This workshop, presented to International Christian School Chaplains, provided a basic understanding of various psychological problems commonly seen in students.

1. Recognizing Psychological Problems
In Those You Serve

2. Psychiatric Disorders Overview

Mood Disorders

Anxiety Disorders

Eating Disorders

Attention Deficit Disorder

3. Major Depressive Disorder

Depressed mood. For children and adolescents, this may be
irritable mood.

A significantly reduced level of interest or pleasure in most or
all activities.

A considerable loss or gain of weight (e.g., 5% or more change
of weight in a month when not dieting). This may also be an
increase or decrease in appetite. For children, they may not gain
an expected amount of weight.

Difficulty falling or staying asleep (insomnia), or sleeping more
than usual (hypersomnia).

Behavior that is agitated or slowed down. Others should be
able to observe this.

4. Major Depressive Symptoms (Cont.)

Feeling fatigued, or diminished energy.

Thoughts of worthlessness or extreme guilt (not about
being ill).

Ability to think, concentrate, or make decisions is
reduced.

Frequent thoughts of death or suicide (with or without
a specific plan), or attempt of suicide.

5. Dysthymic Disorder

A. A person has depressed mood for most the time almost
every day for at least two years. Children and adolescents may
have irritable mood, and the time frame is at least one year.

B. While depressed, a person experiences at least two of the
following symptoms:

Either overeating or lack of appetite.

Sleeping to much or having difficulty sleeping.

Fatigue, lack of energy.

Poor self-esteem.

Difficulty with concentration or decision making.

Feeling hopeless.

C. A person has not been free of the symptoms during the two-
year time period (one-year for children and adolescents).

6. Bipolar Disorder

There are two types of bipolar disorder:

Bipolar I Disorder is diagnosed when a person has had at least
one manic or mixed episode, often along with a major
depressive episode. It affects equal numbers of men and
women in approximately 0.4% to 1.6% of the population.

Bipolar II Disorder is diagnosed when a person has had a major
depressive episode along with at least one hypomanic episode.
It affects more women than men in about 0.5% of the
population.

10-15% of persons with Bipolar Disorder will die from suicide.

For 90%, the condition is recurrent.

7. Bipolar Disorder

A. A person experiences a current or recent episode that is manic,
hypomanic, mixed, or depressed.

To be a manic episode, for at least one week a person's mood must be
out of the ordinary and continuously heightened, exaggerated, or
irritable.

At least three of the following seven symptoms have been significant
and enduring. If the mood is only irritable, then four symptoms are
required.

Self-esteem is excessive or grandiose.

The need for sleep is greatly reduced.

Talks much more than usual.

Thoughts and ideas are continuous and without a pattern or focus.

Easily distracted by unimportant things.

8. Bipolar Disorder

An increase in purposeful activity or productivity, or behaving
and feeling agitated.

Reckless participation in enjoyable activities that create a high
risk for negative consequences (e.g., extensive spending sprees,
sexual promiscuity).

The persons' symptoms do not indicate a mixed episode.

9. Seasonal Affective Disorder

A. A person has experienced a regular pattern of depressive
episodes that begin at specific time of the year (e.g., fall or
winter), and which are not related to specific yearly stressors
such as school/college or seasonal unemployment.

B. The depression also ends or changes at a specific time of the
year (e.g., spring).

C. The pattern has occurred for the most recent two years with
no other symptoms outside of the pattern.

D. A person has had more seasonal depressions than non-
seasonal depressions in his/her lifetime.

10. Anxiety Disorders
Fight or Flight ResponseFight or Flight Response
Created for SurvivalCreated for Survival
 Heart races and pounds
 Short, Shallow Breath
 Muscles Tense
 Sweat More
 Eyes Dilate
 Eyes Dilate
 Hands get Colder
 Increased Blood Sugar
 Digestion Shuts Down
 Immune System Shuts Down
 Brain Blood Shift

11. Impact of Anxiety on the Body

Muscular Headaches

Migraine Headaches

Fatigue

Tremor

Insomnia

Digestive Problems

Increased Startle Response

Appetite Changes

Increased Perspiration

Other Physical Illnesses

12. Impact of Anxiety on the Mind

Increased worry

Increased irritability

Poor judgment

Increased sensitivity

Taking things more personally

Depression

Feeling overwhelmed

Difficulty making decisions

Negative Thinking

13. Sometimes We Underestimate the
Danger

14. Sometimes We Overestimate The
Danger

15. Panic Disorder

Difficulty breathing

Sweating

Chest pain or discomfort

Unsteadiness, dizziness or faintness

Feelings of unreality or detachment

Trembling or shaking

Tingling or numbness

Nausea or abdominal distress

16. Panic Disorder (cont.)

Palpitations or tachycardia

Choking or smothering sensations

Hot flashes or cold chills

Fear of Dying

Fear of going crazy or losing control

Fear of being embarrassed
Can be with or without agoraphobia.

17. Typical Situations Avoided by
Agoraphobics

Driving

Public transport

Waiting in lines

Crowds

Stores

Restaurants

Theaters

Going a long distance from home

Long walks

18. Typical Situations Avoided by
Agoraphobics (Cont.)

Wide, open spaces

Closed in spaces

Boats

Staying at home alone

Auditoriums

Elevators

Escalators

19. Prevalence

3-6 percent of the general population.

Or 7 to 12 million people

Single panic attack = over 30% or population

All socioeconomic levels, professions and
types of persons. Reported more in females.

20. TREATMENT FOR PANIC

Medications: SSRI’s, Beta-blockers,
tranquilizers.

Cognitive-Behavioral Psychotherapy

Relaxation Training

21. Obsessive Compulsive Disorder

Biological/genetic

A “disorder of uncertainty”

Two types of symptoms:
Obsessions – obsessive worrying and
intrusive obsessions (polar bear)
Compulsions

22. Compusions

Checking

Contamination

Counting

Ordering

Rituals-cracks, praying, movements

Repeating

Hoarding

Perfectionism

Trichotillomania

Treatment- SSRI, Exposure and Response Preventation

23. Posttraumatic Stress Disorder

Exposed to a traumatic event

Distressing recollections

Distressing dreams

Flashbacks

Distress at exposure to “reminding” events

Efforts to avoid reminders of the event

Inability to recall aspects of the event

24. PTSD (Cont.)

Diminished interest in normal activities

Detachment or estrangement from others

Restricted range of affect

Sense of foreshortened future

Insomnia

Irritability/anger outbursts

Difficulty concentrating

Hypervigilance

Exaggerated startle response

Treatment-CBT, Meds, EMDR

25. Generalized Anxiety Disorder

Excessive anxiety and worry

Difficulty controlling worry

Restlessness, keyed up or on edge

Being easily fatigued

Difficulty concentrating or mind going blank

Irritability

Muscle tension

Sleep disturbance

Anxiety not focused as in Panic, Phobia or OCD

Treatment-Relaxation training, CBT, Medications

26. Phobias

Marked and persistent fears that are excessive and
unreasonable

Exposure evokes an immediate anxiety response.

Person recognizes that the fear is unreasonable.

Interferes significantly with the person’s normal
routine.

Treatment-Tranquilizers, Systematic Sensitization

27. Social Phobia

Marked and persistent of one or more social or
performance situations in which the person is
exposed to unfamiliar people or to possible
scrutiny by others.

Humiliating or embarrassing

Social or performance situations are avoided.

Treatment- SSRI, Cognitive Therapy, Exposure

28. Eating Disorders
• Anorexia
• Extreme weight loss
• Thin appearance
• Fatigue
• Dizziness or fainting
• Hair that thins, breaks or falls out
• Intolerance of cold
• Refusal to eat
• Denial of hunger
• Fear of gaining weight
• Preoccupation with food

29. Eating Disorders
Bulimia
Regularly self-induce vomiting or misuse of laxatives,
diuretics or enemas after bingeing.
Also may use other methods to rid self of calories such as
fasting, strict diet or excessive exercise. Still binges.
Disappears to bathroom immediately after a meal.
Preoccupation with food.

30. Attention Deficit Disorder
Hyperactive/Impulsive Type
Often fidgets with or taps hands or feet, or squirms in seat.
Often leaves seat in situations when remaining seated is expected
Running or climbing in situations where it is inappropriate
Blurting out answers before hearing the whole question
Talking excessively
Interrupting or intruding on others
Having difficulty waiting in line or taking turns
Unable to play or engage in leisure activities quietly
Feeling very restless, as if “driven by a motor”, or talk excessively.

31. Attention Deficit Disorder
Inattentive Type
Not giving close attention to details or making careless mistakes in schoolwork, work, or
other activities
Often has difficulty sustaining attention in tasks or play activities
Often does not seem to listen when spoken to directly
Often has trouble organizing tasks and activities, often skipping from one uncompleted
activity to another
Becomes easily distracted by irrelevant stimuli, like sights and sounds (or unrelated
thoughts)
Fails to pay attention to instructions and makes careless mistakes, not finishing work,
chores or duties
Loses or forgets things needed for a task, like pencils, books, assignments or tools
Avoids, dislikes or is reluctant to engage in things that take a lot of mental effort for a
long period of time
Is often forgetful in daily activities

32. Conversion Disorder

80+% of Diagnosed Conversion Disorders were
eventually found to be a physical diagnosis.

Disorders often misdiagnosed as Conversion
Disorder:
a. Multiple Sclerosis
b. Lupus
c. Stroke
d. Parkinson's

33. Resources
Local clinicians (psychiatrists, psychologists, etc.)
Medical Assistance
Member Care Services
School Counselor Consultation
My email: psych-tl@msn.com

34. Thank You!
Terry L. Ledford, Ph.D.
Woodridge Psychological Associates, P.A.
Www.TerryLedford.com
(828) 287-7806
psych-tl@msn.com