Chapter 9: Section 3: Psychiatric Disorders
Let’s 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 provided.
1. Delirium, Dementia, Amnestic, and Other Cognitive Disorders
The primary symptoms of these disorders include significant negative changes in the way a person thinks and/or remembers. All of these disorders have either a medical or substance related cause and are therefore not discussed in detail in this chapter.
Like 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.
3. Substance Related Disorders
There 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.
Abuse 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.
Dependence 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, headaches, etc.
4. Schizophrenia and other Psychotic Disorders
The major symptom of these disorders is psychosis, or delusions and hallucinations. The major disorders include schizophrenia and schizoaffective disorder.
Schizophrenia 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 delusions 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.
Schizoaffective 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.
5. Mood Disorders
The 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.
Major 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 of suicide.
Dysthymia 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 extreme lows.
Bipolar 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 hypomanic episodes).
Like Dysthymia and Major Depression, Cyclothymia is considered a lesser form of Bipolar Disorder.
6. Anxiety Disorders
Anxiety 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.
Panic 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.
Agoraphobia 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.
Specific 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 everyday life.
Obsessive-Compulsive 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.
Posttraumatic 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.
Generalized 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.
7. Somatoform Disorders
Disorders 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, Hypochondriasis.
Somatization Disorder refers to generalized or vague symptoms such as stomach aches, sexual pain, gastrointestinal problems, and neurological symptoms which have no found medical cause.
Pain Disorder refers to significant pain over an extended period of time without medical support.
Hypochondriasis 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.
8. Factitious Disorder
Factitious 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 special rights.
9. Dissociative Disorders
The 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.
Dissociative 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 restored.
Dissociative 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.
Depersonalization 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.
Dissociative 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.
10. Sexual Dysfunctions, Paraphilias, and Gender Identity Disorders
These 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 psychological diagnosis.
Sexual 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 Disorder [male][female](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).
Paraphilias include Exhibitionism (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 object), Pedophilia (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).
The 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 identity.
11. Eating Disorders
Eating disorders are characterized by disturbances in eating behavior. There are two types: Anorexia Nervosa and Bulimia Nervosa.
Anorexia 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.
The 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 exercise).
12. Sleep Disorders
All sleep disorders involve abnormalities in sleep in one of two categories, dysomnias and parasomnias.
Dysomnias 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 sleep).
Parasomnias 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 once awakened).
13. Impulse Control Disorders
Disorders in this category include the failure or extreme difficulty in controlling impulses despite the negative consequences.
Specific 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).
14. Adjustment Disorders
This category consists of an inappropriate or inadequate adjustment to a life stressor. Adjustment disorders can include depressive symptoms, anxiety symptoms, and/or conduct or behavioral symptoms.
15. Personality Disorders
Personality 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.
There 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).