Major Depressive Disorder (MDD)

What is it? MDD is a mental health condition where a person feels extremely sad or loses
interest in things they once enjoyed, almost every day, for at least two weeks. It affects how
they sleep, eat, think, and feel.

Symptoms (must have 5 or more):

 Sad mood or loss of interest in almost everything

 Changes in sleep (sleeping too much or too little)
 Feeling very tired
 Eating much more or less than usual
 Moving very slowly or being very restless
 Feeling worthless or guilty
 Trouble focusing or making decisions
 Thinking about death or suicide

Real-Life Example (Alison): Alison shows signs like low energy, sadness, guilt, and
difficulty focusing. She doesn’t enjoy the things she used to love and feels like a burden to
others.

Facts:

 Happens to about 1 in 10 people

 Women are more likely than men to have it
 It can come back again and again
 Average episode lasts 6–9 months

2. Bipolar Disorders

What is it? A mood disorder with extreme mood swings. People go from deep depression to
extreme energy (mania).

Types:

 Bipolar I: At least one full manic episode (very high energy, risky behavior)
 Bipolar II: A milder version of mania (hypomania) + depression

Symptoms of a Manic Episode (lasting at least 1 week):

 Feeling very happy or irritable

 Talking very fast
 Sleeping much less
 Big ideas or inflated self-confidence
 Easily distracted
 Doing risky things (shopping sprees, unsafe sex)
Real-Life Example (John): John talks fast, has big ideas, sleeps very little, and spends
money recklessly. He seems excited but also out of control.

Facts:

 Affects about 1 in 100 people

 Starts around age 20
 Men have more manic episodes, women more depression
 Episodes keep coming back

3. Types of Depression

 Seasonal Affective Disorder (SAD): Happens during certain seasons, usually winter
 Postpartum Depression: After childbirth
 Persistent Depressive Disorder: Chronic, long-term depression
 Premenstrual Dysphoric Disorder (PMDD): Severe mood swings before period

4. Causes of Mood Disorders (Etiology)

A. Genetics:

 Depression runs in families. If your parents have it, you're more at risk.
 Bipolar disorder is even more genetic (twin studies show 65% match in identical
twins).

B. Brain Chemistry (Neurotransmitters):

 Low serotonin, dopamine, or norepinephrine = depression

 Too much dopamine or norepinephrine = mania
 Medications affect these chemicals, but it takes time for people to feel better

C. Stress and HPA Axis:

 When you’re stressed, your brain triggers a "fight or flight" response.

 Too much stress can mess up this system and lead to depression

D. Cognitive Theories (Beck’s Theory):

 People who are depressed see:

o Themselves as worthless
o The world as unfair
o The future as hopeless
 They also think in negative ways like overgeneralizing or jumping to conclusions

E. Interpersonal Theories:
  Depressed people often have poor social support
 They may push people away by needing too much reassurance
 Stressful relationships or breakups can trigger depression

5. Treatment Options

A. Medication:

 Antidepressants: Help balance brain chemicals (e.g., SSRIs)

 Mood Stabilizers: Like lithium, used for bipolar disorder
 Antipsychotics: Sometimes used in severe cases

B. Psychotherapy (Talk Therapy):

 Cognitive-Behavioural Therapy (CBT): Helps change negative thinking

 Interpersonal Therapy (IPT): Focuses on improving relationships
 Mindfulness-Based Therapy: Staying present and managing thoughts

C. Electroconvulsive Therapy (ECT):

 Used for severe depression

 A small electric current is used to trigger a short seizure
 Works fast, but may cause confusion or memory loss

D. Other:

 rTMS: Uses magnets to stimulate the brain

 Light therapy: For SAD

6. Suicide

Key Facts:

 11 people per 100,000 die by suicide in Canada every year

 More common in men, but women attempt more often
 Indigenous communities face very high rates

Terms to Know:

 Suicidal ideation: Thinking about suicide

 Gestures: Non-serious actions (e.g., shallow cuts)
 Attempts: Serious efforts to die
 Completed suicide: Death from suicide

Risk Factors:
  Being male
 Feeling hopeless or alone
 Family history of suicide
 LGBTQ+ identity, especially if not supported
 Physical illness or chronic pain
 Substance use

Interpersonal Theory of Suicide:

 People are more likely to attempt suicide if they:

o Feel alone ("no one cares about me")
o Feel like a burden ("everyone is better off without me")
o Have gotten used to pain or fear (acquired ability)

7. Short & Long Answer Questions (with Sample Answers)

Q1: What are 5 symptoms of major depression? A: Sad mood, lack of energy, sleep
problems, guilt, and suicidal thoughts. These make it hard to go to work, enjoy hobbies, or
maintain relationships.

Q2: Explain the diathesis-stress model. A: This model says that people have a genetic risk
(diathesis), but they need stress (like a breakup or job loss) to trigger depression.

Q3: Describe Beck’s cognitive triad. A: Depressed people have negative thoughts about
themselves, the world, and the future. For example, "I’m useless," "Life is unfair," "Things
will never get better."

Q4: What’s the difference between MDD and bipolar I disorder? A: MDD is just
depression. Bipolar I includes both depression and at least one manic episode (high energy,
risky behavior).

Q5: What are the pros and cons of ECT? A: ECT works fast for severe depression. But it
can cause memory loss and confusion. It’s usually a last resort.

Q6: Why is suicide hard to predict? A: Because many people don’t show signs, and risk
factors don’t always apply to individuals. Also, suicidal thoughts can come and go quickly.

Q7: Describe Alison’s depression (from video). A: Alison felt hopeless, guilty, and tired.
She avoided people and had no interest in things she used to enjoy.

Q8: Describe John’s mania (from video). A: John was overly excited, talked nonstop,
hardly slept, and spent money impulsively. He thought he could do anything.

Chapter 9 - Schizophrenia (Simplified & Detailed)

🔹 What is Schizophrenia?

Schizophrenia is a serious mental disorder where a person struggles to think clearly, manage
emotions, relate to others, and distinguish between what is real and not real. It affects
about 1% of the population and usually appears in late adolescence or early adulthood.

Symptoms of Schizophrenia

Schizophrenia is usually categorized by:

✅ Positive Symptoms (things added to experience):

 Delusions: False beliefs (e.g., thinking you're being watched)

 Hallucinations: Seeing or hearing things that aren't there (esp. voices)
 Disorganized Thinking/Speech: Jumping from topic to topic, nonsensical speech
 Disorganized or Catatonic Behavior: Agitation, odd movements, or no movement at
all

❌ Negative Symptoms (things lost or reduced):

 Affective flattening: Reduced emotional expression

 Alogia: Poverty of speech
 Anhedonia: Inability to feel pleasure
 Avolition: Lack of motivation
 Asociality: Withdrawal from social interaction

🤔 Cognitive Symptoms:

 Poor attention and memory

 Difficulty understanding social cues (e.g., sarcasm, facial expressions)

🧰 Causes and Risk Factors

👨‍👩‍👦 Genetics:

 Runs in families (44% for identical twins)

 Most people with schizophrenia don’t have a parent with it

💊 Dopamine Hypothesis:

 Too much dopamine in some brain areas → hallucinations, delusions (positive

symptoms)
 Too little dopamine in other brain areas → negative symptoms
 Amphetamines increase dopamine and can cause psychosis
🧬 Stress Factors (Diathesis-Stress Model):

 Biological stress: birth complications, viral exposure in womb

 Psychological/social stress: trauma, social exclusion, urban living, high expressed
emotion in families

📈 Course of Illness

1. Prodromal Phase: Early signs like social withdrawal or odd behavior

2. Psychotic Phase: Full symptoms (delusions, hallucinations)
3. Stable Phase: Symptoms may lessen but can come back

Poor prognosis linked to:

 Male gender
 Long delay in treatment
 Severe delusions/hallucinations
 Birth complications

🚀 Cognitive Impairment

 Difficulty with memory, problem-solving, attention

 Trouble recognizing facial expressions and sarcasm
 These deficits appear before full illness and often remain even after other symptoms
improve

📚 Treatments for Schizophrenia

💉 Antipsychotic Medications

 First-generation: Older, more side effects (e.g., Parkinson’s-like symptoms)

 Second-generation: Fewer side effects, used more today

Side effects to know:

 Tardive Dyskinesia: Involuntary movements of face/tongue

 Extrapyramidal Symptoms (EPS): Muscle stiffness, tremors

📅 Psychosocial Treatments

 Cognitive Remediation: Improves thinking skills

 Social Skills Training: Teaches communication & problem solving
 Family Therapy: Reduces stress at home
  Assertive Community Treatment: Care teams in the community
 Housing First: Stable housing without conditions

🔍 Research & Brain Findings

 Ventricular enlargement: Larger fluid-filled spaces in the brain

 Abnormal brain activity in frontal & temporal lobes
 Problems in mesolimbic and mesocortical dopamine pathways

✏️Practice Short & Long Answer Questions

Q1: What are the positive and negative symptoms of schizophrenia? Give examples. A:
Positive symptoms are things added to a person's experience that shouldn't be there. For
example, hallucinations (like hearing voices when no one is there), and delusions (believing
you're being watched or that you're a famous person when you're not). Negative symptoms
are things that are missing or reduced. For example, avolition (having no motivation to do
anything) and alogia (saying very little or having no thoughts to express).

Q2: Explain the dopamine hypothesis in simple terms. A: Dopamine is a chemical in the
brain that helps control emotions and thinking. The dopamine hypothesis says that people
with schizophrenia might have too much dopamine in some brain areas, which can cause
symptoms like hallucinations and delusions. In other areas, they might have too little
dopamine, which could cause problems like low motivation or flat mood.

Q3: What makes someone more likely to get schizophrenia? A: A combination

of genetics (family history), brain differences (like enlarged ventricles), complications at
birth, traumatic experiences during childhood, and ongoing social stress (like being very
isolated or living in high-stress environments) can all increase the chance of developing
schizophrenia.

Q4: What does "expressed emotion" mean and why is it important? A: Expressed
emotion refers to how family members talk and behave toward the person with schizophrenia.
If they are very critical, angry, or overly involved, it can increase the stress on the person
and make symptoms worse. High expressed emotion is linked to more frequent relapses.

Q5: Describe the course of schizophrenia. A: Schizophrenia usually begins with

a prodromal phase, where the person might seem odd, withdraw socially, or show unusual
behaviors. Then comes the psychotic phase, when full symptoms like hallucinations and
delusions appear. After treatment, the person enters a stable phase, where symptoms
improve. But symptoms can come back if not managed properly.

Q6: How do medications help, and what are the risks? A: Medications,
especially antipsychotics, help reduce symptoms like hallucinations, paranoia, and
confusion. However, they can have side effects, especially older drugs, which might
cause movement problems like tremors or stiffness. Newer medications usually have fewer
side effects.
Q7: What are some effective non-medication treatments? A: These include cognitive
remediation (brain training to improve memory and thinking), family therapy (to reduce
stress at home), social skills training (to help the person interact better), and housing
support like Housing First (providing a stable home environment).

Q8: What brain changes are seen in people with schizophrenia? A: Researchers have
found enlarged ventricles(fluid-filled spaces in the brain), less activity in brain areas
responsible for planning and decision-making, and problems in dopamine pathways that
affect thinking, mood, and motivation.

Chapter 10 - Eating Disorders (Simplified & Detailed)

🌟 What Are Eating Disorders?

Eating disorders are serious mental health conditions where a person’s thoughts, emotions,
and behaviours around food, body image, and weight become harmful and obsessive. They
are not the same as disordered eating (e.g., occasional dieting). This chapter focuses on:

 Anorexia Nervosa (AN)

 Bulimia Nervosa (BN)
 Binge Eating Disorder (BED)

Each disorder involves different patterns of eating, compensatory behaviours, and emotional
distress.

🌍 Anorexia Nervosa (AN)

Core features:

 Intense fear of gaining weight

 Refusal to maintain a healthy weight
 Distorted body image (thinking they are overweight even when underweight)

Associated behaviours:

 Strict dieting or eating only "safe" foods

 Eating rituals (e.g., cutting food into tiny pieces)
 Obsessive thoughts about food
 Body checking
 Wearing bulky clothing to hide weight loss
 Amenorrhea (missed periods in women)

Prognosis:

 70% recover eventually

 Relapse is common
  Highest mortality rate of any psychiatric illness
 May shorten life expectancy by 25 years

Lived example: Anna is a 19-year-old who avoids meals with friends, restricts her food to
salads and plain rice, weighs herself multiple times daily, and wears baggy clothes. She
believes she is still "too fat" despite being severely underweight.

🥒 Bulimia Nervosa (BN)

Core features:

 Recurrent binge eating (eating large amounts of food with a sense of loss of control)
 Followed by compensatory behaviours:
o Vomiting
o Laxatives
o Fasting
o Excessive exercise
 Weight is typically normal or slightly overweight
 Body image highly influences self-esteem

Associated behaviours:

 Impulsivity (risky decisions, substance use)

 Depression
 Shame and secrecy
 Preoccupation with food and weight

Lived example: Taylor, 22, eats a large pizza, cake, and snacks in one sitting. Afterward,
they vomit and feel intense shame. Taylor hides this from roommates and often exercises for
hours.

Binge-Eating Disorder (BED)

Core features:

 Recurring binge episodes without compensatory behaviours

 Binges occur at least weekly for several months
 Causes distress and guilt

Symptoms include:

 Eating rapidly and past fullness

 Eating when not hungry
 Eating alone due to shame
 Emotional eating
Lived example: Jordan feels lonely and stressed after work. They order fast food, eat large
amounts quickly while watching TV, then feel guilty but do not vomit or exercise.

📊 Changing Prevalence & Cultural Considerations

 BED is most common (3.5% women, 2% men)

 BN is next (1.5% women, 0.5% men)
 AN is least common (0.9% women, 0.3% men)

Ethno-racial differences:

 Eating disorders affect all cultures, not just white women

 Prevalence in BIPOC communities is rising but often underdiagnosed

Gender differences:

 Women more likely to be diagnosed

 Men underreport symptoms due to stigma

🎡 Causes of Eating Disorders

Risk factors:

 Perfectionism
 Internalization of thin ideal (media)
 High social media exposure
 Negative emotions (depression, shame)

Biological contributors:

 50% heritability
 Serotonin and dopamine dysregulation
 Puberty-related hormone changes

Psychological maintenance factors:

 Body dissatisfaction
 Low self-worth
 Emotional regulation problems

Starvation studies:

 WWII study: men on low-cal diets developed food obsessions, mood swings, and
withdrawal
 Canadian Cree communities were subjected to starvation experiments, showing severe
mental effects
📈 Consequences of Eating Disorders

 Amenorrhea
 Lanugo (fine hair growth)
 Electrolyte imbalances
 Gastrointestinal issues
 Bone loss
 Heart problems

🚪 Treatment Options

🌐 Biological:

 SSRIs (especially in bulimia)

 Not a standalone solution

🏫 Psychological:

 CBT-E (Enhanced Cognitive Behavioural Therapy): Best evidence for all EDs
 Interpersonal Therapy: Especially helpful for BED
 Family-Based Therapy (FBT): Most effective for teens with AN

⚡ Prevention Programs

Universal: Whole population (e.g., media literacy in schools) Selective: High-risk groups
(e.g., girls with body image issues) Indicated: People showing early symptoms

Best Programs:

 CBT-based programs
 Media literacy (challenging thin ideal)
 Psychoeducation

✏️Sample Questions and Answers

Q1: What is the main difference between anorexia and bulimia?

A: Both disorders involve a strong focus on food and body image. However, anorexia is
mainly about eating very little and being underweight. In contrast, bulimia involves eating
large amounts of food (called bingeing) and then trying to get rid of it (called purging), often
by vomiting or over-exercising. People with bulimia are usually normal weight or slightly
overweight.
Q2: How does binge-eating disorder differ from bulimia?
A: People with binge-eating disorder (BED) also eat a lot in one sitting (binge), but they do
not purge afterward. This means they don’t vomit or use laxatives. Bulimia includes
both bingeing and purging, but BED involves just the bingeing, often followed by guilt
and shame.

Q3: What biological factors contribute to eating disorders?

A: Some people may be more likely to get an eating disorder because of their genes. Also,
chemicals in the brain like serotonin and dopamine may not work properly. Hormonal
changes, especially during puberty, can also play a role.

Q4: What are common consequences of eating disorders?

A: Eating disorders can seriously harm the body. People may have heart problems, lose
bone strength (osteoporosis), have trouble with digestion, or grow fine body hair (lanugo).
In anorexia, there's even a risk of death if not treated.

Q5: What is a CBT-based approach for eating disorders?

A: CBT stands for Cognitive Behavioural Therapy. It helps people notice and challenge
unhealthy thoughts they have about their body, food, and self-worth. It also teaches them
to develop healthier eating habits and improve self-esteem.

Q6: How can we prevent eating disorders in communities?

A: We can use prevention programs. Universal programs teach healthy body image in
schools. Selective programsfocus on people at higher risk, like teens with low self-esteem.
The goal is to help people feel better about their bodies and not fall into harmful eating
patterns.

Complete Study Guide: Chapter 11 - Addictive Disorders (Simplified & Detailed)

🚨 What Are Addictive Disorders?

Addictive disorders involve a person becoming dependent on a substance or behavior, to

the point where it interferes with their everyday life. The main focus of this chapter
is Substance Use Disorders (SUDs), especially those related to drugs and alcohol.

📋 How Are Addictive Disorders Diagnosed?

According to DSM-5, a substance use disorder involves 2 or more of the following within
12 months:

1. Impaired control: Using more than intended, can’t stop

2. Social impairment: Problems at work, school, or in relationships
3. Risky use: Using in dangerous situations (e.g., driving drunk)
4. Pharmacological symptoms:
o Tolerance (needing more to feel the same effect)
o Withdrawal (feeling sick when stopping use)
🧍‍♂️Real-life example: Mahesh

 Binge drinks on weekends

 Drives drunk (risky use)
 Has lost license (social consequences)
 Needs long recovery the next day (possible tolerance/withdrawal)

🧠 Theories of Addiction

 Disease Model: Addiction is a brain disease

 Moral Model: Addiction is due to personal failure or weakness
 Coping Model: Addiction is a way to deal with stress or trauma

🧪 Types of Psychoactive Substances & Effects

1. Depressants (alcohol, sedatives, barbiturates, benzodiazepines)

 Slow down brain activity

 Low doses: Relaxation, reduced anxiety
 High doses: Drowsiness, confusion, slowed breathing
 Long-term use: Memory loss, liver damage, dependence

2. Stimulants (cocaine, amphetamines, meth, Ritalin)

 Speed up brain activity

 Increased energy, alertness
 Overuse: Anxiety, paranoia, heart problems

3. Opioids (heroin, morphine, codeine, fentanyl)

 Block pain, give euphoria

 Risk: Overdose, addiction, withdrawal pain

4. Hallucinogens & Dissociatives (LSD, mushrooms, PCP)

 Alter perception of reality

 Can cause hallucinations, paranoia

5. Cannabis (THC)

 Milder effects: relaxation, altered sense of time

 Can impair memory, coordination

6. Nicotine
  Highly addictive, found in tobacco
 Causes long-term heart and lung damage

💔 Consequences of Addiction

 Health problems (heart, liver, brain damage)

 Mental health issues (depression, anxiety)
 Family and social breakdown
 Legal issues (DUIs, arrests)

💊 Opioid Crisis in Canada

 Since 2016: Over 49,000 deaths from opioid toxicity

 Fentanyl involved in ~80% of deaths
 Viewed more as a criminal issue than a health issue (which is problematic)

Harm Reduction Strategies

Goal: Reduce harm even if a person still uses drugs

Examples:

 Insite Supervised Consumption Site (Vancouver):

o Clean needles
o Overdose support
o Connections to treatment
o Reduces public drug use and disease

🧰 Treatments for Substance Use

1. Medications:

 Opioid Agonists: Methadone, buprenorphine

 Antagonists: Naloxone (reverses overdose), Naltrexone
 Suboxone: Mix of agonist + antagonist

2. Therapy:

 Motivational Interviewing: Helps people decide to change

 CBT: Changes harmful thinking patterns
🔬 Alcohol Use: Key Info

Short-term Effects:

 Euphoria, loss of coordination, slowed reaction

 Affects GABA, dopamine, serotonin, glutamate

Long-term Effects:

 Liver disease, brain damage, malnutrition, heart issues

 Fetal Alcohol Syndrome (if pregnant)

Drinking Motives:

1. Enhancement: Feel better

2. Coping: Deal with stress
3. Social: Fit in with others
4. Conformity: Due to pressure

Low-Risk Drinking Guidelines (Canada):

 10 drinks/week (females), 15 drinks/week (males)

✏️Practice Questions

Q1: What are the 4 signs of a substance use disorder? A: Impaired control, social
impairment, risky use, and pharmacological symptoms (tolerance/withdrawal).

Q2: What’s the difference between opioids and stimulants? A: Opioids slow the body
down and relieve pain. Stimulants speed the body up and increase energy.

Q3: How does harm reduction help? A: It reduces disease and death without requiring
people to quit first. Example: supervised injection sites.

Q4: What are short and long-term effects of alcohol? A: Short: Relaxation, impaired
thinking. Long: Liver and heart problems, memory loss.

Q5: Why is motivational interviewing effective? A: It respects the person’s readiness to

change and helps them make decisions at their own pace.

Chapter 12 - Personality Disorders (Simplified & Detailed)

🌟 What Are Personality Disorders?

Personality disorders (PDs) are long-standing patterns of behavior, emotion, and thinking that
are inflexible and unhealthy. People with PDs often have trouble with relationships, work,
and self-identity.

These traits:

 Cause distress or problems in daily life

 Are stable over time (start in adolescence or early adulthood)
 Are different from what most people in the same culture experience

🤔 How Are PDs Diagnosed?

A person must have problems in at least two of these areas:

1. Thinking (cognition)
2. Emotions (affectivity)
3. Interpersonal relationships
4. Impulse control

The pattern must be:

 Inflexible
 Pervasive (happens across situations)
 Cause significant distress or impairment

🧠 DSM-5 Personality Disorder Clusters

Cluster A - Odd/Eccentric

 Paranoid PD: Distrustful, suspicious, holds grudges

 Schizoid PD: Emotionally cold, avoids social contact
 Schizotypal PD: Odd thoughts, magical thinking, social anxiety

Cluster B - Dramatic/Erratic

 Antisocial PD: Violates others’ rights, lacks remorse, aggressive

 Borderline PD: Unstable moods, relationships, and self-image
 Histrionic PD: Seeks attention, theatrical, shallow emotions
 Narcissistic PD: Grandiosity, need for admiration, lacks empathy

Cluster C - Anxious/Fearful

 Avoidant PD: Feels inadequate, fears criticism or rejection

  Dependent PD: Clingy, fears being alone, indecisive
 Obsessive-Compulsive PD: Rigid, perfectionist, controlling

🧰 Alternate DSM-5 Model (Newer Approach)

Criterion A: Problems with identity, self-direction, empathy, intimacy (rated 0-4)

Criterion B: Pathological personality traits (e.g., impulsivity, hostility, emotional instability)

Criterion C: 6 types of PDs:

 Borderline
 Antisocial
 Narcissistic
 Avoidant
 Schizotypal
 Obsessive-compulsive

🌐 Borderline Personality Disorder (BPD)

Symptoms:

 Fear of abandonment
 Intense, unstable relationships
 Unstable self-image
 Impulsive, risky behavior
 Self-harm, suicidal thoughts
 Chronic emptiness
 Mood swings, anger
 Stress-based paranoia or dissociation

Causes (Biosocial Model):

 Genetic link (runs in families)

 Brain dysfunction (impulsivity, emotion regulation)
 Trauma, abuse, invalidating environments

Course:

 Most severe in early adulthood

 Improves with age (by 30s-40s)

Antisocial Personality Disorder (ASPD)

Symptoms (since age 15):

 Violates laws and social norms

 Deceitful, impulsive, aggressive
 Irresponsible, lacks remorse
 Can be charming/manipulative

Difference from Psychopathy:

 Psychopathy includes all of ASPD + emotional coldness, lack of empathy, charm,

and calculated manipulation.
 Not all with ASPD are psychopaths

Risk factors:

 Harsh parenting
 Parental rejection or abuse
 Genetics (higher in adopted kids with antisocial bio-parents)
 Lower skin conductance (less responsive to stress)

⚖️Controversies & Challenges

 PDs overlap with each other

 Diagnosis is subjective (based on traits)
 Gender/cultural biases
 Some experts want to remove certain PDs from the DSM

✏️Practice Questions

Q1: What are the 3 clusters of PDs? Give examples. A: Cluster A (Paranoid, Schizoid,
Schizotypal), Cluster B (Antisocial, Borderline, Narcissistic, Histrionic), Cluster C
(Avoidant, Dependent, OCPD).

Q2: How is BPD diagnosed and what causes it? A: BPD is diagnosed based on unstable
moods, relationships, and behavior. It is caused by a mix of genetic, brain-based, and
environmental factors.

Q3: How does ASPD differ from psychopathy? A: ASPD includes behavior issues
(breaking laws), while psychopathy also includes lack of empathy and emotional coldness.

Q4: What is the alternate DSM-5 model? A: It rates personality functioning (identity,
empathy, etc.), then adds traits (like impulsivity), and sorts people into 6 types.

Q5: Why are PDs hard to diagnose? A: Because symptoms overlap, diagnoses can be
biased, and traits can look different across cultures and genders.