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Abnormal Behavior and Mental Health

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Based on axial 1 of DSM classification, Cindy exhibits post traumatic stress disorder and acute stress disorder. She has social and psychological conditions that may be a focus of clinical attention. In axial 2, she falls under personality disorder in that she deviates markedly from social expectations, suffers depression, causes distress. She does not fall under axial 3 as she has no general medical condition that may play a direct role in causing psychological disorder (Dziegielewski, 2010). In axial 4, she experiences post traumatic stress disorder from a previous trauma and Cindy experiences psychosocial and environmental problems e.g. lack of adequate social support from her friends and joblessness. In axial 5, her global assessment functioning (GAF) is below par.


Axial1-Cindy experiences social and psychological conditions that may be a focus for diagnosis and treatment:             Persistent re-experience of trauma centered on a series of past events that included rape when she was 16 years; Lack of social support from close friends; Low self confidence (avoided eye contact with the interviewer); Addicted to and Abuses marijuana; Lack of insight and judgment as exhibited by extra marital affair; Unemployed for the last 6 months; Has attended 4 therapy sessions and quite the last three sessions after single session.

Axial 2: she exhibits symptoms of personality disorders which are; Depression for at least 3 months; Gets agitated after recollecting the trauma.

Axial 3: No symptoms indicative of general medical conditions.

Axial 4: she has a history of negative life event whereby at 16 years of age an adopted family member raped her. During the assault, which lasted 5 weeks, there were verbal threats, no weapon of physical injuries, and forced to commit heinous acts. She felt detached, numb, guilty and embarrassed. She neither reported to police nor received medical care. After the rape, she withdrew from normal activities; hang out in the wrong company, exhibited changes in behavior including violence, lying, alcohol abuse and derealization. She also reports having had an abortion under her father’s consent. Her childhood was rather intricate, having a former war veteran, who was psychologically and emotionally cold, as a father, and a self absorbed mother. Reminiscing these events during her extra marital affair led to her ending the affair, which indicates she was suffering from post traumatic stress disorder, as she had distressing images, bringing past emotions into present.

AXIAL 5: her current level of functioning indicates the need for treatment.  Poor judgment and insight derealisation, and the recalling of past events indicate that she is in need of psychological attention.

Question A3: Compare Generalised Anxiety Disorder and Acute Stress Disorder using the following table:


Generalised Anxiety Disorder

Acute Stress Disorder

Type of disorder

Anxiety disorder

Anxiety disorder

Diagnostic Axis

Axial 1, DSM IV TR classification number 7.

Axial 1, DSM IV TR classification number 7.

Clinical picture

From history and Mental state examination,

-worry excessively about virtually all aspects of their lives e.g. health, finances, marital status.

-do not have panic attacks, phobias, obsessions or compulsions, rather experience pervasive anxiety or worry about a number of events that occur most days  for at least six months.

- is associated with at least 3 of the following: restlessness, easy fatigability, difficulty concentrating with mind going blank, irritability, muscle tension and sleep disturbance.

From history and Mental state examination,


-detachment and derealisation

-depersonalisation or dissociative amnesia

-continuous re-experiences of events by such ways as thoughts, dreams, and flash backs.

-avoidance of any stimulation that reminds them of events.

-symptoms of anxiety and significant impairment in at least 1 essential area of functioning.


Typical age of onset is early 20s but may begin at any age.

Appear within 4 weeks of the impact of stressful stimuli or event.


Most days for at least 6 months.

2 Days-4 weeks


According to the prescribed book, rape is an offence in which a person forces another to engage in sexual activity without her consent, and may involve threats, weapons, physical injuries and heinous acts. It may be by a person known by the victim, and usually leaves the victim psychologically traumatized.

In my own definition, rape constitutes several parameters: legality, issue of consent, use of threat, force or violence, and the effects. Rape is a criminal offence in which sexual intercourse takes place with an unwilling partner, female or male, known or unknown by the victim, and under threat of force or violence (Welfel et, al. 2001). It occurs in the context that a person is forcefully made to participate in sexual acts without their will. Arguments show that rapists are motivated by a desire to dominate rather than simply an attempt to achieve sexual gratification. Majority of rapes are unreported due to victim’s shame, anxiety about publicity and the fear that the rapists will take reprisals. The victims are usually traumatized severely, both psychologically and physically. Legally it recognizes that rape can happen within marriage also in situations of a known friend of the victim (date rape). Anxiety, depression, PTSD is the common effects of rape. Rape crises counselling, medical therapy and report to authority is a significant requirement.

Question A5:

Distinguish between a depressive episode, a hypomanic episode and a panic attack using the following table.


Depressive Episode

Hypomanic Episode

Panic Attack


2 weeks

4 days

5-30 minutes

Affective symptoms

Depressed mood, decreased interest, pleasure and concentration, decreased indecisiveness.

Overactive desire and drive for success, elevated or irritable mood.

Trembling or shaking

Cognitive symptoms

Thoughts of worthlessness, guilt, self hatred, suicidal.

Flight of ideas.

Fear of losing control or going crazy, fear of dying.

Behavioural symptoms

Agitation, retardation, slow movement and forgetfulness, insomnia

Extremely outgoing, competitive with inflated self esteem and grandiosity, easily distractible

Derealisation and depersonalization and derealisation.

Physical symptoms

Fatigue, low energy, headaches.

Great deal of energy.

Palpitations, chest pain and discomfort, breathlessness, tachycardia, nausea and abdominal distress.


Question B1:

Provide a full diagnosis for Bongani on the five axes of the DSM-IV-TR classification system

Axial I: anxiety disorder: substance induced anxiety disorder, Obsessive compulsive disorder, Social phobia.

Axial II: Personality Disorder. Under cluster A, paranoid; Cluster B, antisocial; Cluster C, avoidant, dependent and obsessive compulsion.

Axial III: No general medical condition.

Axial IV: Sexual and gender identity disorder; difficulty in social adjustment.

Axial IV: The global assessment functioning is below par.

Question B2

Axial I: Bongani strongly believes that his condition is due to the marijuana. During the interview he exhibits restricted emotions, appears tense and anxious with constricted body motions and hesitant deliberate speech. He is also socially detached. Bongani is obsessed about having HIV.

Axial II: Bongani believes others are out to get him; he has delusions of reference in that he believes T.V. reports have a special significance to him. He also experiences auditory hallucinations. He is dependent on his family especially the father.

Axial IV: Bongani has homosexual preferences which he believes is causing him social stigma and criticism especially from his mother, who he claims is non-accepting. He also can not sustain jobs as he does not prefer social interaction. Bongani was dumped in a rubbish bin at birth and adopted. In his childhood, he had no friends, was sensitive to criticism and had difficulty in school.

Axial V: GAF is below par as indicated by: Flat affect, improper thought content, poor perceptions etc.


The multipath model of personality provides a more advanced view of psychological function.MAP model assumes that personality and self-organization are shaped by a number of combined forces that include mental, evolutionary, situational, psycho-spiritual and biological processes. This model can be used in the analysis of psychological functioning as it incorporates various levels of scrutiny in which one level is not complete without looking at the other. When all this levels are taken together, an added view that builds broader and percipient outlook for assessing personality and development. According to this model, the first level of analysis is neuropersonal. This level focuses on biological material functioning. Individuals are driven by genetic and biological functions; chemicals between the brain neurons determine a person’s mood and personality. In the above case, the use of marijuana (a psychoactive drug) may have triggered a change in the chemicals due to the tetrahydrocannabinol it contains.

The second level is intrapersonal level, which is information about self; how you think, perceive, interpret and analyze. According to this, Bogani thought that the marijuana bended his mind. Therefore, he perceived that his mind was broken, and this manifested in his clinical presentation.

The third level is interpersonal; it deals with the family and social aspects. Good relationships lead to good development and vice versa. In the above case, Bogani was abandoned by his biological family. This might be a very disturbing and depressing thing to him. He also has a mother who does not approve of his homosexual lifestyle and calls him by derogatory words. This family and social issues have obviously affected his behavior.


From the clinical case, the history about the mother shows that the family is very superstitious and believed the mother had amafufunya which according to the African culture is a state of possession by an evil spirit due to witch craft so cast her away. In the case of Bogani, they believed he was a product of this sorcery and wanted nothing to do with him. If Bogani would have remained with the biological family that believe in possession, the first thing they would have done would have to send him to a witch doctor suspecting Bogani had the same condition as the mother. Due to their African beliefs the family would take him there knowing and believing that the witch doctor had the powers to bewitch and treat him.

Question B5:


Delusional Disorder

Schizotypal Personality Disorder

Type of disorder

Psychotic disorder

Personality disorder

Diagnostic Axis

DSM-IV-TR number 5 on Axis II

DSM-IV-TR number 16 on Axis II

Clinical picture

Characterised by nonbizarre delusions about things that could happen in real life. The patient’s social adjustment remains normal.

Have few relationships and demonstrate oddities of thought, affect, perception, and belief. Many are highly distrustful and often paranoid. Some may be suicidal.


Generally, it is in middle to late life.

No definite onset


At least 1 month.

At least 2 years




Question B6:


Attention Deficit/Hyperactivity Disorder

Oppositional Defiant Disorder

Conduct Disorder

Purposefulness of behaviour

Attract attention to or away from themselves

Hostility, defiance to authority

Lack of empathic concern for others, major misbehaviour, repetitive behaviour to violate rights of others and social norms.

Motivation for behaviour

Impatience, abnormal perceptions, low self esteem, pre occupied thoughts, environmental factors and neurological dysregulation.

Resentment, disobedience, disregard for authority

Antisocialism, depression, copying from peers, juvenile delinquency.

Interpersonal relationships

Forgetful, deliberately annoys others, easily distracted, defiant.

Stubborn, angry, temper tantrums, annoys others on purpose.

Aggression, verbal and physical, destructive behaviour, truancy, vandalism, lying, stealing, delinquent subsistence.

Duration and Prognosis

6 months

Good with treatment. Many outgrow it.

6 months

Untreated, 52% continue with it for next 3 years, 50% progress to conduct disorder.

Mostly to adolescent years. Prognosis varies depending on if mild, moderate or severe and resistance to treatment


The first thing to do is to open a counseling department in the school. The next step is to employ a behavioral therapy. The behavioral therapy will employ the following steps:

1. To assess the suspected children through a medical and psychological evaluation. This enables the therapy to identify what affects the child before steps can be taken to eliminate them.

2.If any other conditions are found aggressive treatment is recommended. Eliminating them can be the fastest way of treating the above.

3. Omega 3 and vitamin E supplement have been found beneficial in treating the above.

4. Consider involving parents in the behavioral therapy of the children.

5. Medical intervention such a antidepressants.

The type of program is a school based early detection and intervention program. It entails peer to peer discussions, training of social skills and self conduct training.

In developing the program, the consideration of the community is invaluable since the community moulds the children and support can be in terms of financing and voluntary work. The age of the child must be considered. The way to approach a child is not the same way to approach an adolescent.

Learners can be encouraged to take part in role play to gain their interests into the program. Include the peers into the program. Always give the child positive reward.

Involvement of parents is essential in the program. This is an integral part of the program as parents would deal directly with the children in what is known as parent management training. The inclusion of the community as a whole in the program to support and fund the initiative is a crucial step. Support groups among children peers where the children can sit and talk.

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