This section contains information about psychological disorders. Now either click on "An initial series of important general comments" below to look at some important orientating points about diagnosis, general approach to symptoms, and treatment choice, or click on "Specific disorders" to move straight to more detailed information about individual diagnoses.
There are a series of initial orientating comments that are likely to be helpful when trying to understand and cope with almost any type of psychological symptom. I have arranged these under the headings "Psychological symptoms in the general population", "Diagnosis of psychological disorders", "Taking an active problem solving approach", and "Choosing self-help, psychotherapy or medication". Click on the relevant heading below to read more.
It is easy to think from all the diagnostic labels that there are separate, distinct groups of people who suffer from separate, distinct sets of psychological symptoms which can be labelled depression, or panic disorder, or some other diagnostic term. In fact almost all psychological symptoms can be found very widely distributed throughout the general population. For most such symptoms there is a gradient of severity. Somewhat arbitrarily, when symptoms reach a specified degree of severity, health professionals state that the symptoms now qualify as a specific psychological disorder. This process of "splitting" symptoms into diagnostic disorders is helpful in a number of ways, but it can be unhelpful too. Most of us suffer from most psychological symptoms at one time or another. These symptoms qualify as a formal psychological disorder because of their severity (for distress and dysfunction) rather than just because they are present.
Making a formal psychological diagnosis can be a mixed blessing. It has several potential advantages. If many of my symptoms can be accurately grouped under a specific psychological diagnosis, it may well help to understand what is happening, to clarify the likely time course of my symptoms, and to choose treatments that have the best chance of being effective. It's worth noting that often people suffer from more than one psychological disorder at the same time - this is called comorbidity and it is common.
Sometimes putting different individuals into the same diagnostic group can obscure the fact that we are all unique in so many important ways - our life histories, hopes, values, living situations, biochemistries, fears, understandings, and so on. Diagnosis is often helpful but should be seen as only part of a bigger picture. In this psychological section of "Good Knowledge", diagnostic criteria are taken from the American Psychiatric Association's Diagnostic and Statistical Manuals of Mental Disorders (DSM) version IV, published in 1994. The other major classification system which includes psychological disorders is the International Classification of Diseases (ICD) published by the World Health Organization. The ICD psychological diagnostic categories overlap very considerably with those of DSM-IV.
There are descriptions and diagnostic criteria for over 50 of the commonest mental disorders at Canadian psychiatrist Dr Phillip Long's fine website - Internet Mental Health. This site also contains a wealth of other useful information about mental disorders. It's well worth a visit.
Living our lives is a bit like sailing a boat across the sea. It's totally predictable that there will be times when it's relatively calm and the sun shines. It's also totally predictable that there will be times when the sea's rough and the weather stormy. Our lives too are like that. It's normal to meet problems and difficulties. In order to sail through OK, rather than be blown all over the place by the storm, it's crucially important that we realize we can tackle the problems. We are NOT helpless victims. Of course we are not omnipotent, but how we react and respond to difficulties we encounter will make a big difference to the eventual outcome.
There's lots of research showing that "catastrophising" (the tendency to get sucked into catastrophic fears) and avoidance (acting like an ostrich) are both routinely associated with poorer outcomes. Unpleasant symptoms are like a smoke alarm, they tell us that there are problems that need identifying and tackling. Symptoms and smoke alarms can be helpful if they nudge us into action and let us know if we're going in the right direction. Taking time to clarify what the problems are and how we can respond to them is time very well spent. Note though that this encouragement is for active problem solving. In contrast rumination - just going over and over things in one's mind - tends to be very counterproductive.
Our responses may involve actively doing something about the problems, or may involve learning not to have them upset us so much. Again medical research is very clear that an active problem solving attitude is routinely associated with better health outcomes. It's likely to be worth looking at the handouts & questionnaires in the Problem solving & behavioural activation section of this website.
As a general rule it is usually better to use combined treatments (e.g. psychotherapy plus medication) for symptoms that are more severe and/or more long lasting. With relatively recent moderate levels of symptoms it may well be that psychotherapy and medication are pretty much equally effective at relieving the symptoms. It may still, of course, be important to try to understand why the problem developed and what can be done to reduce the chance of similar difficulties recurring in the future.
I'm still building this section. Click on the relevant heading below to find more detailed information on a series of psychological disorders. If the information you want isn't yet available, try clicking on relevant tags.
This section covers panic disorder & agoraphobia, specific phobia, social anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, acute stress disorder, generalized anxiety disorder, and other anxiety disorders.
Acute stress disorder
The US DSM IV diagnostic system describes the "essential features" of agoraphobia in the following way: "There is intense fear of, or discomfort in, settings from which escape is difficult or embarrassing, or in which help (e.g. to alleviate a panic attack) is not available." It then adds the following three criteria:
1.) Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help might not be available in the event of having an unexpected or situationally predisposed panic attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone, being in a crowd or standing in queues, being on a bridge, and travelling in a bus, train, or car. note: consider a diagnosis of specific phobia if the avoidance is limited to one or only a few specific situations, or social phobia if the avoidance is limited to social situations.
2.) The situations are avoided (e.g., travel is restricted), or else endured with marked distress or with anxiety about having a panic attack or panic-like symptoms, or require the presence of a companion.
3.) The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as social phobia (e.g., avoidance limited to social situations because of fear of embarrassment), specific phobia (e.g., avoidance limited to one type of situation), obsessive compulsive disorder (e.g., avoidance of dirt in someone with an obsession about contamination), posttraumatic stress disorder (e.g., avoidance of stimuli associated with a severe stressor), or separation anxiety (e.g., avoidance of leaving home or relatives).
For more on diagnosis and a wealth of other useful information and links, see the relevant section of Dr Phillip Long's fine Internet Mental Health site by clicking here. Other useful agoraphobia-relevant resources can be reached through StressedtoZest's own collection of recommended websites - click here. See too research articles selected by James at Connotea and other information on this site. I frequently use Ost's Agoraphobia Scale to assess severity, to help in selecting desensitization targets, and to monitor progress.
For self-help, many of the website links given above will be very helpful. Also useful is the chapter on 'Help for phobias: exposure" in Edmund Bourne's anxiety and phobia book (see below).
Bourne, E. J. "The anxiety & phobia workbook" 4th ed. Oakland, CA: New Harbinger, 2005. [AbeBooks] [Amazon UK]
Generalized anxiety disorder (GAD)
Obsessive-compulsive disorder (OCD)
Other anxiety disorders include Anxiety Disorders due to a General Medical Condition (where the anxiety is a direct physiological consequence of a general medical condition), Substance-Induced Anxiety Disorder (where the anxiety is directly caused by the physiological effects of a substance - drug of abuse or medication - including prescription use, poisoning, intoxication, or withdrawal), and Anxiety Disorder Not Otherwise Specified (where there is prominent clinically significant anxiety or phobic avoidance that doesn't meet the diagnostic criteria for any other anxiety or adjustment disorder).
Health anxiety disorder and hypochondriasis are typically classified under Somatoform disorders.
Panic disorder
a discrete period of intense fear or discomfort, in which four (or more) of the following symptoms develop abruptly & reach a peak within 10 min:
1.) palpitations, pounding heart, or accelerated heart rate.
2.) sweating.
3.) trembling or shaking.
4.) sensations of shortness of breath or smothering.
5.) feeling of choking.
6.) chest pain or discomfort.
7.) nausea or abdominal distress.
8.) feeling dizzy, unsteady, lightheaded, or faint.
9.) derealization (feelings of unreality) or depers-onalization (being detached from oneself).
10.) fear of losing control or going crazy.
11.) fear of dying.
12.) paraesthesias (numbness or tingling).
13.) chills or hot flushes.
panic attacks are subdivided into unexpected (uncued), situationally bound (cued) and situationally predisposed. "limited-symptom attacks" are episodes meeting fewer than four criteria but otherwise identical to panic attacks.
Wilson, Reid.
Anxieties.com. This is a fine site giving high quality information about cognitive-behavioural therapy, self-help, and medication treatments for a variety of anxiety disorders.
24 Mar 2004.
url : http://www.anxieties.com/.
NIMH Panic Disorder. US National Institute of Mental Health information on panic disorder.
01 Jan 2000.
url : http://www.nimh.nih.gov/anxiety/panicmenu.cfm
Posttraumatic stress disorder (PTSD)
Social anxiety disorder
Specific phobias
This section contains some information on different forms of dementia.
I work primarily with adults but, of course, disorders usually first diagnosed earlier in life are likely to continue to have effects into adulthood. At times the disorder may not be diagnosed until adulthood. This section includes learning disorders, stuttering, autistic disorder, Asperger's, attention-deficit/hyperactivity disorder (ADHD), tic disorders, and separation anxiety disorder.
This section includes depersonalization & derealization, as well as other dissociative disorders.
This section includes anorexia, bulimia and other eating disorders.
This section includes kleptomana (shoplifting, stealing), pathological gambling, and trichitillomania.
This section covers major depressive disorder, minor depressive disorder, dysthymic disorder, recurrent brief depression, bipolar disorders, seasonal affective disorder (SAD), and other depressive disorders.
This section contains information on personality in general as well as on the specific personality disorders.
This section contains information about schizophrenia and other psychotic disorders. This isn't an area I work in much, so the section is fairly limited.
This section includes sexual desire, arousal, orgasmic and pain disorders.
This section contains information on insomnia, breathing-related sleep disorder, nightmares and other sleep difficulties.
Sufferers from somatoform disorders report physical symptoms that, despite full investigation, are not adequately explained by a medical illness, substance abuse, or another psychological disorder. The somatoform disorders category includes health anxiety disorder (hypochondriasis), somatization disorder, body dysmorphic disorder, and other related conditions.
This section contains information about alcohol, benzodiazepine, caffeine, cannabis, smoking and other substance-related issues.