Chapter 9

Psychological Disorder

What Is a Psychological Disorder?

A psychological disorder, also known as a mental disorder, is a pattern of behavioral or psychological symptoms that impact multiple life areas and/or create distress for the person experiencing these symptoms.

The Psychological Disorders In these notes I discuss the psychological disorders: their classification and reclassification, behavioral "symptoms," and, in selected cases where something is known about it, heritability and underlying physiological changes.

Classification of the Psychological Disorders In medicine, classification of the various medical disorders typically is based on the particular combinations of symptoms that patients present to the physician; the physician then renders a diagnosis based on those symptoms. Thus, if a patient comes into the doctor's office complaining about chills and fever, muscular aches and pains, nausia, and so, the physician might conclude from these symptoms that the patient has the flu. The idea here is that patients who present the same symptoms are probably suffering from the same underlying disorder, a common cause for which there will be a specific treatment. Psychiatrists, clinical psychologists, and other mental health workers confronted with a variety of

behavioral, cognitive, and emotional "symptoms" of their clients likewise began to identify combinations of these symptoms that seemed to hang together, forming a particular "syndrome" that differentiated these particular cases from others. Category lables were developed for the different syndromes and it was hoped that those falling into the same category might turn out to be suffering from the same set of underlying causes of their condition. Thus was born labels such as "schizophrenia," "hysteria," and "manic-depressive psychosis. Such labels can be very helpful to practitioners. They make it relatively easy to communicate the major features of a person's disorder to other practioners, as everyone in the field knows what sorts of abnormalities a person diagnosed, for example, as "schizophrenic" is likely to display. And once a person has been identified as having a particular disorder, this immediately suggests which treatments are likely to be the most beneficial to the client. On the negative side, however, it is too easy to label someone as "a schizoprenic" and forget that one is dealing with an individual human being and not merely a collection of symptoms. Furthermore, nonspecialists soon learned that to be labeled a schizophrenic, manic-depressive, or psychpathic personality was not exactly an honor, and as the general public became more familiar with the typical symptoms of the various disorders, they tended to use them as stereotypes, as if everyone with the label "schizophrenic" exhibited the entire set of symptoms in their most extreme forms. Developing category labels for these disorders may have been necessary, but it did not always have positive consequences for those who were being pinned with the label. The initial system of categories developed slowly over decades and in some ways proved unsatisfactory in practice. Eventually the American Psychiatric Association convened a committee to develop a new classification system that would reorganize some of the major categories and provide additional ones based

on the latest information. The result of the committee's deliberations was a publication called the Diagnostic and Statistical Manual or DSM. Over the years this has been revised several times, the current revision is the DSM IV. The old classification system included two main types of psychological disorder which differ in severity and characteristic problem: Neurosis and Psychosis. Although these are no longer considered current, I'll start with these two types, as I believe that they still offer a way to differentiate certain of the classes of disorder now included in the new scheme as presented in the DSM:

Neurosis
o

Characterized by anxiety, often as a result of inner conflict. The outward signs of anxiety may be hidden, however, as the person uses ego defenses to keep the anxiety under control.

person remains in good contact with reality (no irrational thought, delusions, or hallucinations).

Psychosis
o

Characterized by a loss of contact with reality. The person may be delusional, have irrational beliefs that conflict with common sense, or suffer hallucinations.

Although anxiety may be present (or not), it is not a characteristic of the disorder.

The major category of neurosis has been replaced by several more specific categories in the current scheme of classification. I'll take up those milder disorders that would have fallen under "neurosis" first, beginning with the "anxiety disorders."

Abnormal Psychology Abnormal psychology is a division of psychology that studies people who are "abnormal" or "atypical" compared to the members of a given society. There is evidence that some psychological disorders are more common than was previously thought. Depending on how data are gathered and how diagnoses are made, as many as 27% of some population groups may be suffering from depression at any one time (NIMH, 2001; data for older adults). Abnormal psychology is a branch of psychology that deals with psychopathology and abnormal behavior. The term covers a broad range of disorders, from depression to obsession-compulsion to sexual deviation. Counselors, clinical psychologists and psychotherapists often work directly in this field. Understanding Abnormal Psychology In order to understand abnormal psychology, it is essential to first understand what we mean by the term "abnormal." On the surface, the meaning seems obvious; abnormal indicates something that is outside of the norm. But are we talking about the norms of a particular group, gender or age? Many human behaviors can follow what is known as the normal curve. Looking at this bellshaped curve, the majority of individuals are clustered around the highest point of the curve, which is known as the average. People who fall very far at either end of the normal curve might be considered "abnormal." It is important to note that the distinctions between normal and abnormal are not synonymous with good or bad. Consider a characteristic such

as intelligence. A person who falls at the very upper end of the curve would fit under our definition of abnormal; this person would also be considered a genius. Obviously, this is an instance where falling outside of the norms is actually a good thing. When you think about abnormal psychology, rather than focus on the distinction between what is normal and what is abnormal, focus instead on the level of distress or disruption that a troubling behavior might cause. If a behavior is causing problems in a person's life or is disruptive to other people, then this would be an "abnormal" behavior that may require some type of mental health intervention. Perspectives in Abnormal Psychology There are a number of different perspectives used in abnormal psychology. While some psychologists or psychiatrists may focus on a single perspectives, many mental health professionals use elements from multiple areas in order to better understand and treat psychological disorders.

Behavioral: The behavioral approach to abnormal psychology focuses on observable behaviors. In behavioral therapy, the focus is on reinforcing positive behaviors and not reinforcing maladaptive behaviors. This approach targets only the behavior itself, not the underlying causes.

Medical: The medical approach to abnormal psychology focuses on the biological causes on mental illness. This perspective emphasizes understanding the underlying cause of disorders, which might include genetic inheritance, related physical disorders, infections and chemical imbalances. Medical

treatments are often pharmacological in nature, although medication is often used in conjunction with some other type of psychotherapy.

Cognitive: The cognitive approach to abnormal psychology focuses on how internal thoughts, perceptions and reasoning contribute to psychological disorders. Cognitive treatments typically focus on helping the individual change his or her thoughts or reactions. Cognitive therapy might also be used in conjunction with behavioral methods in a technique known as cognitive behavioral therapy.

Models of Abnormality Models of Abnormality are general hypotheses as to the nature of psychological abnormalities. The four main models to explain psychological abnormality are the Biological, Behavioral, Cognitive, and Psychodynamic models. They all attempt to explain the causes and cures for all psychological illnesses, and all from a different approach.

The Biological Model The Biological Model of Abnormality (the only model not based on psychological principles) is based on the assumptions that if the brain, neuroanatomyand related biochemicals are all physical entities and work together to mediate psychological processes, then treating any mental abnormality must be physical/biological. Part of this theory stems from much research into the major neurotransmitter, Serotonin, which seems to show that major psychological illnesses such as bipolar disorder and anorexia nervosa are caused by abnormally reduced levels of Serotonin in the brain.(1) The model also suggests that psychological illness could and should be treated like any physical illness (being caused by chemical imbalance, microbes or physical stress) and

hence can be treated with surgery or drugs. Electroconvulsive therapy has also proved to be a successful short-term treatment for depressive symptoms of bipolar disorder and related illnesses, although the reasons for its success are almost completely unknown. There is also evidence for a genetic factor in causing psychological illness.(2)(3). The main cures for psychological illness under this model: electroconvulsive therapy, drugs and surgery at times can have very good results in restoring "normality" as biology has been shown to play some sort of role in psychological illness. However they can also have consequences, whether biology is responsible or not, as drugs always have a chance of causing allergic reactions or addiction. Electrotherapy can cause unnecessary stress and surgery can dull the personality, as the area of the brain responsible

for emotion (Hypothalmus) is often altered or even completely removed. The Behavioral Model The Behavioural Model to abnormality assumes that all maladaptive behaviour is essentially acquired through one's environment. Therefore, Psychiatrists practising the beliefs of this model would be to prioritise changing the behaviour over identifying the cause of the dysfunctional behaviour. The main solution to psychological illness under this model is aversion therapy, where the stimulus that provokes the dysfunctional behaviour is coupled with a second stimulus, with aims to produce a new reaction to the first stimulus based on the experiences of the second. Also systematic desensitization can be used, especially where phobias are involved by using the phobia that currently causes the dysfunctional behaviour and coupling it with a phobia that produces a more intense reaction. This is meant to make the first phobia seem less fearsome etc. as it has been put in comparison with the second phobia. This model seems to have been quite successful, where phobias andcompulsive disorders are concerned, but it doesn't focus on the cause of the illness or problem, and so risks recurrence of the problem.

The Cognitive Model The Cognitive Model is quite similar to the Behavioural Model but with the main difference that, instead of teaching the patient to behave differently it teaches the patient to think differently. It is hoped that if the patient's feelings and emotions towards something are influenced to change, it will induce external behavioural change. Though similar in ways to the Behavioural Model, psychiatrists of this model use differing methods for cures. The main one is Rational Emotional Therapy (RET) and is based on the principle that an "activating" emotional event will cause a change in thoughts toward that situation, even if it is an illogical thought/s. So with this therapy, it is the psychiatrist's job to question and change the irrational thoughts. It is similar to the Behavioural Model where its success is concerned, as it has also proved to be quite successful in the treatment of compulsive disorders and phobias, although it doesn't deal with the cause of the problem directly, it does attempt to change the situation more broadly than the Behavioral Model. The Psychodynamic Model The Psychodynamic Model is the fourth psychological model of

abnormality, and is based on the work of the famous psychologist, Sigmund Freud. It is based on the principles that psychological illness comes about from repressed emotions and thoughts from experiences in the past (usually childhood), and as a result of this repression, alternative behavior replaces what is being repressed. The patient is believed to be cured when they can admit that which is currently being repressed. The main cure for illnesses under this model is free association where the patient is free to speak while the psychiatrist notes down and tries to interpret where the trouble areas are. There is little proof of why this model

works, but it can be successful, especially where the patient feels comfortable to speak freely, and about issues that are relevant to a cure. The Biopsychosocial Perspective The interaction of biological, psychological, and social aspects of developmental psychology from the essence of the holistic biopsychosocial perspective. The biopsychosocial perspective attributes complex phenomena or events to multiple causes. Figure 1 shows the interrelationship of the fields of study that constitute the biopsychosocial perspective. In contrast to the biopsychosocial perspective is the reductionist perspective, which reduces complex phenomenon or events to a single cause.

This biopsychosocial model of developmental psychology may be applied to the case of John, a depressed adolescent male, who finds it difficult to socialize with his peers. John's problem may be the result of any one of a number of causes. For example, injunctions, or messages received during childhood, may be considered one possible cause of John's depression. Injunctions may include messages regarding worthlessness and shame, distorted perceptions, fears of rejection, and inadequate communication and social skills. John's overly critical parents raised him to believe that he would never amount to anything or have any

friends. As John experiences distress over his negative injunctions about relationships (psychological), he tries too hard to make others like him, which causes his peers to distance themselves from him (social). In time, John may experience rejection and become more depressed (psychological). Berating himself (psychological), John may become less concerned with his outward appearance and hygiene (biological), which in turn may cause his peers to avoid further contact with him (social). For obvious reasons, developmental psychologists are cognizant of these types of interacting biological, psychological, and social components when considering life-span events and issues. In a case such as John's, a developmentalist may choose to conceptualize and treat his problem from all three perspectives, rather than focusing on one. Because of the developmentalist's method of exploring all three perspectives, John benefits from a holistic and comprehensive approach to his difficulties. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition text revision (DSM-IV TR) It is used by clinicians and psychiatrists to diagnose psychiatric illnesses. The DSM-IV TR is published by the American Psychiatric Association and covers all categories of mental health disorders for both adults and children. The manual is non-theoretical and focused mostly on describing symptoms as well as statistics concerning which gender is most affected by the illness, the typical age of onset, the effects of treatment, and common treatment approaches. The DSM-IV was originally published in 1994 and listed more than 250 mental disorders. An updated version, called the DSM-IV TR, was published in 2000 and contains minor text revision in the descriptions of each disorder. Mental health

providers use the manual to better understand a client's potential needs as well as a tool for assessment and diagnosis. The DSM-IV TR is based on five different dimensions. This multiaxial approach allows clinicians and psychiatrists to make a more comprehensive evaluation of a client's level of functioning, because mental illnesses often impact many different life areas.

Axis

I:

Clinical

Syndromes

This axis describes clinical symptoms that cause significant impairment. Disorders are grouped into different categories, including adjustment disorders, anxiety disorders, and pervasive developmental disorders.

Axis

II:

Personality

and

Mental

Retardation

This axis describes long-term problems that are overlooked in the presence of Axis I disorders. Personality disorders cause significant problems in how a patient relates to the world and include antisocial personality

disorder and histrionic personality disorder. Mental retardation is characterized by intellectual impairment and deficits in other areas such as self-care and interpersonal skills.

Axis

III:

Medical

Conditions

These include physical and medical conditions that may influence or worsen Axis 1 and Axis II disorders. Some examples may include HIV/AIDS and brain injuries.

Axis

IV:

Psychosocial

and

Environmental

Problems

Any social or environmental problems that may impact Axis I or Axis II disorders are accounted for in this assessment. These may include such things as unemployment, relocation, divorce, or the death of a loved one.

Axis

V:

Global

Assessment

of

Functioning

This axis allows the clinician to rate the client's overall level of functioning. Based on this assessment, clinicians can better understand how the other four axes are interacting and the effect on the individual's life. While the DSM-IV TR is an important tool, it is important to note that only those who have received specialized training and possess sufficient experience are qualified to diagnose and treat mental illnesses. Clinicians also use the DMS-IV to classify patients for billing purposes, since the government and many insurance carriers require a specific diagnosis in order to approve payment for treatment.

The Anxiety Disorders

Specific Phobia -- The term "phobia" means "fear." A specific phobia is an irrational fear of some specific thing or situation. The fear is "irrational" in the sense that it is all out of proportion to the actual danger presented. For example, some people are terrified when they see a spider, even though it is on a wall 20 feet away and could not possibly do the person any harm from that distance. A common phobia isagoraphobia (literally, "fear of the marketplace"), in which a person develops a fear of being amongst crowds of people.

Panic Disorder -- This is a disorder characterized by unforewarned attacks of extreme dread, as if some terrible thing is about to befall the person, generally lasting only a couple of minutes and leaving the person physically exhausted because of the extreme activation of the physiological mechanisms aroused by terror. These attacks do not appear to be caused by

any particular situation or thing, but if they occur several times within a given context, the person may develop agoraphobia as a secondary effect.

Post-traumatic Stress Disorder -- In World War I, soldiers who came down with this were said to be "shell shocked," the idea being that the symptoms must have resulted from being exposed to too many concussions from exploting artillary shells. Actually, the disorder arises when people are exposed to servely stressful, life-threatening situations in which they perceive that they have no control over the outcome. Those affected have flashbacks about the situation in which they were helpless, nightmares, difficulty sleeping, and and find it impossible to put the situation behind them and get on with their lives. Situations inducing the disorder include military combat, natural disasters (e.g., being caught in an earthquake), accidents (e.g., a plane crash or train wreck) and being taken hostage, among others.

Obsessive-Compulsive Disorder -- The name comes from two related symptoms: obsessions and compulsions. Obsessions are thoughts, usually of a distressing nature, that constantly intrude into awareness, over and over again. Compulsions are ritualistic behaviors the person feels to perform over and over again, because not to perform them means experiencing rapidly increasing levels of anxiety. Certain drugs and behavior modification techniques have been used to treat the disorder.

Generalized Anxiety Disorder -- This gets its name from the theoretical notion that what started as specific phobias has spread though generalization to almost all situations. The person suffering from this disorder experiences continuous, high levels of "free-floating" anxiety that does not seem to have been triggered by any specific thing or situation. The symptoms of anxiety are often treated by prescribing minor

tranquilizers as an initial step; this is followed by psychological therapy aimed and uncovering and eliminating the source of the anxiety. The Somatoform Disorders "Soma" means "body," so these are disorders with some obvious connection to the state of the body. Included are the following two diagnoses:

Hypochondriasis -- You are probably more familiar with the label for the person: "hypochondriac." This is someone who is perpetually convinced that he or she has some dread disease which, if not treated promptly, is going to lead to their demise. If their own diagnosis is not confirmed by the doctor, hypochontriacs are likely to ask for a second opinion or to decide that, well, if it's not THIS, then surely it must be THAT. The disorder may be maintained by a strong fear of death, although being the center of attention and concern of physicians, friends, and others can provide its own source of motivation.

Conversion Disorder (old name: Hysteria) -- The old name comes from the Greek for "womb," suggesting that it is a disorder restricted to females. For reasons unknown it is much more common in women, but men have occasionally been known to develop it. The person with this diagnosis has suffered a loss of sensory experience (sight, hearing, feelings in some part of the body) or a paralysis of some part (e.g., arms, legs), but medical examination reveals no abnormalities. Another symptom is that the person appears to be surprisingly unconcerned about developing the problem and does not wish to seek help to get it cured (indifference toward the disorder). Sigmund Freud suggested that the symptoms appear because they allow the person unconsciously to resolve a "damned if you do, damned if you don't" conflict.

The Dissociative Disorders

This category includes those psychological disorders that involve a "walling off" of some part of the mind from consciousness. (The walled off parts are said to become "dissociated." At one time conversion disorder was included here, but evidently it was needed above so that somatoform disorders would include more than just hypochondriasis!

Dissociative Amnesia -- Loss of memory due to psychological factors as opposed to physical trauma to the brain.

Dissociative Fugue -- The person disappears, forgets their true identity and past, replaceing them with an imaginary identity and past, and begins a new life in some other place, but is not conscious of having done these things.

Dissociative Identity Disorder (old name: "Multiple Personality) -- the person develops several alternate personalities, each of which seems like a normal person. The currently "active" personality may or may not have any awareness of what was happening when other personalities were active.

This completes my review of disorders that fell under the older category of "neurosis." Next I cover two more severe disorders, involving a loss of contact with reality and other extreme symptoms, that fall under the old category of "psychosis." Schizophrenia Although the term "schizophrenia means "split mind," it does not refer to the splitting of the personality into several functioning personality subtypes as in dissociative identity disorder. Rather, the term was intended to convey a splitting of the normally integrated cognitive/behavioral/emotional functioning of the brain. For example, a person may suddenly become emotionally agitated even though there is no apparent objective reason for this change. Symptoms of Schizophrenia

Schizophrenia includes a variety of symptoms, not all of which will necessarily be present at any one time.

Hallucinations -- a hallmark of Schizophrenia. Usually, these take the form of hearing voices. These voices may be critical of the person, and in some cases may tell the person to do certain things. Visual Hallucinations are less common, but do occur in some cases.

Disordered Thought -- Thinking is irrational and disorganized. Attention Difficulties -- The person is easily distracted and has a difficult time focusing attention on one line of thought for long.

"Word Salad" -- In severe cases, the individual may exhibit such disordered thinking that sentences are almost completely disconnected, except perhaps by a chain of loose associations. Occasionally the person uses strange words ("neologisms") which seem to have a private meaning for the person and yet the person seems to believe that others know their meaning.

Delusions -- false beliefs that are firmly held regardless of evidence to the contrary. Paranoid delusions involve (a) delusions of grandeur -- an irrational belief that one is someone of elevated position or abilities, e.g., Christ; and (b) delusions of persecution -- an irrational belief that "they" are out to get you.

Catatonia -- the person "freezes" into a position of "waxy flexibility": you can reposition their arms etc. as if the person were a doll, and they will hold the new position (even a very uncomfortable one) for long periods of time. The person seems to be in a trance-like state, but upon emerging from the catatonia can report what had been happening.

Classification of Schizophrenia

Schizophrenia may be broken into two classes according to the rapidity of its development:

Reactive Schizophrenia
o

Symptoms develop over a period of days or weeks, usually in adulthood.

Good prognosis: the person is likely to recover from the disorder.

Process Schizophrenia
o

Symptoms develop gradually, over a period of months and years, usually beginning in the teens or early twenties.

Poor prognosis: the person is unlikely to recover from the disorder.

Causes of Schizophrenia The causes of schizophrenia are unknown. Genetic factors may somewhat dispose one to develop the disorder, but even among identical twins, if one develops schizophrenia, the other has only about a 50-50 chance of developing it also, so there must be other precipitating factors. It is now known that there is some degree of brain deterioration associated with the disorder, at least in those diagnosed with "process" schizophrenia. A biochemical imbalance involving the

neurotransmitter dopamine is implicated in the disorder, as drugs the have proven effective in reducing the symptoms of schizophrenia tend to be those that reduce activity in the brain's dopamine systems. Bipolar Disorder (Manic-Depressive Disorder) Bipolar Disorder gets its name from the fact that the person alternates between two "poles" along a continuoum of emotion running from mania at one extreme to severe depression at the other. In most cases, the person cycles between these two

extremes over a period of days, weeks, or months, with periods of apparent normality in between. During the manic phase the person exhibits agitation, an emotional high where everything seems possible, high energy with little apparent need for sleep, a flood of ideas coming one right after the other, and irrationalty. During the depressive phase the opposite is evident: little energy, difficulty in initiating activity, slowed thought processes, serious depression. Irrationality is again present -- the person may believe that he or she has done some horrible thing for which they are being punished, for example. As with schizophrenia, there is some evidence that genetics is a factor in that relatives of someone with the disorder are somewhat more likley than nonrelatives also to develop it, but the actual causes remain unknown. The disorder appears to relate to a problem in the regulation of synaptic sensitivities in a certain class of neurotransmitters; one of the effective drug treatments, lithium chloride, may act to stabilize this sensitivity and thereby stop the cycling.

Psychological Disorders & Psychological Counseling Unfortunately, there's a great deal of stigma attached to counseling for psychological disorders -- or psychological disorders in general! Mental illnesses are often embarrassing -- few people are thrilled to tell their friends and family they're seeing a "shrink"! It's also painful to delve into the depths of your soul or apply cognitive behavioral theories to your life, even if the psychological disorder can be overcome this way. Finally, counseling for psychological disorders can be expensive; not many insurance providers cover the cost easily. Overcoming the hurdles of seeing a psychologist or psychiatrist can be extremely valuable to your whole self - not just your mind and emotions, or the psychological disorder. Your physical health is intricately connected to your mind and soul, so dealing with one aspect of your self invariably boosts other parts.

Just like a physical disease like cancer, a psychological disorder can hit anyone at any time in their life, regardless of how wealthy, happy, or well-adjusted they are. It's the luck of the draw - just like many things in life.

The Biological (Medical) Model of Abnormality This activity will help you to: Understand the medical model of abnormality Apply the ideas of the medical model to psychological abnormality The biological (medical) model of abnormality makes the assumption that psychological and behavioural abnormalities have biological causes. behaviour and experience, because something has gone wrong with the brain. Possible Biological Causes of Abnormality Factor Explanation Genetics The genes we inherit from our parents provide the blueprint for our bodies and brains. A slight abnormality in the genes could result in abnormalities in a persons brain functioning with the consequence that their behaviour becomes abnormal. Infection The brain itself has no immune response. It relies on keeping infections (e.g. bacteria or viruses) out with a In other words, things go wrong with

barrier. Infections that get into the brain can cause widespread damage, and if the brain is damaged then a person may start to have abnormal experiences or to behave in abnormal ways. Chemicals To operate properly, the brain relies on hundreds of different chemicals all being in the correct balance. These chemicals (neurotransmitters and hormones) are used to send messages round the brain and nervous system, so too much or too little of any of them can cause the brain to function abnormally. Environmental factors Although the medical model focuses on internal, biological processes, it does not ignore the possibility that the environment can have a role to play in abnormality. On the one hand, a persons experiences, such as high levels of stress, can cause biological reactions that have a knock-on effect on the brains functioning. On the other hand, there are some toxins and pollutants in the environment that affect brain functioning directly, such as mercury, which can cause irrational behaviour and lead, which ca

An Example: Depression Depression is a severe psychological illness characterised by periods of very low mood and feelings of helplessness and guilt. People with depression find it difficult to motivate themselves to do their normal activities and often become socially withdrawn. They may also have disturbed sleep and appetite, amongst other physical symptoms.

People who have depression run a substantially increased risk of suicide. Depression seems to run in families. depressed person are two to three times more likely to develop depression themselves, compared to people with no depressed relatives. People who have depression appear to have abnormal levels of serotonin compared with non-depressed people. A depressed person given a serotonin-boosting drug produces less People who are closely related to a

serotonin and more slowly than a non-depressed person. Drugs that increase serotonin activity are often effective in treating depression. People who are carrying the Borna Disease Virus (usually found in livestock such as horses or sheep) run a higher risk of developing depression than the general population. One study found that 30% of a sample of depressed patients were carrying Borna Virus, compared to 8% carriers in a sample of people suffering from another type of disorder. Stress and depression seem to be related. Prolonged stress causes the body to release cortisol. Cortisol has an inhibitory effect on serotonin, and depression can be a consequence of long-term stress. Exposure to certain chemicals, such as organophosphates, also seems to increase the risk of depression. Occupational groups who use such chemicals in their work are frequently found to have a higher risk of depression than the general populatio

http://www.psychlotron.org.uk/resources/abnormal/AS_AQA_abnormal_biomode ldepression.pdf

THREE (BIPOLAR

MAJOR DISORDER,

PSYCHOLOGICAL SCHIZOPHRENIA,

DISORDERS MULTIPLE

PERSONALITIES) INTRODUCTION "More than 100 million Americans have a close family member who suffers from a major mental illness,' and 1500 million people around the world suffer. It is estimated that by the year 2020, major depression will be main cause of disability and the second leading cause of death in the world. In other words, there is an overwhelming possibility that a major psychological disorder will touch each and every one of us. Anxiety disorder Anxiety disorder is a blanket term covering several different forms of a type of mental illness of abnormal and pathological fear and anxiety. Conditions now considered anxiety disorders only came under the aegis of psychiatry at the end of the 19th century.[1] Gelder, Mayou & Geddes (2005) explain that anxiety disorders are classified in two groups: continuous symptoms and episodic symptoms. Current psychiatric diagnostic criteria recognize a wide variety of anxiety

disorders. Recent surveys have found that as many as 18% of Americans may be affected by one or more of them.[2] The term anxiety covers four aspects of experiences an individual may have: mental apprehension, physical tension, physical symptoms and dissociative anxiety.[3] Anxiety disorder is divided into generalized anxiety disorder, phobic disorder, and panic disorder; each has its own characteristics and symptoms and they require different treatment (Gelder et al. 2005). The emotions present in anxiety disorders range from simple nervousness to bouts of terror (Barker 2003). Standardized screening clinical questionnaires such as the Taylor Manifest Anxiety Scale or the Zung Self-Rating Anxiety Scale can be used to detect anxiety symptoms, and suggest the need for a formal diagnostic assessment of anxiety disorder.[4] Generalized anxiety disorder is characterized by chronic feelings of excessive worry and anxiety without a specific cause. Individuals with generalized anxiety disorder often feel on edge, tense, and jittery. Someone with generalized anxiety disorder may worry about minor things, daily events, or the future. These feelings are accompanied by physical complaints such as elevated blood pressure, increased heart rate, muscle tension, sweating, and shaking There are many types of anxiety disorders that include panic disorder,obsessive compulsive disorder, post-traumatic stress disorder, social anxiety disorder, specific phobias, and generalized anxiety disorder. Anxiety is a normal human emotion that everyone experiences at times. Many people feel anxious, or nervous, when faced with a problem at work, before taking a test, or making an important decision. Anxiety disorders, however, are different. They can cause such distress that it interferes with a person's ability to lead a normal life.

An anxiety disorder is a serious mental illness. For people with anxiety disorders, worry and fear are constant and overwhelming, and can be crippling A phobic disorder A phobic disorder is an irrational intense.and a continuous fear of differentsituations,activities,things,animals,people,or places, the actualize

symptom of this disorder is,its effectiveness in avoiding the feared provocation. If such fear is interfering with one's daily life,then that fear is out of control.Go to cortisol and stress.

Social Anxiety Disorder Social anxiety disorder, also called social phobia, is an anxiety disorder in which a person has an excessive and unreasonable fear of social situations. Anxiety (intense nervousness) and self-consciousness arise from a fear of being closely watched, judged, and criticized by others. A person with social anxiety disorder is afraid that he or she will make mistakes, look bad, and be embarrassed or humiliated in front of others. The fear may be made worse by a lack of social skills or experience in social situations. The anxiety can build into a panic attack. As a result of the fear, the person endures certain social situations in extreme distress or may avoid them altogether. In addition, people with social anxiety disorder often suffer "anticipatory" anxiety -the fear of a situation before it even happens -- for days or weeks before the event. In many cases, the person is aware that the fear is unreasonable, yet is unable to overcome it. People with social anxiety disorder suffer from distorted thinking, including false beliefs about social situations and the negative opinions of others. Without

treatment, social anxiety disorder can negatively interfere with the person's normal daily routine, including school, work, social activities, and relationships. People with social anxiety disorder may be afraid of a specific situation, such as speaking in public. However, most people with social anxiety disorder fear more than one social situation. Other situations that commonly provoke anxiety include:

Eating or drinking in front of others. Writing or working in front of others. Being the center of attention. Interacting with people, including dating or going to parties. Asking questions or giving reports in groups. Using public toilets. Talking on the telephone. Social anxiety disorder may be linked to other mental illnesses, such as panic disorder, obsessive compulsive disorder, and depression. In fact, many people with social anxiety disorder initially see the doctor with complaints related to these disorders, not because of social anxiety symptoms. What Are the Symptoms of Social Anxiety Disorder? Many people with social anxiety disorder feel that there is "something wrong," but don't recognize their feeling as a sign of illness. Symptoms of social anxiety disorder can include:

Intense anxiety in social situations. Avoidance of social situations. Physical symptoms of anxiety, including confusion, pounding heart, sweating, shaking, blushing, muscle tension, upset stomach, and diarrhea.

Children with this disorder may express their anxiety by crying, clinging to a parent, or throwing a tantrum. How Common Is Social Anxiety Disorder? Social anxiety disorder is the most common anxiety disorder and the third most common mental disorder in the U.S., after depression and alcohol dependence. An estimated 19.2 million Americans have social anxiety disorder. The disorder most often surfaces in adolescence or early adulthood, but can occur at any time, including early childhood. It is more common in women than in men

Specific Phobias The term "phobia" refers to a group of symptoms brought on by certain objects or situations. A specific phobia, formerly called a simple phobia, is a lasting and unreasonable fear caused by the presence or thought of a specific object or situation that usually poses little or no actual danger. Exposure to the object or situation brings about an immediate reaction, causing the person to endure intenseanxiety (nervousness) or to avoid the object or situation entirely. The distress associated with the phobia and/or the need to avoid the object or situation can significantly interfere with the person's ability to function. Adults with a specific phobia recognize that the fear is excessive or unreasonable, yet are unable to overcome it.

There are different types of specific phobias, based on the object or situation feared, including:

Animal phobias: Examples include the fear of dogs, snakes, insects, or mice. Animal phobias are the most common specific phobias.

Situational phobias: These involve a fear of specific situations, such as flying, riding in a car or on public transportation, driving, going over bridges or in tunnels, or of being in a closed-in place, like an elevator.

Natural environment phobias: Examples include the fear of storms, heights, or water.

Blood-injection-injury phobias: These involve a fear of being injured, of seeing blood or of invasive medical procedures, such as blood tests or injections

Other phobias: These include a fear of falling down, a fear of loud sounds, and a fear of costumed characters, such as clowns. A person can have more than one specific phobia. What Are the Symptoms of Specific Phobias? Symptoms of specific phobias may include:

Excessive or irrational fear of a specific object or situation. Avoiding the object or situation or enduring it with great distress. Physical symptoms of anxiety or a panic attack, such as a pounding

heart,nausea or diarrhea, sweating, trembling or shaking, numbness or tingling, problems with breathing (shortness of breath), feeling dizzy or lightheaded, feeling like you are choking.

Anticipatory anxiety, which involves becoming nervous ahead of time about being in certain situations or coming into contact with the object of your phobia. (For example, a person with a fear of dogs may become anxious about going for a walk because he or she may see a dog along the way.) Children with a specific phobia may express their anxiety by crying, clinging to a parent, or throwing a tantrum. Agoraphobia

Definition The word agoraphobia is derived from Greek words literally meaning "fear of the marketplace." The term is used to describe an irrational and often disabling fear of being out in public. Causes and symptoms Agoraphobia is the most common type of phobia, and it is estimated to affect between 5-12% of Americans within their lifetime. Agoraphobia is twice as common in women as in men and usually strikes between the ages of 15-35. The symptoms of the panic attacks which may accompany agoraphobia vary from person to person, and may include trembling, sweating, heartpalpitations (a feeling of the heart pounding against the chest), jitters,fatigue, tingling in the hands and feet, nausea, a rapid pulse or breathing rate, and a sense of impending doom. Agoraphobia and other phobias are thought to be the result of a number of physical and environmental factors. For instance, they have been associated with biochemical imbalances, especially related to certain neurotransmitters (chemical nerve messengers) in the brain. People who have a panic attack in a given situation (e.g., a shopping mall) may begin to associate the panic with that situation and learn to avoid it. According to some theories, irrational anxiety results from unresolved emotional conflicts. All of these factors may play a role to varying extents in different cases of agoraphobia.

Ablutophobiabathing.

Fear

of

washing

or

Agraphobia- Fear of sexual abuse. Agrizoophobia- Fear of wild animals. Agyrophobia- Fear of streets or crossing the street.

Acarophobia- Fear of itching or of the insects that Fear Fear Fear of of cause of of of itching. sourness. darkness. noise. heights. drafts, air

AcerophobiaAchluophobiaAcousticophobiaAcrophobiaAerophobiaswallowing, substances.

Aichmophobia- Fear of needles or pointed AilurophobiaFear Fear of of objects. cats. kidney

Fear Fear or

Albuminurophobiadisease. AlektorophobiaAlgophobiaAlliumphobia-

airbourne

noxious

Fear Fear Fear

of of of

chickens. pain. garlic.

Aeroacrophobia- Fear of open high places. Aeronausiphobiasecondary AgateophobiaAgliophobiaFear to Fear Fear of of of vomiting airsickness. insanity. pain.

Allodoxaphobia- Fear of opinions. BacillophobiaBacteriophobiaFear Fear of of microbes. bacteria.

Ballistophobia- Fear of missiles or bullets. BolshephobiaBarophobiaFear Fear of of Bolsheviks. gravity.

Agoraphobia- Fear of open spaces or of being in crowded, public places like markets. Fear of leaving a safe place.

Basophobia or Basiphobia- Inability to

stand. Fear of walking or falling. Bathmophobia- Fear of stairs or steep slopes. BathophobiaFear of depth.

Cyberphobia- Fear of computers or working Cyclophobiaon Fear a of computer. bicycles.

Cymophobia or Kymophobia- Fear of Didaskaleinophobia- Fear of going to school. DikephobiaDinophobiawhirlpools. Diplophobia- Fear of double vision. Fear Fear of of justice. or

Batophobia- Fear of heights or being close to high buildings.

Batrachophobia- Fear of amphibians, such as frogs, newts, salamanders, etc. Belonephobia- Fear of pins and needles. (Aichmophobia) BibliophobiaBlennophobiaFear Fear of of books. slime.

dizziness

Dipsophobia-

Fear

of

drinking.

Dishabiliophobia- Fear of undressing in front of someone.

Bogyphobia- Fear of bogeys or the bogeyman. BotanophobiaFear of plants.

Disposophobia- Fear of throwing stuff out. Hoarding.

Bromidrosiphobia or BromidrophobiaFear of body smells.

Domatophobia- Fear of houses or being in a house.(Eicophobia, Oikophobia) Doraphobia- Fear of fur or skins of animals. Doxophobia- Fear of expressing opinions

Brontophobia- Fear of thunder and lightning. Bufonophobia- Fear of toads. CoulrophobiaFear of clowns.

or

of

receiving

praise.

Counterphobia- The preference by a phobic for fearful Fear of situations. precipices.

Dromophobia- Fear of crossing streets. DutchphobiaFear of the Dutch.

Cremnophobia-

Dysmorphophobia- Fear of deformity. DystychiphobiaFear of accidents.

Cryophobia- Fear of extreme cold, ice or frost. Crystallophobia- Fear of crystals or glass.

Hierophobia- Fear of priests or sacred things. HippophobiaFear of horses.

HippopotomonstrosesquipedaliophobiaFear of long words.

Onomatophobia- Fear of hearing a certain word or Fear of of names. snakes.

Hobophobia- Fear of bums or beggars. HodophobiaHormephobiaHomichlophobiaHomilophobiaHominophobiaHomophobiaFear of road of of of of of travel. shock. fog.

Ophidiophobia(Snakephobia)

Fear Fear Fear Fear Fear

Ophthalmophobia- Fear of being stared at. OpiophobiaFear medical doctors

sermons. men.

experience of prescribing needed pain medications for patients.

sameness,

monotony or of homosexuality or of becoming HoplophobiaFear of homosexual. firearms.

Optophobia- Fear of opening one's eyes. OrnithophobiaOrthophobiaFear Fear of of birds. property.

Hydrargyophobia- Fear of mercurial medicines. Hydrophobia- Fear of water or of rabies. HydrophobophobiaFear of rabies.

Stygiophobia or Stigiophobia- Fear of hell. SuriphobiaFear of mice.

Symbolophobia- Fear of symbolism. Symmetrophobia- Fear of symmetry. SyngenesophobiaFear Fear Fear Fear Fear or of of of of of relatives. syphilis. injury.

Lilapsophobia- Fear of tornadoes and hurricanes. LimnophobiaLinonophobiaLiticaphobiaLockiophobiaFear Fear Fear Fear of of of of lakes. string. lawsuits. childbirth.

SyphilophobiaTraumatophobiaTremophobiaTrichinophobia-

trembling. trichinosis.

Melanophobia- Fear of the color black. Melophobia- Fear or hatred of music. Meningitophobia- Fear of brain disease. MenophobiaFear of menstruation.

Trichopathophobia Fear of hair.

Trichophobia(Chaetophobia,

Hypertrichophobia) Triskaidekaphobia- Fear of the number 13. Tropophobia- Fear of moving or making changes.

Merinthophobia- Fear of being bound or tied MetallophobiaFear of up. metal.

Trypanophobia-

Fear

of

injections.

2)

Forests.

Tuberculophobia- Fear of tuberculosis. TyrannophobiaFear of tyrants.

Xyrophobia-Fear of razors. ZelophobiaFear of jealousy.

Uranophobia or Ouranophobia- Fear of heaven. Urophobia- Fear of urine or urinating. VerminophobiaVestiphobiaVirginitiphobiaVitricophobiaFear Fear Fear Fear of of of of germs. clothing. rape.

Zeusophobia- Fear of God or gods. Zemmiphobia- Fear of the great mole rat. Zoophobia- Fear of animals.

step-father.

Walloonphobia- Fear of the Walloons. Wiccaphobia: Fear of witches and

witchcraft. Xerophobia- Fear of dryness. Xylophobia- 1) Fear of wooden objects.

Panic Disorder Panic disorder is different from the normal fear and anxiety reactions to stressful events in our lives. Panic disorder is a serious condition that strikes without reason or warning. Symptoms of panic disorder include sudden attacks of fear and nervousness, as well as physical symptoms such as sweating and a racing heart. During a panic attack, the fear response is out of proportion for the situation, which often is not threatening. Over time, a person with panic disorder develops a constant fear of having another panic attack, which can affect daily functioning and general quality of life. Panic disorder often occurs along with other serious conditions, such

asdepression, alcoholism, or drug abuse What Are the Symptoms of Panic Disorder?

Symptoms of a panic attack, which often last about 10 minutes, include:

Difficulty breathing. Pounding heart or chest pain. Intense feeling of dread. Sensation of choking or smothering. Dizziness or feeling faint. Trembling or shaking. Sweating Nausea or stomachache. Tingling or numbness in the fingers and toes. Chills or hot flashes. A fear that you are losing control or are about to die. Beyond the panic attacks themselves, a key symptom of panic disorder is the persistent fear of having future panic attacks. The fear of these attacks can cause the person to avoid places and situations where an attack has occurred or where they believe an attack may occur.

Obsessive-Compulsive Disorder Obsessive-compulsive disorder (OCD), a type of anxiety disorder, is a potentially disabling illness that traps people in endless cycles of repetitive thoughts and behaviors. People with OCD are plagued by recurring and distressing thoughts, fears, or images (obsessions) they cannot control. The anxiety (nervousness) produced by these thoughts leads to an urgent need to perform certain rituals or routines (compulsions). The compulsive rituals are performed in an attempt to prevent the obsessive thoughts or make them go away.

Although the ritual may temporarily alleviate anxiety, the person must perform the ritual again when the obsessive thoughts return. This OCD cycle can progress to the point of taking up hours of the person's day and significantly interfering with normal activities. People with OCD may be aware that their obsessions and compulsions are senseless or unrealistic, but they cannot stop them. What Are the Symptoms of OCD? The symptoms of OCD, which are the obsessions and compulsions, may vary. Common obsessions include:

Fear of dirt or contamination by germs. Fear of causing harm to another. Fear of making a mistake. Fear of being embarrassed or behaving in a socially unacceptable manner. Fear of thinking evil or sinful thoughts. Need for order, symmetry, or exactness. Excessive doubt and the need for constant reassurance. Common compulsions include:

Repeatedly bathing, showering, or washing hands. Refusing to shake hands or touch doorknobs. Repeatedly checking things, such as locks or stoves. Constant counting, mentally or aloud, while performing routine tasks. Constantly arranging things in a certain way. Eating foods in a specific order. Being stuck on words, images or thoughts, usually disturbing, that won't go away and can interfere with sleep.

Repeating specific words, phrases, or prayers. Needing to perform tasks a certain number of times.

Collecting or hoarding items with no apparent value

Generalized Anxiety Disorder Generalized anxiety disorder (or GAD) is characterized by excessive,

exaggerated anxiety and worry about everyday life events with no obvious reasons for worry. People with symptoms of generalized anxiety disorder tend to always expect disaster and can't stopworrying about health, money, family, work, or school. In people with GAD, the worry is often unrealistic or out of proportion for the situation. Daily life becomes a constant state of worry, fear, and dread. Eventually, the anxiety so dominates the person's thinking that it interferes with daily functioning, including work, school, social activities, and relationships. What Are the Symptoms of GAD? GAD affects the way a person thinks, but the anxiety can lead to physical symptoms, as well. Symptoms of GAD can include:

Excessive, ongoing worry and tension An unrealistic view of problems Restlessness or a feeling of being "edgy" Irritability Muscle tension Headaches Sweating Difficulty concentrating Nausea The need to go to the bathroom frequently Tiredness Trouble falling or staying asleep

Trembling Being easily startled In addition, people with GAD often have other anxiety disorders (such as panic disorder, obsessive-compulsive disorder, and phobias), suffer from depression, and/or try to selfmedicate by using drugs or alcohol.

What causes anxiety disorders? Psychological factors The two main schools of thought that attempt to explain the psychological influences on anxiety disorders are the cognitive andbehavioural theories. The ideas expressed by these theories help us to understand cognitive-behavioural treatment, which will be outlined in the next chapter. A third way of looking at the psychological causes of anxiety is the developmental theory, which seeks to understand our experience of anxiety as adults by looking at what we learn as children. Cognitive Theory Danger is a part of life. To protect us, evolution has genetically prepared us to fear danger. We know to avoid vicious animals and to be careful at great heights. Cognitive theory suggests, however, that people with anxiety disorders are prone

to overestimate danger and its potential consequences. For example, people may overestimate the danger of particular animals, such as spiders or snakes, and thus believe that harm from that animal is far greater and more common than it actually is. Thinking of the worst possible scenario, they may imagine that a snake will bite and poison them, when it may be completely harmless. This is known as catastrophizing, and is common among people with anxiety disorders. People who overestimate danger tend to avoid situations that might expose them to what they fear. For example, a person who fears flying will avoid trips that require air travel.

Such behaviours are referred to as safety behaviours because they momentarily allow a person to feel less anxiety. However, when feared situations are avoided, the fears are strengthened. Cognitive theory suggests that fears can be reduced when people are able to experience the thing that they fear, allowing them to see that it is not as dangerous as they once believed. Behavioural theory Behavioural theory suggests that people learn to associate the fear felt during a stressful or traumatic life event with certain cues, such as a place, a sound or a feeling. When the cues reoccur, they cause the fear to be re-experienced. Once the association between the fear and the cue is learned, it is automatic, immediate and out of conscious control. The fear is felt before there is time to tell if danger is near. Such cues may be external or internal. An example of an external cue might be a certain smell that occurred at the time of the stressful event. When this smell occurs again, even at a time when there is no danger present, the person is reminded of the event and becomes fearful. Internal cues, such as a rapid heart rate, may also provoke fear if the persons heart raced during the actual threat. Later, when the persons heart beats rapidly during a workout routine, he or she may become fearful. People with anxiety disorders may go to extreme lengths to avoid such cues. The original cues may even generalize to other similar cues, such as a bad encounter with a bulldog leading to the avoidance of all dogs. When people avoid such cues, they may feel more secure, but in the long run, these avoidance behaviours actually increase the anxiety associated with the cues. Avoidance prevents the person from unlearning the association, which can only be done when the person is exposed to such cues in a safe situation. Developmental theory

According to developmental theory, the way in which children learn to predict and interpret life events contributes to the amount of anxiety they experience later in life. The amount of control people feel over their own lives is strongly related to the amount of anxiety they experience. A persons sense of control can range from confidence that whatever happens is entirely in his or her hands, to feeling complete uncertainty and helplessness over upcoming life events. People who feel that life is out of their control are likely to feel more fear and anxiety. For example, these people may feel that no amount of preparation or qualifications will give them any control over the outcome of an upcoming job interview, and they arrive at the interview fearing rejection. Somatoform disorders Somatoform disorders are mental illnesses that cause physical pain and other symptoms without any physical explanation. These disorders can be very challenging and distressing for both patient and doctor. For a patient, it is very frustrating to experience pain and discomfort that has no known explanation. This frustration can turn into a vicious cycle, leading people to seek out diagnoses and imagine that they have diseases that they do not have. For doctors it can be difficult to search and search for an explanation and find nothing. Doctors and psychologists are reluctant to assert that a patient's pain is psychological because it can be very difficult to rule out all possible causes of physical pain. It is also challenging to deal with a patient who keeps complaining of symptoms - patients will often become increasingly agitated over time and may even question an attending physician's competence. Hypochondriasis Hypochondriasis or hypochondria (sometimes referred to as health phobia or health anxiety) refers to excessive preoccupation or worry about having a serious illness. This debilitating condition is the result of an inaccurate perception of the bodys condition despite the absence of an actual medical condition.[1] An individual suffering from

hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical symptoms they detect, no matter how minor the symptom may be. They are convinced that they have or are about to have a serious illness.[2] Often, hypochondria persists even after a physician has evaluated a person and reassured them that their concerns about symptoms do not have an underlying medical basis or, if there is a medical illness, their concerns are far in excess of what is appropriate for the level of disease. Many hypochondriacs focus on a particular symptom as the catalyst of their worrying, such as gastro-intestinal problems, palpitations, or muscle fatigue. The duration of these symptoms and preoccupation is 6 months or longer.[3] Somatization Disorder What Is It? A person with somatization disorder is chronically preoccupied with numerous "somatic" (physical) symptoms over many years. These symptoms, however, cannot be explained fully by a non-psychiatric diagnosis. Nonetheless, the symptoms cause significant distress or impair the person's ability to function. The person is not "faking." Somatization disorder is a medical problem. The disorder, however, is probably related to brain functioning or emotional regulation rather than the area of the body that has become the focus of the patient's attention. The symptoms are real and are not under the person's conscious control. People with somatization disorder report multiple medical problems over many years, involving several different areas of the body. For example, the same person might have back pain, headaches, chest discomfort, and stomach or urinary distress. Women often report irregular periods. Men may report erectile dysfunction (impotence). The person may:

Describe symptoms in dramatic and emotional terms

Seek care from more than one physician at the same time Describe symptoms in vague terms Lack specific signs of medical illness Have complaints that medical tests fail to support

Many people with a non-psychiatric illness describe their symptoms in dramatic terms. Thus, if a person is dramatic, it does not necessarily mean he or she has somatization disorder. People with somatization disorder get other diagnosable medical illnesses, too, so doctors must be careful not to dismiss symptoms too easily. A person with somatization disorder also may have symptoms

of anxiety and depression.He or she may begin to feel hopeless and attempt suicide, or may have trouble adapting to the stresses of life. The person may abuse alcohol or drugs, including prescription medications. Spouses and other family members may become distressed because the person's symptoms continue for long periods of time and no medical treatment seems to help. Symptoms of somatization disorder vary by culture. Cultural factors also affect the proportions of men and women with the disorder. Female relatives of people with somatization disorder are more likely to develop the disorder. Male relatives are more likely to develop alcoholism and personality disorder. Scientists do not know the cause of the symptoms reported by people with somatization disorder, but researchers have some theories. It is possible, for example, that people with this disorder perceive bodily sensations in an unusual way. Trauma or stress may cause a person's physical sensations to change. Conversion Disorder

A conversion disorder is a rare mental disorder in which a person has physical symptoms that no medical condition can explain. The person is not "faking." The symptoms do not appear to be under the person's conscious control and they can cause significant distress. Examples of symptoms are a loss of muscle control, blindness, deafness, seizures or even apparent unconsciousness. Conversion disorder often appears after conflict or stress, though the person is not aware of this connection. The person believes the problem is physical. The name of the disorder comes from the idea that some sort of psychological distress is being converted into a physical symptom. Some experts believe that a conflict or painful thought is so unacceptable that it never reaches the person's awareness. In some cases, the person shows little concern about the physical symptom, a phenomenon sometimes called la belle indifference. Conversion disorder is more common in women than in men. It occurs most frequently between adolescence and middle age. It appears more often in places where people know less about medicine and psychology, such as in developing countries. When the disorder occurs in a person who is knowledgeable about medical advancements, the symptoms tend to be subtler; symptoms are likely to be more severe in a person who doesn't know as much about medicine. A very high percentage of people with conversion disorder have another psychiatric problem, such as generalized anxiety, obsessive-compulsive disorder or some form of depression. They also report a higher than average frequency of emotional or physical abuse during childhood. Symptoms Conversion disorder is characterized by one or more symptoms that suggest a neurological condition. Examples include:

Poor coordination or balance Paralysis or weakness Difficulty speaking or swallowing Retention of urine Loss of touch or pain sense Blindness or other visual symptoms Deafness Seizures or convulsions

Psychological factors, such as stress or conflict, are associated with the appearance of the physical symptoms. Causes of Somatoform Disorder Biological Factors This factor relates to the possibility of genetic effects that usually occurs insomatization disorder. Social Environmental Factors

Socialization, especially in a woman in the role in society is more dependent on others can also be expressed as a form of somatoform disorder. Factors Conduct

In these behavioural factors, there are some behaviours that seem obvious, such as: free from sick the role, usual responsibilities or run away or with body escape from

situation that is uncomfortable or causing anxiety (profit secondary), the attention to the compulsive behaviours associated dysmorphic

disorder orhypochondriasis or can be partially relieve anxiety associated with glued on worries about health or physical damage is perceived. Emotional and Cognitive Factors

Causes of Somatoform Disorder associated with emotion and cognition can be: miss

interpretation of changes in body or physical symptoms as a sign, from a serious illness (Hypochondriasis), in traditional Freudian theory, the psychic energy that was cut off from the impulse-unacceptable impulses are converted into physical symptoms (conversion disorder), blaming the poor performance of the declining health may is a strategic elf-handicapping (Hypochondriasis). Dissociative disorder

Dissociative disorders are defined as conditions that involve disruptions or breakdowns of memory, awareness, identity and/or perception. People with dissociative disorders use dissociation, a defence mechanism, pathologically and involuntarily. Dissociative disorders are thought to primarily be caused bypsychological trauma. The five dissociative disorders listed in the DSM IV are as follows[1]:

Depersonalization disorder: periods of detachment from self or surrounding which may be experienced as "unreal" (lacking in control of or "outside of" self) while retaining awareness that this is only a feeling and not a reality.

Dissociative amnesia: (formerly Psychogenic Amnesia): noticeable impairment of recall resulting from emotional trauma

Dissociative fugue: (formerly Psychogenic Fugue): physical desertion of familiar surroundings and experience of impaired recall of the past. This may lead to confusion about actual identity and the assumption of a new identity.

Dissociative identity disorder: (formerly Multiple Personality Disorder): the alternation of two or more distinct personality states with impaired recall, among personality states, of important information.

Dissociative disorder not otherwise specified: which can be used for forms of pathological dissociation not covered by any of the specified dissociative disorders.

The ICD-10 classifies conversion disorder as a dissociative disorder[2] while the DSM-IV classifies it as a somatoform disorder. Depersonalization disorder (DPD) is a dissociative disorder (ICD-10 classifies the disorder as an anxiety disorder) in which the sufferer is affected by persistent or recurrent feelings of depersonalization and/or derealization. Diagnostic criteria include persistent or recurrent experiences of feeling detached from one's mental processes or body.[1] The symptoms include a sense of automation, going through the motions of life but not experiencing it, feeling as though one is in a movie, loss of conviction with one's identity, feeling as though one is in a dream, feeling a disconnection from one's body, out-of-body experience (a detachment from one's body), and difficulty relating oneself to reality and the environment. Occasional moments of mild depersonalization are normal;[2] strong, severe, persistent, or recurrent feelings are not. A diagnosis of a disorder is made when the dissociation is persistent and interferes with the social and occupational functions necessary for everyday living. Depersonalization disorder is thought to be largely caused by severe traumatic lifetime events including childhood sexual, physical, and emotional abuse; accidents, war, torture, panic attacks and bad drug experiences. It is unclear whether genetics play a role; however, there are many neurochemical and hormonal changes in individuals suffering with depersonalization disorder.[3] As the core symptoms of the disorder are thought to protect the victim from negative stimuli, depersonalization disorder can be conceptualized as a defense mechanism. Depersonalization disorder is often comorbid with anxiety disorders, panic

disorders, clinical depression and bipolar disorder. Although depersonalization disorder is an alteration in the subjective experience of reality, it is not related to psychosis, as sufferers maintain the ability to distinguish between their own internal experiences and the objective reality of the outside world. During episodic and continuous depersonalization, sufferers are able to distinguish between reality and fantasy, and their grasp on reality

Psychogenic amnesia, also known as functional amnesia or dissociative amnesia, is a memory disorder characterized by extreme memory loss that is caused by extensive psychological stress and that cannot be attributed to a known neurobiological cause.[1] Psychogenic amnesia is defined by (a) the presence of retrograde amnesia (the inability to retrieve stored memories leading up to the onset of amnesia), and (b) an absence of anterograde amnesia(the inability to form new long term memories).[2][3][4] Dissociative amnesia is due to psychological rather than physiological causes and can sometimes be helped by therapy.[5] A fugue state, formally dissociative fugue or psychogenic fugue (DSM-IV Dissociative Disorders 300.13[1]), is a rare psychiatric disorder characterized by reversible amnesia for personal identity, including the memories, personality and other identifying

characteristics of individuality. The state is usually short-lived (ranging from hours to days), but can last months or longer. Dissociative fugue usually involves unplanned travel or wandering, and is sometimes accompanied by the establishment of a new identity.

Reference http://psychology.about.com/od/psychotherapy/tp/psychological-disorders.htm http://users.ipfw.edu/abbott/120/PsychDisorders.html http://l-pawlik-kienlen.suite101.com/psychological-disorders-a16446 http://www.simplypsychology.org/abnormal-psychology.html http://psychology.about.com/od/abnormalpsychology/f/abnormal-psychology.htm http://en.wikipedia.org/wiki/Model_of_Abnormality#The_Biological_.28Medical.29_Mo del http://www.cliffsnotes.com/study_guide/The-BiopsychosocialPerspective.topicArticleId-26831,articleId-26751.html http://urbandreams.ousd.k12.ca.us/lessonplans/psychology/index.html http://psychology.about.com/od/gindex/g/gad.htm http://www.webmd.com/anxiety-panic/specific-phobias http://healthtools.aarp.org/galecontent/agoraphobia?CMP=KNC-360i-YAHOOBINGHEA&HBX_PK=agoraphobia&utm_source=YAHOOBING&utm_medium=cpc&utm_te rm=agoraphobia&utm_campaign=M_Diseases%252Band%252BConditions&360cid=SI _194857354_320874028_1

http://phobialist.com/ http://www.webmd.com/anxiety-panic/guide/mental-health-panic-disorder http://www.webmd.com/anxiety-panic/guide/generalized-anxiety-disorder http://www.camh.net/About_Addiction_Mental_Health/Mental_Health_Information/Anx iety_Disorders/causes_anxiety.html http://en.wikipedia.org/wiki/Hypochondriasis http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/10774.html http://somatoformdisorders.net/overview/causes-of-somatoform-disorder.html http://en.wikipedia.org/wiki/Dissociative_disorder http://en.wikipedia.org/wiki/Dissociative_fugue http://en.wikipedia.org/wiki/Dissociative_amnesia http://en.wikipedia.org/wiki/Depersonalization_disorder

References: Kessler, R.C., McGonagle, K.A., Zhoa, S., Nelson, C.B., Hughes, M., Eshleman, S., & others. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey (NCS). Archives of General Psychiatry, 51, 8-19.

National Institute of Mental Health. (2008). The numbers count: Mental disorders in America. Found online at http://www.nimh.nih.gov/health/publications/the-numberscount-mental-disorders-in-america/index.shtml#Intro