Now, let's get into the second broad bean of psychological disorder
that I would say is probably the most common would be mood disorders.
So these are -- disorders characterized by a persistent pattern of abnormal mood
and there's -- well, referring to you is affect and mood.
So affect refers to an individual's visible emotion in the moment
and mood is sustain internal emotion that reflects his or her view of life.
So when we look at things like depression, now, would follow under mood disorder,
this is sort of a long term impact on their view on life and the emotion they're going to portray.
So somebody who is depressed isn't going to be smiling all the time and super happy
and smelling the roses, emotionally speaking the visible emotion that you see would be a little bit more down --
would be a little bit more on the negative side and their internal mood
would be that they feel like, "What's the point of living, I'm so unhappy,
I don’t find happiness in the things that I should be finding happiness in."
The DSM-5 separates mood disorders into two categories. There are depressive
and related disorders, and bipolar and related disorders.
Let's start by discussing the depressive disorders. First, there is major depressive disorder,
this one is often called unipolar or a major depression.
For diagnosis five or more of the following conditions must have been present nearly every day during the same two week period
and one of them must be depressed mode or lost of interest or pleasure.
The conditions are: depressed mood most of the day; markedly diminished interest
or pleasure in all or almost all activities for most of the day.
Significant so more than 5% weight gain or loss or decreased or increase appetite.
Insomnia, often sleep-maintenance insomnia or hypersomnia; psychomotor agitation
or retardation observed by other, not self-reported. Fatigue or loss of energy.
Feelings of worthlessness or excessive or inappropriate guilt.
Diminished ability to think or concentrate or indecisiveness.
Recurrent thoughts of death or suicide. A suicide attempt or a specific plan for committing suicide.
The next form is persistent depressive disorder.
It is characterized by depressive symptoms that persist for two or more years without remission.
PDD consolidates disorders, formally termed chronic major depressive disorder and dysthymic disorder.
For diagnosis, patients must have had a depress mode for most of the day for two or more years plus two or more
of the following conditions: poor appetite or over eating; insomnia or hypersomnia; low energy or fatigue;
low self-esteem; poor concentration or difficulty in making decisions; feelings of hopelessness.
Now, let's talk about premenstrual dysphoric disorder. It involves mood and anxiety symptoms
that are clearly related to the menstrual cycle with onset during the pre-menstrual phase
had the symptom free interval after menstruation.
The symptoms must be present during most menstrual cycles during the past year.
For diagnosis, patients must have five or more symptoms during the week before menstruation.
Symptoms must begin to remit within a few days after onset of menses
and become minimal or absent in the week after menstruation.
Symptoms are the following: Marked mood swings, for example suddenly feeling sad or tearful.
Marked irritability or anger or increased interpersonal conflict; marked depressed mode,
feelings of hopelessness or self-deprecating thoughts.
Marked anxiety, tension or an on-edge feeling. In addition, one or more of the following must be present.
Decreased interest in usual activities, difficulty concentrating, low energy or fatigue,
marked change in appetite, overeating or specific food cravings.
Hypersomnia or insomnia, feeling overwhelmed or out of control.
Physical symptoms such as breast tenderness or swelling, joint or muscle pain. A feeling of being bloated and weight gain.
Lastly, there is disruptive mood dysregulation disorder. This is a newly added classification to the DSM-5.
DMDD is a mental disorder in children and adolescence, characterized by a persistently irritable or angry mood
and frequent temper outburst that are disproportionate to the situation and significantly more severe
than the typical reaction of same age peers.
The symptoms of the DMDD resemble those of attention deficit hyperactivity disorder, ADHD.
Oppositional defiant disorder, ODD, anxiety disorders and childhood bipolar disorder.
The next group you need to know about are the bipolar disorders. First, there's bipolar disorder type I.
It is distinguished by the presence or history of one or more manic episodes or mixed episodes
with or without major depressive episodes.
A depressive episode is not required for the diagnosis of bipolar I disorder but depressive episodes
are usually part of the course of the illness,
the specifier with mixed features has been added to the DSM-5
that can be applied when patients have MDD or PDD. Next, there is bipolar disorder type II.
The DSM-5 diagnosis of bipolar II continuous to require at least one episode of current or past hypomania
and at least one episode of current or past major depression with no history of an episode of mania.
Lastly, there is cyclothymic disorder. This one is distinguished by the presence or history of one or more manic episodes
or mixed episodes with or without major depressive episodes.
In addition, the DSM-5 criteria clarify that hypomanic or depressive symptoms
must be present at least half of the time, during the required two year period.
Now, let's talk about dissociative disorders. The first one in this group is dissociative identity disorder.
There are conditions that involve disruptions or a breakdowns of memory, awareness, identity or perception.
People with dissociative disorders use dissociation as a defense mechanism pathologically and involuntarily.
Dissociative disorders are sometimes triggered by psychological trauma, but may be preceded only by stress,
psychoactive substances or no identifiable trigger at all.
This disorder is formerly known as multiple personality disorder. There are symptoms of disruption of identity
that may be reported as well as observed.
Next, there is depersonalization/derealization disorder,
this disorder occurs when you persistently or repeatedly have the feeling that you're observing yourself
from outside your body or you have a sense that things around you aren’t real or both.
Feelings of depersonalization and derealization can be very disturbing and may feel like you're living in a dream.
The diagnosis of depersonalization/derealization disorder is clinical based on criteria in the DSM-5.
Patients have persistent or recurrent episodes of depersonalization/derealization or both.
Patients know that their unreal experiences are not real. They have an intact sense of reality.
Symptoms cause significant distress or significantly impair social or occupational functioning.
Now, let's talk about dissociative amnesia. The information you lost in this type of amnesia
would normally be part of conscious awareness and would be described as autobiographic memory.
Although the forgotten information may be inaccessible to consciousness, it sometimes continues to influence behavior.
For example, a woman who is attacked in an elevator, refuses to ride in elevators even though she cannot recall the attack.
In a change from the DSM-4 to the DSM-5, dissociative fugue is now subsumed under dissociative amnesia.
Lastly, let's talk about personality disorders. There are ten types of them which are grouped into three clusters, A, B and C.
In cluster A, we find paranoid personality disorder. It is characterized by excessive distressed and suspicion.
People with paranoid personalities rarely confide in others and tend to misinterpret harmless comments and behavior as malicious.
PPD usually begins by early adulthood, and is manifested by an overall sense of distrust and unjustified suspicion
that causes persistent misinterpretation of others intentions as being malicious.
People with the paranoid personality disorder are usually unable to acknowledge their own negative feelings
towards others but do not generally lose touch with reality.
The next type in cluster A is schizoid personality disorder. People with Schizoid personality disorder,
rarely feel there is anything wrong with them. Symptoms include: an indifference to social relationships
and a limited range of emotional expression. It manifests itself by early adulthood, through social
and emotional detachment that prevent people from having close relationships.
People with it are able to function in everyday life, but will not develop meaningful relationships with others,
they are typically solitary or loners and may be prone to excessive day dreaming, as well as forming attachments to animals.
The last disorder in this cluster is schizotypal personality disorder.
It is a psychiatric condition marked by disturb thoughts and behavior, unusual beliefs in fears
and difficulty with forming and maintaining relationships.
Speech may include digressions, odd use of words or display magical thinking
such as a belief in clairvoyance and bizarre fantasies.
Patients usually experience distorted thinking behaves strangely and avoid intimacy,
they typically have few if any close friends and feel nervous around strangers.
Although they may marry and maintain jobs. This disorder appears more frequently in males,
surfaces by early adulthood and can exacerbate anxiety and depression.
Next, let's have a closer look on cluster B disorders, there we find antisocial personality disorder,
it is characterized by a pattern of disregard for and violation of the rights of others.
The diagnosis of APD disorder is not given to individuals under the age of 18
but is given only if there is a history of some symptoms of conduct disorder before age 15.
People with this illness may seem charming on the surface, but they are likely to be irritable and aggressive as well as irresponsible.
They may have numerous somatic complaints and perhaps attempts suicide.
Due to their manipulative tendencies, it is difficult to tell whether they are lying or telling the truth.
Another disorder is the borderline personality disorder,
here you find an instability and impulse control or mood or image of self and others.
So these individuals really don’t quite grasp their personality in what they're expressing and there's a change in that.
So you see that they act very odd and that they are starting to express behaviors
that you might not normally associate with them saying, "Well, that's unlike them," because of this,
they have trouble actually defining their personality. This instability often disrupts family and work life,
long term planning and an individual sense of identity.
Then we have the histrionic personality disorder. It is characterized by constant attention seeking,
emotional overreaction and suggestibility.
A person with this condition, tends to overdramatize situations which may impair relationships and lead to depression.
People with this disorder are uncomfortable or feel unappreciated when they are not the center of attention.
Those with HPD take on the role of life of the party, interest and conversation will be self-focused.
They use physical appearance to draw attention to themselves.
And the last disorder in cluster B, is narcissistic personality disorder.
This is when individuals feel like they are better than everyone else
and more than maybe some of the proud peacocks you might know.
They have no empathy, so if somebody is hurt or needs help, they're not there to help,
they're those who say, "Well, you deserve tha." Or, "Why should I help you?"
These are individuals who get something that's termed the God-complex
and you see this sometimes with individuals who have highly impactful or important jobs.
Things like doctors that are world renowned neurosurgeons and are saving lives.
But that doesn’t necessarily mean that they're better than say the nurse who's assisting in the surgery.
The last cluster is C, and here we find avoidant personality disorder,
this is characterized by a lifelong pattern of extreme social inhibition, feelings of inadequacy and sensitivity to rejection.
People with APD may avoid work activities or decline job offers
because of fears of criticism or disappointment from others.
They may be pre-occupied with their own shortcomings and form relationship with others,
only if they think they will not be rejected.
Loss and rejection are so painful through these individuals that they will choose loneliness
rather than risk trying to connect with others.
The next type is dependent personality disorder. It is described as a pervasive
and excessive need to be taken care of that leads to submissive and clinging behavior, as well as fears of separation.
This pattern begins at early adulthood and is present in a variety of context.
The dependent and submissive behaviors are designed to elicit caregiving
and arise from a self-perception of being unable to function adequately without the help of others.
These individuals have great difficulty making every day decisions such as what shirt to wear
or whether to carry an umbrella without an excessive amount of advice and re-assurance from others.
The last personality disorder we discuss, is the obsessive-compulsive personality disorder,
please be aware that it is distinct from obsessive-compulsive disorder. OCD is an anxiety disorder,
and OCPD is a personality disorder but nevertheless, some OCPD individuals do have OCD.
People with obsessive compulsive personality disorder have overarching concerns with things being perfect.
So their concern with orderliness, perfectionism and control over ones environment,
they obsessed about themselves and their room and their desk, everything needs to be perfect
and to the point again where it supersedes and becomes the primary goal of their daily functioning.