1: Introduction and History of Mental Illness
2: Classifying Psychopathology
3: Psychiatric Disorders
4: Stigma, Stereotyping, and the Mentally Ill
discuss the first two axes in more detail now as these are what we
typically think of when we think of mental illness or psychopathology.
The DSM IV (American Psychiatric Association, 1994) identifies 15 general areas of adult mental illness. We'll
discuss each one briefly. For more information about a specific
category, open Psychiatric Disorders on the Main Menu and follow the links
Delirium, Dementia, Amnestic, and Other Cognitive Disorders
Mental Disorders Due to a Medical Condition
those above, all disorders in this category are directly related to a
medical condition. If symptoms of anxiety, depression, etc are a
direct result of a medical condition, this is the classification used.
are two disorders listed in this category: Substance Abuse and Substance
Dependence. Both involve the ingestion of a substance (alcohol,
drug, chemical) which alters either cognitions, emotions, or behavior.
refers to the use of the substance to the
point that it has a negative impact on the person's life. This can
mean receiving a DUI for drinking and driving, being arrested for public
intoxication, missing work or school, getting into fights, or struggling
with relationships because of the substance.
refers to what we typically think of as
'addicted.' This occurs when (a) the use of the substance is
increased in order to get the same effect because the person has
developed a tolerance, (b) the substance is taken more frequently and in
more dangerous situations such as drinking and driving, or (c) the
person continues to take the substance despite negative results and/or
the desire to quit, or (d) withdrawal symptoms are present when the
substance is stopped, such as delirium tremors (DTs), amnesia, anxiety,
and other Psychotic Disorders
major symptom of these disorders is psychosis, or delusions and
hallucinations. The major disorders include schizophrenia and
is probably the most recognized term in the
study of psychopathology, and it is probably the most misunderstood.
First of all, it does not mean that the person has multiple
personalities. The prefix 'schiz' does mean split, but it refers
to a splitting from reality. The predominant features of
schizophrenia include hallucinations
and disorganized speech and behavior, inappropriate affect, and
avolition. There is no known cure for schizophrenia and is without
doubt the most debilitating of all the mental illnesses.
Disorder is characterized by a
combination of the psychotic symptoms such as in Schizophrenia and the
mood symptoms common in Major Depression and/or Bipolar Disorder.
The symptoms are typically not as severe although when combined together
in this disorder, they can be quite debilitating as well.
disorders in this category include those where the primary symptom is a
disturbance in mood. The disorders include Major Depression,
Dysthymic Disorder, Bipolar Disorder, and Cyclothymia.
Depression (also known as
depression or clinical depression) is characterized by depressed mood,
diminished interest in activities previously enjoyed, weight
disturbance, sleep disturbance, loss of energy, difficulty
concentrating, and often includes feelings of hopelessness and thoughts
is often considered a lesser, but more
persistent form of depression. Many of the symptoms are similar
except to a lesser degree. Also, dysthymia, as opposed to Major
Depression is more steady rather than periods of normal feelings and
Disorder (previously known as
Manic-Depression) is characterized by periods of extreme highs (called
mania) and extreme lows as in Major Depression. Bipolar Disorder
is subtyped either I (extreme or hypermanic episodes) or II (moderate or
Dysthymia and Major Depression, Cyclothymia
is considered a lesser form of Bipolar Disorder.
Disorders categorize a large number of disorders where the primary
feature is abnormal or inappropriate anxiety. The disorders in
this category include Panic Disorder, Agoraphobia, Specific Phobias,
Social Phobia, Obsessive-Compulsive Disorder, Posttraumatic Stress
Disorder, and Generalized Anxiety Disorder.
Disorder is characterized by a
series of panic attacks. A panic attack is an inappropriate
intense feeling of fear or discomfort including many of the following
symptoms: heart palpitations, trembling, shortness of breath, chest
pain, dizziness. These symptoms are so severe that the person may
actually believe he or she is having a heart attack. In fact,
many, if not most of the diagnoses of Panic Disorder are made by a
physician in a hospital emergency room.
literally means fear of the marketplace.
It refers to a series of symptoms where the person fears, and often
avoids, situations where escape or help might not be available, such as
shopping centers, grocery stores, or other public place.
Agoraphobia is often a part of panic disorder if the panic attacks are
severe enough to result in an avoidance of these types of places.
or Simple Phobia and Social
Phobia represents an intense fear and often an avoidance of a
specific situation, person, place, or thing. To be diagnosed with
a phobia, the person must have suffered significant negative
consequences because of this fear and it must be disruptive to their
Disorder is characterized by
obsessions (thoughts which seem uncontrollable) and compulsions
(behaviors which act to reduce the obsession). Most people think
of compulsive hand washers or people with an intense fear of dirt or of
being infected. These obsessions and compulsions are disruptive to
the person's everyday life, with sometimes hours being spent each day
repeating things which were completed successfully already such as
checking, counting, cleaning, or bathing.
Stress Disorder (PTSD) occurs
only after a person is exposed to a traumatic event where their life or
someone else's life is threatened. The most common examples are
war, natural disasters, major accidents, and severe child abuse.
Once exposed to an incident such as this, the disorder develops into an
intense fear of related situations, avoidance of these situations,
reoccurring nightmares, flashbacks, and heightened anxiety to the point
that it significantly disrupts their everyday life.
Anxiety Disorder is diagnosed
when a person has extreme anxiety in nearly every part of their life.
It is not associated with just open places (as in agoraphobia), specific
situations (as in specific phobia), or a traumatic event (as in PTSD).
The anxiety must be significant enough to disrupt the person's everyday
life for a diagnosis to be made.
in this category include those where the symptoms suggest a medical
condition but where no medical condition can be found by a physician.
Major disorders in this category include Somatization Disorder, Pain
Disorder refers to generalized or vague symptoms such as stomach aches,
sexual pain, gastrointestinal problems, and neurological symptoms which
have no found medical cause.
Disorder refers to significant pain over an extended period of time
without medical support.
is a disorder characterized by significant and persistent fear that one
has a serious or life-threatening illness despite medical reassurance
that this is not true.
Disorder is characterized by the intentionally produced or feigned
symptoms in order to assume the 'sick role.' These people will
often ingest medication and/or toxins to produce symptoms and there is
often a great secondary gain in being placed in the sick role and being
either supported, taken care of, or otherwise shown pity and given
main symptom cluster for dissociative disorders include a disruption in
consciousness, memory, identity, or perception. In other words,
one of these areas is not working correctly causing significant distress
within the individual. The major diagnoses in this category
include Dissociative Amnesia, Dissociative Fugue, Depersonalization
Disorder, and Dissociative Identity Disorder.
Amnesia is characterized by
memory gaps related to traumatic or stressful events which are too
extreme to be accounted for by normal forgetting. A traumatic
event is typically a precursor to this disorder and memory is often
Fugue represents an illness where
an individual, after an extremely traumatic event, abruptly moves to a
new location and assumes a new identity. This disorder is very
rare and typically runs its course within a month.
Disorder, occurring after an
extreme stressor, includes feelings of unreality, that your body does
not belong to you, or that you are constantly in a dreamlike state.
Identity Disorder (DID) is most
widely known as Multiple Personality Disorder or MPD. DID is the
presence of two or more distinct personalities within an individual.
These personalities must each take control of the individual at varying
times and there is typically a gap in memory between personalities or
"alters." This disorder is quite rare and a significant
trauma such as extended sexual abuse is usually the precursor.
Paraphilias, and Gender Identity
disorders are all related to sexuality, either in terms of functioning
(Sexual Dysfunctions), distressing and often irresistible sexual urges
(Paraphilias), and gender confusion or identity (Gender Identity
Disorder. It should be noted that for these, as well as many other
categories, a medical reason should always be ruled out before making a
Dysfunctions include Hypoactive
Sexual Desire Disorder (deficiency or absence of sexual fantasies
and desire for sexual activity), Sexual
Aversion Disorder (persistent or recurring aversion to or avoidance
of sexual activity), Sexual
Arousal and Male
Erectile Disorder (Inability to attain or maintain until completion
of sexual activity adequate lubrication (in women) or erection (in men)
in response to sexual excitement), Orgasmic
(delay or absence of orgasm following normal excitement and
sexual activity), and Premature
Ejaculation (ejaculation with minimal sexual stimulation before or
shortly after penetration and before the person wishes it).
(the intense urge to expose oneself to an unsuspecting stranger), Voyeurism
(the intense urge to watch an unsuspecting person in various states of
undress or sexual activity), Fetishism
(intense sexual fantasies, urges, and behaviors involving an inanimate
(sexually arousing fantasies. urges, and behavior involving a
prepubescent child), Sexual
Masochism (intense sexual fantasies, urges, and behavior involving
the act of being beaten, humiliated, and/or bound), and Sexual
Sadism (intense sexual fantasies, urges, and behavior involving the
infliction of pain and/or humiliation on another person).
final category, Gender
Identity Disorder, is characterized by a strong and persistent
identification with the opposite sex and the belief that one is actually
the opposite sex due to an extreme discomfort in one's present sexual
disorders are characterized by disturbances in eating behavior.
There are two types: Anorexia Nervosa and Bulimia Nervosa.
is characterized by failure to maintain body
weight of at least 85% of what is expected, fear of losing control over
your weight or of becoming 'fat.' There is typically a distorted
body image, where the individual sees themselves as overweight despite
overwhelming evidence to the contrary.
key characteristics of Bulimia
include bingeing (the intake of large quantities of food) and purging
(elimination of the food through artificial means such as forced
vomiting, excessive use of laxatives, periods of fasting, or excessive
sleep disorders involve abnormalities in sleep in one of two categories,
dysomnias and parasomnias.
are related to the amount, quality and/or timing of sleep.
Examples of sleep disorders include insomnia (inability or reduced
ability to sleep), hypersomnia (excessive sleepiness and prolonged sleep
without physical justification), and narcolepsy (irresistible attacks of
refer to sleep disturbances related to behavioral or physiological
events related to sleep. Disorders in this subcategory include
nightmare disorder (occurance of extremely frightening dreams which
result in awakening and resulting distress), sleep terror disorder
(similar to nightmare disorder but the fear is more intense and the
person is often unresponsive during the episode), and sleepwalking
disorder (walking or performing tasks during sleep without recollection
in this category include the failure or extreme difficulty in
controlling impulses despite the negative consequences.
disorders include Intermittent Explosive Disorder (failure to resist
aggressive impulses resulting in serious assaults or destruction of
property), Kleptomania (stealing objects which are not needed),
Pyromania (fire starting for pleasure or relief of tension),
Pathological Gambling (maladaptive gambling behavior), and
trichotillomania (pulling out of one's own hair).
Disorders are characterized by an enduring pattern of thinking, feeling,
and behaving which is significantly different from the person's culture
and results in negative consequences. This pattern must be
longstanding and inflexible for a diagnosis to be made.
are ten types of personality disorders, all of which result in
significant distress and/or negative consequences within the individual:
Paranoid (includes a pattern of distrust and suspiciousness, Schizoid
(pattern of detachment from social norms and a restriction of emotions),
Schizotypal (pattern of discomfort in close relationships and
eccentric thoughts and behaviors), Antisocial (pattern of
disregard for the rights of others, including violation of these rights
and the failure to feel empathy), Borderline (pattern of
instability in personal relationships, including frequent bouts of
clinginess and affection and anger and resentment, often cycling between
these two extremes rapidly), Histrionic (pattern of excessive
emotional behavior and attention seeking), Narcissistic (pattern of
grandiosity, exaggerated self-worth, and need for admiration), Avoidant
(pattern of feelings of social inadequacies, low self-esteem, and
hypersensitivity to criticism), and Obsessive-Compulsive (pattern
of obsessive cleanliness, perfection, and control).