Psychological Disorders

The One Thing

Psychological disorders are clinically significant patterns of thought, emotion or behaviour that cause distress, impairment or risk. Their assessment and treatment require culturally sensitive classification and a biopsychosocial explanation that considers biological, psychological and social influences.

Who and What

• Abnormality: A pattern of behaviour, thought or emotion that significantly deviates from expected functioning and causes distress, impairment or risk. No single definition is sufficient; cultural context, age, situation, duration and degree of impairment must be considered.
• Four Ds: The common indicators of abnormality: deviance from social or cultural norms, distress, dysfunction in daily life and danger to self or others. Unusual behaviour is not automatically abnormal, while common behaviour may still be harmful or dysfunctional.
• Psychological disorder: A clinically significant disturbance in cognition, emotion regulation or behaviour associated with distress, disability or impaired functioning. Mental disorders are health conditions, not signs of weak character or lack of willpower.
• Classification: The organised grouping of disorders according to shared symptoms, causes, course or other features. Systems such as the DSM and ICD organise disorders by symptom patterns and clinical features.
• Diagnosis: The identification of a disorder through assessment of symptoms, duration, severity, context and effects on functioning. Diagnosis should be conducted by trained mental-health professionals using medical, psychological, developmental and social information.
• Biopsychosocial approach: An explanation of disorders through the combined influence of biological, psychological and social factors.
• Anxiety disorders: Disorders involving excessive, persistent fear, worry or apprehension that interferes with daily life.
• Generalised anxiety disorder: Persistent and excessive worry about several areas of life, often accompanied by restlessness, fatigue, poor concentration and sleep problems.
• Panic disorder: Repeated unexpected panic attacks involving intense fear and physical symptoms such as palpitations, trembling or breathlessness, followed by concern about further attacks.
• Phobia: An intense, unreasonable and persistent fear of a particular object, situation, activity or social setting.
• Obsessive-compulsive disorder: A disorder involving unwanted recurring thoughts or images, called obsessions, and repetitive acts or mental rituals, called compulsions. Compulsions are performed to reduce anxiety or prevent a feared event.
• Trauma- and stressor-related disorders: Disorders that may develop after traumatic or highly stressful events and may involve intrusive memories, avoidance, negative mood and heightened arousal.
• Somatic symptom disorder: Excessive thoughts, feelings or behaviours related to physical symptoms, which may or may not have a clear medical explanation.
• Dissociative disorders: Disorders involving disruptions in the normal integration of consciousness, memory, identity, emotion, perception or surroundings.
• Dissociative amnesia: Inability to recall important personal information, often related to a stressful or traumatic experience.
• Dissociative identity disorder: A disturbance involving two or more distinct identity states or personality patterns, together with gaps in memory.
• Depressive disorders: Disorders marked by persistent sadness or loss of interest, together with changes in sleep, appetite, energy, concentration, self-worth or functioning. Depression is more than temporary sadness because it is persistent and affects several areas of functioning.
• Mania: A period of unusually elevated, expansive or irritable mood with increased energy, reduced need for sleep, rapid speech, grand ideas and impulsive behaviour. It can also involve inflated self-esteem, racing thoughts, distractibility and risky activities.
• Bipolar disorder: A mood disorder involving episodes of depression and episodes of mania or hypomania.
• Schizophrenia spectrum disorders: Severe disorders involving disturbances in thought, perception, emotion, language, behaviour and social functioning. They may involve positive symptoms, negative symptoms and cognitive difficulties.
• Positive symptoms: Experiences or behaviours added to normal functioning, such as delusions, hallucinations and disorganised speech.
• Negative symptoms: Reductions or losses of normal functioning, such as reduced emotional expression, lack of motivation, social withdrawal and poverty of speech.
• Delusion: A strongly held false belief that persists despite clear evidence against it.
• Hallucination: A false sensory experience occurring without an appropriate external stimulus. Hallucinations and delusions are distinct experiences.
• Neurodevelopmental disorders: Conditions beginning during the developmental period that affect learning, communication, attention, behaviour or intellectual functioning.
• Stigma: Negative, uninformed or discriminatory attitudes toward people with psychological disorders.
• Culture-bound understanding: Recognition that symptoms, explanations of distress and standards of normality may vary across cultures.
• Diathesis-stress model: The model that explains disorder as an underlying vulnerability interacting with significant stress.
• Comorbidity: The occurrence of two or more psychological disorders in the same person at the same time.

Causes and Consequences

• Multiple indicators are necessary for assessment. Abnormality should not be judged solely by social unusualness; deviance, distress, dysfunction and danger must be considered alongside cultural context, age, situation, duration and impairment.

• Classification improves clinical practice. Systems including the DSM and ICD support communication, research, diagnosis and treatment planning by organising disorders according to symptom patterns and clinical features.

• Classification has limitations. Diagnostic categories are not perfect labels and must be applied with cultural sensitivity and professional judgment. Culture can influence both the expression of symptoms and the interpretation of normality.

• Anxiety is not inherently abnormal. Proportionate anxiety may be normal and useful, but it becomes disordered when excessive, persistent and disruptive. Generalised anxiety disorder, panic disorder and phobias illustrate different forms of pathological anxiety.

• Obsessive-compulsive disorder is defined by the relationship between obsessions and compulsions. Intrusive thoughts or images produce anxiety, while repetitive behaviours or mental acts are used to reduce anxiety or prevent a feared event.

• Trauma and stress can affect several psychological systems. Trauma- and stressor-related disorders may produce intrusive memories, avoidance, negative mood and heightened arousal. Stressful or traumatic experiences may also be associated with dissociative amnesia.

• Dissociation disrupts psychological integration. Dissociative disorders affect consciousness, memory, identity, emotion, perception or surroundings. Dissociative identity disorder involves two or more distinct identity states or personality patterns and gaps in memory.

• Depressive and bipolar disorders involve significant changes in mood and functioning. Depressive disorders involve persistent sadness or loss of interest and multiple associated changes. Bipolar disorder involves episodes of depression and mania or hypomania; mania may include reduced need for sleep, rapid speech, racing thoughts, inflated self-esteem and risky activities.

• Schizophrenia-spectrum disorders affect several areas of functioning. Positive symptoms add experiences such as delusions, hallucinations and disorganised speech, whereas negative symptoms involve losses such as reduced emotional expression, lack of motivation, social withdrawal and poverty of speech. Cognitive difficulties may also occur.

• Disorders usually have interacting causes. Genetic vulnerability, brain and hormonal factors, learning, stress, trauma, personality, family relationships and wider social conditions may combine to produce psychological difficulties.

• The diathesis-stress model explains interaction between vulnerability and experience. An underlying predisposition may result in disorder when combined with significant stress, rather than producing disorder independently.

• Comorbidity complicates diagnosis and treatment. When two or more psychological disorders occur simultaneously, assessment must account for overlapping symptoms and treatment needs.

• Treatment is multidimensional. Psychotherapy, medication, lifestyle support, family or social support, rehabilitation and relapse prevention may all contribute to treatment and recovery.

• Early identification and humane treatment have broad consequences. Accurate assessment, early intervention and reduction of stigma can improve recovery and social participation. People experiencing severe distress, danger or thoughts of self-harm should receive immediate support from a trusted adult, mental-health professional or emergency service.

What Gets Asked

• Why is no single definition of abnormality sufficient, and how do the Four Ds improve assessment?
• How are classification and diagnosis useful, and what limitations require cultural sensitivity and professional judgment?
• Compare anxiety disorders, obsessive-compulsive disorder, trauma- and stressor-related disorders, somatic symptom disorder and dissociative disorders.
• Distinguish depressive disorders, mania and bipolar disorder, including the effects of mania on behaviour and functioning.
• Compare positive and negative symptoms of schizophrenia-spectrum disorders, including delusions and hallucinations.
• Evaluate the biopsychosocial approach and the diathesis-stress model as explanations of psychological disorders, including the significance of comorbidity, treatment and stigma.