Wednesday, January 25, 2012

Personality Disorders

-Begin early in life and effects functioning but doesn't prevent it.

-Always ends in "personality disorders"
-All go on axis 2
- no date of onset. lifelong patterns of behavior.

Cluster A: paranoid, schizoid, and schizotypal Disorders (also referred to as "odd or eccentric behavior disorders"). Thinks the world is out to get them. Socially Isolated and Withdrawn.

Cluster B: impulsivity and/or affective dysregulation disorders (also referred to as "dramatic, emotional, or erratic disorders").Cluster B includes: antisocial, borderline, histrionic, and narcissistic personality disorders.

Cluster C: anxiety and compulsive disorders (also referred to as "anxious or fearful disorders").
Finally Cluster C includes: obsessive/compulsive, avoidant, and dependent personality disorders.

The additional category for indeterminate behaviors that appear to characteristic of a personality disorder is called: "personality disorder, NOS" (not otherwise specified). Clusters tend to run in families.


The Duty to Protect as derived from the Tarasoff case has been rigorously debated in terms of other mechanisms of harm. A situation where a client is human immunodeficiency virus (HIV) positive and is known to be having unprotected sex with a victim who is not aware of the client's HIV positive status is one. Given the deadly nature of the sexually and blood-to-blood transmitted HIV, it has been determined that a social worker or other clinician may be warranted in breaching confidentiality if education about the dangers and efforts at counseling have failed to alter the HIV positive client's behavior. However, the following 5 specific criteria must be met: 1) The client must be known to be HIV positive. 2) The client must be engaging in unprotected sex or sharing drug injection paraphernalia. 3) The behavior must actually be unsafe. 4) The client must indicate an intent to continue the behavior even after counseling regarding potential harm. 5) HIV transmission must be likely to occur.

Monday, January 23, 2012

Piaget Cognitive Development

Sensorimotor: 0-2 - learning is through feeling and movement. -Obtain Object Permanence.

Preoperational: 2-7- Achieve Irreversibility ie. death is final. Children learn symbols and can use them to communicate.

       2 sub stages: Preconceptual- 2-4 yrs
      Intuitive: 4-7
-children are still egocentric until 6.

Concrete Operational: 7-11 yrs old. understand symbols.
-Achieve Conservation.

Formal Operational: abstract thinking -only half of adults achieve this. Can solve problems in head no just on finger or paper. Develop inner value system and moral judgement.

Kohlberg's Stages of Moral Development

6 stages

Pre-conventional: (4-10)
Stage 1: Punishment and Obedience- can't reason with the kids. has to punish to get them to understand.
Stage 2: Instrumental-Relative- bribery. motivation is rewards to get to them to do what they need to do. Adults- "Whats in it for me?"

Conventional Morality (10-13)
Stage 3: Peer Pressure, acceptance of social group, wants to avoid disapproval. It's wrong when others disapprove. Golden Rule
Stage 4: Law and order orientation, judgement is made according to if it is legal. Understand their own impact

Post-Conventional Morality (adolescent and up)
Stage 5: Social Contract Orientation, ie. law makers, have beliefs but willing to negotiate them.
Stage 6: Universal Ethical Stage. My beliefs are more important than the law. Greater law for all humans. ie. MLK, he believed human rights were more important than the law.

Erikson- Psychosocial Development

Great video of the stages makes them interesting.

0-12/18 mo Oral/Sensory, Trust vs. Mistrust- clearly attached to caregiver Outcome:trust/optimism

12/18 mo-3 yrs Autonomy vs. Shame and Doubt- exploring the world, Outcome: self-esteem, self control

3-6 yrs Initiative vs. Guilt- doing things on your own successfully, Outcome: sense of purpose

6-12 Industry vs. inferiority- comparing self to the world, Outcome: productivity/competence

12-18 identity vs. role confusion- who am I? Outcome: Ability to view self as an individual

19-35(40) Early Adulthood. Intimacy vs. Isolation -establishing significant relationships, Outcome: love

40-65 Generality vs. Stagnation -career and family focus successfully, Outcome: concerns for the future

65-80 Integrity vs. Despair- did I accomplish what I was supposed to in life?, Outcome: Wisdom

Psychosexual Development- Freud

5 stages:

Oral- 0-12/18 mo, everything has to do with the mouth. primary conflict weaning. arrested development here results in passivity or dependence. ex. excessive eating, smoking, nail biting

Anal: 1-3 yrs, primary conflict- toliet training, those whose development have stopped here often exhibit obsessions with neatness (anal-retentive), selfishness, rigidity, stinginess or are excessively reckless and disorganized (anal-expulsive).

Phallic: -3-6 yrs. electra/oedopis complex develops. Wants to have sex with parent of opposite sex & hate for same sex parent, extreme fear of being found out. successful development is ability to ID with same sex parent & development of the superego.

Latency: 6-12 yrs. development is focused on social skills not sexual ones.

Genital: 12 yrs or beginning of puberty. mature (adult) sexual love begins

*Goal of therapy bring the unconscious to the conscious so that it can be overcame to move on. Techniques "primary process thinking" used are slips of tongue, dream analysis, free association, projective techniques

ID- unconscious, primal, and reflexive
Ego- attempt to control ID impulses as to what is socially acceptable.
Superego- guilt, conscious, moral development.

Substance Abuse

Know dependence and abuse.

Both are using substances even though it causes you harm.

Substance Abuse is LESS severe than dependence.

Withdrawal goes with Dependence.

Most problematic withdrawal are alcohol and heroin.

Common signs of withdrawal are  nausea, restlessness, insomnia, depression, sweating, shaking, and anxiety

11 Classes of substance-related disorders:

1. Polysubstance Dependence- Is not exclusively one specific type of use. Is 3 or more types taken together.

2. Alcohol- can lead to DTs or delirium tremors  -can be fatal if not monitored closely -Other common symptoms include intense perceptual disturbance such as visions of insects, snakes, or rats.

3. Opiods (morphine, heroin, condone, Oxycodone, hydrocodone) -most addicts have comorbid SMI -produces euphoria when using -withdrawal symptoms are

DTs- Delirium Tremens usually includes extremely intense feelings of "impending doom". Can occur in alcohol & sedative hypnotics such as benzos and barbituates.

The main symptoms of Delirium Tremens are confusion, diarrhea, insomnia, nightmares, disorientation and agitation and other signs of severe autonomic instability (fever, tachycardia, hypertension.

-can be fatal if not monitored closely -Other common symptoms include intense perceptual disturbance such as visions of insects, snakes, or rats.

Physical warning signs of drug abuse

  • Bloodshot eyes, pupils larger or smaller than usual.
  • Changes in appetite or sleep patterns. Sudden weight loss or weight gain.
  • Deterioration of physical appearance, personal grooming habits.
  • Unusual smells on breath, body, or clothing.
  • Tremors, slurred speech, or impaired coordination.

Behavioral signs of drug abuse

  • Drop in attendance and performance at work or school.
  • Unexplained need for money or financial problems. May borrow or steal to get it.
  • Engaging in secretive or suspicious behaviors.
  • Sudden change in friends, favorite hangouts, and hobbies.
  • Frequently getting into trouble (fights, accidents, illegal activities).

Psychological warning signs of drug abuse

  • Unexplained change in personality or attitude.
  • Sudden mood swings, irritability, or angry outbursts.
  • Periods of unusual hyperactivity, agitation, or giddiness.
  • Lack of motivation; appears lethargic or “spaced out.”
  • Appears fearful, anxious, or paranoid, with no reason.

Warning Signs of Commonly Abused Drugs

  • Marijuana: Glassy, red eyes; loud talking, inappropriate laughter followed by sleepiness; loss of interest, motivation; weight gain or loss.
  • Depressants (including Xanax, Valium, GHB): Contracted pupils; drunk-like; difficulty concentrating; clumsiness; poor judgment; slurred speech; sleepiness.
  • Stimulants (including amphetamines, cocaine, crystal meth): Dilated pupils; hyperactivity; euphoria; irritability; anxiety; excessive talking followed by depression or excessive sleeping at odd times; may go long periods of time without eating or sleeping; weight loss; dry mouth and nose.
  • Inhalants (glues, aerosols, vapors):  Watery eyes; impaired vision, memory and thought; secretions from the nose or rashes around the nose and mouth; headaches and nausea; appearance of intoxication; drowsiness; poor muscle control; changes in appetite; anxiety; irritability; lots of cans/aerosols in the trash.
  • Hallucinogens (LSD, PCP): Dilated pupils; bizarre and irrational behavior including paranoia, aggression, hallucinations; mood swings; detachment from people; absorption with self or other objects, slurred speech; confusion.
  • Heroin: Contracted pupils; no response of pupils to light; needle marks; sleeping at unusual times; sweating; vomiting; coughing, sniffling; twitching; loss of appetite.
For more symptoms and effects of commonly abused drugs, see the Helpguide PDF Factsheet.

Warning signs of teen drug abuse

While experimenting with drugs doesn’t automatically lead to drug abuse, early use is a risk factor for developing more serious drug abuse and addiction. Risk of drug abuse also increases greatly during times of transition, such as changing schools, moving, or divorce. The challenge for parents is to distinguish between the normal, often volatile, ups and downs of the teen years and the red flags of substance abuse. These include:
  • Having bloodshot eyes or dilated pupils; using eye drops to try to mask these signs.
  • Skipping class; declining grades; suddenly getting into trouble at school.
  • Missing money, valuables, or prescriptions.
  • Acting uncharacteristically isolated, withdrawn, angry, or depressed.
  • Dropping one group of friends for another; being secretive about the new peer group.
  • Loss of interest in old hobbies; lying about new interests and activities.
  • Demanding more privacy; locking doors; avoiding eye contact; sneaking around.

Saturday, January 21, 2012

Adult Disorders in the DSM



different types. can have more than one type at a time.

look at social, family functioning and independent living skills

Childhood Disorders in DSM

Biggest difference between the two is the behaviors in the PD's they are not normal at any age.

The LD's are normal & usually 2 yrs behind

Autism-onset infancy or childhood
-self stimulating, self injuring behaviors,
 -2/3s are MR Usually moderately MR
-more common in boys. ALL mental health px are more common in boys.

-don't have language delay

-only in females, deceleration of head growth, start out normal but btw 5-24 mo. starts to have px

Childhood disintegrate disorders

Learning Disorders
-speaking, reading, writing, math, listening
Usually diagnosed btw 8-13 yrs old
-Don't overcome it but compensate it.

ADHD- usually diagnosed before 7

Conduct Disorder -scary kids -aggression to people & animals -destroy parties -teach behaviors/consequences

ODD -annoying kids -don't harm others but question everything

Tourettes- motor and vocal tics. motor is the movement with the vocal

Separation Anxiety Disorder- child can't separate from the parent.

Things you NEED to know

Things you NEED to know

IQ as reguards to MR including numbers.

Research- relability & Validity

Relability -/+ 5 points
 -repeat, replicate, elminates random error
-get the same thing over and over again within a measure

- starts with v and has to do with value of what you're doing.
does it measure what you want?


Normal IQ 90-110 - 68% of people

average IQ is 115-85

130 or higher you are gifted. NOT IN THE DSM. If you get this high the numbers don't mean anything anymore

IQ remains stable throughout a persons life.

70-80 borderline intellectual functioning. 

70 or below is Mental retardation.

 4 types of MR:

Mild 55-70
-educatable- they can learn -can get to a 6th grade level

Moderate 35-55
-trainable- can teach to do things but can't think beyond what they are taught. ie when it's snowing person doesn't wear a coat.

Severe 20-35
Profound below 20

-The higher the level the more common it is

Research- Bell Shaped Curves

kurtosis- not normal distribution

measures of central tendency: mean, median, mode

mean- average

median- middle score

mode- most frequently occuring score

- mean, median, mode all are same place on a bell shaped curve

variants- units on the bell shaped curve
68% of scores within one SD (standard deviations) on the curve
97% of scores are within 2 SD on the curve
99% of scores within 3 SD

variants- big picture

statistical regression- on a reliable curve we regress to the mean. 

standard deviations- one piece

Pie example- variants is the pie, SD is a slice

What to do first in case scenarios

The following Information will make the difference between passing and failing your exam:

When faced with the dreaded "What do you do NEXT/FIRST" questions - Know these seven tasks
in order. Always look for these within the answers and given two options, choose the one that
is closest to the top of the list:

Feelings - acknowledge clients

... and this is how you will remember them in order from Choosing First to Choosing last:

Feelings Assess Refer Educate Advocate Facilitate Intervene

Farmer Aladdin Raises Expensive Apples From India


-from social work

5 Axis Diagnosis

All 5 axis to make a diagnosis

Axis 1:
-most and least severe
-usually has a date of onset.
- clinically significant effect i.e. effects functioning

Most severe:
schizophrenia, bipolar, depression, anxiety

Least severe:
malingering, adolescent antisocial act, V codes

Axis II:
-if you remeber what goes on axis 2. everything else goes on axis 1

MR, personality disorders, and defense mechanisms

-borderline intellectal functioning

Axis III:
- medical conditions related to mental conditions including hearing and vision problems

Axis IV:
-environmental stressors

Axis X:
GAF- global assessment funtioning
-the higher the number the higher the level of functioning
-highest level of functioning over the last
50 or lower is inpatient admission.

Defense Mechanisms

Goes on Axis II

repression- most basic, can be with other ones, keeping memories in the unconcious in the id

reaction formation-avoiding anxiety instincts by expressing opposite...ex. sexually abused male is acting VERY macho or closeted homosexuals are homophobic ie. glee - with repression a lot of times

regression- going back to an earlier stage,

rationalization- making an unacceptable situation acceptable
when life gives you lemons make lemonade...they are still lemons

projection- putting your own issues onto someone else falsely

displacement- dealing with negative feelings on a less threatening person or thing...kicking the dog or in divorce therapy kid acts out on the custodial parent because bond is secure

sublimation- making unacceptable situation socially acceptable in some way...trickatilamaniac who is a hair dresser OR kid with anger problem playing football to let it out during the game -high adaptive live of defense mechanism

Object Relations- Mahler

Infant must contact with mom essential

Ego Psychology


From Wikipedia:

Reality Testing: The ego’s capacity to distinguish what is occurring in one’s own mind from what is occurring in the external world. It is perhaps the single most important ego function because it is necessary for negotiating with the outside world. One must be able to perceive and understand stimuli accurately. Reality testing is often subject to temporary, mild distortion or deterioration under stressful conditions. Such impairment can result in temporary delusions and hallucination and is generally selective, clustering along specific, psychodynamic lines. Chronic deficiencies suggest either psychotic or organic interference.

Impulse Control: The ability to manage aggressive and/or libidinal wishes without immediate discharge through behavior or symptoms. Problems with impulse control are common; for example: road rage; sexual promiscuity; excessive drug and alcohol use; and binge eating.

Affect Regulation: The ability to modulate feelings without being overwhelmed.

Judgment: The capacity to act responsibly. This process includes identifying possible courses of action, anticipating and evaluating likely consequences, and making decisions as to what is appropriate in certain circumstances.

Object Relations: The capacity for mutually satisfying relationship. The individual can perceive himself and others as whole objects with three dimensional qualities.

Thought Processes: The ability to have logical, coherent, and abstract thoughts. In stressful situations, thought processes can become disorganized. The presence of chronic or severe problems in conceptual thinking is frequently associated with schizophrenia and manic episodes.

Defensive Functioning: A defense is an unconscious attempt to protect the individual from some powerful identity-threatening feeling. Initial defenses develop in infancy and involve the boundary between the self and the outer world; they are considered primitive defenses and include projection, denial, and splitting. As the child grows up, more sophisticated defenses that deal with internal boundaries such as those between ego and super ego or the id develop; these defenses include repression, regression, displacement, and reaction formation. All adults have, and use, primitive defenses, but most people also have more mature ways of coping with reality and anxiety.
Synthesis: The synthetic function is the ego’s capacity to organize and unify other functions within the personality. It enables the individual to think, feel, and act in a coherent manner. It includes the capacity to integrate potentially contradictory experiences, ideas, and feelings; for example, a child loves his or her mother yet also has angry feelings toward her at times. The ability to synthesize these feelings is a pivotal developmental achievement.


None of this is my original material. I'm cramming for the LCSW