14. Psychological Disorders

Define psychological disorders and explain how they are classified

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• Describe how psychological disorders are defined, as well as the inherent difficulties in doing so

• Describe the basic features of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR) and how it is used to classify disorders

• Discuss perspectives on the origin of psychological disorders

Describe the features and characteristic symptoms of anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder

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• Explain phobias and their acquisition through learning

• Describe the main features of social anxiety disorder and generalized anxiety disorder

• Explain panic disorder and panic attacks

• Describe the main features, development, and prevalence of obsessive-compulsive disorder, body dysmorphic disorder, and hoarding disorder

• Describe the nature, development, symptoms, and risk factors associated with posttraumatic stress disorder

Describe the characteristic symptoms and risk factors of mood disorders, including major depressive disorder and bipolar disorder

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• Describe the symptoms, results, and risk factors of major depressive disorder and related disorders

• Describe the symptoms and risk factors of bipolar disorder

• Describe genetic, biological, and psychological explanations of major depressive disorder

• Discuss the relationship between mood disorders and suicidal ideation, as well as factors associated with suicide

Explain symptoms and potential causes of schizophrenic and dissociative disorders

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• Categorize and describe the major symptoms of schizophrenia

• Describe the interplay between genetic, biological, and environmental factors that are associated with the development of schizophrenia

• Identify and differentiate the symptoms and potential causes of dissociative amnesia, depersonalization/ derealization disorder, and dissociative identity disorder

Describe and differentiate between personality disorders, including borderline and antisocial personality disorder

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• Define personality disorders and distinguish between the three clusters of personality disorders

• Identify the basic features of borderline personality disorder, and its etiology

• Describe the basic features of antisocial personality disorder and its etiology

Explain common neurodevelopmental disorders, including attention deficit/hyperactivity disorder and autism spectrum disorder

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• Describe the symptoms, prevalence, and contributing factors of attention deficit/hyperactivity disorder

• Describe the symptoms and prevalence of autism spectrum disorder, as well as the contributing factors that cause the disorder

Essential Concepts

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Defining Psychological Disorders

Psychological disorders are characterized by abnormal thoughts, feelings, and behaviors, but determining what constitutes a disorder is a complex task. Harmful dysfunction describes the view that psychological disorders result from the inability of an internal mechanism to perform its natural function. Many of the features of harmful dysfunction conceptualization have been incorporated in the APA’s formal definition of psychological disorders. According to this definition, the presence of a psychological disorder is signaled by significant disturbances in thoughts, feelings, and behaviors; these disturbances must reflect some kind of dysfunction (biological, psychological, or developmental), must cause significant impairment in one’s life, and must not reflect culturally expected reactions to certain life events.

The DSM-5 is the classification system widely used to diagnose and study psychological disorders, providing explicit criteria for each disorder. The International Classification of Diseases (ICD) is a comprehensive classification system used for healthcare worldwide, including mental health, and is published by the World Health Organization (WHO), while the Diagnostic and Statistical Manual of Mental Disorders (DSM) is favored for research and clinical diagnosis in the United States.

Psychopathology integrates biological (e.g. faulty biological processes) and psychosocial (e.g. stress and environment) perspectives on the origin of psychological disorders. The diathesis-stress model proposes that individuals with underlying vulnerabilities are more likely to develop a disorder when exposed to stressful events.

Anxiety and Related Disorders

Anxiety disorders are a group of disorders in which a person experiences excessive, persistent, and distressing fear and anxiety that interferes with normal functioning. Anxiety disorders include specific phobia: a specific unrealistic fear; social anxiety disorder: extreme fear and avoidance of social situations; panic disorder: suddenly overwhelmed by panic even though there is no apparent reason to be frightened; agoraphobia: an intense fear and avoidance of situations in which it might be difficult to escape; and generalized anxiety disorder: a relatively continuous state of tension, apprehension, and dread.

Obsessive-compulsive and related disorders in the DSM-5 involve intrusive thoughts and/or repetitive behaviors. This includes obsessive-compulsive disorder with unwanted thoughts and repetitive actions, body dysmorphic disorder with excessive preoccupation about physical flaws, and hoarding disorder characterized by difficulty discarding objects leading to cluttered living spaces.

PTSD, formerly known as shell shock and combat neurosis, is now defined as a disorder resulting from a traumatic or highly stressful event, with symptoms lasting one month or longer. These symptoms include intrusive memories, flashbacks, avoidance, negative emotions, detachment, irritability, and hypervigilance. Not everyone who experiences trauma develops PTSD, as there are identified risk factors associated with its development.

Depression and Related Disorders

Mood disorders are those in which the person experiences severe disturbances in mood and emotion. They include depressive disorders and bipolar and related disorders. Depressive disorders include major depressive disorder, which is characterized by episodes of profound sadness and loss of interest or pleasure in usual activities and other associated features, and persistent depressive disorder, which marked by a chronic state of sadness.

Bipolar disorder is characterized by mood states that vacillate between sadness and euphoria; a diagnosis of bipolar disorder requires experiencing at least one manic episode, which is defined as a period of extreme euphoria, irritability, and increased activity. During a manic episode, a person will likely exhibit behaviors atypical for that person. They may become excessively talkative, exhibit flight of ideas, and make grandiose plans. They may go on a spending spree, maxing out their credit card with items they can not afford, gamble, or engage in risky sexual behaviors. About fifty percent of people suffering from bipolar disorder do not receive treatment. Bipolar disorder is a definitive risk factor for suicide, with about a third of people with bipolar disorder attempting suicide.

When a person’s pain and distress completely overwhelm their ability to cope, some people may consider suicide. People who suffer from mental health and substance abuse problems are at a much higher risk of suicide than the general public. Males die by suicide at a significantly higher rate than females, and males use much more lethal means in their attempts. A person contemplating suicide needs help and should not have access to lethal means of suicide, such as firearms. If you or someone you know is contemplating suicide, there are many helpful resources. Three of them are listed below:

• Visit National Suicide Prevention Lifeline, call 1-800-273-8255, or text the Crisis Text Line (text HELLO to 741741).

• Visit the American Foundation for Suicide Prevention.

• Visit The National Institute of Health Website page on suicide.

Schizophrenia and Related Disorders

Schizophrenia is a severe disorder that leads to a breakdown in functioning and often requires hospitalization. It is characterized by hallucinations, delusions, incoherent thinking, bizarre behavior, flat emotions, and lack of motivation. Genetic factors play a central role, while environmental factors and neurotransmitter abnormalities are also implicated. A promising new area of schizophrenia research involves identifying individuals who show prodromal symptoms and following them over time to determine which factors best predict the development of schizophrenia. Future research may enable us to pinpoint those especially at risk for developing schizophrenia and who may benefit from early intervention.

The main characteristic of dissociative disorders is that people become dissociated from their sense of self, resulting in memory and identity disturbances. Dissociative disorders listed in the DSM-5 include dissociative amnesia, depersonalization/derealization disorder, and dissociative identity disorder. A person with dissociative amnesia is unable to recall important personal information, often after a stressful or traumatic experience.

Depersonalization/derealization disorder is characterized by recurring episodes of depersonalization (i.e., detachment from or unfamiliarity with the self) and/or derealization (i.e., detachment from or unfamiliarity with the world). A person with dissociative identity disorder exhibits two or more well-defined and distinct personalities or identities, as well as memory gaps for the time during which another identity was present.

Dissociative identity disorder has generated controversy, mainly because some believe its symptoms can be faked by patients if presenting its symptoms somehow benefits the patient in avoiding negative consequences or taking responsibility for one’s actions. The diagnostic rates of this disorder have increased dramatically following its portrayal in popular culture. However, many people legitimately suffer over the course of a lifetime with this disorder.

Personality Disorders

Individuals with personality disorders exhibit a personality style that is inflexible, causes distress and impairment, and creates problems for themselves and others. The DSM-5 recognizes 10 personality disorders, organized into three clusters. The disorders in Cluster A include those characterized by a personality style that is odd and eccentric. Cluster B includes personality disorders characterized chiefly by a personality style that is impulsive, dramatic, highly emotional, and erratic, and those in Cluster C are characterized by a nervous and fearful personality style.

Two Cluster B personality disorders, borderline personality disorder and antisocial personality disorder, are especially problematic. People with borderline personality disorder show marked instability in mood, behavior, and self-image, as well as impulsivity. They cannot stand to be alone, are unpredictable, have a history of stormy relationships, and frequently display intense and inappropriate anger. Genetic factors and adverse childhood experiences (e.g., sexual abuse) appear to be important in its development. People with antisocial personality display a lack of regard for the rights of others; they are impulsive, deceitful, irresponsible, and unburdened by any sense of guilt. Genetic factors and socialization both appear to be important in the origin of antisocial personality disorder. Research has also shown that those with this disorder do not experience emotions the way most other people do.

Neurodevelopmental Disorders

Neurodevelopmental disorders are a group of disorders that are typically diagnosed during childhood and are characterized by developmental deficits in personal, social, academic, and intellectual realms; these disorders include attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder. ADHD is characterized by a pervasive pattern of inattention and/or hyperactive and impulsive behavior that interferes with normal functioning. Genetic and neurobiological factors contribute to the development of ADHD, which can persist well into adulthood and is often associated with poor long-term outcomes.

The major features of autism spectrum disorder include deficits in social interaction and communication and repetitive movements or interests. As with ADHD, genetic factors appear to play a prominent role in the development of autism spectrum disorder; exposure to environmental pollutants such as mercury have also been linked to the development of this disorder. Although it is believed by some that autism is triggered by the MMR vaccination, evidence does not support this claim.

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Psychological Disorders Cheat Sheet from Lumen One Introduction to Psychology, Lumen Learning, https://lumenlearning.com/, CC BY.

Psychology, 2e, OpenStax, https://openstax.org/books/psychology-2e/, CC BY.

David Wiley