Chapter 117. Comparing Psychological Disorders

1. Psychological disorders are persistent disturbances in thinking, behavior, or emotions. In order to be considered clinically significant, a disorder must be distressing and must lead to dysfunctional behavior. The standard system of classifying psychological disorders is based on the Diagnostic and Statistical Manual of Mental Disorders (DSM). The current edition (DSM-5) was published in 2013.

2. The DSM-5 describes roughly 300 specific disorders, grouped into about 20 major categories. This activity will focus on only six categories of disorders: anxiety disorders—including obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD)—dissociative disorders, eating disorders, personality disorders, mood disorders, and schizophrenia.

3. What is the chief symptom of an anxiety disorder? Anxiety, of course—anxiety that is out of proportion to the actual danger or threat that is posed. The clearest example of this kind of anxiety is phobia, a persistent irrational fear of a specific object or situation. In contrast, a person with generalized anxiety disorder is constantly tense and in a state of autonomic nervous system arousal for no apparent reason, experiencing "free-floating" anxiety. Panic disorder is marked by frequent panic attacks, each one a minutes-long episode of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations. Panic attacks can also accompany any of the other anxiety disorders.

4. Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are also characterized by high levels of anxiety, but DSM-5 has moved them out of the anxiety disorders category and given each of them its own category. OCD is characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions). In contrast, a person with PTSD is constantly tense and apprehensive, startles easily, has frequent haunting memories ("flashbacks" to a specific traumatic event), and insomnia with frequent nightmares.

5. In dissociative disorders, a person’s current conscious awareness becomes separated (dissociated) from other aspects of the person’s life, including memories of past events. Dissociative amnesia is characterized by selective memory loss, typically memories of stressful or traumatic experiences. Dissociative identity disorder is more extreme, involving temporary loss of one’s identity and personality traits, as the person shifts from one "personality" to another. This was formerly called multiple personality disorder.

6. Eating disorders are serious and distressing disruptions to a person’s pattern of food consumption. This category of disorders is more common in females than males, and it usually has a strong anxiety component. Anorexia nervosa involves a sharp reduction in eating, producing weight loss so dramatic that it can lead to health problems or even death. Individuals with bulimia nervosa typically go through a "binge-purge" cycle, with episodes of excessive eating followed by attempts to cancel the ingested calories through vomiting or use of laxatives. Binge-eating disorder is characterized by episodes of excessive eating followed by remorse, but without attempts to purge.

7. Personality disorders are disorders characterized by rigid, persistent behavior patterns that impair social functioning, usually without anxiety, depression, or delusions. These disorders are often more distressing to the individual’s family and friends than to the person with the disorder! Antisocial personality disorder, more common in males, is characterized by a ruthless disregard for the welfare of others and a lack of remorse for wrongdoing. Individuals with avoidant personality disorder have high levels of anxiety and pervasive feelings of social inadequacy, leading them to withdraw from contact with others. Narcissistic personality disorder involves inflated self-perceptions and self-focused behavior coupled with a lack of interest and empathy toward others. Individuals with borderline personality disorder are unstable and unpredictable, due to abrupt mood swings and impulsive behavior.

8. Mood disorders are characterized by a dramatic and persistent shift in a person’s mood and energy level. These mood disturbances come in two forms, which DSM-5 calls depressive disorders (mood swings, but downward only) and bipolar and related disorders (mood swings in both directions). Major depressive disorder involves a period of weeks or months of deeply depressed mood, accompanied by feelings of worthlessness and diminished interest in life. Dysthymia is a more persistent, but usually milder, depression. Individuals with bipolar disorder typically experience a few weeks of extreme optimism and high energy (called mania) followed by months of deep depression. Cyclothymia is considered a milder but more persistent form of bipolar disorder.

9. Schizophrenia is often regarded as the most serious of the psychological disorders, because it involves a break from reality and rational behavior. A person with schizophrenia may show positive symptoms such as perceptual distortions, irrational beliefs, or disturbances in thinking and speech. Alternatively, the person may exhibit negative symptoms such as social withdrawal and lack of appropriate emotions. In chronic (process) schizophrenia the (mainly negative) symptoms begin in the teen years and gradually worsen. In acute (reactive) schizophrenia, a well-adjusted person suddenly develops (mainly positive) symptoms in response to traumatic experiences. Recovery is more likely in cases of acute schizophrenia.