COUN. 5150 - Dr. Bachmann
1. The multi-axial classification system in diagnosing psychopathology in the DSM-
IV involves an assessment on several axes. Each axis represents a different domain of
information about an individual that may assist the clinician plan individual treatment
and predict outcome. Axis I – Clinical Disorders/Other Conditions That May Be a
Focus of Clinical Attention; Axis II – Personality Disorders/Mental Retardation; Axis III –
General Medical Conditions; Axis IV – Psychosocial and Environmental Problems; Axis
V – Global Assessment of Functioning.
An advantage of labeling individuals with a mental disorder is that
communication among professionals responsible for their treatment is made
easier. Another advantage in labeling would be providing the individual
suffering from a mental disorder the appropriate treatment.
A disadvantage of labeling would be that once a person has been “diagnosed”
with a label, that diagnostic label can be hard to shake, even if the person’s
disorder is in full remission. Another disadvantage would be that, socially, people
may make the assumption of referring to the person by their diagnosis (a
schizophrenic or a manic-depressive) rather than “a person with…” or “a person that
suffers from…” said mental illness.
2. My understanding of abnormal behavior is that there is no universal agreement
about what is meant by abnormality. Also, I realize that there is a negative
connotation or negative judgment associated with what we consider abnormal.
We assess what is abnormal by evaluating certain elements of behavior. These
elements are 1) suffering, 2) maladaptiveness, 3) deviancy, 4) violation of the
standards of society, 5) social discomfort, and 6) irrationality and unpredictability.
The causal and contributing factors in the development of psychopathology:
Primary Causes – condition must be present for the disorder to occur;
Predisposing Causes – condition comes before, paves the way to the disorder (eg,
child abuse); Precipitating Causes – triggers disorder; Reinforcing Causes –
maintains maladaptive behavior.
Diathesis-Stress Model. Diathesis is a predisposition or vulnerability toward
developing a disorder. It can derive from biological, psychosocial, and/or
sociocultural causal factors. Stress is the response of an individual to the
demands that he or she perceives as taxing or exceeding his or her personal
resources. Many mental disorders are believed to develop as the result of some
kind of stressor operating on a person who has a diathesis for that disorder. An
example would be a child that experiences the death of a parent and may thereby
acquire a diathesis for becoming depressed later in life.
3. Some of the important clinical observations that a counselor needs to make during
an initial assessment are: appearance, behavior, attitude; characteristic of talk;
emotional state/affective reactions; content of thought; orientation and awareness;
memory; and general intellectual evaluation.
Once the mental status evaluation is completed, a summary of all observations
must be made. And from that summary and in addition to the medical history and
physical examination, a diagnosis can be made and the best course of treatment
can be determined to fit the diagnosis.
For example, after a mental status evaluation has been completed on a child that
exhibits a flat affect, poor hygiene, refuses to answer the interviewer’s questions,
and (per parental reports) child recently withdrawing from friends and family and
a decrease in the child’s appetite, a possible diagnosis could be depressive
disorder. Therefore, a possible course of treatment could be cognitive-behavioral
9. Some of the most common symptoms during a panic attack are: rapid heartbeat,
pounding heart or palpitations; sweating; trembling or shaking; shortness of breath
or smothering; feeling of choking; chest pain; nausea or abdominal distress; feeling dizzy,
lightheaded, or faint; derealization or depersonalization; fear or losing control; fear of
dying; paresthesias; and chills or hot flashes.
Individuals suffering from a panic attack initially seek treatment in an emergency
room or physician’s clinic, thinking that they are experiencing a heart attack.
The DSM-IV criteria for Panic Disorder are A) recurrent unexpected Panic Attacks
and at least one of the attacks has been followed by 1 month (or more) of one (or more)
of the following: persistent concern about having additional attacks; worry about the
implications of the attack or its consequences (e.g., losing control, having a heart attack,
“going crazy”); a significant change in behavior related to the attacks; B) Absence of
Agoraphobia; C) The panic attacks are not due to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication) or a general medical condition; and D)
The panic attacks are not better accounted for by another mental disorder, such as
Social Phobia (e.g., occurring on exposure to fearedsocial situations)., Specific Phobia
(e.g., on exposure to a specific phobic situation), Obsessive-Compulsive Disorder
(e.g., on exposure to dirt in someone with an obsession about contamination), PTSD
(e.g., in response to stimuli associated with a severe stressor), or Separation Anxiety
Disorder (e.g., in response to being away from home or close relatives.)
Agoraphobia stems from anxiety about having a panic attack in situations where
escape might prove difficult or embarrassing, which include both open and
In the treatment of Panic Disorder, the best forms are medication (SSRIs,
tricyclics, and benzodiazepines) and behavioral and cogni ive-behavioral
treatments. Depending on each individual who suffers from Panic Disorder, a
combination of these treatments may be appropriate.
10. The similarities in Bulimia Nervosa and Anorexia Nervosa are: fears of weight
gain, becoming “fat”; both have a distorted image of their body weight and shape;
and each is accompanied by a physical consequences relative to each disorder that
inevitably could lead to death.
The differences in Bulimia Nervosa and Anorexia Nervosa are: a person
suffering from A.N. severely restricts their intake of calories whereas a person
with B.N. eats an enormous amount of food in a short period of time; a person
with A.N. refuses to maintain at or above minimally normal weight, whereas a
person with B.N. generally maintains normal body weight; and a person with
A.N. typically does not engage in purgin to the extent that someone with B.N.
Some of the contributing factors associated with the development of an eating
disorder are: biological and genetic (ex. genes increasing the risk for anorexia or
chemical balance/imbalance that effect brain chemistry); family (ex.
Physical/sexual abuse or emphasis on their weight); culture (ex. Influence of the
media on being thin or ideas that thinness will bring a person success, power, and
approval); and triggers (ex. A period of adjustment, a traumatic event, or large life
My understanding of how the American culture impacts our views on weight is
that there is an idealization of thinness and appearance in women, especially with
our female role models mostly consisting of actresses, models, and athletes (who
more often than not are thin and rich). So, it makes sense why we attribute
success, power, and strength with body image. What does not make sense is that
even though we know what the consequences ofthese disorders are, these
disorders still run rampant.
14. The essential features of Borderline Personality Disorder are a pervasive pattern
of instability of interpersonal relationships, self-image, and affects and marked by
impulsivity beginning by early adulthood and present in a variety of contexts, as
indicated by five or more of the following:
1) frantic efforts to avoid real or imagined abandonment
2) a pattern of unstable and intense relationships characterized by alternating
between extremes of idealization and devaluation
3) identity disturbance; unstable self image or sense of self
4) impulsivity in at least two areas that are potentially self-damaging
5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behaviors
6) emotional instability due to a marked reactivity of mood
7) chronic feelings of emptiness
8) inappropriate, intense anger or difficulty controlling anger
9) short-term, stress-related paranoid ideat on or severe dissociative symptoms
Four personality disorders that co-occur with BPD are: histrionic, dependent,
antisocial, and schizotypal.
People suffering from Borderline Personality Disorder can be challenging for
therapist to treat because: 1) the tend to vio boundaries; 2) they have a hard
time forming a working and trusting relationship with their therapist; 3) they are
impulsive; 4) they are resistant to participating in treatment; 5) they often do not
see anything about themselves that needs changing or improvement;and 6) they
are likely to terminate treatment prematurely.
15. The primary characteristics of Autism are a wide range of problematic behaviors
such as: deficits in language, perceptual, and motor development; defective reality
testing; and an inability to function in social situations.
In Autism, the domains that are affected are: social, 1) not showing any need for
affection or contact with anyone and 2) a deficit in the ability to attend to social
cues from others; language, 1) an absence or severely limited use of speech and
2) echolalia, the parrot-like repetition of a few words; cognition, 1) deficits in
social reasoning but can manipulate objects and 2) difficulty with symbolic tasks
such as pantomime, in which they are asked to recall motor actions to imitate
tasks with imagined objects, in spi e of the fact that they might perform the task
well with real objects; and behavior, 1) repetitive movements (head banging,
spinning, and rocking) and 2) an autistic child may at one moment be severely
agitated or panicked by a very soft sound and at another time be totally oblivious
to loud music.
The primary treatment consideration for autism is that the parents and therapist
are the primary agents of improvement and change. In addition, having the
treatment done primarily in the home (rather than an institution) may also show
16. The primary characteristics of Asperger’s Syndrome are:
A) qualitative impairment in social interactions, as manifested by at least two of
the following: 1) marked impairment in the use of multiple nonverbal behaviors
such as eye to eye gaze, facial expression, body postures, and gestures to regulate
social interactions. 2) failure to develop peer relationships appropriate to
developmental level. 3) a lack of spontaneous seeking to share enjoyment,
interests, or achievements with other people (e.g., buy a lack of showing,
bringing, or pointing out objects of interest to other people). 4) lack of social or
emotional reciprocity. B) restricted repetitive and stereotyped patterns of
behaviors, interests, and activities, as manifested by at least one of the following:
1) encompassing preoccupation with one or more stereotype and restricted
patterns of interest that is abnormal either in intensity or focus, 2) apparently
inflexible adherence to specific, nonfunctional routines or rituals, 3) stereotyped
and repetitive and motor mannerisms (e.g., hand or finger flapping or twisting, or
complex whole body movement) 4) persistent preoccupation with parts of objects.
C) the disturbance causes clinically significant impairment in social, occupatio nal,
or other important areas of functioning. D) There is no clinically significant general
delay in language (e.g., single words used by age 2 years, communicative phrases used
by 3 years). E) There is no clinically significant delay in cognitive development or in the
development of age-appropriate self-help skills, adaptive behavior (other than social
interaction), and curiosity about the environment in the childhood. F) Criteria are not
met for another specific pervasive developmental disorder or schizophrenia.
This disorder is difficult to identify and diagnose for reasons such as: 1) they
have a high degree of functionality and are often viewed as eccentric or odd,
however, they do not appear to warrant a DSM-IV diagnosis; and 2) it is not
uncommon for a child diagnosed with disorders such as: Pervasive Developmental
Disorder (NOS); High Functioning Autism, ADD, ADHD, and Nonverbal Learning
Disability to be rediagnosed with AS. This is because, until recently Asperger’s
Syndrome was virtually unknown until a few years ago and many people were
misdiagnosed or remained undiagnosed.
Some of the comormid disorders associated with Asperger’s Syndrome are Tic
Disorders, Tourette’s Syndrome, attention problems and mood problems (e.g.,
depression and anxiety).
Although there is no cure for Asperger’s Syndrome, treatment needs to consist of
focused and structured counseling. This can help address the issues of
overwhelming experiences ofsadness or negativity, anxiety, family functioning,
frustration in regard to vocational goals and placement, and ongoing social
17. The diagnostic criteria for ADHD are: six or more symptoms of inattention or
hyperactivity-impulsivity that have persisted for at least six months to a degree
that is maladaptive and inconsistent with developmental level; some hyperactive-
impulsive symptoms that caused impairment were present before age seven; some
impairment from the symptoms is present in two or more settings; clear evidence
of clinically significant impairment in social, academic, or occupational
functioning; and symptoms do not occur exclusively during the course of a
pervasive developmental di order, schizophrenia, or other psychotic disorder and
are not better accounted for by another mental disorder, such as mood disorder,
anxiety disorder, dissociative disorder, or personality disorder.
The difficulty in diagnosing ADHD-Predominately Inattentve Type is, because
the children do not tend to be disruptive, it is often missed/overlooked.
My understanding of the problem/contro versy of the wide use of medication for
the treatment of children with behavioral disorders is that 1) I think children
might be placed on meds to deal specifically with symptoms or behaviors, when
the behaviors may actually be due to some trauma (ex. Anxiety Disorder) that
occurred in the past that is overlooked as the cause of the undesired behaviors; 2)
young children may be diagnosed with ADHD when in fact, it could be age-
appropriate behaviors being exhibited and meds appear to be an easy fix; 3)
medication appears to either not work on a great deal of children diagnosed with
ADHD, or parents do not want the children to be on medication despite
recommendations from medical professionals; and/or 4) the parents may not want
others to question their parenting skills (when in fact, the child’s behavior can
improve simply by an improvement in parenting sk ills).
19. The types of sexual dysfunctions are: hypoactive sexual desire disorder, little or
no sexual drive or interest; sexual aversion disorder, total lack of interest in sex
and avoidance of sexual contact; male erectile disorder, inability to achieve or
maintain an erection; female sexual arousal disorder, nonresponsiveness to erotic
stimulation both physically and emotionally; premature ejaculation,
unsatisfactorily brief period between the begin ning of sexual stimulation and the
occurrence of ejaculation; male orgasmic disorder, inability to ejaculate during
intercourse; female orgasmic disorder, difficulty in achieving orgasm, either
manually or during sexual intercourse; vaginismus, involuntary muscle spasm at
the entrance to the vagina that prevents penetration and sexual intercourse; and
dyspareunia, painful coitus (may have either an organic or psychological basis).
The primary treatment considerations for sexual dysfunctions are to provide
education, enhance stimulation and eliminate routines, provide distraction
techniques, and encourage non-coital behaviors.
Gender identity disorder is characterized by two components: 1) a strong and
persistent cross-gender identification (the desire to be, or the insistence that one
is, of the opposite sex) and 2) gender dysphoria (persistent discomfort about one’s
biological sex or the sense that the gender role of that sex is inappropriate). The
disorder may occur in children or adults and in males or females.
Homosexuality is not considered a psychopathological condition because the vast
majority of evidence shows that homosexuality is compatible with psychological