Chapter 2:

Types of Mental
Disorders
 DSM-5 *
• Diagnostic and Statistical Manual of Mental Disorders: clarifies mental disorders in
psychiatry
• DSM-5 was published in 2013 by the American Psychiatric Association
• First 3 editions were criticized for questionable scientific validity*
• The new DSM-5 is supposed to further refine the classification of mental disorders, backed by
research*
• Not without controversy- the National Institute for Mental Health argues the DSM-5 should not guide
research but should be based on biological, genetic, and neurological causes
• Another issue is the distinctions between disorders and nondisorders
• What’s the difference between just being sad and being depressed?
• DSM-IV-TR said that no definition of mental disorder adequately specifies precise boundaries*
• What does this mean?
• Number of classifiable disorders:
• 1st edition (1953) = 60
• 4th edition TR (2000) = 365
• 5th edition (2013)=157
• …………………. So, in 47 yrs we’ve created 305 new problems you can have!!!!
• ………………………..and then in 13 years reduced this number by 208???
 DSM-5 *
• Current practice is to “medicalize” deviant behavior
• Remind me, what is deviant???

• Medicalization is when previously nonmedical problems are defined and treated as

an illness or medical disorder*
• Two sides to every coin- is it good or is it bad?

• Sociologists also had problems with the dichotomous system

• Another issue is symptom inventories (how many licks to crazy?)
• DSM-5 proposed a severity rating on a scale of
• 1 (not ill) to 7 (most severely ill)
• This was rejected by the APA

• DSM 5-reduced the number of symptoms

required for diagnosing*
 Neurodevelopmental Disorders*
• Include (9 types, including):
• 1) intellectual development disorders (intellectual dev. disorders)
• 2) communication disorders (language, speech, and social communication
difficulties)
• 3) autism spectrum (varying degrees)*
• 4) specific learning disorder*
• 5) motor disorders (coordination, tics)
• Major controversy occurred when the DSM-5 was proposed and had eliminated some
forms of autism (Asperger’s syndrome)
• Various autism support groups protested against this change and autism scale was broadened in
response to public pressure
• Sooooooooo, if something is not a disorder and you want it to be a disorder how do you do it?
• Flip-side: If something is a disorder and you do not want it to be a disorder how do you do it?
 Schizophrenia Spectrum and
Other Psychotic Disorders

• Schizophrenia is a disturbance in mood, thinking, and behavior manifested by

distortions of reality (includes delusions and hallucinations).
• 1.1% of US pop/ 3.5 million people
• Affects men and women equally (possibly slightly more men)
• Exists on a spectrum- low end is schizoid personality disorder (excessively introverted and lacks
the ability to form social relationships)* “loners”
• Middle level is delusional disorder (has a foundation of unrealistic thoughts)
• 1) erotomanic type- believing another person is in love with them (usually higher status)
• 2) grandiose type- inflated self-worth, power, knowledge
• 3) jealous type- believing one’s sexual partner is unfaithful
• 4) persecutory type- believe they or another are being treated badly
• 5) somatic type- believing they have a medical condition
• 6) mixed type- a combination of 2 or more of the above
• Higher level is brief psychotic disorder- lasts from 1 day to less than 1 month
• Next highest is schizphreniform disorder- lasts more than 1 month
• Highest is schizophrenia- symptoms must be present at least 6 months
• Are these time periods arbitrary?
 Schizophrenia Spectrum and
Other Psychotic Disorders*

• Schizophrenia has an onset typically during adolescence or early adulthood

• Strongest evidence on schizophrenia comes from genetic studies involving studies of
children of schizophrenic parents who are raised in foster homes by normal adults*
• These children are 10 times more likely to develop schizophrenia than the average population
• We do not know the specific genes that cause it but we do know that it is also biochemical
• We can control schizophrenia with drugs and we can cause schizophrenic symptoms with drugs
• However, most people diagnosed with schizophrenia have no family history so genetics is not the only
cause

• Schizophrenia has a social factor- it can be related to stressful life events

• The exact etiology is unknown
• What does etiology mean?
 Bipolar & Related Disorders*

• Bipolar disorders consist of manic and depressive episodes.

• Occurs equally among men and women- usually before age 30.*
• 6 million adults in the US/ 2.6% of the population
• Other disorders in this category:
• Cyclothymic disorder- both manic and depressive but not serious enough to be considered bipolar
• Substance-induced bipolar disorder
• Bipolar disorder associated with another medical condition
 Depressive Disorders *

• Affect about 16 million in US/ 6.7% of pop.

• 1 out of every 6 adults in US experiences this at least once in lifetime
• Much more likely in women than men*
• No known cause
• Clusters within family lineage
• Can be related to a stressful life event
• NEW Disorder: disruptive mood dysregulation disorder- temper tantrums/angry
moods/rage*
• Must last 12 months or more- in at least 2 settings*
• Only applied to children 6 to 18 years*

• Multiple other depressive disorders (see text)

• Last category is “depressive disorder not elsewhere classified”
 Anxiety Disorders *

• Most commonly diagnosed mental health problem in US*

• 18.1% of US pop/ 40 million people
• Includes: extreme fear and anxiousness, usually experienced at first in early 20s-
more common in women than men
• Other associated disorders:
• Separation anxiety disorders- must last more than 4 weeks?
• Panic disorder-reoccurring panic attacks
• Agoraphobia-abnormal fear of leaving home or being in a closed space*
• Specific phobia
• Social anxiety disorder (social phobia)
• Generalized anxiety disorder
• Substance –induced anxiety disorder
• Anxiety disorder attributed to another medical condition
• Anxiety disorder not elsewhere classified
 Obsessive-Compulsive Disorders *

• Obsessive-Compulsive Disorders are recurrent obsessions (repetitive ideas and

thoughts) and compulsions (repetitive irrational acts)*
• Begins in adolescence or early childhood- is more common in certain families than
others
• 2.2 million adults or 1% of US pop
• No known differences between the sexes
• Other associated disorders:
• Body dysmorphic disorder, Hair-pulling disorder, Skin-picking disorder*
• Hoarding disorder
• Substance-induced obsessive-compulsive disorder
• obsessive-compulsive disorder related to another medical condition
• obsessive-compulsive disorder not elsewhere classified
 Trauma & Stressor-Related Disorders *

• Reactive Attachment Disorder (children that lack social interaction) and Disinhibited
Social Engagement Disorder (excessive social involvement by child with strangers)
are believed to be the result of a failure to develop normal attachments to parents or
caregivers in early childhood.*
• Acute Stress Disorders- anxiety develops within a month after the traumatic event
(absence of emotional response)
• Posttraumatic Stress Disorders- due to traumatic event such as war.
• Symptoms: persistent re-experiencing event through memory, dreams, nightmare
• 8 million 18+, 3.5% of US, average age is 23 (onset)

• Also includes: Adjustment Disorders, Trauma and Stressor-related disorder not

elsewhere classified
 Dissociative Disorders

• Definition: a sudden and temporary loss of motor behavior, consciousness, or identity

• Effects women more than men
• 5 Types of Dissociative Disorders:
• 1. Dissociative Amnesia (different types based on length)
• 2. Dissociative Fugue-leaving home and assuming a new identity unable to recall past
• 3. Dissociative Identity Disorder (formerly multiple personality)-domination of a person by 1 or more
other personalities
• Seen in adolescent females
• very rare
• 4. Depersonalization Disorder- feeling dreamlike or mechanical
• 5. Dissociative Disorder not otherwise specified-trancelike states w/o depersonalization
 Somatic Symptom Disorders*

• Symptoms of physical illness with no physical causes but due to psychological

factors*
• Not under a person’s voluntary control (they do not believe they are making it up)
• Principle Subtypes:
• 1. Somatic symptom disorder-includes hypochondriasis (fear of loss of control of body)
• 2. Illness anxiety disorder
• 3. Conversion disorder
• 4. Psychological factors affecting medical condition
• 5. Factitious disorder (faking illness)
• 6. Somatic symptom disorder not elsewhere classified

• More common in women than men

• Really?
 Feeding and Eating Disorders*

• Severe disturbances in eating behavior, primarily anorexia nervosa and bulimia

nervosa
• Pica (eating non-nutritive substances (dirt, sand, etc) for 1 month or more
• Rumination Disorder
• Avoidant/Restrictive food intake disorder (are you really allergic?)
• Binge eating disorder-compulsive eating followed by depression

• Most prevalent in industrialized societies where there is an abundance of food*

• More common in women
 Sexual Dysfunctions*

• The principle problem inherent in this disorder is an inhibition in the psycho-

physiological changes that occur in the sexual response cycle*
• 75% of men always reach orgasm during sex; only 29% of women do the same (Source: National
Health and Social Life Survey)
• At least 50% of sexually active men and women will have a genital HPV infection at some point
in their lives (Source: Centers for Disease Control and Prevention)
• 1. erectile disorder
• 2. female orgasmic disorder
• 3. delayed ejaculation (see text p.38)
• 4. early ejaculation
• 5. female sexual interest/arousal disorder
• 6. male hypoactive sexual desire disorder (what about women?)
• 7. genito-pelvic pain/penetration disorders
• 8. substance/medication-induced sexual dysfunction
• 9. sexual dysfunction not elsewhere classified
• All of these must cause the person distress and interpersonal difficulty
 Gender Dysphoria

• A strong, persistent cross-gender identification and desire to be the other sex

• Individual must be in significant distress
• Prevalence is unknown

• What is wrong with this, sociologically?

 Other Disorders:

• Disruptive, Impulse-Control, and Conduct Disorder

• Includes socially disruptive behavior…how is this not sociological?

• Substance Use & Addictive Disorders

• Alcohol is the most abused substance in the world
• In the US, 9 million are alcoholics
• 20 million in the US have tried cocaine
• Men are more likely to abuse drugs than women
• Strong among young adults but a decline with high schoolers due to social disapproval
 Neurocognitive Disorder:

• Impaired functioning due to medical condition or substance abuse or a combination

thereof
• Leading neurocognitive disorder is Alzheimer’s disease subtype*
• Between 11% of the pop over 65 has Alzheimer’s disease
• Currently about 5 million but will grow to 14-16 million by 2050
• Why?
 Personality Disorders:*

• More common with men

• 9.1% of the US adult pop.*
• Personality disorders have undergone a major revision in DSM-5
• Now divided into 3 clusters:
• A. Paranoid, Schizoid, and Schizotypal Personality Disorders
• Paranoid: pervasive and long-standing suspicion and distrust of others
• Schizoid: excessively introverted, lacks social relationships
• Schizotypal: odd thinking, behavior, communication
• B. Antisocial, Borderline, Histrionic, and Narcissistic Personality Disorders
• Antisocial: ignoring other’s rights (3% of all US males, less than 1% of females)
• Borderline: impulsive, unpredictable, high risk taking
• Narcissistic: self-centered
• C. Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders
• Avoidant: sensitive to being rejected by others
• Dependent: extreme reliance on other (mostly women)
•
 Paraphilic Disorder:*

• These are persistent, intense sexually arousing fantasies, urges, or behaviors that are
associated with 1) nonhuman objects, 2) suffering or humiliation, or 3) children or other
nonconsenting partners.*
• Sociologically, apply the concept of norms to this.

• This disorder includes:

• 1. exhibitionistic disorder-exposing oneself
• 2. fetishistic disorder-nonliving objects
• 3. frotteuristic disorder-touching or rubbing another in public (nonconsenting)
• 4. pedophilic disorder-sexual activity with children
• 5. sexual masochism-sexual excitement from our own suffering
• 6. sexual sadism disorder-sexual excitement from another’s suffering
• 7. transvestic disorder- when a heterosexual male cross-dresses as a female and masturbates while
imagining himself to be both the male and female subject of his sexual fantasy. (What about the
ladies?)
• 8. voyeuristic disorder- peeping
• 9. paraphilic disorder not otherwise specified- includes: lewdness over phone, zoophilia (sex with
animals)
On to Chapter 4: Causes and Cures