Psychological Disorders Groups According to DSM-5
“There is no standard normal. Normal is subjective.” – Matt Haig
Psychological disorders have often been a subject of curiosity and have been painted in different lights throughout history. Many ancient philosophers forwarded their idea on psychological disorders- Socrates forwarded the ‘organismic approach’ explaining that disturbing behavior is a result of conflict between emotion and reason; Galen elaborated on the role of blood, black bile, yellow bile, and phlegm in shaping temperament and personality. Marked changes occurred in the 17th and 18th centuries as a scientific approach was adopted to understand abnormal behavior with a focus on deinstitutionalization.
At present, the term psychological disorder is often used interchangeably with a mental disorder, mental illness, etc. According to the Diagnostic and Statistical Manual of Mental Disorders – 5 (DSM 5), a mental disorder can be defined as “a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation or behavior that reflects a dysfunction in the psychological, biological and developmental processes underlying mental functioning.”
The DSM 5 divides psychological disorders into various groups. This paper focuses on two quite spoken on but dehumanized disorders – Major Depressive Disorder which falls under Depressive Disorders and Schizophrenia which falls under Schizophrenia Spectrum and other psychotic disorders (DSM 5, 2013). Mental disorders change the very core of an individual by altering their thinking, perception, and consciousness which is in extreme degree for psychotic and bipolar disorders and comparatively lesser degree for anxiety, mood, eating disorder, etc. (Malla, Joober & Garcia, 2015).
Schizophrenia is a psychological disorder where patients suffer from psychosis, i.e., loss of contact with reality and is defined by delusions, hallucinations, disorganized thinking, and grossly disorganized motor behavior referred as the positive symptoms and negative symptoms include avolition, alogia, anhedonia, and diminished emotional expression (DSM 5, 2013). Schizophrenia can be caused as a result of genetic factors, biochemical imbalances, and abnormal brain structures.
The dopamine hypothesis explains the cause of schizophrenia from a biochemical imbalance perspective – evidence shows that Amphetamine misuse, which increases synaptic dopamine release, can produce ideas of reference, delusions, and auditory hallucinations in healthy people (Picchioni &Murray, 2007). However, with the recent discovery of a new group of antipsychotic drugs, referred to as atypical antipsychotic drugs which bind not only to D-2 dopamine receptors but also to D-1 and to receptors for other neurotransmitters such as serotonin (Goldman-Rakic et aI., 2004; Roth et aI., 2004).
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Thus, schizophrenia may be related to abnormal activity or dopamine and serotonin interactions and some other neurotransmitters (for example glutamate and GABA) as well, rather than to abnormal dopamine activity alone (Bach, 2007; Folsom et al., 2006). The psychodynamic view explains schizophrenia as a result of two psychological processes – regression to a pre-ego state and efforts to establish ego control (Freud, 1914, 15, 24); later psychodynamic clinician Frieda Fromm-Reichmann (1948) explained ‘schizopherogenic (schizophrenia causing) mother’ as the cause of schizophrenia, however, both the views received little research support.
Behaviorists’ explain schizophrenia as a result of operant conditioning and reinforcement. The cognitive view explains that when individuals attempt to understand their unusual experiences, they turn to their family and friends who deny the reality of the sensations causing the individuals to reject their feedback and develop beliefs (delusions) that they are being persecuted (Perez-Alvarez et aI., 2008; Bach, 2007). Many sociocultural factors like social labeling (Modrow 1992), dysfunctional family, and family stress (Boye et aI., 2002; Schiffman et aI., 2002, 2001) also can contribute to schizophrenia. Other than these environmental factors like low birth weight, premature birth, and perinatal hypoxia, and drug abuse can be causes of schizophrenia.
On grounds of gender, schizophrenia is more common in men than women – a ratio of 1.4:1 (Saha, Chant, Welham, McGrath, 2005). A schizophrenic patient’s symptoms can be controlled mostly with the help of antipsychotic drugs and in some cases psychological treatment such as cognitive behavior therapy. The prognosis for schizophrenia can be successful as well; more than 80% of patients with their first episode of psychosis will recover, although less than 20% will never have another episode (Robinson, Woerner, Alvir, Bilder, Goldman, Geisler, Koreen, Sheitman, Chakos, Mayerhoff, Lieberman, 1999).
Often schizophrenia is differentially diagnosed against Major Depressive or Bipolar disorder with psychotic and catatonic features, Schizoaffective Disorder, Delusional Disorder, etc. (DSM – 5, 2013)
Major Depressive disorder(MDD) can be defined as a psychological disorder that includes emotional symptoms – feeling ‘miserable’, anhedonia, angry, anxious; motivational symptoms – suffering from ‘paralysis of will’, suicidal thoughts; behavioral symptoms – less active, slow speech(Joiner, 2002); cognitive symptoms – extreme negative views of oneself, pessimism, hopelessness and helplessness and physical symptoms - headaches, indigestion, constipation, dizzy spells, and general pain (Fishbain, 2000).
Depression can be a result of biological factors like genetic, biochemical factors, brain anatomy, and brain circuits. Earlier low activity of the neurotransmitter serotonin and norepinephrine was strongly linked to depression (Carlson, 2008), however, later it seemed that no one but the interaction between different neurotransmitters could account for Major Depressive Disorder. The brain circuit comprising of the prefrontal cortex (Higgins & George, 2007; Goldapple et al., 2004), the hippocampus, the amygdala, and the Broadmann Area 25 (Insel, 2007; Mayberg, 2006, 2003) is seen to play a vital role in MDD.
The psychodynamic and behavioral view of MDD has not received much research support but however, the two most important cognitive explanations are the theory of negative thinking given by Aaron Beck where he explains that maladaptive attitudes, a cognitive triad, errors in thinking, and automatic thoughts combine to cause MDD which has received enormous research support and the theory of learned helplessness which explains that people become depressed when they perceive to have no control over their reinforcements in life and that they themselves are responsible for this state which has received research support too but has certain limitations.
Depression has also been linked repeatedly to the unavailability of social support (Doss et aI., 2008; Kendler et aI., 2005). Gender differences in MDD show that women are twice as likely to develop depression (Whiff en & Demidenko, 2006; McSweeney, 2004; Pajer, 1995). Often the worst fatality in a case of depression can be death by suicide. Hence, seeking help at the earliest and providing family support to the depressed patient can result in a successful prognosis. MDD is often differentially diagnosed against manic episodes with irritable mood or mixed episodes, substance/ medication-induced depressive or bipolar disorder, Attention-deficit/hyperactivity disorder, etc. (DSM-5).
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