removal of the multiaxial system in DSM-5, how will disability and functioning be

assessed?  The Global Assessment of Functioning (GAF) scale, recommended for Axis V in the DSM-IV, was used for determinations of medical necessity for treatment by many payers, and eligibility for

short- and long-term disability compensation. Clinician-researchers at the APA have

conceptualized need for treatment as based on diagnosis, severity of symptoms and diagnosis,

dangerousness to self or others, and disability in social and self-care spheres. We do not believe

that a single score from a global assessment, such as the GAF, conveys information to

adequately assess each of these components, which are likely to vary independently over time.

Therefore, we are recommending that clinicians continue to assess the risk of suicidal and

homicidal behavior and use available standardized assessments for symptom severity, diagnostic

severity, and disability such as the measures in Section III of DSM-5 (online at

http://www.psychiatry.org/practice/dsm/dsm5/online-assessment-measures). For those who relied

on the use of a GAF number, we expect there will be a transitional period from the GAF to the

use of separate assessments of severity and disability. The World Health Organization Disability Assessment Schedule (WHODAS 2.0) was judged by the DSM-5 Disability Study Group to be the best current measure of disability for routine clinical use. The WHODAS 2.0 is based on the International Classification of Functioning, Disability, and Health (ICF) and is applicable to patients with any health condition.  The scale, as well as scoring information is included in Section III of DSM-5.

How do I code “diagnosis deferred” or report “no diagnosis given”?

If a mental disorder is not present V71.09 can be used. “Diagnosis deferred” can use the code

799.9. It is preferable to use an “unspecified” diagnosis rather than a deferred diagnosis, if

clinically indicated. Because the multiaxial system is no longer in use, the commonly used

“diagnosis deferred on Axis II” is no longer needed.Frequently Asked Questions about DSM-5 Implementation- For Clinicians

UPDATED 9/20/13

How should specifiers and subtypes be recorded using DSM-5?

Thank you for your inquiry. When a specifier or subtype has an associated code, it will be listed

below the diagnostic criteria. However, as was the case in DSM-IV, many specifiers and subtypes

in DSM-5 do not have associated codes. If the specifier or subtype is not associated with its own

code, the name of the diagnosis with subtype and/or all relevant specifiers should be recorded in

the medical record along with the code for the disorder.

I found a possible error in DSM-5.  How do I report this?

You can use the feedback mechanism on this website (www.dsm5.org) to report any errors. We

will update our coding corrections listing, also located on this site, as any coding errors are

reported and confirmed. Any minor text edits will be compiled and corrected in later, future

printings.

Is it normal for a manual such as this to contain errors?

It is normal for a book of this scope and complexity to contain some errors. In fact, every

publication of this magnitude, such as the ICD, provides continually updated listings of errata,

addendums, and updates. Please visit www.dsm5.org frequently for any such updates.

I see that “Not Otherwise Specified” (NOS) diagnoses from DSM-5 have been replaced with

“Other” and “Unspecified” conditions.  How will this change impact diagnoses?

An important clinical tool in the Fifth Edition of the Diagnostic and Statistical Manual of Mental

Disorders" (DSM-5) is the revised diagnoses of "other specified" and "unspecified" mental

disorders.  Revised from DSM-IV's "Not Otherwise Specified" categories, these diagnoses give

clinicians the flexibility necessary in some settings to provide patients with the best care. For

example, if a patient comes into an emergency department and is acutely psychotic, it might not

be immediately clear if this is due to schizophrenia, bipolar disorder, drug use or severe

hyperthyroidism. These diagnoses allow a clinician to be as specific as possible, without needing

to declare that all criteria are met for a more definitive diagnosis.

The changes also bring DSM more in line with the World Health Organization's International

Classification of Diseases. Every section of the ICD-9-CM, including those for diabetes,

pulmonary disease and other physical illnesses, require mandatory codes for disorders that don't

precisely fit current definitions of major disorders. To help clinicians make an appropriate

diagnosis we have maintained a requirement for individuals with these diagnoses to have

clinically significant distress or impairment in social, occupational, or other important areas of

functioning.

How do I correctly reference DSM-5 in papers?

The correct citation for the DSM-5 is:

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth

Edition. Arlington, VA, American Psychiatric Association, 2013.

How do I attain permission to use DSM-5 criteria or content in publications, lectures, or other

formats?

To obtain copyright permissions, please contact the APA Rights Manager, Cecilia Stoute at

cstoute@psych.org.

Is DSM-5 available in any languages besides English?Frequently Asked Questions about DSM-5 Implementation- For Clinicians

UPDATED 9/20/13

The DSM-5 is not currently available in other languages. A list of translation publishers for DSM-5

and related products, including the anticipated publication dates of translated products, can be

found on APPI.org: http://www.appi.org/Pages/DSM.aspx

http://www.apa.org/monitor/2009/10/icd-dsm.aspx

THEORETICAL ORIENTATIONS/PERSPECTIVES

BIOLOGICAL

Genetic inheritance physiological changes exposure to toxic substances.

Main Tenets of this Perspective: A theoretical perspective in which it is assumed that disturbances in emotions, behavior, and cognitive processes are caused by abnormalities in the functioning of the body.

Biological Causes: domain includes genetic and environmental influences on physical functioning. People with psychological disorders may inherit a predisposition to developing behavioral disturbances. Of particular interest are inherited factors that alter the functioning of the nervous system. There are also physiological changes that affect behavior, which other conditions in the body cause, such as brain damage or exposure to harmful environmental stimuli, For example, a thyroid abnormality can cause a person’s moods to fluctuate widely. Brain damage resulting from a head trauma can result in aberrant thought patterns. Toxic substances or allergens in the environment can also cause a person to experience disturbing emotional changes and behavior.

Biological Perspective: Family inheritance studies provide strong evidence in favor of genetic explanations of antisocial personality disorder, the personality trait of psychopathy, an antisocial behavior with heritability estimates as high as 80% to explain this genetic variation, their attention is focused on genes related to the activity of serotonin and dopamine. One of particular is monoamine oxidase A, an enzyme coded by the MAOA gene.  A mutation in this gene results in abnormally high levels of dopamine, serotonin, and norepinephrine. High levels of these neurotransmitters are linked to greater impulsivity. Researchers also believe that dependence of the mother during pregnancy can lead to epigenetic influences through DNA methylation. Malnutrition in early life may serve as another risk factor for the development of antisocial personality disorder.

In a study of children tested form age 3 to 17, those who experienced poor nutrition at  age 3 showed more aggressiveness and motor activity as they grew up. By age 17 they had a higher likelihood of conduct disorder, a precursor to antisocial personality disorder (Liu, Raine, Venables, & Mednick, 2004)

Biological Treatments Medication /Neurotransmitters/Herbal Supplements

Other Medical Methods as Fit  ECT Psychosurgery

How might this perspective view a disorder (e.g., depression)?

PSYCHOANALYTIC / PSYCHODYNAMIC

Emphasizes unconscious determinates of behavior. Of all the psychological approaches it gives greatest emphasis to the role of processes beneath the surface of awareness as influences on abnormality.

Classic Theorist:

Psychodynamic Treatments  INTRAPSYCHIC METHODS

Methods used to access the unconscious conflicts in the psyche

Intensive Therapy: “Talk Therapy”

Free Association

Hypnosis

Dream Analysis

How might this perspective view a disorder (e.g., depression)?

BEHAVIORAL

The theoretical perspective in which it is assumed that abnormality is caused by faulty learning experiences.

Classic Theorist:

Main Tenets:

Behavioral Treatments

Functional Assessment Look at environment and see how person is functioning in the environment.Systematic Desensitization Progressively pairing an incompatible response (relaxation) with a subject of fear Sequential therapy spanning many sessions

Exposure Therapy (In Vivo)

Expose individual to subject of fear in safe situation with therapist involved

How might this perspective view a disorder (e.g., depression)?

COGNITIVE:

It is assumed that abnormality is caused by maladaptive thought processes that result in dysfunctional behavior.

Main Tenets:

Cognitive Treatments CBT: Cognitive Behavioral Therapy

Uncover internal thoughts, beliefs, feelings. See how inner beliefs are affecting behavior and contribute to conflict in one’s life

Overgeneralizations

Negative Thinking

Illogical Thought Patterns

Inflexible Standards of Perfection

Become aware of “automatic” self-talk

Challenge distortions & Reframe CBT

Common cognitive distortions:

All-or-none-thinking

“Ugly or good looking”     

“You trust someone or you don’t”

“If I can’t get an A, I’m not studying”

“That was a waste of time”

“If I can’t do it well, I’m not doing it at all”

“She is perfect”

“They completely messed up”

CBT Challenge your belief system!

Common cognitive distortions:

Overgeneralization (inaccurate use of always & never)

“I never do this right”

“She always yells at me”

Discounting the Positive

“He was just being nice. He felt sorry for me.”

Jumping to Conclusions

“I know I’m not going to pass, so I’m not going to try.”

How might this perspective view a disorder (e.g., depression)?

HUMANISTIC-EXISTENTIAL:

Psychological disorders as the result of cruelty, stress, or poor living conditions. The need to understand themselves and the world and toderive great enrichment form their experiences by fulfilling their unique individual potential.

Main Tenets:

TX Strategies:

Humanistic  Model Existential-Humanistic Theory

Existentialism

Here and Now

Freedom

Responsibility

Existential Anxiety

Meaning

Rollo May

Irvin Yalom

Humanism

Here and Now

Human Potential

Self-Actualization

Self-Transcendence

Carl Rogers

Abraham Maslow

Person-Centered Therapy

Actualizing Tendency:

Developing all of your capacities

Potential

Self:

We see ourselves as a unique phenomenon

Person-Centered Therapy

Self-Actualizing Tendency:

Meeting your potential as your unique self…who are YOU?

Organismic Valuing & Conditions of Worth

Positive Regard

Being true to your self…

Unconditional Positive Regard

Humanistic Treatments

Individual Therapy

Group Therapy  I.I.H.S. (International Institute for Humanistic Studies:

                                   www.human-studies.org

How might this perspective view a disorder (e.g., depression)?

DIATHESIS-STRESS

The proposal that people are born with a predisposition  (or diathesis) that places them at risk for developing a psychological sisorder if exposed to certain exptemely stressful life experiences.

Diathesis-Stress Theory
An “Interactionist” Approach

Genetic Vulnerability + Stress = Illness

Biological Factors:  Genetic Predisposition/Congenital Birth Issue/Virus or Illness during Pregnancy

Stressful Events:  Trauma (Abuse, Accident, Injury) Loss (Death, Early Attachment)

Stressors: drug use, exposure to toxins

MODEL Main Proposal:

BIO-PSYCHO-SOCIAL: A model in which the interaction of biological, psychological, and sociocultural factors is seen as influencing the development of the individual.

Psychosocial Rehabilitation

Biological Supports

Medication: Approaching chemical needs with Chemical Treatments

Psychological Supports

Therapeutic Interventions

Social Supports (Sociological) Social Skills, Cultural Supports

Psychodynamic Treatments

INTRAPSYCHIC METHODS

Methods used to access the unconscious conflicts in the psyche

Intensive Therapy: “Talk Therapy”

Free Association

Hypnosis

Dream Analysis

INTRO, HISTORY, ASSESSMENT, DIAGNOSIS

INTRODUCTION

Normal: Typical standard pattern,  average.

Abnormal: Away from the norm.

Abnormal behaviors are not always bizarre; no clear distinction can be drawn between normal and abnormal behaviors. No geniuses are particularly prone to insanity.  Most psychological disorders are treatable.

Para-normal:

THE 4 D’S:

DEVIANCE: Deviation from the norm.Departing from usual standards.

DYSFUNCTION: How is the person functioning in daily life? Hygiene, Employment, Relationships More objective.

 DISTRESS:  How does the individual feel?  What is the level of suffering experienced? More subjective

DANGER:Is the individual a danger to self?

Is the individual a danger to others?

Is the individual gravely disabled?

5150: Involuntary 72-hour hold

PSYCHOLOGIST  PhD can do assessment, research, and therapy

PSYCHIATRIST MD licensed by state to practice medicine

LCSW: SOCIAL WORKER

Licensed Clinical Social Worker

Master’s in Social Work & License

MFT: Marriage & Family Therapist

Master’s in Counseling & License

HISTORY

5150:

Trepanation (Def / Purpose):

Trephination (also known as trepanning or burr holing) is a surgical intervention where a hole is drilled, incised or scraped into the skull using simple surgical tools. In drilling into the skull and removing a piece of the bone, the dura mater is exposed without damage to the underlying blood-vessels, meninges and brain. Trephination has been used to treat health problems associated with intracranial diseases, epileptic seizures, migraines and mental disorders by relieving pressure. There is also evidence it was used as a primitive form of emergency surgery to remove shattered pieces of bone from fractured skulls after receiving a head wound, and cleaning out the pools of blood that would form underneath the skull.

Hippocrates & 4 Humors:

Lobotomy:

Today, the word “lobotomy” is rarely mentioned. If it is, it’s usually the butt of a joke.But in the 20th century, a lobotomy became a legitimate alternative treatment for serious mental illness, such as schizophrenia and severe depression. Physicians even used it to treat chronic or severe pain and backaches. (As you’ll learn below, in some cases, there was no compelling reason for the surgery at all.) There’s a surprising history of the lobotomy for its use in mental health.

A lobotomy wasn’t some primitive procedure of the early 1900s. In fact, an article in Wired magazine states that lobotomies were performed “well into the 1980s” in the “United States, Britain, Scandinavia and several western European countries.”

ECT (Electroconvulsive Tx)

Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses. It often works when other treatments are unsuccessful.

Much of the stigma attached to ECT is based on early treatments in which high doses of electricity were administered without anesthesia, leading to memory loss, fractured bones and other serious side effects.

ECT is much safer today and is given to people while they're under general anesthesia. Although ECT still causes some side effects, it now uses electrical currents given in a controlled setting to achieve the most benefit with the fewest possible risks.

Deinstitutionalization:

Deinstitutionalization is becoming more and more of a popular choice of mental hospitals because pharmacotherapy can supply the needs of the patients in most cases by taking a drug to solve a problem that should be faced more directly.The early focus was on moving individuals out of state public mental hospitals and from 1955 to 1980, the resident population in those facilities fell from 559,000 to 154,000; the number of patients in mental hospitals decreased significantly. Then, in the 1990’s whole institutions began to close in significant numbers. However, this also led to many mentally unstable people out on the streets where they would be receiving no treatment.

In Your Own Words

Removing patients from hospitals and into normal living conditions, caused by successful use of medication but has resulted in a high rate of homelessness for people with mental disorders.

The policy when the hospital has to send some patients home after their treatments, even if the patient might become homeless, or they don't have family that can give them the proper care.

Removal of patients, even those still in chronic states, to take in more patients and decrease overcrowding, with the hopes that the patients could survive on their own and keep up with their medical agendas alone.

Releasing mental patients from the hospitals and back into the public.

Examples/Functions

Patients may have a hard time assimilating into everyday life, especially if their families are not helping to support them. It may be difficult finding a job,
causing homelessness to be a potential issue of deinstitutionalization in the cases where medication is at a price unattainable to the released patients and/or they are unable to adapt from a controlled environment to an uncontrolled environment.

Patients who are successfully deinstitutionalized may be able to maintain relatively normal lifestyles as they continue therapy and treatment for their condition.

Allowing patients with psychological disorders to be placed, ideally, in the hands of a relative to resume treatment outside of a mental hospital.

Current Issues in Care:

ASSESSMENT TESTS

OBJECTIVE SELF-REPORT: (Briefly define and give examples)

PROJECTIVE TESTS: (Briefly define and give examples)

Mental Status Exam:

MRI:  (Magnetic Resonance Imaging)

fMRI:

MRI that now captures functional pictures of the brain

Can see changes from one moment to the next

Replacing PET scans

See immediate response

SOME IMPORTANT INTERVIEW TOPICS: 1.     2.  3. 

DSM  Diagnostic and Statistical Manual of Mental Disorders

Kraeplin:

DSM Classification History

Emil Kraeplin (1856-1926)

Endogenous: Caused from within--internal

Exogenous: External Cause

DSM Classification

DSM is published by:  American Psychiatric Association

Primary Purpose of the DSM: Facilitate Communication Provide Shorthand Information

Diagnostic Tool Focuses on MANIFEST symptoms (Not dependent on your theoretical background)

DSM Classification

Limitations: What is in DSM is what has sufficient data and research to justify the inclusion. If it is not in there, it doesn’t mean it is not important, means not enough justifiable data

DSM Classification History

Emil Kraeplin (1856-1926)

Classified disorders into 13 categories

Grouped things together that he thought had a common etiology

Created descriptive categories based on symptom similarity

The system we use today is a DIRECT relation to his system

DSM Classification History PRIMARY PURPOSE:  To standardize data collection

To Facilitate Communication among Clinicians

Strongly influenced by Psychodynamic Approach

Very little empirical data available

Listed 60 disorders (diagnostic make-up represented a CONSENSUS of disorders that were being noticed by psychiatrists in the 50s and 60s

Disorders were considered to be reactions to real or imagined trauma

DSM Classification History

DSM I: 1952: Labeled things as REACTION

DSM II: 1968

Didn’t label everything a reaction (major departure from DSM I)

BOTH distinguished between psychosis (break from reality—hallucinations, delusions, illogical thinking) and neurosis (most commonly depression and anxiety)

DSM Classification History

DSM III: 1980

Partially to revise out the psychodynamic over-influence

THE MEDICAL MODEL becomes the primary approach

DSM becomes “ATHEORETICAL” in that it had no preferred etiology for the disorders

Spitzer gets homosexuality out of the DSM

DSM Classification History

DSM IV: 1994 (TR in 2000)

Minor revisions in codes to be more compatible with ICD-(International Classification of Diseases)

18 Major Categories with many disorders

Based upon a comprehensive review of literature

New categories included only if enough data

DSM Classification History

DSM IV: 1994 (TR in 2000)

Minor Revision

Multi-Axial Diagnostic System

5 Axes seeking essential factors necessary for a comprehensive diagnosis

Specific to DSM IV (started with DSM III

Axes: Define & give example:

Axis I: General Clinical Disorders.

Major depression disorder

Generalized anxiety disorder.

Axis II: Personality Disorders Mental Retardation.

Dependant Personality DX

Panic Disorder

AXIS III: General Medical Conditions

Broken Hip

Hypertension

Diabetes

AXIS IV: Multi-Axial Diagnosis

Resent Job Loss

Obese

AXIS V: Psychosocial Stressors

46 scles from 1 to 100 (number 46)

GAF and severity scales

Axis V: GAF (Global Assessment of Functioning)

Scale of 1-100

DSM Classification History

DSM 5: Published May, 2013

Removal of Multi-Axial System

Looking at Basic Nomenclature Issues

E.G., Some disorders added, condensed, removed Neuroscience and Genetics Research

Lifespan Approach

DSM as a “living document” (DSM 5.1, etc.)

Cross Cultural & Gender Issues

Cohesion with ICD-9, 10 & 11 (11 out 2014)

Removal of NOS – now “Unspecified” or “Other Specified”

TREATMENT STRATEGIES

BIOLOGICAL: TX:

Biological Treatments Medication Neurotransmitters Herbal Supplements

Other Medical Methods as Fit

ECT

Psychosurgery

PSYCHODYNAMIC: TREATMENT

INTRAPSYCHIC METHODS

Methods used to access the unconscious conflicts in the psyche

Intensive Therapy: “Talk Therapy”

Free Association

Hypnosis

Dream Analysis

BEHAVIORAL: TX:

Functional Assessment

Systematic Desensitization Functional Assessment

Look at environment and see how person is functioning in the environment.

Systematic Desensitization

Progressively pairing an incompatible response (relaxation) with a subject of fear

Sequential therapy spanning many sessions

Exposure Therapy (In Vivo)

Expose individual to subject of fear in safe situation with therapist involved

COGNITIVE-BEHAVIORAL TX:

COGNITIVE:

It is assumed that abnormality is caused by maladaptive thought processes that result in dysfunctional behavior.

Main Tenets:

Cognitive Treatments CBT: Cognitive Behavioral Therapy

Uncover internal thoughts, beliefs, feelings. See how inner beliefs are affecting behavior and contribute to conflict in one’s life

Overgeneralizations

Negative Thinking

Illogical Thought Patterns

Inflexible Standards of Perfection

Become aware of “automatic” self-talk

Challenge distortions & Reframe CBT

Common cognitive distortions:

All-or-none-thinking

“Ugly or good looking”     

“You trust someone or you don’t”

“If I can’t get an A, I’m not studying”

“That was a waste of time”

“If I can’t do it well, I’m not doing it at all”

“She is perfect”

“They completely messed up”

CBT Challenge your belief system!

Common cognitive distortions:

Overgeneralization (inaccurate use of always & never)

“I never do this right”

“She always yells at me”

Discounting the Positive

“He was just being nice. He felt sorry for me.”

Jumping to Conclusions

“I know I’m not going to pass, so I’m not going to try.”

How might this perspective view a disorder (e.g., depression)?

Brain Hemispheres

Left Hemisphere:

Words

Right Hemisphere: Images Dialectical Behavioral Therapy (DBT)

Dialectical—tension between acceptance and change /Problem-solving skills & Coping Skills

Weekly psychotherapy/ Weekly 2.5 hours skills-training group/Phone consultations with primary therapist

Weekly consultation of team members/6 hours/week therapist time (direct & indirect)

DBT Objectives

Decreasing suicidal behaviors/Decreasing therapy-interfering behaviors

Nonattendance

Noncollaboration

Noncompliance

Increasing Quality of Life improving behaviors

Increase behavioral skills

Mindfulness skills

Interpersonal effectiveness

DBT Modules

Mindfulness

Emotional Regulation

Distress Tolerance

Interpersonal Effectiveness

HUMANISTIC Person-Centered/UPR

Exam I is worth 50 points. Completing the review sheet posted above by filling in the spaces with pertinent defining information & related examples will help you greatly with your exam preparation. In addition, reviewing and creating responses to the following questions will help you in preparing for any written responses.

Humanistic Treatments:

Individual Therapy

Group Therapy  I.I.H.S. (International Institute for Humanistic Studies:

   www.human-studies.org

Sociocultural Treatments

Examine a person’s social surroundings

Explanations focus on:

Family structure and communications

Social Networks

Societal Conditions

Societal labels and roles

Therapy:

Family Systems

Individual, Group, Couple Therapy      I.I.H.S. (International Institute for Humanistic Studies:

                                   www.human-studies.org

How do you define abnormal? What is the purpose of defining abnormal? List and describe the 4 Ds and discuss these criteria may assist you in your definition? Explain the ways these 4 criteria may be useful to keep in mind during an assessment. Use examples to support your discussion.

Discuss the history of the treatment of mental illness up until deinstitutionalization in the 1960s. Discuss the implications of deinstitutionalization upon mental health treatment and the creation of Community Based Organizations. Discuss what you feel is necessary for effective mental health treatment.

Discuss the use of trepanation in the history of treatment of mental illness and describe for what reasons it was likely used. Describe the treatment of lobotomy and describe how it is similar to and different from the use of trepanation as a former method of treatment.

List each of the 5 DSM axes and describe what each axis represents (use an example to support your definition of each). Imagine you are a professional psychotherapist. What assessment techniques might you have utilize in coming up with your diagnosis? Select 2 and describe with detailed examples.

Using depression as an example, describe how depression might be viewed from each of the following therapeutic models: Biological, Psychodynamic, Cognitive-Behavioral, Humanistic-Existential. Describe the possible etiology and potential treatment for depression from each of the 4 listed models.

Differentiate the Behavioral treatment method of Systematic Desensitization with the Cognitive treatment method of Cognitive Behavioral Therapy (CBT). Discuss the purpose and method of each. Describe the ways in which each are utilized to help an individual achieve improved mental health. Use examples.

Discuss the history and evolution of the DSM. Describe some of the major changes that have occurred moving from DSM-IV to DSM-5. Discuss the removal of the axes in particular. In doing so, describe the axes and what was listed on each axis. Describe how you might list a diagnosis in the model of DSM-5 as well.

Theoretical Orientations

Biological

Psychodynamic

Behavioral

Cognitive (Cognitive-Behavioral)

Humanistic (Existential-Humanistic)

Sociocultural

Interactionist:

Biopsychosocial & Diathesis Stress

Biological

Physical Processes as Key to Behavior

“BioMedical” Perspective

Emphasizes Genetic Contributions

Genetic Predispositions

Heredity

Factors within the Nervous System

Hormones, Neurotransmitters

Physical Trauma, Illness

Biological Treatments

Medication

Neurotransmitters

Herbal Supplements

Other Medical Methods as Fit

Surgery to remove tumor if tumor is the organic problem

ECT

Psychosurgery

Psychodynamic Model

Psyche= Soul/Mind     

Dynamic= Inherently conflicted organisms

Based on the concept of the Unconscious

Emphasis on Early Childhood

Inner Conflict of the Unconscious:

Ego & Defense Mechanisms

Repression

Denial

Projection

Psychodynamic

Psychoanalytic

Psychodynamic: Id, Ego, Superego

Unconscious

Emphasis on Early Childhood Experiences

Formative Years

Attachment Styles

Secure, Insecure, Anxious, Avoidant

Psychodynamic Treatments

INTRAPSYCHIC METHODS

Methods used to access the unconscious conflicts in the psyche

Intensive Therapy: “Talk Therapy”

(Now some shorter-term models, but classically long-term)

Free Association

Hypnosis

Dream Analysis

Behavioral Model

Based upon Skinner’s Operant Conditioning

An Individual Operates on the Environment

Concentrates on the behaviors or responses an individual makes to the environment

Do not look at the psyche, look at the organism

Look at what is happening in your life NOW

Deal with the behavior and alter the environment in order to change the behavior.

Behavioral Terms Behavioral

Reinforcement

Positive OR Negative

Most effective: Intermittent Reinforcement

Punishment

Shaping

Pairing

Generalization

Extinction

Behavioral Treatments

Functional Assessment

Look at environment and see how person is functioning in the environment.

Change environment, change person

Systematic Desensitization

Progressively pairing an incompatible response (relaxation) with a subject of fear

A sequential therapy spanning many sessions

Exposure Therapy (In Vivo)

Exposing individual to subject of fear in a safe situation with therapist involved

Cognitive (Cognitive-Behavioral)

The way you construe the world has bearing on how you are affected by events in the world.

Your thoughts influence your behavior.

Attributions:

Inferences we make about causes of events

Beliefs we hold about our abilities (self-efficacy)

Beliefs we hold about the behaviors of others

Cognitive Treatments

CBT: Cognitive Behavioral Therapy

Uncover internal thoughts, beliefs, feelings

See how inner beliefs are affecting behavior and conflict in one’s life

Overgeneralizations, all-or-none thinking

Negative Thinking

Illogical Thought Patterns

Inflexible Standards of Perfection

Become aware of “automatic” self-talk

Humanistic Existential-Humanistic)

Existential-Humanistic Theory

Existentialism

Here and Now

Freedom

Responsibility

Existential Anxiety

Meaning

Rollo May

Irvin Yalom

Humanism

Here and Now

Human Potential

Self-Actualization

Self-Transcendence

Carl Rogers

Abraham Maslow

Humanistic Treatments

Individual Therapy

Group Therapy I.I.H.S. (International Institute for Humanistic Studies: www.human-studies.org)

Sociocultural

Sociocultural Model

Sociology: Human relationships ; social groups

Anthropology: Human cultures & institutions; cultural context that influence people

Questions:

What are the norms of society?

What roles does the person play in the social environment?

What family structure is the person a part of?

What is the social network of support?

Sociocultural Treatments

Examine a person’s social surroundings

Explanations focus on:

Family structure and communications

Social Networks

Societal Conditions

Societal labels and roles

Therapy:

Family Systems

Individual, Group, Couple Therapy

Biopsychosocial & Diathesis Stress

Psychosocial Rehabilitation

Biological Supports

Medication: Approaching chemical needs with Chemical Treatments

Psychological Supports

Therapeutic Interventions

Social Supports (Sociological)

Social Skills, Cultural Supports

Diathesis-Stress Theory
An “Interactionist” Approach

Genetic Vulnerability + Stress = Illness

Biological Factors:

Genetic Predisposition

Congenital Birth Issue

Virus or Illness during Pregnancy

Brain cell loss due to stress or disease

Stressful Events:

Trauma (Abuse, Accident, Injury)

Loss (Death, Early Attachment)

Any number of stressors: drug use,

exposure to toxins

Causes of Stress:
Nature and Nurture

Physical Illness

Chronic Pain

Genetic Make-up & Heritability

Birth Trauma, Illness

Attachment Styles

Drug Use

Marriage / Divorce

Final Exams

Poverty

Stress Changes the Brain

Stressors experienced over a period of time and severity—whether biological or environmental—create a chronic stress response in the brain.

                  www.human-studies.org

Vygotsky's Theories

            The work of Lev Vygotsky focuses  on how culture, the values , beliefs, customs, and skills of social group is transmitted to the next generation. According to Vygotsky’s, Social interaction in particular cooperative dialogues with more knowledgeable members of society. It is necessary for children to acquire the ways of thinking and behaving that make up a community's culture ( Rowe and Wertsch, 2002). Vygotsky's theories stress the fundamental role of social interaction in the development of cognition (Vygotsky, 1978; Wertsch, 1985), as he believed strongly that community plays a central role in the process of "making meaning. Vygotsky's theory suggests that development depends on interaction with people and the tools that the culture provides to help form their own view of the world. There are three ways a cultural tool can be passed from one individual to another. The first one is imitative learning, where one person tries to imitate or copy another. The second way is by instructed learning which involves remembering the instructions of the teacher and then using these instructions to self-regulate. The final way that cultural tools are passed to others is through collaborative learning, which involves a group of peers who strive to understand each other and work together to learn a specific skill.

            Vygotsky theory combines the social environment and cognition. Children will acquire the ways of thinking and behaving that make up a culture by interacting with a more knowledgeable person, and  believed that social interaction will lead to ongoing changes in a child's thought and behavior. Theses thoughts and behaviors would vary between cultures (Berk, 1994).

             Vygotsky places considerably more emphasis on social factors contributing to cognitive development (Piaget is criticized for underestimating this).  Vygotsky states cognitive development stems from social interactions from guided learning within the zone of proximal development as children and their partners co-construct knowledge. In contrast Piaget maintains that cognitive development stems largely from independent explorations in which children construct knowledge of their own.  For Vygotsky, the environment in which children grow up will influence how they think and what they think about.  Vygotsky places more and different,  emphasis on the role of language in cognitive development (again Piaget is criticized for lack of emphasis on this). For Vygotsky, cognitive development results from an internalization of language.

 Sociocultural Model

Sociology: Human relationships & social groups

Anthropology: Human cultures & institutions; cultural context that influence people

Questions:

What are the norms of society?

What roles does the person play in the social environment?

What family structure is the person a part of?

What is the social network of support?

Sociocultural Treatments

Examine a person’s social surroundings

Explanations focus on:

Family structure and communications

Social Networks

Societal Conditions

Societal labels and roles

Developmental Cognitive Neuroscience

Biological psychology, behavioral neuroscience, biopsychology, and psychobiology are all terms encompassing the application of biology, particularly neurobiology, to the study of physiological, genetic, and developmental mechanisms of behavior in human and non-human animals. Biological psychology investigates at the level of nerves, neurotransmitters, brain circuitry and the basic biological processes that underlie normal and abnormal behavior. Most research in behavioral neuroscience involves non-human animal models which have implications for understanding human pathology and contribute to evidence-based practice.

Cognitive-Behavioral The way you construe the world has bearing on how you are affected by events in the world. Your thoughts influence your behavior.

Attributions:  Inferences we make about causes of events

Beliefs we hold about our abilities (self-efficacy)

Beliefs we hold about the behaviors of others

Cognitive Treatments

CBT: Cognitive Behavioral Therapy

Uncover internal thoughts, beliefs, feelings

See how inner beliefs are affecting behavior and conflict in one’s life

Overgeneralizations, all-or-none thinking

Negative Thinking

Illogical Thought Patterns

Inflexible Standards of Perfection

Become aware of “automatic” self-talk

Behavioral Terms Behavioral

Reinforcement

Positive OR Negative

Most effective: Intermittent Reinforcement

Punishment

Shaping

Generalization

Extinction

Behavioral Treatments

Functional Assessment

Look at environment and see how person is functioning in the environment. Change environment, change person

References

(Berk, 1994).

Rowe and Wertsch, 2002

Vygotsky, 1978; Wertsch, 1985

1. How might Dissociative & Somatic Symptom Disorders be defined by Freud’s Psychoanalytic theory? What is the proposed cause of Dissociative Disorders as per a psychoanalytic perspective? What psychoanalytic treatment might be used to treat a Dissociative Disorder?

A conversion disorder causes patients to suffer from neurological symptoms, such as ... The term "conversion" has its origins in Freud's doctrine that anxiety is ... as a somatoform disorder while the ICD-10 classifies it as a dissociative disorder. ..... of the classic psychoanalytic cases of hysteria, such as "Anna O.", may actually ...

What is the proposed cause of Dissociative Disorders as per a psychoanalytic perspective?

Research tends to show that dissociation stems from a combination of environmental and biological factors. The likelihood that a tendency to dissociate is inherited genetically is estimated to be zero (Simeon et al., 2001).

Most commonly, repetitive childhood physical and/or sexual abuse and other forms of trauma are associated with the development of dissociative disorders (e.g., Putnam, 1985). In the context of chronic, severe childhood trauma, dissociation can be considered adaptive because it reduces the overwhelming distress created by trauma. However, if dissociation continues to be used in adulthood, when the original danger no longer exists, it can be maladaptive. The dissociative adult may automatically disconnect from situations that are perceived as dangerous or threatening, without taking time to determine whether there is any real danger. This leaves the person “spaced out” in many situations in ordinary life, and unable to protect themselves in conditions of real danger.

Dissociation may also occur when there has been severe neglect or emotional abuse, even when there has been no overt physical or sexual abuse (Anderson & Alexander, 1996; West, Adam, Spreng, & Rose, 2001). Children may also become dissociative in families in which the parents are frightening, unpredictable, are dissociative themselves, or make highly contradictory communications (Blizard, 2001; Liotti, 1992, 1999a, b).

The development of dissociative disorders in adulthood appears to be related to the intensity of dissociation during the actual traumatic event(s); severe dissociation during the traumatic experience increases the likelihood of generalization of such mechanisms following the event(s). The experience of ongoing trauma in childhood significantly increases the likelihood of developing dissociative disorders in adulthood (International Society for the Study of Dissociation, 2002; Kisiel & Lyons, 2001; Martinez-Taboas & Guillermo, 2000; Nash, Hulsey, Sexton, Harralson & Lambert, 1993; Siegel, 2003; Simeon et al., 2001; Simeon, Guralnik, & Schmeidler, 2001; Spiegel & Cardeña, 1991).

What psychoanalytic treatment might be used to treat a Dissociative Disorder?

The goals of treatment for DID are to relieve symptoms, to ensure the safety of the individual, and to "reconnect" the different identities into one well-functioning identity. Treatment also aims to help the person safely express and process painful memories, develop new coping and life skills, restore functioning, and improve relationships. The best treatment approach depends on the individual and the severity of his or her symptoms. Treatment is likely to include some combination of the following methods:

Psychotherapy

This kind of therapy for mental and emotional disorders uses psychological techniques designed to encourage communication of conflicts and insight into problems.

Cognitive therapy

This type of therapy focuses on changing dysfunctional thinking patterns.

Medication

There is no medication to treat the dissociative disorders themselves. However, a person with a dissociative disorder who also suffers from depression or anxiety might benefit from treatment with a medication such as an antidepressant or anti-anxiety medicine.

Family therapy

This kind of therapy helps to educate the family about the disorder and its causes, as well as to help family members recognize symptoms of a recurrence.

Creative therapies (art therapy, music therapy)

These therapies allow the patient to explore and express his or her thoughts and feelings in a safe and creative way.

Clinical hypnosis

This is a treatment technique that uses intense relaxation, concentration and focused attention to achieve an altered state of consciousness or awareness, allowing people to explore thoughts, feelings and memories they might have hidden from their conscious minds.

2. Differentiate Major Depressive Disorder from Bipolar Disorder in detail—use specific examples of the symptoms that differentiate each; also, discuss a treatment strategy for EACH.

Everyone occasionally feels blue or sad. But these feelings are usually short-lived and pass within a couple of days. When you have depression, it interferes with daily life and causes pain for both you and those who care about you. Depression is a common but serious illness.

Many people with a depressive illness never seek treatment. But the majority, even those with the most severe depression, can get better with treatment. Medications, psychotherapies, and other methods can effectively treat people with depression.

There are several forms of depressive disorders.

Major depression,—severe symptoms that interfere with your ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a person’s lifetime, but more often, a person has several episodes.

Persistent depressive disorder—depressed mood that lasts for at least 2 years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for 2 years.

Some forms of depression are slightly different, or they may develop under unique circumstances. They include:

•          Psychotic depression, which occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations).

•          Postpartum depression, which is much more serious than the "baby blues" that many women experience after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.

•          Seasonal affective disorder (SAD), which is characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.

Bipolar disorder, also called manic-depressive illness, is not as common as major depression or persistent depressive disorder. Bipolar disorder is characterized by cycling mood changes—from extreme highs (e.g., mania) to extreme lows (e.g., depression).

Causes

Most likely, depression is caused by a combination of genetic, biological, environmental, and psychological factors.

Depressive illnesses are disorders of the brain. Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different than those of people without depression. The parts of the brain involved in mood, thinking, sleep, appetite, and behavior appear different. But these images do not reveal why the depression has occurred. They also cannot be used to diagnose depression.

Some types of depression tend to run in families. However, depression can occur in people without family histories of depression too. Scientists are studying certain genes that may make some people more prone to depression. Some genetics research indicates that risk for depression results from the influence of several genes acting together with environmental or other factors. In addition, trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger a depressive episode. Other depressive episodes may occur with or without an obvious trigger.

Signs & Symptoms

"It was really hard to get out of bed in the morning. I just wanted to hide under the covers and not talk to anyone. I didn't feel much like eating and I lost a lot of weight. Nothing seemed fun anymore. I was tired all the time, and I wasn't sleeping well at night. But I knew I had to keep going because I've got kids and a job. It just felt so impossible, like nothing was going to change or get better."

People with depressive illnesses do not all experience the same symptoms. The severity, frequency, and duration of symptoms vary depending on the individual and his or her particular illness.

Signs and symptoms include:

•          Persistent sad, anxious, or "empty" feelings

•          Feelings of hopelessness or pessimism

•          Feelings of guilt, worthlessness, or helplessness

•          Irritability, restlessness

•          Loss of interest in activities or hobbies once pleasurable, including sex

•          Fatigue and decreased energy

•          Difficulty concentrating, remembering details, and making decisions

•          Insomnia, early-morning wakefulness, or excessive sleeping

•          Overeating, or appetite loss

•          Thoughts of suicide, suicide attempts

•          Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

3. Discuss 1 Dissociative (Dissociative Identity Disorder, Dissociative Fugue, Depersonalization/Derealization)

Dissociative Disorders (SCID-D), which investigates 5 groups of dissociative symptoms (amnesia, depersonalization, derealization, identity confusion, and identity alteration) and systematically rates the severity of individual symptoms and the evaluation of overall diagnosis of dissociative disorder. 41 patients with dissociative or nondissociative psychiatric disorders (aged 23–62 yrs) and 7 normal controls (aged 20–64 yrs) were assessed with the SCID-D. Findings indicate good to excellent reliability and discriminant validity for the SCID-D as a diagnostic instrument for the 5 dissociative disorders and as a tool for the evaluation of dissociative symptoms encountered within nondissociative syndromes. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

 AND 1 Somatic Symptom Disorder (Illness Anxiety Disorder, Conversion Disorder, Somatic Symptom Disorder) Disorder. Describe symptoms and a possible treatment strategy for EACH of the two disorders selected.

4. Discuss the differences between Major Depressive Disorder, Persistent Depressive Disorder, and Premenstrual Dysphoric Disorder. For what reason can Persistent Depressive Disorder be considered particularly challenging to treat? Discuss in detail (use specific examples) 3 different possible treatment strategies to deal with Depressive Disorders.

5. Differentiate a conversion disorder from Post Traumatic Stress Disorder (PTSD).

Post-traumatic stress disorder (PTSD) was studied in the Piedmont region of North Carolina. Among 2985 subjects, the lifetime and six month prevalence figures for PTSD were 1•30 and 0•44 % respectively. In comparison to non-PTSD subjects, those with PTSD had significantly greater job instability, family history of psychiatric illness, parental poverty, child abuse, and separation or divorce of parents prior to age 10. PTSD was associated with greater psychiatric co-morbidity and attempted suicide, increased frequency of bronchial asthma, hypertension, peptic ulcer and with impaired social support. Differences were noted between chronic and acute PTSD on a number of measures, with chronic PTSD being accompanied by more frequent social phobia, reduced social support and greater avoidance symptoms.

 Create a potential scenario listing what an example of an individual with a Conversion Disorder might look like. Discuss a possible treatment strategy.

6.         Discuss Cognitive Behavioral Therapy in relation to the treatment of Depression. Why is this a common treatment method? Discuss how Cognitive Behavioral therapy works and how it might be used to treat depression. Discuss in detail why this is not a likely first choice of treatment for Bi-Polar?

7.         Differentiate generalized anxiety, panic, obsessive-compulsive, body dysmorphic disorder, and post-traumatic stress disorders. (What are the main distinguishing characteristics of each?) Select one of these disorders and recommend a treatment strategy in detail.

Body Dysmorphic Disorder (BDD)

Most of us have something we don't like about our appearance — a crooked nose, an uneven smile, or eyes that are too large or too small. And though we may fret about our imperfections, they don’t interfere with our daily lives.

But people who have body dysmorphic disorder (BDD) think about their real or perceived flaws for hours each day.

They can't control their negative thoughts and don't believe people who tell them that they look fine. Their thoughts may cause severe emotional distress and interfere with their daily functioning. They may miss work or school, avoid social situations and isolate themselves, even from family and friends, because they fear others will notice their flaws.

They may even undergo unnecessary plastic surgeries to correct perceived imperfections, never finding satisfaction with the results.

Characteristics of BDD

BDD is a body-image disorder characterized by persistent and intrusive preoccupations with an imagined or slight defect in one's appearance.

People with BDD can dislike any part of their body, although they often find fault with their hair, skin, nose, chest, or stomach. In reality, a perceived defect may be only a slight imperfection or nonexistent. But for someone with BDD, the flaw is significant and prominent, often causing severe emotional distress and difficulties in daily functioning.

BDD most often develops in adolescents and teens, and research shows that it affects men and women almost equally. About one percent of the U.S. population has BDD.

The causes of BDD are unclear, but certain biological and environmental factors may contribute to its development, including genetic predisposition, neurobiological factors such as malfunctioning of serotonin in the brain, personality traits, and life experiences.

Symptoms

People with BDD suffer from obsessions about their appearance that can last for hours or up to an entire day. Hard to resist or control, these obsessions make it difficult for people with BDD to focus on anything but their imperfections. This can lead to low self-esteem, avoidance of social situations, and problems at work or school.

People with severe BDD may avoid leaving their homes altogether and may even have thoughts of suicide or make a suicide attempt.

BDD sufferers may perform some type of compulsive or repetitive behavior to try to hide or improve their flaws although these behaviors usually give only temporary relief. Examples are listed below:

camouflaging (with body position, clothing, makeup, hair, hats, etc.)

comparing body part to others' appearance

seeking surgery

checking in a mirror

avoiding mirrors

skin picking

excessive grooming

excessive exercise

changing clothes excessively

BDD and Other Mental Health Disorders

People with BDD commonly also suffer from the anxiety disorders obsessive-compulsive disorder (OCD) or social anxiety disorder, as well as depression and eating disorders.

BDD can also be misdiagnosed as one of these disorders because they share similar symptoms. The intrusive thoughts and repetitive behaviors exhibited in BDD are similar to the obsessions and compulsions of OCD. And avoiding social situations is similar to the behavior of some people with social anxiety disorder.

Diagnosis and Treatment

To get an accurate diagnosis and appropriate treatment, people must mention specifically their concerns with their appearance when they talk to a doctor or mental health professional. A trained clinician should diagnose BDD.

However, you can take a self-test that can help suggest if BDD is present, but it will not offer a definitive diagnosis.

ANXIETY DISORDERS & TRAUMA /STRESSOR RELATED

Sympathetic Nervous System: The sympathetic nervous system (SNS) is part of the autonomic nervous system (ANS), which also includes the parasympathetic nervous system (PNS).

The sympathetic nervous system activates what is often termed the fight or flight response.

Sympathetic neurons are frequently considered part of the peripheral nervous system (PNS), although there are many that lie within the central nervous system (CNS).

Sympathetic neurons of the spinal cord (which is part of the CNS) communicate with peripheral sympathetic neurons via a series of sympathetic ganglia.

Parasympathetic Nervous System: The parasympathetic nervous system (abbreviated PN to avoid confused with the Peripheral nervous system (PNS)) is one of the three main divisions of the autonomic nervous system (ANS), the other two being the sympathetic (SN) and enteric systems.

The part of the autonomic nervous system originating in the brain stem and the lower part of the spinal cord that, in general, inhibits or opposes the physiological effects of the sympathetic nervous system, as in tending to stimulate digestive secretions, slow the heart, constrict the pupils, and dilate blood vessels.

GAD= Generalized Anxiety Disorder: Generalized anxiety disorder (or GAD) is characterized by excessive, exaggerated anxiety and worry about everyday life events with no obvious reasons for worry. People with symptoms of generalized anxiety disorder tend to always expect disaster and can't stop worryingabout health, money, family, work, or school. In people with GAD, the worry is often unrealistic or out of proportion for the situation. Daily life becomes a constant state of worry, fear, and dread. Eventually, the anxiety so dominates the person's thinking that it interferes with daily functioning, including work, school, social activities, and relationships.

Sx of GAD: Excessive, ongoing worry and tension

•          An unrealistic view of problems

•          Restlessness or a feeling of being "edgy"

•          Irritability

•          Muscle tension

•          Headaches

•          Sweating

•          Difficulty concentrating

•          Nausea

•          The need to go to the bathroom frequently

•          Tiredness

•          Trouble falling or staying asleep

•          Trembling

•          Being easily startled

Extra info: What Causes GAD? The exact cause of GAD is not fully known, but a number of factors -- including genetics, brain chemistry, and environmental stresses -- appear to contribute to its development.

•          Genetics: Some research suggests that family history plays a part in increasing the likelihood that a person will develop GAD. This means that the tendency to develop GAD may be passed on in families.

•          Brain chemistry: GAD has been associated with abnormal functioning of certain nerve cell pathways that connect particular brain regions involved in thinking and emotion.  These nerve cell connections depend on chemicals called neurotransmitters that transmit information from one nerve cell to the next.  If the pathways that connect particular brain regions do not run efficiently, problems related to mood or anxiety may result.  Medicines, psychotherapies, or other treatments that are thought to "tweak" these neurotransmitters may improve the signaling between circuits and help to improve symptoms related to anxiety or depression.

•          Environmental factors: Trauma and stressful events, such as abuse, the death of a loved one, divorce, changing jobs or schools, may lead to GAD. GAD also may become worse during periods of stress. The use of and withdrawal from addictive substances, including alcohol,caffeine, and nicotine, can also worsen anxiety.

PANIC DISORDER Sx:

Panic attacks involve sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. A person experiencing a panic attack may believe that he or she is having aheart attack or that death is imminent. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them. Most people with panic attacks experience several of the following symptoms:

•          "Racing" heart

•          Feeling weak, faint, or dizzy

•          Tingling or numbness in the hands and fingers

•          Sense of terror, or impending doom or death

•          Feeling sweaty or having chills

•          Chest pains

•          Breathing difficulties

•          Feeling a loss of control

Panic attacks are generally brief, lasting less than 10 minutes, although some of the symptoms may persist for a longer time. People who have had one panic attack are at greater risk for having subsequent panic attacks than those who have never experienced a panic attack. When the attacks occur repeatedly, a person is considered to have a condition known as panic disorder.

People with panic disorder may be extremely anxious and fearful, since they are unable to predict when the next episode will occur. Panic disorder is fairly common and affects about 2.4 million people in the U.S., or 1.7% of the adult population between the ages of 18 and 54. Women are twice as likely as men to develop the condition, and its symptoms usually begin in early adulthood.

AGORAPHOBIA: The word agoraphobia means "a fear of wide, open spaces." The word originates from the ancient Greek word "agora," referring to a place of assembly or market place.

Agoraphobia is an anxiety disorder involving anxiety and intense fear of any situation where escape may be difficult, or where help may not be available. It often involves a fear of crowds, bridges or of being outside alone.

PHOBIA Sx (Symptoms) : Signs and symptoms of phobias. The symptoms of a phobia can range from mild feelings of apprehension and anxiety to a full-blown panic attack. Typically, the closer you are to the thing you're afraid of, the greater your fear will be. Your fear will also be higher if getting away is difficult.

PTSD Sx: (Symptoms) : In a small number of cases, though, PTSD symptoms may not appear until years after the event. Post-traumatic stress disorder symptomsare generally grouped into three types: intrusive memories, avoidance and numbing, and increased anxiety or emotional arousal (hyperarousal).

ANXIETY DISORDER TREATMENT

Successful Treatments: A recently developed cognitive-behavioral treatment for generalized anxiety disorder (GAD) targets intolerance of uncertainty by the reevaluation of positive beliefs about worry, problem-solving training, and cognitive exposure. As previous studies have established the treatment's efficacy when delivered individually, the present study tests the treatment in a group format as a way to enhance its cost-benefit ratio. A total of 52 GAD patients received 14 sessions of cognitive-behavioral therapy in small groups of 4 to 6 participants. A wait-list control design was used, and standardized clinician ratings and self-report questionnaires assessed GAD symptoms, intolerance of uncertainty, anxiety, depression, and social adjustment. Results show that the treatment group, relative to the wait-list group, had greater posttest improvement on all dependent variables and that treated participants made further gains over the 2-year follow-up phase of the study. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Exposure In Vivo Therapy:

Might work well to treat:

Systematic Desensitization:

Might work well for:

Cognitive Restructuring:

Might work well for:

Support Groups:

Might work well for:

Thought Stopping:

Might work well for:

Relaxation Techniques:

Might work well for:

Role Playing:

Might work well for:

Other:

Might work well for:

OBSESSIVE COMPULSIVE & RELATED DISORDERS

OBSESSIVE COMPULSIVE DISORDER:

TX:

BODY DYSMORPHIC DISORDER:

TX:

HOARDING:

TRICHOTILLOMANIA:

EXCORIATION:

DISSOCIATIVE DISORDERS

How might you define or describe dissociation?

DISSOCIATIVE AMNESIA:

DISSOCIATIVE FUGUE:

DISSOCIATIVE IDENTITY DIS.

DEPERSONALIZATION / DEREALIZATION:

What defense mechanism is strongly linked to Dissociative disorders?

Describe a theoretical paradigm that may be well suited to explore Dissociative disorders in depth?

TX Approaches?:

SOMATIC SX DISORDERS

SOMATIC SYMPTOM DISORDER:

CONVERSION DS.=

ILLNESS ANXIETY DISORDER:

FACTITIOUS DISORD.

By Proxy:

MALINGERING

DEPRESSIVE DISORDERS

Exogenous or Reactive Depression=

MAJOR DEPRESSIVE DISORDER:

ERSISTENT DEPRESSIVE DS:

PREMENSTRUAL DYSPHORIC DISORDER (PMDD):

DISRUPTIVE MOOD DYSREGULATION DISORDER:

List 3 treatments for Depression:

1)        

2)

3)

BI-POLAR DISORDERS

Differentiate Unipolar Depression from BiPolar Disorder:

Define and list some criteria/features of Mania:

HYPOMANIA:

BIPOLAR I:

BIPOLAR II:

CYCLOTHYMIA:

Main Treatment Strategies:           

1.         SUICIDE: the action of killing oneself intentionally.

"he committed suicide at the age of forty"

synonyms:      self-destruction, taking one's own life, killing oneself, self-murder

"was it suicide or murder?"

–        a person who does this.

–        a course of action that is disastrously damaging to oneself or one's own interests.

"it would be political suicide to restrict criteria for unemployment benefits"

o          relating to or denoting a violent act or attack carried out by a person who does not expect to survive it.

modifier noun: suicide

"a suicide bombing"

verb

verb: suicide; 3rd person present: suicides; past tense: suicided; past participle:suicided; gerund or present participle:

suiciding       

1. intentionally kill oneself. "he leaves the service and then suicides"  Origin

Stressors/factors that might contribute to suicide? People who kill themselves exhibit one or more warning signs, either through what they say or what they do. The more warning signs, the greater the risk.

Talk

If a person talks about:

•          Killing themselves.

•          Having no reason to live.

•          Being a burden to others.

•          Feeling trapped.

•          Unbearable pain.

Behavior

A person’s suicide risk is greater if a behavior is new or has increased, especially if it’s related to a painful event, loss, or change.

•          Increased use of alcohol or drugs.

•          Looking for a way to kill themselves, such as searching online for materials or means.

•          Acting recklessly.

•          Withdrawing from activities.

•          Isolating from family and friends.

•          Sleeping too much or too little.

•          Visiting or calling people to say goodbye.

•          Giving away prized possessions.

•          Aggression.

Mood

People who are considering suicide often display one or more of the following moods.

•          Depression.

•          Loss of interest.

•          Rage.

•          Irritability.

•          Humiliation.

•          Anxiety.

Psychological Factors:

Sociocultural Factors: Reviews the literature on psychosocial factors of suicide in adolescents. Topics discussed included demographic factors, sociocultural factors, role of family, depression, and suicidal behavior in abused children. A summary of a study by S. A. Husain and T. Vandiver (1984) who conducted a statistical analysis of 167 case studies of suicide behavior reported in the literature during 1953–1980 is presented. Family-related factors appear to be the most significant contributors to youth suicide. Family turmoil, disturbed parent–child relationships, physical and sexual abuse, and hostile rejecting parental attitudes promote suicide behavior. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Biological (Genetics): Psychiatric evaluations of the relatives were made on the basis of independent blind diagnoses based on mental hospital and other official records. Analysis of the data showed an eightfold increase in unipolar depression among the biological relatives of the index cases and a 15-fold increase in suicide among the biological relatives of the index cases. These data demonstrate a significant genetic contribution to unipolar depression and suicide. They fail to disclose a significant contribution of family-associated transmission in the genesis of the mood disorders.

Cognitive Factors:

Suicide is one of the leading causes of adolescent death and is an important clinical problem. According to World Health Organisation, it is the third cause of death for ages 15-44 worldwide and is the second cause of death for ages 15-24 in Turkey . The presence of a psychiatric disorder and previous suicidal acts, social, cultural and family related factors are well known predictors of suicide. However, cognitive developmental level and schemes are as important as the other factors. For prevention and treatment it is essential to understand cognitive factors that lead adolescents to suicide. Cognitive factors and distortions that might have a role in adolescent suicides are hoplessness, problem solving deficits, cognitive rigidity, dichotomous thinking, perfectionism, personalizing, catastrophising and time perspective. In this article, adolescent suicide and related cognitive factors are briefly reviewed.

Risk Assessment—Factors:

C:

P:

R:

Discuss Prevention & Postvention:

List an actual Crisis Hotline Number:

Piaget stage of Concrete Operations

October 30, 20xx

Jean Piaget stage of Concrete Operations:

 Ages Seven through Eleven

·         Jean Piaget devoted his life to how thoughts were transformed into a body of knowledge. His theories of cognitive development were inspired by observations of his three children from infancy. Piaget believed that children were active participants in learning. He viewed children as busy, motivated explorers whose thinking developed as they acted directly on the environment using their eyes, ears, and hands. According to Piaget, between

·         The stage of concrete operations begins when the child is able to perform mental operations. Piaget defines a mental operation as an interiorized action, an action performed in the mind. Mental operations permit the child to think about physical actions that he or she previously performed. The preoperational child could count from one to ten, but the actual understanding that one stands for one object only appears in the stage of concrete operations.

·         The primary characteristic of concrete operational thought is its reversibility. The child can mentally reverse the direction of his or her thought. A child knows that something that he can add, he can also subtract. He or she can trace her route to school and then follow it back home, or picture where she has left a toy without a haphazard exploration of the entire house. A child at this stage is able to do simple mathematical operations. Operations are labeled “concrete” because they apply only to those objects that are physically present.

·         Conservation is the major acquisition of the concrete operational stage. Piaget defines conservation as the ability to see that objects or quantities remain the same despite a change in their physical appearance. Children learn to conserve such quantities as number, substance (mass), area, weight, and volume; though they may not achieve all concepts at the same time.

 

STAGE THREE: The Concrete Operational Stage

QUICK SUMMARY: Children have schemata (cognitive structures that contain pre-existing ideas of the world), which are constantly changing. Schemata constantly undergo adaptation, through the processes of assimilation and accommodation. When seeing new objects there is a state of tension, and a child will attempt to assimilate the information to see if it fits into prior schemata. If this fails, the information must be accommodated by either adding new schemata or modifying the existing ones to accommodate the information. By balancing the use of assimilation and accommodation, an equilibrium is created, reducing cognitive tension (equilibration).

Name some drugs from each category:

STIMULANTS

DEPRESSANTS

HALLUCINOGENS

Discuss one drug of interest:

Why are some substance so popular?

What influences this?

Socially:

Cognitively:

Behaviorally:

Biologically:

Personality Disorders Definition

What is Personality?

Consistent characteristic ways of being

Thoughts

Feelings

Behaviors

PERSONALITY DISORDERS: A specific notable pattern of thinking, feeling, and behaving that is—

Enduring, persistent over time

Pervasive—existing across broad range of personal and social situations

Inner and External experience is affected

AREAS AFFECTED: Thoughts, Feelings, Behaviors

THOUGHTS: Ways of perceiving / interpreting self, others, and events

FEELINGS: Emotional range, intensity, stability, appropriateness

INTERPERSONAL FUNCTIONING: Style and nature of their relationships

IMPULSE CONTROL: Ability to restrain, delay, or manage impulses

SOCIAL AREAS: Marriage friends, family, acquaintances

OCCUPATIONAL AREAS: Bosses, co-workers, clients

OTHER AREAS OF LIFE SKILLS: Finances, planning, safety, legalities

Clusters A, B, & C

CLUSTER A: Odd or eccentric

Paranoid Personality Disorder

Schizoid Personality Disorder

Schizotypal Personality Disorder

CLUSTER B: Dramatic, emotional, erratic

Antisocial Personality Disorder

Narcissistic Personality Disorder

Borderline Personality Disorder

Histrionic Personality Disorder

CLUSTER C: Anxious & Fearful

Dependent Personality Disorder

Avoidant Personality Disorder

Obsessive Compulsive Personality Disorder

CLUSTER A: Odd or Eccentric

PARANOID PERSONALITY DISORDER

CLUSTER A: Odd or Eccentric

PARANOID PERSONALITY DISORDER

Suspects (without sufficient basis) that others are exploiting, harming, or deceiving him or her

Preoccupied with unjustified doubts about loyalty or trustworthiness of others

Reluctant to confide in others because of unwarranted fear that information will be used maliciously against him or her

Reads hidden, demeaning, threatening messages into benign remarks

Persistently bears grudges; unforgiving of insults, injuries, slights they think they’ve received

Perceives character attacks on reputation—quick to anger and counter-attack

May be pathologically jealous, suspecting unfaithfulness

Paranoid Personality Disorder Cont’d

May be quick to anger and act out upon it

OVERALL PATTERN: Pervasive pattern of distrust & suspiciousness of others so that their motives are interpreted as malevolent.

TREATMENT:

Limited effect in therapy

Help treat anxiety & improve skills at interpersonal levels / problems

Work with anger

Work with deep wish for a satisfying relationship

Progress is SLOW

CLUSTER A: Odd or Eccentric

SCHIZOID PERSONALITY DISORDER

CLUSTER A: Odd or Eccentric

SCHIZOID PERSONALITY DISORDER

Neither desires nor enjoys close relationships, including being part of a family. Lack of desire for intimacy.

Almost always chooses solitary activities

Little, if any, sexual interest with others. Takes pleasure in few activities

Lacks close friends and confidants other than first-degree relatives

Shows emotional coldness, detachment, flattened affectivity

Schizoid Personality Disorder Cont’d

Loners—prefer to keep to themselves

No effort to start or keep relationships

Often weak social skills

Difficulty picking up emotional cues, trouble perceiving environment correctly

May seem self-absorbed, withdrawn

Often don’t show feelings

OVERALL PATTERN: Pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings.

TREATMENT: Therapy; teach social skills; role playing; expressive techniques.

CLUSTER A: Odd or Eccentric

SCHIZOTYPAL PERSONALITY DISORDER

CLUSTER A: Odd or Eccentric

SCHIZOTYPAL PERSONALITY DISORDER

Ideas of reference (incorrect interpretations of casual incidents as having a particular and unusual meaning

Behavior or appearance odd, eccentric, or peculiar

Lack of close confidants other than first degree relatives

Suspiciousness or paranoid ideation

May have excessive social anxiety that doesn’t diminish with familiarity—likely related to paranoid fears

Inappropriate or constricted affect

Odd thinking and speech

Vague, metaphorical, elaborate

Unusual perceptual experiences, including body illusions

Odd beliefs or magical thinking

Superstitious, belief in clairvoyance, telepathy

Sense the presence of someone when alone

Emotions may be flat

Difficulty keeping attention focused

No effort to start or keep relationships

OVERALL PATTERN: Pervasive pattern of social & interpersonal deficits marked by acute discomfort with—and reduced capacity for—close relationships as well as by cognitive or perceptual distortions & eccentricities of behavior.

May seek TX: for anxiety, depression

TREATMENT: Help reconnect with world and recognize limits of thinking & “powers”. Increase positive social contacts, ease loneliness, become more aware of personal feelings.

CLUSTER B: Dramatic, Emotional, Erratic

ANTISOCIAL PERSONALITY DISORDER

CLUSTER B: Dramatic, Emotional, Erratic

ANTISOCIAL PERSONALITY DISORDER

Deceitfulness / Manipulation (Repeated lying, use of aliases, conning others for money, sex, power)

Lack of remorse

Impulsivity & reckless disregard for safety of self or others & consistent irresponsibility

Irritability / aggressiveness-- Physical fights or assaults; violate rights of others

Failure to conform to social norms with respect to lawful behaviors

Repeated acts that are grounds for arrest

Destroying property, harassing others, stealing, illegal

May lie incessantly

Person is at least 18 years old

Evidence of Conduct Disorder onset before age 15

May seem self-absorbed, withdrawn, indifferent

Disregard for others

OVERALL PATTERN: Pervasive pattern of disregard for, and violation or the rights of others

TREATMENT: No treatment appears to be very effective (often treatment is court-ordered); Try cognitive therapy to see the importance of respecting others

CLUSTER B: Dramatic, Emotional, Erratic

BORDERLINE PERSONALITY DISORDER

CLUSTER B: Dramatic, Emotional, Erratic

BORDERLINE PERSONALITY DISORDER

Frantic efforts to avoid real or imagined abandonment

Identity Disturbance: markedly, persistently unstable self-image or sense of self

Impulsivity in at least 2 areas potentially self-damaging

Spending, sex, substance abuse, reckless driving, binge eating

Unstable interpersonal relationships

Alternating between extremes of idealization & devaluation

Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior

Suicide Rates: 8-10% within this disorder population

Gestures / threats / self-mutilation

An addictive behavior (may relieve dysphoria by feeling numb or by substituting external pain for internal pain

May be a way to communicate pain and distress.  If feel no one understands their suffering, may “turn up the volume”

SOME EXAMPLES MAY BE:

Cutting

Bruising

Burning

Head or body “banging”

Biting

Intense reactivity to interpersonal stressors

Chronic feelings of emptiness, unfulfillment

Affective instability--marked reactivity of mood

Intense episodic dysphoria, irritability, anxiety

Moods are often disrupted by periods of anger, panic, despair

Inappropriate intense anger or difficulty controlling anger

Extreme sarcasm, enduring bitterness, verbal outbursts.

Often elicited when feeling neglected, abandoned, uncared for

Such anger often followed by shame, guilt, and contribute to the feeling they have of being evil.

OVERALL PATTERN: Pervasive pattern of instability of interpersonal relationships, self-image, affects, and marked impulsivity.

Borderline Personality

TREATMENT: THERAPY: DBT: Dialectical Behavioral Therapy; Cognitive-Behavioral: Model ways to interpret and react to situations;   Group Therapy

MEDICATION: Anti-Depressants, Mood Stabilizer

Anti-Depressants may have some effect, but certainly not all symptoms and don’t work for everyone with BPD

BPD is often misdiagnosed as Bipolar Disorder. People are put on mood stabilizers which may initially have some effect, but will soon cease entirely in their efficacy

CLUSTER B: Dramatic, Emotional, Erratic

HISTRIONIC PERSONALITY DISORDER

CLUSTER B: Dramatic, Emotional, Erratic

HISTRIONIC PERSONALITY DISORDER

Uncomfortable in situations in which not center of attention

Interaction with others is characterized by inappropriate sexually seductive or provocative behavior

Displays rapidly shifting and shallow expression of emotions

Consistently uses physical appearance to draw attention to self

Speech excessively impressionistic & lacking in detail

Self-dramatization, theatrical, exaggerated expression of emotion

Suggestible: easily influenced by others or circumstances

Considers relationships to be more intimate than they are

Vain or self-centered, may tantrum

May exaggerate physical illness to draw attention to self

Exaggerate depth of relationships

May tell of many emotions but you don’t feel or empathize with them

May manipulate to meet their needs

Long term relationships may be neglected to make way for excitement of new relationships

OVERALL PATTERN: Pervasive pattern of excessive emotionality and attention-seeking behavior.

TREATMENT: May seek treatment, but because of the demands, tantrums, seductiveness they are likely to employ, treatment will be difficult. They may pretend to have important insights to gain attention or to please therapist. Therapist must maintain good boundaries.

CLUSTER B: Dramatic, Emotional, Erratic

NARCISSISTIC PERSONALITY DISORDER

Narcissistic Personality

NARCISSISTIC PERSONALITY

Grandiose sense of self-importance

Exaggerates achievements and talents

Expects to be recognized as superior without commensurate achievements

Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

Believes he or she is special and unique and can only be understood by—or should associate with, others of special or high status (or institutions)

Sense of entitlement, expect to be catered to

Interpersonally exploitative, lack sensitivity to others

Extremely Self-Involved

Need continual attention and admiration

May fish for compliments

Lacks empathy

Fail to recognize that others have needs

May take advantage of others to achieve their own ends

Seldom interested in feelings of others

Narcissistic Personality Dis. Cont’d

May be preoccupied with how favorably they are regarded by others

Often appear boastful and pretentious

May compare themselves favorably with famous or privileged people

May be condescending, patronizing, tiring to be around

OVERALL PATTERN: Pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy.

TREATMENT: Do not often seek treatment—at least not directly to address their own issues (“they are not the problem”)

CLUSTER C: Anxious, Fearful

AVOIDANT PERSONALITY DISORDER

CLUSTER C: Anxious, Fearful

AVOIDANT PERSONALITY DISORDER

Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval or rejection

May decline job promotion because fear criticism from co-workers as a result of new responsibilities

Unwilling to get involved with people unless certain of being liked & accepted without criticism

Shows restraint within intimate relationships because of the fear of being shamed or ridiculed

Often described as shy, timid, lonely, isolated

Preoccupied with being criticized or rejected in social situations

Expect that no matter what is said, others will see them as wrong, so say nothing at all

Avoidant Personality Dis. Cont’d

Low self-esteem, doubt social competence and personal appeal (feels socially inept) and inferior

May not join in group activities unless receive repeated and generous offers of support and nurturance

Tend to be quiet, inhibited, and ‘invisible’ because of fear that any attention would be degrading and or rejecting.

May exaggerate potential dangers of ordinary situations

May cancel job interview for ear of being embarrassed by not dressing appropriately

OVERALL PATTERN: Pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation.

TREATMENT: Poor prognosis for treatment.

CLUSTER C: Anxious, Fearful

DEPENDENT PERSONALITY DISORDER

CLUSTER C: Anxious, Fearful

DEPENDENT PERSONALITY DISORDER

Difficulty making everyday decisions without an excessive amount of advice and reassurance from others

What color shirt to wear to work, whether or not to carry an umbrella

Needs others to assume responsibility for most major areas of life (job to have, friends to have, where to live)

Difficulty expressing disagreement with others because of fear or loss of support or approval

Fear of developing competence because fear abandonment

Excessive lengths to obtain nurturance and support, to the point of doing things that are unpleasant

Willing to submit to others, even to unreasonable demands

Difficulty initiating projects or doing things on own

Lack of self-confidence in judgment or abilities rather than lack of motivation or energy

Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for him or herself.

Urgently seeks another relationship as source of care and support when a close relationship ends (because of belief that can’t subsist on own)

Unrealistically preoccupied with fears of being left to take care of self (pessimism, self-doubt, belittle abilities)

OVERALL PATTERN: Pervasive pattern of excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation. Dependent and submissive behaviors are designed to elicit care giving and arise from a self-perception of being unable to function adequately without the help of others.

TREATMENT: Therapy to provide skill-building, build self-esteem, competence, self-efficacy. Modeling & role playing.

CLUSTER C: Anxious, Fearful

OBSESSIVE COMPULSIVE PERSONALITY DISORDER

CLUSTER C: Anxious, Fearful

OBSESSIVE COMPULSIVE PERSONALITY DISORDER

Preoccupied with details, rules, lists, order, organization, schedules to the extent that major point of the activity is lost (attempt to maintain a sense of control)

Excessively devoted to work and productivity to the exclusion of leisure activities and friendships

May keep postponing pleasurable activity or be uncomfortable on vacation, don’t want to “waste time”

Over-conscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)

Shows perfectionism that interferes with task completion

Unable to complete task because own overly strict standards are not met (deadlines missed, aspects of life fall to the wayside because of focus of striving for perfection)

Obsessive Compulsive Personality Ds. Cont’d

Rigidity, stubbornness

Miserly spending style; money hoarded for future catastrophes

Reluctant to delegate tasks or work with others unless they submit to his/her way of doing things

Excessively careful, prone to repetition

Unable to discard worn-out objects (pack rats)

“You never know when you might need something.”

Extraordinary attention to detail and repeatedly checking for possible mistakes

OVERALL PATTERN: Pervasive pattern of orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.

TREATMENT: Therapy to provide skill-building, teach relaxation skills, anxiety & relaxation techniques.

Neurocognitive Disorders

 Top 3 issues in elderly population:

Neurocognitive Disorders (formerly Dementia)

Delirium

Depression

 Cognitive Disorders

 Neurocognitive Disorder:

 Multiple cognitive deficits

 Memory Deficits

 Forgetfulness

 Disorientation

Concrete Thinking

 DELIRIUM:

 Rapid Fluctuation in levels of Consciousness (agitated to lethargic)

Disorientation to place and time

 Memory Deficits—difficulty maintaining attention span

 Neurocognitive Disorders

 NEUROCOGNITIVE Ds:

Perseveration (repetitive speech & movements)

GRADUAL ONSET– difficult to peg the onset (differentiate from depression)

 DELIRIUM:

 Perceptual Disturbances such as hallucinations, language deficits

 Unfocused speech, disorganized thinking

 RAPID ONSET

 Neurocognitive Disorder due to…

 Vascular: Stroke (interruption in blood supply to part of the brain. Neural tissue dies because of lack of oxygen and nutrients.)

 Genetic & Environmental Factors

 RISK FACTORS:

High blood pressure

 Cardiovascular disease

 Cigarette smoking

 Poor (low protein) diet

 Obesity & inactivity

 Psychological Stressors

 Neurocognitive Disorder due to…

 Substance-Induced: Related to drugs or poisons. Persists even after the substance is withdrawn. Drugs, alcohol, inhalants, solvents, insecticides, lead, mercury, carbon monoxide. (Destroys brain tissue or disrupts brain metabolism.)

 Head Injuries / Tumors / Infectious Diseases

 Aspects of Neurocognitive Disorder

 Rates are similar cross-culturally & socioeconomically

 Most types are not curable

 Aphasia: Difficulty or inability to recall words (usually associated with damage to left hemisphere of brain).

 May not be able to remember “car”, but may attempt to get message across by saying “the machine with wheels”

Aspects of Neurocognitive Disorder

Agnosia: Failure to recognize familiar objects despite normal vision, touch, and hearing.

Apraxia: Inability to carry out desired motor actions despite normal muscle control. Or disturbance in executive functioning—planning, organizing, sequencing.

 Neurocognitive Disorder due to Alzheimer’s Disease

 ETIOLOGY: Genetic & environmental factors

 Neurofibrillary Tangles (within the neurons): collapsed neural structures

 Amyloid Plaques (outside of neurons): Dense deposits of deteriorated protein surrounded by dead cells (glial & nerve cells)

Neurocognitive Disorder due to Alzheimer’s Disease

 Disruptions in the neuronal structure

 Large numbers of neurons die

 Results in decline in neurotransmitters

 Acetylcholine is reduced (necessary for communication within the brain)

Drops in serotonin

ALZHEIMER’S

 Alzheimer’s—MOST COMMON Neurocognitive

 Neurocognitive Disorder due to Alzheimer’s Disease

Structural & Chemical brain deterioration

 Gradual loss of many aspects of thought & behavior

 Physical Response may be affected

 Slower response time, may get lost

 Paranoia (Suspiciousness)

 Item lost because can’t remember where placed, but may blame others for “stealing” them

Alzheimer’s Cont’d

 Alzheimer’s Alterations of Perception

 Alterations in interpretations of sound and images, hallucinations

Wandering & Social Withdrawal

 Personality Changes (“loss of sparkle”)

 May become impulsive, belligerent, reduced initiative

 Disinhibition

 Spontaneous undressing without regard for privacy. Inappropriate sexual overtures

 Alzheimer’s

 Most common neurocognitive ds. (50-60%)

 More women than men

 Starts as memory disturbance that seems like mere forgetfulness

•             As time passes, the memory disturbance becomes more obvious

•             Person forgets facts, events, and new learning becomes difficult

•             Old memories are often preserved, but in time, are lost

 Alzheimer’s

 Person may initially show childish behavior, irritability, depression, confusion, disorientation, anxiety.

 Late stages, may lose control of bodily functions.

 May have deficiencies in dressing, bathing, eating (swallowing)

 May lose ability to speak or understand speech

Delirium

 Develops rapidly (within a few hours or days)

 Differentiated from Dementia: by rapid onset, short duration, alternating lucid intervals, presence of hallucinations and delusions, and minimal long-term effect on personality.

 Present in 10-15% pf emergency room pts.

 While delirious, people seem to be unaware of where they are or what is going on around them

–             Difficulty focusing, sustaining, or shifting attention

–             Memories may be poor

–             May lose track of the day or even the month

–             Language may be rambling and incoherent

o             May have hallucinations and delusions

–             May be anxious, fearful, irritable

–             Delirium Cont’d

–             Some Causes of Delirium:

–             Brain Tumors

–             Blows to the head

–             Dehydration

–             Systemic diseases (AIDS)

–             Intoxication with prescription or illicit drugs

–             Infections

–             Hyperthermia / hypothermia

Nutritional Deficiencies (usually iron, folate, B12)

 Delirium Tremens: Alcohol Withdrawal from habitual drinkers

 Also psychological and social factors that can facilitate the development of delirium

Severe stress

 Sleep Deprivation

 Sensory Deprivation (solitary confinement)

 Forced Immobilization (patients with serious burns)

 Treatment: Related to the identified cause.

 Amnestic Disorders

 Causes: Organic Causes

Traumatic brain injury

Exposure to highly toxic substances

Brain disease produces amnestic disorders rapidly

Drugs and nutritional deficiencies produce memory disorders that develop gradually

 TIAs

–             May develop with an episode of delirium

–             Example: Korsakoff’s Syndrome

–             Most common, yet still rare caused by prolonged alcohol abuse (resulting in neuronal damage; alcohol poisoning to nerve cells; deficiency due to poor diet—thiamine deficiency)

–             Begins with an acute episode of delirium

–             When delirium clears, the person is left with severe memory deficit (affecting new memories)

–             Depression

–             In older adults, depression may appear as:

–             Forgetfulness

–             Self-neglect

–             Poor Hygiene

–             Weight Loss

–             Social Withdrawal

–             Lack of Attention to Finances

–             Complaints of Memory Loss or Difficulty Concentrating

–             Treatment of Neurocognitive Disorders

–             No single treatment works for all cases. Tx must be tailored to each specific case.

–             Substance-induced is treated by removing offending substance.

–             Symptoms of demential and amnestic disorders may be minimized by treating associated conditions:

–             Anti-depressant medication and cognitive-behavioral modification may help to relieve cognitive impairments caused by depression

–             Treatment of Neurocognitive Disorders

–             Alzheimer’s treatment is limited: no definitive tx

–             First drug approved was Cognex (prevents breakdown of acetylcholine): results in modest improvement in cognitive functioning, but can have unpleasant side effects and liver damage

–             Work to preserve person’s sense of independence and self-esteem

–             Help person to maintain social contacts

–             Provide as much enjoyment and meaning as possible

–             Special labels on things in house

–             Keeping a familiar environment

–             Community Services: meal preparation, visiting nurse

–             Prevention

–             Prevention is best!

–             No smoking (reduce hypertension and vascular dementia)

–             Treating high blood pressure

–             Low-fat diets (fish; olive oil)

–             Programs to combat alcohol and drug abuse

–             Immunizations against causes of encephalitis and other illnesses

–             Keep active SOCIAL & INTELLECTUAL LIFE

–             Studying, doing crossword puzzles,

–             EDUCATION?

–             Neurodevelopmental Disorders

–             Autism Spectrum, ADD/ADHD, Intellectual Disability & Tourettes

–             Neurodevelopmental Disorders

–             This is a new chapter in the DSM, including a broad range of disorders that are all thought to have a neurological base

–             Each typically begins in early childhood (these disorders were formerly listed in the chapter titled as Childhood Disorders in DSM-IV)

–             AUTISM SPECTRUM DISORDERS

–             MAJOR CHANGE – All of the following disorders are now included in the title of Autism Spectrum Disorders:

–             Asperger’s Disorder

–             Child Disintegrative Disorder

–             Rett’s Disorder

–             Pervasive Developmental Disorders NOS (Not Otherwise Specified)

–             Autism Spectrum Disorders: Reasoning For the Changes

–             DSM Task force looked at the research and used statistical factor analysis and found that there were no symptoms that truly distinguished categorical differences between the disorders.

–             There were no symptoms that truly differed that would give reason to maintain an entirely separate diagnostic category

–             There has not been any genetic evidence for differences between the disorders

–             Autism Spectrum Disorder

–             Deficits in social communication and social interactions (individuals really lack the give and take of conversation, don’t understand nonverbal cues, don’t read people, trouble maintaining social relationships, don’t bond

–             Repetitive behaviors and restricted interests: self-stimulating behaviors, self-injurious behaviors, demand the same environment, same schedule, same activities. These individuals tend to over- or under- react to change or excessive stimuli.

–             AUTISM SPECTRUM DISORDER

–             Marked impairment in social interaction

–             Eye-to-eye gaze, facial expression, gestures

–             Developmentally appropriate peer relationships

–             Lack of spontaneous sharing of interests

–             Lack of social or emotional reciprocity

–             Qualitative impairment in communication

–             Delay or lack of language (or lack initiating speech)

–             Repetitive use of language

–             Lack of varied make-believe play

AUTISM SPECTRUM DISORDER

                Restricted repetitive stereotyped behaviors

                Preoccupation with one or more restricted patterns of interest

                Repetitive motor mannerisms

                Preoccupation with parts of objects

                Inflexible adherence to specific routines / rituals

                AUTISM SPECTRUM

                First sign is lack of responsiveness

                Avoidance of eye contact

                Problems with attention, planning, problem solving

                Problems with “Theory of Mind”

                Theory of Mind (has it) 1:01

                Theory of Mind (doesn't have it) 1:07

                Good Theory of Mind (Alison Gropnik) 3:54

                More mild on the spectrum:

                Similar but without serious language and communication problems

                Videos for Autism Spectrum

                ABA 5:51

                Lovaas 3:57

                Lovaas Technique 9:57

                Teaching Language Lovaas 1:44

                Spinning hand flapping1:14

                Hand flapping 2:15

                Signs and symptoms 5:57Aspergers Autism Interview 4:57

                Autism Spectrum Disorders

                Specifiers:

                With or without intellectual impairment

                With or without language impairment

                If there’s an existing medical condition related

                Severity:

                Based upon social communication / interaction & repetitive / restricted AND how much support is needed, given the symptoms

                ADD / ADHD

                Impairment and symptoms need to show before age 12 (used to be age 7) – this is the most significant change

                Need clear evidence that the symptoms occur in multiple settings and have an impact

                If over 17, need 5 symptoms rather than 6

                Attention Deficit (Hyperactivity) Disorder (ADD or ADHD)

                INATTENTION maladaptive and inconsistent with developmental level

                Difficulty organizing…easily distracted…forgetful

                Hyperactivity

                “On the go” “Driven like by a motor”

                Impulsivity

                Interrupts or intrudes on others

                Impairment in 2+ settings

INTELLECTUAL DISABILITIES

                This is a new name for Developmental Disability (formerly titled Mental Retardation)

                Multiple measures will be used to assess Intellectual Disabilities

                Onset in Developmental Period

                Deficits in intellectual functioning

                Deficits in adaptive skills tied to social, personal, and adaptive functioning

                Intellectual Disorders

                Intellectual Disability:

                score of approximately 70 or below on intelligence tests (sub-average intellectual functioning) – though no longer specific requirement for Diagnosis as of DSM-5 AND

                Concurrent deficits or impairments in present adaptive functioning in at least 2 of the following areas:

                Self-care

                Communication

                Social / Interpersonal skills

                Need for community resources

                Self-direction

                Functional academic skills

                Work, leisure

                Health & Safety

                Intellectual Disability

                Some Causal Factors:

                Genetic (chromosomal)

                Inherited conditions

                Pregnancy Complications

                Caused by alcohol,

                drug poisoning, illness

                Birth Trauma (lack of oxygen or stressful delivery)

                Childhood diseases or accidents

                Social Factors (poor nutrition, abuse / neglect)

                Fetal Alcohol Syndrome: may cause learning disabilities, physical defects (usually related to what level of development fetus was at during the time of the substance abuse)

Down’s Syndrome

                Causes: Trisomy 21

                Features: Physically different

                Small heads and ears, heads--flat backs

                Eyes have fold of skin, mouth is small

                Broad hands with short fingers

                Reduced muscle tone (“floppiness”)

                Significant health problems; high incidence of heart problems (40-50% born with Congenital heart disease)

                Mental retardation becomes apparent in the first year or two of life

                For some, dementia occurs relatively early in life, many get early-onset Alzheimer’s (Neurocognitive Ds.)

                1 in 1,500 – 2,000 when mother is below 25

                1 in 400 when mother is over 35

                1 in 40 when mother is over 45

                Mother with DS Child has 1 in 25 risk of having another child with DS

                Down’s Syndrome

Treatment:

                Support Groups--parents and families

                Finding environment matching skills

                Physiotherapy, occupational therapy, speech therapy, play therapy, self-help, daily living skills, academic skills, special education & mainstreaming

                Behavior Modification, positive reinforcement

                Some corrective measures:

                surgery to remove the skin folds from the inner corners of the eyes

                Some have reduction of tongue size to help with clarity of speech

                Nasal surgery to augment and increase the projection of nose                SPECIFIC LEARNING DISORDERS

                Tends to affect boys more than girls

                Causes: Brain Damage, early deprivation, genetics, neglect

                Learning Disabilities & Math, reading, written expression

                Performance substantially below expectancy for age, schooling, and intelligence

                May include difficulties in:

                Reading

                Writing

                Math

                Language

                Coordination (motor delays, clumsiness)

                Treatment: Educational goals to overcome disabilities or to integrate them and work with them.

                TOURETTES & TIC DISORDERS

                Utterances

                Eg, swearing, barking

                Motor tics

                Sudden, rapid, recurrent, nonrhythmic, stereotyped

                Multiple motor and one or more vocal tics

                Tics occur many times a day (usually in bouts)

                Generally chronic

Intellectual Disorders & Brief Look at Learning Differences

Intellectual Disorders

Intellectual Disability:

score of approximately 70 or below on intelligence tests (sub-average intellectual functioning) – though no longer specific requirement for Diagnosis as of DSM-5 AND

Concurrent deficits or impairments in present adaptive functioning in at least 2 of the following areas:

                Self-care

                Communication

                Social / Interpersonal skills

                Need for community resources

                Self-direction

                Functional academic skills

                Work, leisure

                Health & Safety

Intellectual Disability Cont’d

AAMR equates degrees of DD based upon level of support a person requires.

Mild: 50/55 – 70 (85% DD population)

Needs intermittent support

Expected to be able for independent living and unskilled work

Moderate: 35/40 – 50/55 (10%)

Needs limited support

 Expected to be able for group home and some sheltered work

Severe: 20/25 – 35/40 (3-4%)

Needs extensive support

Expected to be institutionalized, but some self-help

 Profound: 20 or 25 (1%)

Needs pervasive support; total institutional supervision

 Intellectual Disability

 Some Causal Factors:

Genetic (chromosomal)

Inherited conditions

 Pregnancy Complications

 Caused by alcohol,

drug poisoning, illness

Birth Trauma (lack of oxygen or stressful delivery)

 Childhood diseases or accidents

 Social Factors (poor nutrition, abuse / neglect)

 Fetal Alcohol Syndrome: may cause learning disabilities, physical defects (usually related to what level of development fetus was at during the time of the substance abuse)

 Down’s Syndrome

Causes: Trisomy 21

 Features: Physically different

Small heads and ears, heads--flat backs

Eyes have fold of skin, mouth is small

Broad hands with short fingers

Reduced muscle tone (“floppiness”)

Significant health problems; high incidence of heart problems (40-50% born with Congenital heart disease)

Mental retardation becomes apparent in the first year or two of life

For some, dementia occurs relatively early in life, many get early-onset Alzheimer’s (Neurocognitive Ds.)

                Down’s Syndrome Cont’d

                1 in 1,500 – 2,000 when mother is below 25

                1 in 400 when mother is over 35

                1 in 40 when mother is over 45

                Mother with DS Child has 1 in 25 risk of having another child with DS

                Down’s Syndrome

Treatment:

Support Groups--parents and families

Finding environment matching skills

Physiotherapy, occupational therapy, speech therapy, play therapy, self-help, daily living skills, academic skills, special education & mainstreaming

Behavior Modification, positive reinforcement

 Some corrective measures:

 surgery to remove the skin folds from the inner corners of the eyes

 Some have reduction of tongue size to help with clarity of speech

 Nasal surgery to augment and increase the projection of nose

Learning Disabilities

 Affect boys more than girls

 Causes: Brain Damage, early deprivation, genetics, neglect

 Learning Disabilities: learning, motor skills, and communication disorders

 Performance substantially below expectancy for age, schooling, and intelligence

 May include difficulties in:

                Reading

                Writing

                Math

                Language

                Coordination (motor delays, clumsiness)

Treatment: Educational goals to overcome disabilities or to integrate them and work with them.