Axis I listed the primary or principal diagnoses that

needed immediate attention; this included recording of

clinical disorders as well as Other Conditions That May
Be a Focus of Clinical Attention (e.g., life stressors,
impairments in functioning; APA, 2000, p. 27).

Axis II contained pervasive psychological issues such as

personality disorders, personality traits and mental
retardation (now intellectual disability disorder) that
shaped responses to Axis I disorders.

Axis III was intended to cue reporting of medical or

neurological problems that were relevant to the
individuals current or past psychiatric problems.

Axis IV required clinicians to indicate which of nine

categories of psychosocial or environmental stressors
influenced client conceptualization or care (e.g., recent
divorce, death of partner, job loss).

Finally, Axis V included the opportunity to provide a Global

Assessment of Functioning (GAF) rating, a number
between 0 and 100 intended to indicate overall level of
distress or impairment.

Axes I, II and III have been eliminated in the DSM-5 (APA,

2013). Clinicians can simply list any disorders or
conditions previously coded on these three Axes
together and in order of clinical priority or focus (APA,
2013).

ANXIETY AND MOOD DISORDERS

Ch. 16 Psychological Disorders

The DSM-5 added a new category of disorders called ObsessiveCompulsive and Related Disorders (OCRDs) (also called ObsessiveCompulsive Spectrum Disorders in the research literature).
The OCRDs category includes the familiar obsessive-compulsive
disorder. It also includes two newly defined disorders with obsessivecompulsive features.
These are hoarding disorder and excoriation (skin-picking) disorder.
Also included in the new OCRD category are body dysmorphic
disorder (previously classified as a Somatoform Disorder) and
trichotillomania (hair-pulling, previously classified as an Impulse
Control Disorder Not Elsewhere Classified).

ANXIETY DISORDERS

anxiety disorders: psychological disorders

characterized by distressing, persistent anxiety
or maladaptive behaviors that reduce anxiety

There are several types of anxiety disorders,

including:

generalized anxiety disorder

panic disorder

phobias

obsessive-compulsive disorder

Generalized Anxiety
Disorder

An anxiety disorder in which a person is

continually tense, apprehensive, and in a state
of autonomic nervous system arousal

Tension and apprehension might be observable

through furrowed brows, twitching eyelids,
trembling, perspiration, fidgeting

Concentration is difficult (worrying all the time)

2/3 of the sufferers are women

Panic Disorder

An anxiety disorder marked by minutes-long

episodes of intense dread in which a person
experiences terror and accompanying chest
pain, choking, or other frightening sensations

The fear of having a panic attack becomes a

problem itself, possibly leading to agoraphobia
(fear or avoidance of situations in which escape
might be difficult or help unavailable when
panic strikes)

Panic Disorder

Smokers have 2 to 4 times more risk of a first-time panic

attack

Phobia

An anxiety disorder marked by a persistent, irrational fear

and avoidance of a specific object or situation

specific phobia: fears that are selective, persistent, out of

proportion (e.g. heights, seeing blood)

social phobia: an intense fear of being scrutinized by others

person avoids potentially

embarrassing social
situations

Phobias
Just the As.
Ablutophobia- fear of washing or bathing.
Acousticophobia- fear of noise.
Alektorophobia- fear of chickens.
Alliumphobia- fear of garlic.
Allodoxaphobia- fear of opinions.
Amathophobia- fear of dust.
Ambulophobia- fear of walking.
Anthrophobia or Anthophobia- fear of flowers.
Anuptaphobia- fear of staying single.
Arachibutyrophobia- fear of peanut butter sticking to
the roof of the mouth.
Arithmophobia- fear of numbers.

Obsessive-Compulsive Di
sorder
An

anxiety disorder characterized by

unwanted

repetitive thoughts
(obsessions)

and/or

actions (compulsions)

Obsessive thoughts and compulsive behaviors can be

called a disorder when they are so persistent that they
interfere with the way we live or when they cause
distress

For some people with the disorder, obsessions &

compulsions lessen over time

Common Obsessions & Compulsions

Among Children & Adolescents with ObsessiveCompulsive Disorder
Thought or Behavior

% Reporting
Symptom

Obsessions (repetitive thoughts)

Concern with dirt, germs, or toxins

40%

Something terrible happening (fire, death,

illness)

24

Symmetry, order, or exactness

17

Compulsions (repetitive behaviors)

Excessive hand washing, bathing, tooth
brushing, or grooming

85

Repeating rituals (in/out of a door, up/down from

a chair)

51

Checking doors, locks, appliances, car brake,

46

Howard Hughes, a
billionaire, developed
obsessive-compulsive
disorder. He was afraid of
germs, and so avoided
contact with possible
sources of dirt (including
other people) and
constantly washed his
hands.
He was obsessed with the
size of peas, and used a
special fork to sort them by
size. Also, he compulsively
said the same phrases over
and over again.

Explaining Anxiety
Disorders

Freuds psychoanalytic perspective assumed

that, starting in childhood, people repress
intolerable impulses, ideas, and feelings and
that this submerged mental energy sometimes
produced symptoms like anxiety

Todays psychologists have turned away from

Freud to two contemporary perspectives:

Learning
Biological

Explaining Anxiety Disorder

Learning Perspective
Fear

conditioning:

General

anxiety is linked with classical

conditioning of fear

In

the laboratory, when rats were given

unpredictable electric shocks, they later became
anxious and apprehensive in their lab environment

58%

of those with social phobia experienced their

disorder after a traumatic event

For

many victims of post-traumatic stress disorder

(PTSD), anxiety increases with any reminder of the
trauma

PTSD Post-Traumatic
Stress Disorder
PTSD

is an anxiety disorder that can develop after

going through a severely threatening,
uncontrollable event that included a sense of
helplessness and fear
e.g.

war, assault, road accident, natural disaster,

rape

Post-Traumatic Stress
Disorder
Symptoms include:
Haunting

memories (flashbacks)
Nightmares
Social withdrawal
Jumpy anxiety
Insomnia
Suffered by about 15% of war veterans (higher
among those who experienced heavy combat),
50% of people kidnapped, tortured, or raped, and
4% of people who experienced a natural disaster
Some psychologists believe that PTSD is
overdiagnosed, and most people are quite
resilient to traumatic experiences

Explaining Anxiety Disorder

Learning
Perspective
Stimulus generalization:

Remember that generalization is the tendency (once a

response has been conditioned) for stimuli similar to the
conditioned stimulus to bring out similar responses

ex. A person who is afraid

of heights after falling
might later generalize that fear
to planes

Explaining Anxiety Disorder

Learning Perspective

Reinforcement:

After phobias & compulsions develop,

reinforcements help maintain them

Avoiding or escaping the feared situation reduces

anxiety thus reinforcing the phobic behavior

Compulsive behaviors similarly reduce anxiety

Observational learning:

Learn fear by observing others fears

Explaining Anxiety Disorder

Biological Perspective
Natural
We

Selection:

are biologically prepared to fear

threats that had been faced by our
ancestors
Therefore phobias focus on dangers
faced by our ancestors (e.g. snakes,
closed spaces, heights, storms,
darkness)
Compulsive acts typically exaggerate
behaviors that help our survival

Explaining Anxiety Disorder

Biological Perspective
Genes:
Some

people seem more genetically

predisposed to particular fears & high
anxiety

Identical

twins often develop similar

phobias, sometimes even when raised
separately

Explaining Anxiety Disorder

Biological Perspective

Physiology:

Anxiety disorders are biologically measurable as

an overarousal of brain areas involved in
impulse control and habitual behaviors

PET scans of people with obsessive-compulsive

disorder reveal unusually high activity in the
frontal lobes

Fear learning experiences can traumatize the

brain, by affecting the amygdala

MOOD DISORDERS

Mood disorders: psychological disorders

characterized by emotional extremes

The changes to Depressive Disorders are a bit more

substantial. There are now four main disorders, rather than
just two.

We still have Major Depressive Disorder and Dysthymia; though,

this is now called Persistent Depressive Disorder. As the name
implies, Persistent Depressive Disorder features chronicity as its
defining symptom. It includes not only what was formerly known
as Dysthymia, but also chronic Major Depression.

Research has been unable to find meaningful differences between

the two.

Two new disorders have been added: Disruptive Mood

Dysregulation and Premenstrual Dysphoric Disorder.

The DSM-5 no longer has a separate category of disorders for

children. Instead, disorders are grouped together into diagnostic
categories that share similar features and presumed etiologies.
This disorder applies to children up to age 18 with persistent and
frequent irritable episodes of behavioral dysregulation.

The Grief/Bereavement exclusion for depression has

been removed!

Mood Disorders

Depression is the common cold of

psychological disorders.

In fact:

Depression is the number one reason

for people to seek mental heath
services

It is the leading cause of disability

worldwide

Mood Disorders

Depression is a response to past and current loss. (As

opposed to anxiety which a response to a future threat)

It acts as a signal for our body to take protective measures!

Two emotional extremes of mood disorder:

(1) major depressive disorder
(2) bipolar disorder

A mood disorder in which a person

experiences 2 weeks or more of

Major Depress -depressed moods

ive Disorder -feelings of worthlessness
:
-decreased interest or pleasure in
activities

-weight gain/loss
-inability to sleep or too much sleep
-thoughts of death/suicide
for no apparent reason.

(Dysthymic Disorder)
Persistent Depressive
Disorder:

A depressed mood that lasts most of the day, nearly

every day, for two years or more

It is less severe than major depressive disorder, but it

lasts longer

Experience chronic low energy & self-esteem, have

difficulty concentrating or making decisions, and sleep
& eat too much or too little

Some depression facts:

Compared

with men, women are twice as

vulnerable to major depression, even more so if
they have been depressed before

Most

major depressive episodes self-terminate

Stressful

events related to work, marriage, and

close relationships often precede depression

With

each new generation, the rate of depression

is increasing

Disorder

teens)

is striking earlier (now often in late

Depressed people, however, reach REM more

rapidly, generally in less than 45 minutes. They also
tend to awaken frequently during the night.

Most people feel slightly better during the summer (when the sun is out
most of the day) than during the winter (when there are fewer hours of
sunlight). People with seasonal affective disorder (SAD) feel good in the
summer and seriously depressed in the winter (or good in the winter and
depressed in the summer). Seasonal affective disorder is commonest in far
northern locations such as Scandinavia, where the summer days are very
long and bright and the winter days are very short and dark. The disorder is
unheard-of in tropical locations such as Hawaii, where the amount of
sunlight per day varies only slightly between summer and winter.

Bipolar Disorder

Manic episode: an episode marked by a

hyperactive, wildly optimistic state.

Bipolar disorder: a mood disorder in which the

person alternates between the hopelessness &
lethargy of depression and the overexcited state
of mania

Bipolar Disorder

During the manic state in the bipolar disorder,

the person becomes highly talkative, overactive
and may engage in reckless activities (unsafe
sex, spending sprees, investments) with
dangerously soaring self-esteem.
However, milder forms of mania can help
creativity:
George Frideric Handel, who was believed to
have suffered from bipolar disorder, composed
the four-hour-long Messiah during the three
weeks of his manic episode.
Other creative bipolar people include Edgar
Allan Poe, and Samuel Clemens (Mark Twain)..

Bipolar Disorder
Bipolar

disorder is much less

common than major depression
occurs

in about 1% of the
population

afflicts

both men and women

equally

Explaining Mood
Disorders

Freuds psychoanalytic theory (importance of

early childhood experiences and unconscious
impulses) suggests that depression occurs when
significant losses evoke feelings associated with
losses experienced in childhood

Todays bio-psycho-social perspective is

replacing Freudian explanations with biological &
cognitive explanations

Explaining Mood Disorders

Biological Perspective
Genetic
mood

influences:

disorders run in families

risk of major depression & bipolar
disorder increases if you have a
depressed parent or sibling
even if identical twins are raised in
different environments, they have
greater similarities for depressive
tendencies

Explaining Mood Disorders

Biological Perspective
Depressed

brain
norepinephrine (a neurotransmitter
that increases arousal and boosts
mood) is overabundant during mania
and scarce during depression
serotonin is scarce during depression
repetitive physical exercise
reduces depression
(it increases serotonin)

 PET

scans show that brain energy

consumption rises and falls with emotional
swings of bipolar disorder

Depressed state

Manic state

Depressed state

Explaining Mood
Disorders
Biological
Depressed brain
Perspective
neurological

signs of depression

many

recent studies have found the brains of

depressed people to be less active

left

frontal lobe (active during positive emotions) is

likely to be inactive in depressed states

MRI

scans have shown frontal lobes to be 7%

smaller in severely depressed people

hippocampus

(memory processing center linked

with brains emotional circuitry) can be affected by
stress-related damage

Explaining Mood Disorders:

The Social-Cognitive
Perspective

Self-defeating beliefs feed depressions

vicious cycle.

Self-defeating beliefs may arise from

learned helplessness through
uncontrollable painful events.

Women are more often abused or made

to feel helpless than men, and they may
respond more strongly to stress.

Explaining Mood Disorders

The Social-Cognitive
Perspective

Negative thoughts feed negative moods; negative moods feed

negative thoughts (cycle)

Depressed people tend to explain bad events in terms that are

Stable (its going to last forever)

Global (Its going to affect everything I do)

Internal (its all my fault)

Result of these pessimistic, over generalized, self blaming

attributions is a depressing sense of hopelessness.

Social-Cognitive
Around The World

Depression is common among young people in

the Western world because of epidemic
hopelessness stemming from the rise of
individualism and decline of commitment to
religion and family.

Self-focused individuals take on personal

responsibility for problems and have nothing to
fall back on for hope

Non-western cultures encourage close-knit

relationships and cooperation depression is
less common and less tied to self-blame.

Depressions Vicious
Cycle
Dude,
where
are
your
pink
A recipe for severe depression is
glasses?
preexisting pessimism

encountering failure Martin

Seligman.

Depression can be brought on by

stressful experiences (losing a
job, getting divorced, suffering
physical traumas, etc.) that
disrupt your sense of who you are
and why you are a worthy human
being.

Depressions Vicious
Cycle
Dude,
where are your pink
Brooding can be adaptive gain insights
during the times of depressed inactivity can
glasses?
later lead to more effective strategies for
interacting with the world.

But when down, brooding amplifies negative

feelings trigger depressions other cognitive
and behavioral symptoms. This phenomenon
may explain womens doubled risk of
depression.

Depression: Women vs
Men

Woman often have more vivid

memories for both wonderful
and horrid experiences than
men.

Woman may fret and act

anxious or depressed, while a
man may distract himself by
drinking, acting out, delving
into work, or watching sports.

Depressions Vicious
Cycle
Dude, where are your pink
When bad things happen, those
glasses?
who are pessimistic are more at
risk for depression.

If you are optimistic, failure or

stress is unlikely to provoke
depression. Even if you do fall into
depression, you are more likely to
recover quickly!

Depressions Vicious
Cycle
Dude,
where are your pink
Lauren Alloy and her collaborators monitored
glasses?
Temple University and University of Wisconsin

students. Among those identified as having

optimistic thinking styles as they began college,
only 1% had a first episode of major depression,
compared to 17% of those who began college
with pessimistic views.

Students who show optimism as they begin

college develop more social support lowered
risk of depression.

Depressions Vicious
Cycle
1. Stressful
Experiences
(Divorce, job loss,
etc)

4. Cognitive
and
Behavioral
Changes
(Hopeless
Attitude,
Fatigue)

2. Negative
Explanatory
Style
(Pessimism,
self-blaming)
3. Depressed
Mood