Types of Disorders
12 Clinical Psychology
STEP 4 Review the Knowledge You Need to Score High
The main DSM-5 categories of mental disorders are the following:
1. Neurodevelopmental Disorders
2. Schizophrenia Spectrum and Other Psychotic Disorders
3. Bipolar and Related Disorders
4. Depressive Disorders
5. Anxiety Disorders
6. Obsessive-Compulsive and Related Disorders
7. Trauma and Stressor-Related Disorders
8. Dissociative Disorders
9. Somatic Symptom and Related Disorders
10. Feeding and Eating Disorders (see Chapter 11)
11. Elimination Disorders
12. Sleep-Wake Disorders (see Chapter 6)
13. Sexual Dysfunctions
14. Gender Dysphoria
15. Disruptive, Impulse Control, and Conduct Disorders
16. Substance Use and Addictive Disorders (see Chapter 6)
17. Neurocognitive Disorders
18. Personality Disorders
19. Paraphilic Disorders
20. Other Mental Disorders which may include
• Medication-Induced Movement Disorders and Other Adverse Effects of Medication
• Other Conditions That May Be the Focus of Clinical Attention
In an abnormal psychology or psychological disorders course you might study all of these disorders, but introductory psychology students typically study selected disorders in addition to the eating disorders, sleep disorders, and substance-related disorders you’ve already encountered. These include anxiety disorders, obsessive-compulsive disorders, trauma and stressor-related disorders, somatic symptom disorders, dissociative disorders, depressive disorders, bipolar disorder, schizophrenia, personality disorders, neurodevelopmental disorders, and neurocognitive disorders.
Anxiety is the primary symptom, or the primary cause of other symptoms, for all anxiety disorders. Anxiety is a feeling of impending doom or disaster from a specific or unknown source that is characterized by mood symptoms of tension, agitation, and apprehension; bodily symptoms of sweating, muscular tension, and increased heart rate and blood pressure; and cognitive symptoms of worry, rumination, and distractibility. Anxiety disorders include panic disorder, generalized anxiety disorder, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder.
• Panic disorder is the diagnosis when an individual experiences repeated attacks of intense anxiety along with severe chest pain, tightness of muscles, choking, sweating, or other acute symptoms. These symptoms can last anywhere from a few minutes to a couple of hours. Panic attacks have no apparent trigger and can happen at any time. Since these are statistically rare, having perhaps three of these in a 6-month period would be cause for alarm.
• Generalized anxiety disorder is similar to a panic disorder. Symptoms must occur for at least 6 months and include chronic anxiety not associated with any specific situation or object. The person frequently has trouble sleeping, is hypervigilant and tense, has difficulty concentrating, and can be irritable much of the time.
Panic disorder has acute symptoms short in duration, whereas generalized anxiety disorder has less intense symptoms for a longer time.
• Phobias are intense, irrational fear responses to specific stimuli. Nearly 5 percent of the population suffers from some mild form of phobic disorder. A fear turns into a phobia when it provokes a compelling, irrational desire to avoid a dreaded situation or object, disrupting the person’s daily life. Common phobias include the following:
agoraphobia—fear of being out in public
acrophobia—fear of heights
claustrophobia—fear of enclosed spaces
zoophobia—fear of animals (such as snakes, mice, rats, spiders, dogs, and cats)
Obsessive-Compulsive and Related Disorders
• Obsessive-compulsive disorder (OCD) is a compound disorder of thought and behavior. Obsessions are persistent, intrusive, and unwanted thoughts that an individual cannot get out of his or her mind. Obsessions are different from worries; they generally involve a unique topic (such as dirt or contamination, death, or aggression), are often repugnant, and are seen as uncontrollable. If a person were frequently bothered by thoughts of wanting to harm others, this would be called an obsession. Obsessions are often accompanied by compulsions, ritualistic behaviors performed repeatedly, which the person does to reduce the tension created by the obsession. Common compulsions include handwashing, counting, checking, and touching.
• Hoarding disorder is characterized by persistent difficulty discarding or parting with possessions due to a perceived need to save the items and distress parting with them.
Trauma and Stressor-Related Disorders
• Post-traumatic stress disorder (PTSD) is a result of some trauma experienced (natural disaster, war, violent crime) by the victim. Victims reexperience the traumatic event in nightmares about the event, or flashbacks in which the individual relives the event and behaves as if he or she is experiencing it at that moment. Victims may also experience reduced involvement with the external world and general arousal characterized by hyperalertness, guilt, and difficulty concentrating.
The behavioral perspective says that anxiety responses associated with anxiety, obsessive- compulsive, and post-traumatic stress disorders are acquired through classical conditioning and maintained through operant conditioning. The cognitive perspective attributes anxiety responses of anxiety, obsessive-compulsive, trauma and stressor-related disorders to misinterpretation of harmless situations as threatening, focusing excessive attention on perceived threats, and selectively recalling threatening information. The biological perspective attributes anxiety responses at least partly to neurotransmitter imbalances. Generalized anxiety disorder, often treated with benzodiazepines (Valium, Xanax), is associated with too little availability of the inhibitory neurotransmitter GABA in some neural circuits, while obsessive- compulsive disorder and panic disorder, often treated with antidepressants (Prozac, Paxil, Zoloft), are associated with low levels of serotonin. The evolutionary perspective attributes the presence of anxiety to natural selection for enhanced vigilance that operates ineffectively in the absence of real threats.
Somatic Symptom and Related Disorders
According to the DSM-5, somatic symptom disorders are characterized by psychiatric symptoms associated with physical complaints. People with these disorders are primarily seen in medical settings where patients/clients complain of physical symptoms such as lumps, lightheadedness, pain, paralysis, blindness, or deafness and are experiencing anxiety or maladaptive thoughts, feelings, and behavior. The terms hypochondriasis and hypochondria are no longer used.
• Somatic symptom disorder (SSD) is characterized by physical symptoms including pain and high anxiety in these individuals about having a disease. Patients need to have complained about, taken medicine for, changed lifestyle because of, or seen a physician about the symptoms and experienced anxiety that has interfered with carrying on normal activities for 6 months.
• Illness anxiety disorder (IAD) is characterized by a preoccupation with a serious medical or health condition with either no or mild physical (somatic) symptoms such as nausea or dizziness that has persisted for 6 months. A woman who was preoccupied with a callus on her finger thought the lump could be cancer although several doctors told her it was not. She kept thinking that she was going to die from it and could not get that off her mind. She was diagnosed with IAD.
• Conversion disorder (functional neurologic symptom disorder) is characterized by loss of some bodily function, such as becoming blind, deaf, or paralyzed, without physical damage to the affected organs or their neural connections as assessed by neurological examination. It is often marked by indifference and quick acceptance on the part of the patient. The symptoms usually last as long as anxiety is present.
Psychoanalyst Sigmund Freud attributed somatic symptom disorders to bottled-up emotional energy that is transformed into physical symptoms. Behaviorists explain that operant responses are learned and maintained because they result in rewards. Cognitive behaviorists further explain that the rewards enable individuals with somatoform symptom disorders to avoid some unpleasant or threatening situation, provide an explanation or justification for failure, or attract concern, sympathy, and care. Social cognitive theorists think that individuals with somatoform symptom disorders focus too much attention on their internal physiological experiences, amplifying their bodily sensations, and forming disastrous conclusions about minor complaints.
Dissociative disorders are psychological disorders that involve a sudden loss of memory (amnesia) or change in identity. If extremely stressed, an individual can experience separation of conscious awareness from previous memories and thoughts. Dissociative disorders include dissociative amnesia and dissociative identity disorder.
• Dissociative amnesia is a loss of memory for a traumatic event or period that is too painful for an individual to remember. The person holds steadfast to the fact that he or she has no memory of the event and becomes upset when others try to stimulate recall. In time, parts of the memory may begin to reappear. A woman whose baby has died in childbirth may block out that memory and perhaps the entire period of her pregnancy. When more emotionally able to handle this information, the woman may gradually come to remember it. Dissociative fugue is a subtype of dissociative amnesia.
• Dissociative fugue is a memory loss for anything having to do with personal memory, accompanied by flight from the person’s home, after which the person establishes a new identity. All skills and basic knowledge are still intact. The cause of the fugue is often abundant stress or an immediate danger of some news coming out that would prove embarrassing to the individual.
• Dissociative identity disorder (DID), formerly called multiple personality disorder, is diagnosed when two or more distinct personalities are present within the same individual. Although extremely unusual, it is most common in people who have been a victim of physical or sexual abuse when very young. Amnesia is involved when alternate personalities “take over.” Missing time is one of the clues to this diagnosis. Each alternate personality has its own memories, behaviors, and relationships and might have different prescriptions, allergies, and other physical symptoms. Although there has been some interesting work done by the National Institute for Mental Health that lends credibility to this diagnosis, many professionals are still skeptical about it.
Psychoanalysts explain dissociative disorders as repression of anxiety and/or trauma caused by such disturbances of home life as mental and/or physical abuse, rejection from parents, or sexual abuse. Many social learning theorists are skeptical about DID and think that individuals displaying the disorder are role-playing. They question why dissociative identity disorder, also known as multiple personality, has become so much more prevalent since the publication of books and the production of films dealing with the disorder and why different personalities pop out, in contrast to years ago when alternate personalities emerged very slowly.
Depressive disorders are psychological disorders characterized by extremely sad mood and lack of energy that colors the individual’s entire emotional state and disrupts the person’s normal ability to function in daily life. Most people with depressive disorders are treated at least in part by drugs, suggesting a biological etiology or cause. The prevalence of depression has been increasing, affecting at least twice as many women as men.
Because it occurs so often, depression has been called the “common cold of psychological disorders.”
• Major depressive disorder (single and recurrent episodes) involves intense depressed mood, reduced interest or pleasure in activities, loss of energy, and problems in making decisions for a minimum of 2 weeks. The individual feels sad, hopeless, discouraged, “down,” and frequently isolated, rejected, and unloved. In addition to this sadness, there are a series of changes in eating, sleeping, and motor activity, and a lack of pleasure in activities that usually caused pleasure in the past. Cognitive symptoms include low self-esteem, pessimism, reduced motivation, generalization of negative attitudes, exaggeration of seriousness of problems, and slowed thought processes. Suicidal thoughts, inappropriate guilt, and other faulty beliefs may also be present. Depression with seasonal pattern, also known as seasonal affective disorder (SAD), is a subtype of depression that recurs, usually during the winter months in the northern latitudes. Patients often respond to regular exposure to artificial bright light sources. One hypothesis as to why this happens is that shorter periods of less direct sunlight during winter disturb both mood and sleep/wake schedules, bringing on the depression.
• Premenstrual dysphoric disorder may be an unfamiliar name, but its symptoms are probably more familiar to you if you know a woman who is between menarche and menopause who tells you to excuse her behavior because she is “premenstrual.” Symptoms include at least five of the following occurring most months in the days before a woman starts her “period” (menses): marked affective lability (e.g., mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection); marked irritability, anger, or increased interpersonal conflicts; markedly depressed mood, feeling of hopelessness, or self-deprecating thoughts; marked anxiety, tension, feelings of being “keyed up” or “on edge”; decreased interest in usual activities; subjective sense of difficulty in concentration; lethargy, tiring easily, or marked lack of energy; marked change in appetite, overeating, or specific food cravings; change in sleep patterns such as sleeping too much or insomnia; a subjective sense of being overwhelmed or out of control; and other physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.
Biological psychologists have evidence from family studies, including twin studies, that there is a genetic component involved in depressive, bipolar, and related disorders. Too much of the neurotransmitter norepinephrine is available during mania; too little of norepinephrine or serotonin, during depression. Prozac, Zoloft, and Paxil belong to a class of drugs known as selective serotonin reuptake inhibitors, or SSRIs, that increase the availability of serotonin by blocking reuptake. PET and fMRI scans reveal lowered brain energy consumption in individuals with depression, especially in the left frontal lobe, associated with positive emotions; and MRI and CAT scans show abnormal shrinkage of frontal lobes in long-term severely depressed patients. Psychoanalysts attribute depression to early loss of or rejection by a parent, resulting in depression when the individual experiences personal losses later in life and turns angry inside. Behaviorists say that depressed people elicit negative reactions from others, resulting in maintenance of depressed behaviors. The social cognitive (cognitive-behavioral) perspective holds that self-defeating beliefs that may arise from learned helplessness influence biochemical events, fueling depression. Learned helplessness is the feeling of futility and passive resignation that results from inability to avoid repeated aversive events. According to psychologist Martin Seligman, a negative explanatory style puts an individual at risk for depression when bad events occur. When bad events happen, people with a negative (pessimistic) explanatory style think the bad events will last forever, affect everything they do, and are all their fault; they give stable, global, internal explanations. Cognitive viewpoints include Aaron Beck’s theory (cognitive triad) that depressed individuals have a negative view of themselves, their circumstances, and their future possibilities, and that they generalize from negative events; and Susan Nolen-Hoeksema’s rumination theory that depressed people who go over and over the negative event in their minds are prone to more intense depression than those who distract themselves.
Bipolar and Related Disorders
• Bipolar disorder is characterized by mood swings alternating between periods of major depression and mania, the two poles of emotions. Symptoms of the manic state include an inflated ego, little need for sleep, excessive talking, and impulsivity. Rapid cycling is usually characterized by short periods of mania followed almost immediately by deep depression, usually of longer duration. Newer drug treatments, including lithium carbonate, have proven successful in bringing symptoms under control for many sufferers.
Schizophrenia Spectrum and Other Psychotic Disorders
Schizophrenia spectrum and other psychotic disorders are a diverse group of disorders that include disorders also included in other groups, such as schizotypal personality disorder. Psychosis, reality distortion evidenced by highly disordered thought processes, distinguishes the disorders in this classification. The most common disorder in the group is schizophrenia. An addition in DSM-5 is catatonia.
• Schizophrenia is characterized by symptoms such as hallucinations, delusions, disorganized thought (speech), disorganized or abnormal motor behavior (including catatonia), and negative symptoms. About 1 percent of people in the world have this disorder. Because one cause of schizophrenia is an excess of dopamine, anti-psychotic drugs are effective in treating some symptoms in about 50 percent of patients. A positive symptom of schizophrenia isn’t something that is good; it is a behavioral excess or peculiarity rather than an absence. Delusions and hallucinations, two frequent signs of schizophrenia, are both positive symptoms. Delusions are fixed beliefs that are maintained even when compelling evidence to the contrary is presented. Hallucinations are false sensory perceptions, such as the experience of seeing, hearing, or otherwise perceiving something that is not present. A lack of emotion, sometimes called flat affect; social withdrawal; apathy; inattention; and a lack of communication are examples of negative symptoms of schizophrenia.
Some people with schizophrenia may make no sense when talking and act in a bizarre way that is inappropriate for a situation, such as laughing or acting silly during a solemn ceremony. Other people with schizophrenia evidence paranoid symptoms characterized by delusions of grandeur, persecution, and/or reference. For example, people with paranoid symptoms often think that ordinary events, objects, or behaviors of others have unusual and particular meaning for them (delusions of reference). They often misinterpret occurrences as directly relevant to them, such as lightning being a signal from God. They frequently believe that such attention is because of their specialness and that they are world leaders (delusions of grandeur). They then think that others are so threatened that these other people plot against them (delusions of persecution). Suffering delusions of persecution, people are fearful and can be a danger as they attempt to defend themselves against their imagined enemies. Schizophrenia with catatonic symptoms is characterized by disordered movement patterns, sometimes immobile stupor, or frenzied and excited behaviors.
Biological psychologists attribute some positive symptoms of schizophrenia, such as hallucinations and delusions, to excessively high levels of the neurotransmitter dopamine, and some negative symptoms, such as lack of emotion and social withdrawal, to lack of the neurotransmitter glutamate. Brain scans show abnormalities in numerous brain regions of individuals with schizophrenia. These abnormalities may result from teratogens such as viruses or genetic predispositions. The diathesis-stress model holds that people predisposed to schizophrenia are more vulnerable to stressors than other people. Thus, only people who are both predisposed and stressed are likely to develop schizophrenia. Psychoanalysts attribute schizophrenia to fixation at the oral stage and a weak ego. Behaviorists assume that schizophrenia results from reinforcement of bizarre behavior. Humanists think schizophrenia is caused by a lack of congruence between the public self and actual self.
Schizophrenia is NOT split personality! People with schizophrenia experience a split with reality. People with dissociative identity disorder show two or more personalities.
• Catatonia is characterized by the presence of behavior and movement traits. Movement traits can include immobility, not reacting to external stimuli (stupor), posturing, rigidity, staring, and grimacing. Waxy flexibility is a motor symptom demonstrated when someone else moves the arm or leg of a patient remaining in one position like a statue, and the patient keeps the arm or leg in the new position maintaining a posture that would normally be impossible to hold by others. Behavioral interactions with others can include unresponsiveness (mutism), negativism, meaningless repetition of words or sounds (echolalia), and withdrawal. Diminished activity may or may not cycle with short periods of agitation and frenzied, purposeless movements such as neck twitches, arm jerks, or even running and kicking. In the excited state, patients can evidence impulsivity, or combativeness. Catatonic excitement can be very dangerous.
People with personality disorders have longstanding, maladaptive thought and behavior patterns that are troublesome to others, harmful, or illegal. Although these patterns impair people’s social functioning, individuals do not experience anxiety, depression, or delusions. DSM-5 groups personality disorders into three clusters: odd/eccentric (including paranoid, schizoid, schizotypal), dramatic/emotionally problematic (including histrionic, narcissistic, borderline, and antisocial), and chronic fearfulness/avoidant (including avoidant, dependent, and obsessive-compulsive). See Table 12.1.
Table 12.1 Personality Disorders
Disorders of infancy, childhood, and adolescence include intellectual disability (see Chapter 9), attention-deficit/hyperactivity disorder, and autism spectrum disorder.
• Attention-deficit/hyperactivity disorder (ADHD) is a common childhood disorder with evident symptoms by age 12. ADHD affects up to 9 percent of teens between 13 to 19 years old. Boys are four times more at risk than girls. Symptoms include difficulty paying attention and staying focused, difficulty controlling behavior, and hyperactivity to a greater degree than most other children of the same age over a period of at least 6 months. Symptoms of inattention are evidenced when a child is easily distracted, misses details, forgets things, switches from one activity to another, gets bored with a task after only a few minutes, does not complete tasks, loses things needed to complete tasks, does not listen when spoken to, daydreams, becomes easily confused, and has difficulty processing information as quickly and accurately as others. A child who has symptoms of impulsivity may be very impatient, blurt out comments inappropriately, act out without considering consequences, interrupt conversations or the activities of others, and have difficulty waiting for things they want or waiting to take a turn. A child showing symptoms of hyperactivity may fidget and squirm, talk incessantly, move around touching or playing with everything in sight, have trouble sitting still, and have difficulty doing activities silently. Three subtypes of ADHD are predominantly hyperactive-impulsive, predominantly inattentive, and combined hyperactive-impulsive and inattentive. Most children with ADHD have the combined type. The inattentive and inappropriate behaviors of people with ADHD often lead to personal, social, and academic or work problems.
• Autism spectrum disorder (ADS) is a category of disorders, new to DSM-5, that were previously four separate disorders and is now considered a single condition with varying levels of severity. These include autistic disorder (autism), Asperger’s disorder, childhood disintegrative disorder, and persuasive developmental disorder not otherwise specified. ASD is a neurological umbrella of disorders first diagnosed in childhood. Diagnosis is based on three primary symptoms: a lack of responsiveness to other people, impairment in verbal and nonverbal communications, and very limited activities and interests. Children with ASD engage in repetitive behaviors such as hand flapping or repeating sounds or phrases. About 1 in 88 children is diagnosed with autism. ASD is three to four times more common in boys than girls.
Changes in the brain can affect all aspects of behavior and mental processes. DSM-5 labels disorders characterized by a decline from a previous level of neurocognitive function as neurocognitive disorders, and ICD-11 labels them as organic disorders. A loss of function may involve complex attention, executive function, learning and memory, language, perceptual-motor skills, and social cognition. DSM-5 categorizes disorders as major or mild and may be linked to a specific disease or brain damage such as Alzheimer’s disease, traumatic brain injury, HIV infection, and Parkinson’s disease. All of these can result in dementia, the loss of mental abilities.
• Alzheimer’s disease is a fatal degenerative disease in which brain neurons progressively die. Mild or major neurocognitive disorder due to Alzheimer’s disease is characterized by loss of memory, reasoning, emotion, and control of bodily functions. Alzheimer’s strikes 10 percent of the world’s population age 65 and older. Almost two-thirds of Americans with Alzheimer’s are women.
• Delirium is characterized by impaired attention and a lack of awareness of the environment. It may involve loss of recent memory or orientation, language disturbance such as rambled speech or mumbling, and perceptual disturbance. Associated features include change in the sleep-wake cycle, change in emotional states, and worsening of behavioral problems in the evening.