Unit 5.4: Selection of Categories of Psychological Disorders

Key Symptoms:

• Chronic, excessive worry about multiple areas (work, health, family, finances)
• Difficulty controlling worry
• Restlessness, feeling on edge
• Easily fatigued
• Difficulty concentrating, mind going blank
• Irritability
• Muscle tension
• Sleep disturbances

Panic Attack Symptoms:

Sudden surge of intense fear or discomfort that peaks within minutes:

• Pounding heart, rapid heart rate
• Sweating, trembling, shaking
• Shortness of breath, feeling of choking
• Chest pain or discomfort
• Nausea, dizziness, lightheadedness
• Chills or heat sensations
• Numbness or tingling
• Feeling of unreality (derealization) or detachment from self (depersonalization)
• Fear of losing control or "going crazy"
• Fear of dying

Specific Phobia

Intense fear of specific object or situation

• Animal type: Spiders, snakes, dogs
• Natural environment: Heights, storms, water
• Blood-injection-injury: Seeing blood, getting injections
• Situational: Flying, elevators, enclosed spaces (claustrophobia)

Social Anxiety Disorder (Social Phobia)

Intense fear of social situations where person might be scrutinized or judged

• Fear of public speaking, performing, eating in public
• Fear of embarrassment or humiliation
• Avoids social situations
• Physical symptoms: blushing, sweating, trembling

Agoraphobia

Fear of situations where escape might be difficult or help unavailable if panic symptoms occur

• Fear of open spaces, crowds, public transportation
• Fear of leaving home
• Often accompanies panic disorder
• Person requires companion to go out or stays home

Obsessions

Recurrent, intrusive thoughts, urges, or images that cause anxiety or distress. Person tries to ignore or suppress them.

• Contamination concerns (germs, dirt, illness)
• Need for symmetry or exactness
• Aggressive or horrific thoughts (harming loved ones)
• Sexual or religious obsessions
• Fear of losing things or forgetting

Compulsions

Repetitive behaviors or mental acts performed in response to obsessions to reduce anxiety or prevent dreaded event. Excessive and not realistically connected to outcome.

• Excessive hand washing, cleaning, showering
• Checking (locks, appliances, switches)
• Counting, repeating actions
• Ordering, arranging in precise way
• Mental rituals (praying, counting, repeating words)

Core Symptoms (Need 5+, including at least one core):

• Depressed mood: Sad, empty, hopeless most of the day, nearly every day
• Anhedonia: Loss of interest or pleasure in activities once enjoyed
• Weight/appetite changes: Significant weight loss/gain or change in appetite
• Sleep disturbances: Insomnia or hypersomnia (sleeping too much)
• Psychomotor changes: Agitation or retardation (slowed movements/speech)
• Fatigue: Loss of energy nearly every day
• Worthlessness/guilt: Feelings of worthlessness or excessive guilt
• Concentration problems: Difficulty thinking, concentrating, making decisions
• Suicidal ideation: Recurrent thoughts of death or suicide

Important Notes:

• NOT just sadness — clinical depression is more severe and persistent
• More than just reaction to loss (grief is different)
• Can include severe cases with psychotic features (hallucinations, delusions)
• More common in women than men

Manic Episode

Abnormally elevated, expansive, or irritable mood lasting at least 1 week. Increased energy and activity.

• Inflated self-esteem or grandiosity: Unrealistic belief in one's abilities
• Decreased need for sleep: Feel rested after 3 hours
• More talkative: Pressured speech, hard to interrupt
• Flight of ideas: Racing thoughts
• Distractibility: Attention easily drawn to irrelevant stimuli
• Increased goal-directed activity: Excessive involvement in activities
• Excessive risky behaviors: Spending sprees, sexual indiscretions, reckless driving

Hypomanic Episode

Similar to manic but less severe. Lasts at least 4 days. Noticeable change in functioning but not severe impairment. No psychotic features. Person may feel productive and good.

Types of Bipolar Disorder:

• Bipolar I: At least one manic episode (may or may not have depressive episodes)
• Bipolar II: At least one hypomanic episode AND one major depressive episode (no full manic episodes)

⭐ CRITICAL: Positive vs. Negative Symptoms

Know the difference between positive symptoms (excess/distortion of normal functions) and negative symptoms (absence/reduction of normal functions). Frequently tested!

Positive Symptoms (Presence of Abnormal Behaviors)

"Adding" something that shouldn't be there — excesses or distortions

Negative Symptoms (Absence of Normal Behaviors)

"Subtracting" something that should be there — reduction or absence of normal functions

• Flat affect: Reduced emotional expression, monotone voice, expressionless face
• Avolition: Lack of motivation to initiate or sustain purposeful activities
• Alogia: Poverty of speech — brief, empty replies
• Anhedonia: Inability to experience pleasure
• Social withdrawal: Lack of interest in social interactions

Important Facts:

• Onset typically late adolescence/early adulthood
• Affects about 1% of population
• Strong genetic component
• Involves brain abnormalities (enlarged ventricles, dopamine dysregulation)
• Positive symptoms respond better to medication than negative symptoms

Key Features:

• Two or more distinct identities or personality states (alters)
• Each identity has own pattern of perceiving, relating, thinking
• Gaps in memory for everyday events, personal information, traumatic events
• Identities may have different names, ages, genders, behaviors
• Switching between identities
• Often associated with severe childhood trauma/abuse

Types:

• Localized: Can't remember specific event or period (e.g., car accident)
• With dissociative fugue: Sudden travel away from home, confusion about identity, may assume new identity

Key Features:

• Failure to conform to social norms, repeated lawbreaking
• Deceitfulness, lying, conning others
• Impulsivity, failure to plan ahead
• Irritability and aggressiveness, repeated fights/assaults
• Reckless disregard for safety of self or others
• Consistent irresponsibility (work, financial obligations)
• Lack of remorse — indifferent to or rationalizes hurting others
• Often charming and manipulative
• Evidence of conduct disorder before age 15

Key Features:

• Frantic efforts to avoid real or imagined abandonment
• Unstable, intense relationships (alternating idealization and devaluation)
• Identity disturbance — unstable self-image
• Impulsivity in potentially damaging areas (spending, sex, substance use, reckless driving, binge eating)
• Recurrent suicidal behavior, gestures, threats, or self-harm
• Emotional instability — intense episodes of sadness, anxiety, irritability
• Chronic feelings of emptiness
• Inappropriate intense anger or difficulty controlling anger
• Stress-related paranoid thoughts or dissociation

Key Features:

• Restriction of energy intake leading to significantly low body weight
• Intense fear of gaining weight or becoming fat, even though underweight
• Disturbance in body image — sees self as fat despite being thin
• Denial of seriousness of low body weight
• Types: Restricting (diet/exercise) or Binge-Eating/Purging
• More common in females
• Highest mortality rate of any mental disorder

Key Features:

• Binge eating: Eating large amount in discrete period, sense of lack of control
• Compensatory behaviors: Self-induced vomiting, laxatives, fasting, excessive exercise
• Occurs at least once per week for 3 months
• Self-evaluation unduly influenced by body shape and weight
• Person is usually normal weight or overweight (unlike anorexia)
• Feelings of shame, guilt, disgust after binging

Key Features:

• Recurrent binge eating episodes (at least once/week for 3 months)
• Eating much more rapidly than normal
• Eating until uncomfortably full
• Eating large amounts when not physically hungry
• Eating alone due to embarrassment
• Feeling disgusted, depressed, or guilty after
• NO regular compensatory behaviors (no purging)
• Often leads to obesity

Inattention Symptoms:

• Fails to give close attention to details, makes careless mistakes
• Difficulty sustaining attention in tasks
• Doesn't seem to listen when spoken to directly
• Doesn't follow through on instructions, fails to finish tasks
• Difficulty organizing tasks and activities
• Avoids tasks requiring sustained mental effort
• Loses things necessary for tasks
• Easily distracted by extraneous stimuli
• Forgetful in daily activities

Hyperactivity-Impulsivity Symptoms:

• Fidgets, taps hands/feet, squirms
• Leaves seat when expected to remain seated
• Runs/climbs inappropriately (or restlessness in adults)
• Unable to engage quietly in leisure activities
• Always "on the go," acts as if "driven by a motor"
• Talks excessively
• Blurts out answers before questions completed
• Difficulty waiting turn
• Interrupts or intrudes on others

Three Presentations:

• Predominantly inattentive
• Predominantly hyperactive-impulsive
• Combined presentation (both)

Social Communication Deficits:

• Deficits in social-emotional reciprocity (back-and-forth conversation, sharing emotions)
• Deficits in nonverbal communication (eye contact, body language, facial expressions)
• Deficits in developing and maintaining relationships
• Difficulty understanding social cues

Restricted, Repetitive Patterns:

• Stereotyped or repetitive motor movements, speech (echolalia — repeating words)
• Insistence on sameness, inflexible adherence to routines
• Highly restricted, fixated interests
• Hyper- or hypo-reactivity to sensory input (bothered by textures, sounds)
• Wide range of severity (spectrum)