Reviewer NCM116 • Excessive worry about health and

symptoms.
SOMATOFORM DISORDER
• Frequent doctor visits or medical tests with
I. Definition no definitive results.
Somatoform disorders are a group of psychological • Emotional distress (anxiety, depression)
conditions where a person experiences physical related to symptoms.
symptoms without a medical explanation. These
symptoms are real to the person but are caused by • Difficulty functioning in daily life due to
psychological factors rather than physical illness or health concerns.
injury.
IV. Causes and Risk Factors
II. Classification of Somatoform Disorders
1. Biological Factors
Somatoform disorders were originally classified
• Genetics (family history of anxiety or
under DSM-IV but have been revised in DSM-5 as
depression).
Somatic Symptom and Related Disorders. The
following are the types: • Abnormal brain activity in areas processing
emotions and pain.
1. Somatic Symptom Disorder (SSD)
2. Psychological Factors
• Characterized by excessive thoughts,
feelings, or behaviors related to physical • High levels of stress or trauma.
symptoms.
• Tendency to focus on bodily sensations.
• Symptoms may or may not have a medical
cause, but the person is overly distressed • Negative past experiences with illness.
about them. 3. Social & Environmental Factors
• Common complaints: pain, fatigue, • Overprotective or critical family
shortness of breath. environment.
2. Illness Anxiety Disorder (Hypochondriasis) • Reinforcement (e.g., attention received for
• Extreme worry about having or developing a being sick).
serious illness despite medical reassurance. • Cultural influences on illness perception.
• May frequently check their body for signs of V. Diagnosis
illness or avoid doctors due to fear of bad
news. • Clinical Interview: Detailed history of
symptoms and emotional factors.
3. Conversion Disorder (Functional
Neurological Symptom Disorder) • Medical Tests: To rule out actual medical
conditions.
• Neurological symptoms (e.g., paralysis,
blindness, seizures) without a medical • Psychological Assessments: To check for
explanation. anxiety, depression, or trauma-related
issues.
• Symptoms are not intentionally produced
and often occur after stress or trauma. • Criteria Based on DSM-5: Must
significantly interfere with daily life.
4. Factitious Disorder (Munchausen Syndrome)
VI. Treatment Approaches
• Faking or exaggerating symptoms for
emotional attention, not for material gain 1. Psychotherapy
(unlike malingering).
• Cognitive Behavioral Therapy (CBT):
• May even undergo unnecessary medical Helps change negative thought patterns
procedures. about health.
5. Body Dysmorphic Disorder (BDD) • Mindfulness-Based Therapy: Teaches
relaxation techniques to manage symptoms.
• Preoccupation with perceived flaws in
physical appearance, often leading to • Trauma-Focused Therapy: If past trauma
repetitive behaviors (e.g., excessive is a factor.
grooming).
2. Medications
• Causes severe distress and impairs daily
functioning. • Antidepressants (e.g., SSRIs) for underlying
anxiety or depression.
III. Symptoms of Somatoform Disorders
• Pain management strategies if pain is a
• Physical symptoms without a medical cause primary symptom.
(e.g., pain, fatigue, dizziness).
3. Lifestyle Modifications
 • Regular exercise and relaxation techniques • Derealization: Feeling like the external
(yoga, meditation). world is unreal or distorted.
• Healthy sleep and diet habits. • Reality testing remains intact (the person
knows the experiences are not real).
• Stress management strategies.
4. Other Specified Dissociative Disorder (OSDD)
4. Support Groups & Psychoeducation & Unspecified Dissociative Disorder (UDD)
• Educating the patient about the mind-body • Symptoms of dissociation that don’t fit
connection. exactly into the above categories.
• Support groups for individuals with chronic • May have dissociative symptoms but not
illness concerns. meet full criteria for DID or other disorders.
VII. Key Takeaways III. Symptoms of Dissociative Disorders
• Somatoform disorders involve real physical • Memory loss (amnesia) about personal
symptoms without a medical cause. identity, life events, or trauma.
• Psychological factors like stress, anxiety, • Feeling detached from one’s body
and trauma play a key role. (depersonalization).
• Treatment focuses on therapy, lifestyle • Feeling like the world is unreal
changes, and sometimes medication. (derealization).
• Early intervention can prevent long-term • Having different identities or personality
disability and improve quality of life. states (DID).
DISSOCIATIVE DISORDER • Difficulty functioning in daily life due to
I. Definition dissociation.

Dissociative disorders are a group of mental health IV. Causes and Risk Factors
conditions characterized by a disconnection 1. Psychological Factors
between a person's thoughts, memories, identity,
emotions, or sense of self. This dissociation is often • Severe trauma (especially childhood
a coping mechanism for stress, trauma, or abuse or neglect) is the most common
psychological distress. cause.

II. Classification of Dissociative Disorders • Extreme stress or repeated traumatic

(Based on DSM-5) experiences.

1. Dissociative Identity Disorder (DID) (Formerly • Defense mechanism to cope with

Multiple Personality Disorder) overwhelming emotions.

• Presence of two or more distinct identities 2. Biological Factors

or personality states.
• Changes in brain function (especially areas
• Each identity may have different behaviors, related to memory and emotion).
memories, and emotions.
• Genetics may play a minor role.
• May experience memory gaps (amnesia)
3. Environmental & Social Factors
when switching personalities.
• Exposure to abuse, war, or disaster.
• Often linked to severe childhood trauma or
abuse. • Lack of social support after a traumatic
experience.
2. Dissociative Amnesia
V. Diagnosis
• Sudden loss of memory for important
personal information, not due to brain injury • Clinical Interview: Assess personal history
or medical condition. and symptoms.
• Usually triggered by traumatic or stressful • Dissociative Experiences Scale (DES): A
events. psychological test for dissociative
symptoms.
• May be localized (forgetting a specific
event) or generalized (forgetting entire life • Medical Evaluation: Rule out neurological
history). or medical causes.
3. Depersonalization/Derealization Disorder • DSM-5 Criteria: Used to determine specific
dissociative disorder diagnosis.
• Depersonalization: Feeling detached from
one’s own body or thoughts (as if watching VI. Treatment Approaches
oneself from outside).
1. Psychotherapy (Main Treatment)
 • Cognitive Behavioral Therapy (CBT): o Intense fear of gaining weight or
Helps manage distressing thoughts and becoming fat.
behaviors.
o Restriction of food intake leading to
• Dialectical Behavior Therapy (DBT): significantly low body weight.
Effective for emotion regulation, especially
in trauma-related dissociation. o Distorted body image (seeing
oneself as overweight even when
• Eye Movement Desensitization and underweight).
Reprocessing (EMDR): Used for trauma
processing. • Subtypes:

• Hypnotherapy: Sometimes used to access o Restricting Type: Severe calorie

repressed memories. restriction without bingeing or
purging.
2. Medications
o Binge-Eating/Purging Type:
• No specific medication for dissociative Occasional binge eating followed by
disorders, but some are prescribed for purging (vomiting, laxatives,
related symptoms: excessive exercise).
o Antidepressants (SSRIs) – For • Health Consequences:
depression and anxiety.
o Malnutrition, brittle hair and nails,
o Mood stabilizers – For emotional heart complications, osteoporosis,
regulation. organ failure.
o Antipsychotics – Sometimes used 2. Bulimia Nervosa (BN)
for severe symptoms.
• Main Characteristics:
3. Lifestyle and Coping Strategies
o Repeated binge eating episodes
• Grounding techniques (e.g., holding an (consuming large amounts of food in
object, deep breathing). a short period).
• Mindfulness and meditation. o Followed by compensatory
behaviors like vomiting, laxatives,
• Support groups and trauma-informed fasting, or excessive exercise.
therapy.
o Self-esteem heavily influenced by
• Developing a safe environment and support body shape and weight.
system.
• Health Consequences:
VII. Key Takeaways
o Electrolyte imbalances, dehydration,
• Dissociative disorders involve disruptions in digestive problems, dental erosion
memory, identity, and perception. from acid reflux, heart issues.
• Most cases are linked to severe trauma or 3. Binge-eating disorder (BED)
stress.
• Main Characteristics:
• DID is the most severe form, involving
multiple personalities. o Frequent episodes of consuming
large amounts of food in a short
• Treatment primarily involves psychotherapy, time.
trauma processing, and coping strategies.
o No compensatory behaviors (unlike
• Early intervention can improve outcomes bulimia).
and quality of life.
o Feelings of guilt, distress, or lack of
EATING DISORDER control during episodes.
I. Definition • Health Consequences:
Eating disorders are serious mental health o Obesity, diabetes, heart disease,
conditions characterized by abnormal eating high blood pressure, depression.
behaviors, extreme concern about body weight or
shape, and unhealthy relationships with food. 4. Avoidant/Restrictive Food Intake Disorder
These disorders can lead to severe physical and (ARFID)
emotional consequences.
• Main Characteristics:
II. Classification of Eating Disorders (Based on
o Extreme picky eating or avoidance
DSM-5)
of food due to sensory issues, fear
1. Anorexia Nervosa (AN) of choking, or lack of interest.

• Main Characteristics: o Not related to body image concerns.

 o Can lead to nutritional deficiencies • Medical Evaluation: Checking for weight
and weight loss. changes, nutritional deficiencies, and health
complications.
5. Other Specified Feeding or eating disorders
(OSFED) • Psychological Assessments: Identifying
coexisting disorders like depression or
• Eating disorders that don’t meet full criteria anxiety.
for AN, BN, or BED but still cause significant
distress. VI. Treatment Approaches
III. Symptoms of Eating Disorders 1. Psychotherapy (Main Treatment)
Physical Symptoms: • Cognitive Behavioral Therapy (CBT):
Helps change negative thoughts about food,
• Extreme weight loss or fluctuations. weight, and self-worth.
• Fatigue, dizziness, fainting. • Family-Based Therapy (FBT): Involves
• Digestive issues, bloating, or constipation. family members in the treatment process,
especially for adolescents.
• Hair thinning or brittle nails.
• Dialectical Behavior Therapy (DBT):
• Dry skin or sensitivity to cold. Helps with emotional regulation and impulse
control.
Behavioral Symptoms:
2. Medical and Nutritional Support
• Obsession with calorie counting, dieting, or
food rituals. • Supervised meal plans by dietitians.
• Avoiding social situations involving food. • Hospitalization in severe cases
(malnutrition, heart issues).
• Secretive eating or hoarding food.
• Nutritional counseling for balanced eating
• Excessive exercise beyond healthy limits.
habits.
Emotional Symptoms:
3. Medications
• Intense fear of weight gain.
• Antidepressants (SSRIs) – Often used for
• Low self-esteem and body dissatisfaction. bulimia and binge-eating disorder.

• Anxiety and depression. • Mood stabilizers – Sometimes prescribed

for those with severe mood fluctuations.
• Guilt or shame after eating.
4. Lifestyle & Coping Strategies
IV. Causes and Risk Factors
• Practicing self-compassion and body
1. Biological Factors positivity.
• Genetics (family history of eating disorders • Avoiding diet culture and unhealthy weight-
or mental illness). loss pressures.
• Hormonal imbalances affecting appetite • Engaging in mindful eating and stress-
regulation. reducing activities.
2. Psychological Factors VII. Key Takeaways
• Perfectionism, low self-esteem, body • Eating disorders involve unhealthy
dysmorphia. relationships with food, weight, and body
• Anxiety, depression, or trauma. image.
• They can have severe physical and
• Need for control over one’s body and
environment. emotional consequences.
• Causes are complex and include genetic,
3. Social & Environmental Factors
psychological, and societal factors.
• Cultural pressure to be thin (media, beauty
• Early intervention and therapy are crucial for
standards).
recovery.
• Peer or family influence on dieting
• A supportive environment and professional
behaviors.
help improve long-term outcomes.
• History of bullying or body shaming.
POST-TRAUMATIC STRESS DISORDER (PTSD)
V. Diagnosis
I. Definition
• Clinical Interview: Assessment of eating
behaviors, thoughts about body image, and Post-Traumatic Stress Disorder (PTSD) is a mental
emotional state. health condition that develops after experiencing or
witnessing a traumatic event. It is characterized by • Negative beliefs about oneself, others, or
persistent fear, anxiety, and distressing symptoms the world.
that interfere with daily life.
• Feelings of guilt, shame, or blame.
• Loss of interest in activities once enjoyed.
II. Causes & Risk Factors
• Difficulty experiencing positive emotions.
1. Common Causes of PTSD:
4. Hyperarousal (Increased Reactivity)
• Combat exposure (common in military
personnel). • Constantly feeling "on edge" or easily
startled.
• Physical or sexual assault (rape, domestic
violence, abuse). • Irritability, anger outbursts, or aggressive
behavior.
• Natural disasters (earthquakes,
hurricanes, fires). • Difficulty sleeping (insomnia, nightmares).

• Serious accidents (car crashes, workplace • Trouble concentrating.

injuries). • Self-destructive behavior (reckless driving,
• Sudden loss of a loved one (especially in substance abuse).
violent circumstances). IV. PTSD Subtypes & Related Disorders
• Childhood trauma or neglect. 1. Complex PTSD (C-PTSD)
2. Risk Factors: • Develops from prolonged or repeated
• Previous trauma history. trauma (e.g., childhood abuse, long-term
domestic violence).
• Lack of social support.
• Symptoms include severe emotional
• Family history of mental health dysregulation, relationship difficulties,
disorders. and a distorted sense of self.
• High levels of stress or ongoing danger 2. Acute Stress Disorder (ASD)
(e.g., abusive relationships).
• Similar to PTSD but symptoms last less
• Brain chemistry (abnormal stress than one month after the trauma.
hormone regulation).
• May develop into PTSD if symptoms persist.
III. Symptoms of PTSD (According to DSM-5)
3. PTSD with Dissociative Symptoms
PTSD symptoms usually appear within 3 months
after a traumatic event but can also develop years • Includes depersonalization (feeling
later. Symptoms must last more than one month detached from oneself) or derealization
and significantly impair daily life. (feeling the world is unreal).

1. Intrusive Symptoms (Re-experiencing the V. Diagnosis of PTSD

Trauma) • Clinical Interview: Assess symptoms,
• Flashbacks (feeling like the event is trauma history, and impact on daily life.
happening again). • DSM-5 Criteria: Symptoms must last more
• Nightmares about the trauma. than one month and cause significant
distress.
• Distressing memories that keep resurfacing.
• Psychological Assessments: PTSD
• Intense emotional or physical reactions to screening tools (e.g., CAPS-5, PCL-5).
trauma reminders (e.g., heart racing,
sweating). VI. Treatment Approaches

2. Avoidance Symptoms 1. Psychotherapy (Main Treatment)

• Avoiding places, people, or activities related • Cognitive Behavioral Therapy (CBT):

to the trauma. Helps challenge negative thoughts and
change behavioral responses.
• Refusing to talk or think about the traumatic
event. • Prolonged Exposure Therapy (PE):
Gradual exposure to trauma memories to
• Emotional numbness or detachment from reduce fear responses.
others.
• Eye Movement Desensitization and
3. Negative Changes in Thoughts & Mood Reprocessing (EMDR): Uses guided eye
movements to process traumatic memories.
• Difficulty remembering key details of the
trauma.
 • Trauma-Focused Cognitive Behavioral • Slow down brain activity, causing relaxation
Therapy (TF-CBT): Specifically for children and drowsiness.
and adolescents with PTSD.
• Examples: Alcohol, benzodiazepines
2. Medications (Xanax, Valium), barbiturates, opioids
(heroin, morphine, fentanyl).
• Selective Serotonin Reuptake Inhibitors
(SSRIs): Common antidepressants for 2. Stimulants
PTSD (e.g., Sertraline, Paroxetine).
• Increase brain activity, causing alertness
• Prazosin: Used to reduce nightmares and and energy.
sleep disturbances.
• Examples: Cocaine, methamphetamine,
• Anti-anxiety or mood stabilizers: amphetamines (Adderall, Ritalin), nicotine,
Sometimes prescribed for severe cases. caffeine.
3. Lifestyle & Coping Strategies 3. Hallucinogens
• Mindfulness and meditation to reduce • Alter perception, mood, and cognitive
stress. processes.
• Regular exercise to improve mood and • Examples: LSD, psilocybin (magic
sleep. mushrooms), PCP, ketamine, MDMA
(ecstasy).
• Journaling or expressive writing to
process emotions. 4. Cannabis
• Support groups and therapy to connect • Has both stimulant and depressant effects.
with others.
• Examples: Marijuana, hashish, synthetic
VII. PTSD in Special Populations cannabinoids (Spice, K2).
• Veterans & First Responders: Higher risk 5. Inhalants
due to repeated trauma exposure.
• Chemicals that produce psychoactive
• Children & Adolescents: May show effects when inhaled.
behavioral issues, nightmares, or
withdrawal instead of verbalizing trauma. • Examples: Glue, paint thinners, nitrous
oxide, gasoline fumes.
• Sexual Assault Survivors: PTSD is
common and often accompanied by III. Stages of Substance Use Disorder
depression or dissociation. 1. Experimentation – Trying a substance out
VIII. Key Takeaways of curiosity or peer pressure.

• PTSD is a serious mental health condition 2. Regular Use – Developing a habit but still
triggered by trauma. maintaining control.

• Symptoms include intrusive memories, 3. Risky Use – Using despite negative effects
avoidance, negative thoughts, and on health, work, or relationships.
hyperarousal. 4. Dependence – Experiencing withdrawal
• Treatment includes therapy (CBT, EMDR), symptoms when not using.
medication, and coping strategies. 5. Addiction (SUD) – Loss of control over
• Early intervention and social support substance use, with compulsive behavior.
improve recovery outcomes. IV. Symptoms of Substance Use Disorder
(According to DSM-5)
SUBSTANCE USE DISORDER (SUD)
A person is diagnosed with SUD if they meet at
I. Definition
least 2 out of 11 criteria within 12 months,
Substance Use Disorder (SUD), commonly known classified as:
as substance abuse or addiction, is a chronic
• Mild: 2-3 symptoms
condition characterized by compulsive drug or
alcohol use despite negative consequences. It • Moderate: 4-5 symptoms
affects the brain’s reward system, leading to
dependence, withdrawal, and difficulty controlling • Severe: 6 or more symptoms
substance use. 1. Impaired Control
II. Classification of Substances (Based on DSM- • Using more than intended.
5 & WHO)
• Unsuccessful attempts to cut down.
1. Depressants (CNS Depressants)
• Spending a lot of time obtaining, using, or
recovering from the substance.
 • Intense cravings. VII. Withdrawal Symptoms (Varies by
Substance)
2. Social Impairment
• Alcohol: Tremors, seizures, hallucinations
• Neglecting work, school, or home (Delirium Tremens).
responsibilities.
• Opioids: Muscle pain, sweating, nausea,
• Continued use despite relationship cravings.
problems.
• Stimulants: Fatigue, depression, sleep
• Giving up important activities due to disturbances.
substance use.
• Nicotine: Irritability, increased appetite,
3. Risky Use restlessness.
• Using in dangerous situations (e.g., driving VIII. Diagnosis of SUD
under the influence).
• Clinical Interview: Assess substance use
• Continuing use despite physical or patterns and impact.
psychological harm.
• Screening Tools:
4. Pharmacological Dependence
o CAGE Questionnaire (for alcohol).
• Tolerance: Needing more of the substance
for the same effect. o Drug Abuse Screening Test (DAST).
• Withdrawal: Physical or emotional o AUDIT (Alcohol Use Disorders
symptoms when stopping use. Identification Test).
V. Causes and Risk Factors • Lab Tests: Blood, urine, or hair analysis for
substance detection.
1. Biological Factors
IX. Treatment Approaches
• Genetics (family history of addiction).
1. Psychotherapy (Behavioral Therapies)
• Changes in brain chemistry affecting
dopamine and reward pathways. • Cognitive Behavioral Therapy (CBT):
Helps change thought patterns related to
2. Psychological Factors substance use.
• Stress, anxiety, or depression. • Motivational Interviewing (MI):
• Childhood trauma or PTSD. Encourages self-motivation to quit.

• Low self-esteem or lack of coping skills. • 12-Step Programs (AA, NA): Peer support
groups for long-term recovery.
3. Environmental Factors
2. Medications for SUD
• Peer pressure or social influences.
• Alcohol Addiction: Disulfiram (Antabuse),
• Easy access to substances. Naltrexone, Acamprosate.
• Family history of substance use. • Opioid Addiction: Methadone,
Buprenorphine, Naltrexone.
VI. Short-Term & Long-Term Effects of
Substance Abuse • Nicotine Addiction: Nicotine patches,
Varenicline (Chantix), Bupropion (Zyban).
Short-Term Effects
3. Detoxification & Rehabilitation
• Impaired judgment and coordination.
• Medical Detox: Supervised withdrawal to
• Euphoria or altered mood.
manage symptoms.
• Increased or decreased heart rate and
• Inpatient Rehabilitation: 24/7 medical and
blood pressure.
psychological support.
• Risk of overdose.
• Outpatient Rehabilitation: Therapy and
Long-Term Effects treatment while living at home.

• Brain damage and cognitive decline. 4. Support Systems & Relapse Prevention

• Liver disease (from alcohol or drugs like • Family therapy and social support.
acetaminophen-opioid combinations).
• Stress management techniques (meditation,
• Heart problems (from stimulants like exercise).
cocaine).
• Avoiding triggers and high-risk situations.
• Increased risk of mental disorders
(depression, anxiety, schizophrenia).
X. Substance Use Disorder in Special
Populations
• Adolescents: High risk due to peer
pressure and lack of impulse control.
• Pregnant Women: Risk of birth defects,
premature birth, and neonatal withdrawal
syndrome.
• Elderly: Increased risk of prescription drug
misuse.
XI. Key Takeaways
• Substance Use Disorder (SUD) is a
chronic disease that affects brain function
and behavior.
• Common substances include alcohol,
opioids, stimulants, and cannabis.
• Symptoms include loss of control, social
impairment, and physical dependence.
• Treatment includes therapy, medication,
and lifestyle changes.
• Recovery is possible with the right
support and interventions.