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PSYCHIATRIC AND PSYCHOLOGICAL DISORDERS
Signs and Symptoms
The following is not meant for self-diagnosis, since the signs and symptoms listed for each of the disorders may also meet the criteria for other disorders. If you are seeking a diagnosis, be sure to consult a mental health professional.
MAJOR DEPRESSION
Symptoms of Major Depression
- depressed mood most of the day, nearly every day, as indicated by either subjective report (feels sad or empty) or observation made by others (e.g. appears tearful). (Note: In Children and adolescents can be irritiable mood).
- markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
- significant weight loss when not dieting or weight gain (e.g. a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
- insomnia or hypersomnia nearly every day.
- psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessnessor being slowed down)
- fatigue or loss of energy nearly every day.
- feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
- diminished ability to think or concentrate, or decisiveness, nearly every day (either by subjective account or as observed by others)
- recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
(From the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), Fourth Edition, Published by the American Psychiatric Association, Washington D.C., 1994)
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GENERALIZED ANXIETY DISORDER
Symptoms of Generalized Anxiety Disorder
Excessive anxiety and worry, accompanied by some of the following:
- restlessness or feeling keyed up or on edge
- being easily fatigued
- difficulty concentrating or mind going blank
- irritability
- muscle tension
- sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
(From the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), Fourth Edition, Published by the American Psychiatric Association, Washington D.C., 1994)
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PANIC DISORDER
Symptoms of Panic Disorder
The presence of recurrent, unexpected Panic Attacks followed by at least one month of persistent concern about having another Panic Attack. The Panic Attacks are discrete periods of intense fear or discomfort, accompanied by some of the following:
- palpitations
- sweating
- trembling or shaking
- sensations of shortness of breath or smothering
- feeling of choking
- chest pain or discomfort
- nausea or abdominal distress
- feeling dizzy, unsteady, lightheaded, or faint
- derealization (feelings of unreality) or depersonalization (being detached from oneself)
- fear of losing control or going crazy
- fear of dying
- paresthesias (numbness or tingling sensations)
- chills or hot flushes
(From the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), Fourth Edition, Published by the American Psychiatric Association, Washington D.C., 1994)
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SPECIFIC PHOBIA
Symptions of Specific Phobias
- Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).
- Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed Panic Attack. Note: In children, the anxiety may be expressed by crying, tantrums, freezing or clinging.
- The person recognizes that the fear is excessive or unreasonable. Note: In children, this feature may be absent.
- The phobic situation(s) is avoided or else is endured with intense anxiety or distress.
- The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
(From the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), Fourth Edition, Published by the American Psychiatric Association, Washington D.C., 1994)
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OBSESSIVE-COMPULSIVE DISORDER
Symptions of Obsessive-Compulsive Disorder
A. Either obsessions or compulsions:
Obsessions as defined by the following:
- recurrent and persistent thoughts, impulses. Or images that are experienced, at some time during the disturbance, as intrusive and inappopriate and that cause marked anxiety or distress
- the thoughts, impulses, or images are not simply excessive worries about real-life problems
- the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
- the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion.)
Compulsions as defined by the following:
- repetitive behaviors (e.g. hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
- the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children.
C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour per day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships.
(From the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), Fourth Edition, Published by the American Psychiatric Association, Washington D.C., 1994)
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POST-TRAUMATIC STRESS DISORDER
Symptoms of Post-traumatic Stress Disorder
A. The person has been exposed to a traumatic event in which both of the following were
present:
- the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
- The person’s response involved intense fear, helplessnes, or horror.
B. The traumatic event is persistently reexperienced in one (or more) of the following ways:
- recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
- recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
- acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
- Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
- physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
- efforts to avoid thoughts, feelings, or conversations associated with the trauma.
- efforts to avoid activities, places, or people that arouse recollections of the trauma.
- inability to recall an important aspect o f the trauma.
- markedly diminished interest or participation in significant activities.
- feeling of detahcment or estrangement from others.
- restricted range of affect (e.g. unable to have loving feelings).
- sense of a foreshortened future (e.g. does not expect to have a career, marriage, children or a normal life span).
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two or more of the following:
- difficulty falling or staying asleep
- irritability or outbursts of anger
- difficulty concentrating
- hypervigilance
- exaggerated startle response
E. Duration of the disturbance is more than 1 month
F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
(From the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), Fourth Edition, Published by the American Psychiatric Association, Washington D.C., 1994)
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ANOREXIA AND BULIMIA NERVOSA
Symptoms of Anorexia and Bulimia Nervosa
Anorexia Nervosa
A. Refusal to maintain body weight at or above a minimally normal weight for age and height.
B. Intense fear of gaining weight or becoming fat, even though under weight.
C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
D. In postmenarcheal females, amenorrhea, i.e. the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g. estrogen, administration).
Bulimia Nervosa
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- eating, in a discrete period of time, an amount of food that is definitely larger than most people would eat in a similar period of time and under similar circumstances.
- A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight
E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
(From the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), Fourth Edition, Published by the American Psychiatric Association, Washington D.C., 1994)
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BORDERLINE PERSONALITY DISORDER
Symptoms of Borderline Personality Disorder
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- frantic efforts to avoid real or imagined abandonment
- a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
- identity disturbance: markedly and persistently unstable self-image or sense of self.
- impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating).
- recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
- affective instability due to a marked reactivity of mood (e.g. intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
- chronic feelings of emptiness.
- inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper, constant anger, recurrent physical fights).
- transient, stress-related paranoid ideation or severe dissociative symptoms.
(From the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), Fourth Edition, Published by the American Psychiatric Association, Washington D.C., 1994)
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NARCISSISTIC PERSONALITY DISORDER
Symptoms of Narcissistic Personality Disorder
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
- is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
- believes he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
- requires excessive admiration.
- has a sense of entitlement, i.e. unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations.
- is interpersonally exploitive, i.e. takes advantage of others to achieve his or her own ends.
- lacks empathy: is unwilling to recognize or identify with the feelings or needs of others.
- is often envious of others or believes that others are envious of him or her.
- shows arrogant, haughty behaviors or attitudes.
From the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), Fourth Edition, Published by the American Psychiatric Association, Washington D.C., 1994
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SCHIZOID PERSONALITY DISORDER
Symptoms of Scizoid Personality Disorder
A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early childhood and present in a variety of contexts, as indicated by four (or more) of the following:
- neither desires nor enjoys close relationships, including being part of a family.
- almost always chooses solitary activities.
- has little, if any, interest in having sexual experiences with another person.
- takes pleasure in few, if any, activities.
- lacks close friends or confidants other than first-degree relatives.
- appears indifferent to the praise or criticism of others.
- shows emotional coldness, detachment, or flattened affectivity.
From the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), Fourth Edition, Published by the American Psychiatric Association, Washington D.C., 1994
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PASSIVE-AGGRESSIVE PERSONALITY DISORDER
Symptoms of Passive-Aggressive Personality Disorder
A pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
- passively resists fulfilling routine social and occupational tasks.
- complains of being misunderstood and unappreciated by others.
- is sullen and argumentative.
- unreasonably criticizes and scorns authority.
- expresses envy and resentment toward those apparently more fortunate.
- voices exaggerated and persistent complaints of personal misfortune.
- alternates between hostile defiance and contrition.
From the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), Fourth Edition, Published by the American Psychiatric Association, Washington D.C., 1994
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