Depression, Phobias and OCD

Psychologists try to classify Mental Disorders:

The DSM is the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. It contains mental health disorders and is systematically reviewed and modified in line with new research

1. The DSM is used to classify disorders using defined diagnostic criteria. This includes a list of symptoms which can be used as a tool for diagnostic

2. The DSM makes diagnosis concrete and descriptive

3. Classifications allow data to be collected about a disorder. This can help in the development of new treatments and medication

4. This type of classification has been criticised for stigmatising people and ignoring their ‘uniqueness’ by putting them in artificial group

Depression is a Mood Disorder:

Mood disorders are characterised by strong emotions, which can influence a person’s ability to function normally. A mood disorder can affect a person’s perceptions, thinking and behaviour

Depression is one of the most common mood disorders. There are many types, including:

1. Major depression (unipolar disorder)- an episode of depression that can occur suddenly

   • Major depression can be reactive- caused by external factors, e.g. the death of a loved one

   • Or, it can be endogenous- caused by internal factors, e.g. neurological factors

2. Manic depression (bipolar disorder)- the alternation between two mood extremes (mania and depression)

   • The change in mood often in regular cycles of days or weeks

   • Episodes of mania involve overactivity, rapid speech and feeling extremely happy or agitated

   • Episodes of depression involve the symptoms covered below

Depression has lots of clinical characteristics:

People with depression can experience a range of possible symptoms:

Physical/behavioural symptoms:

• Sleep disturbances- insomnia (being unable to sleep) or hypersomnia (sleeping a lot more than usual)

• Change in appetite- people may eat more or less than usual, and gain or lose weight

• Pain- especially headaches, joint aches and muscle aches

• Lack of activity- social withdrawal and loss of sex drive

Cognitive symptoms:

• Experiencing persistent negative about themselves and their abilities

• Suicidal thoughts

• Slower thought processes- difficulty concentrating and making decisions

Affective/emotional symptoms:

• Extreme feelings of sadness, hopelessness and despair

• Diurnal mood variation- changes in mood throughout the day, e.g. feeling worse in the morning

• Anhedonia- No longer enjoying activities or hobbies that used to be pleasurable

For a person to be diagnosed with major depression, the DSM states that at least five symptoms must have been present nearly every day for at least two weeks

A phobia is an Irrational Fear:

A phobia is an example of an anxiety disorder- it’s an extreme, irrational fear of a particular object or situation. The DSM classifies types of phobia:

1. Specific phobias:

   This is a fear of specific objects or situations. There are 5 subtypes:

   1. Animal type (zoophobia, e.g. fear of spiders)

   2. Environmental dangers type (e.g. fear of water)

   3. Blood-injection-injury type (e.g. fear of needles)

   4. Situational type (e.g. fear of enclosed spaces or height)

   5. ‘Other’ (any phobia which isn’t covered in the categories above)

2. Agoraphobia

   1. This is a fear of open spaces, using public transport, being in an enclosed space, waiting in line or being in a crowd, or not being at home

   2. It’s specifically linked to the fear of not being able to escape or find help if an embarrassing situation arises

   3. It often involves the sufferer avoiding the situation to avoid distress

   4. It may develop as a result of other phobias because the sufferer is afraid that they’ll come across the source of their fear if they leave the house

3. Social anxiety disorder (social phobia)

   This is the fear of being in social situations (e.g. eating in public or talking in front of a group of people). It’s usually down to the possibility of being judged or being embarrassed

Phobias have several Clinical Characteristics:

The different types of phobia all have very similar clinical characteristics

• Cognitive symptoms:

  • Irrational beliefs about the stimulus that causes fear

  • People often find it hard to concentrate because they’re preoccupied by anxious thoughts

• Behavioural symptoms:

  • Avoiding social situations because they cause anxiety. This happens especially if someone has social anxiety disorder (social phobia) or agoraphobia

  • Altering behaviour to avoid the feared object or situation, and trying to escape if it’s encountered. People are often generally restless and easily startled

• Physical symptoms:

  • Activation of the fight or flight response when the feared object or situation is encountered or thought about. This involves the release of adrenaline, increased heart rate and breathing, and muscle tension

• Emotional symptoms:

  • Anxiety and a feeling of dread

There are various Diagnostic Criteria for phobias:

The DSM classifies a fear as a phobia if you can put a tick next to these criteria:

1. There’s a significant prolonged fear of an object or situation which lasts more than 6 months

2. People experience an anxiety response (e.g. increased heart rate) if they’re exposed to a phobic stimulus

3. Phobias are out of proportion to any actual danger

4. Sufferers go out of their way to avoid the phobic stimulus

5. The phobia disrupts their lives, e.g. they avoid social situations

OCD has two parts:

1. Obsessive-compulsive disorder has two parts- obsessions and compulsions. Most people with OCD experience obsessions and compulsions that are linked to each other. For example, excessive worrying about catching germs (an obsession) may lead to excessive hand-washing (a compulsion)

2. Obsessions are the cognitive aspect of OCD, and compulsions are the behavioural aspect. OCD also has an emotional aspect- the obsessions tend to cause people anxiety, and their compulsions are an attempt to relieve this

3. Obsessive-compulsive disorder affects about 2% of the world’s population. Sufferers usually develop the disorder in their late teens or early 20s. The disorder occurs in men and women and in all ethnic groups

Obsessions are the cognitive part of the disorder:

Obsessions are intrusive and persistent thoughts, images and impulses. They are the internal aspects of OCD. They can range from worrying that you left the oven on to worrying that you might kill your parents. For thoughts like these to be classified as obsessions, the DSM outlines the following criteria:

• Persistent and reoccurring thoughts, images or impulses that are unwanted and cause distress to the person experiencing them. For example, imagining that you’ve left the door unlocked and burglars are rampaging through your house

• The person actively tries to ignore the thoughts, images or impulses but is unable to

• The obsessions have not been caused by other physiological substances, such as drugs

Compulsions are repetitive actions:

• Compulsions are physical or mental repetitive actions. They are the external aspect of OCD

• For example, checking the door is locked nine times or repeating a certain phrase or prayer to neutralise an unwanted thought

• The problem is that the action only reduces the anxiety caused by an obsession for a short time, which means that the obsession starts up again

• The DSM uses the following diagnostic criteria:

  1. The person repeats physical behaviours or mental acts that relate to an obsession. Sometimes the person has rules that they must follow strictly. For example, a rule that you must check the door is locked ten times before you can leave home

  2. The compulsions are meant to reduce anxiety or prevent a feared situation- in reality, they’re excessive or wouldn’t actually stop a dreaded situation

  3. Other physiological substances, such as drugs have caused the compulsions

The DSM states that if the obsessions or compulsions last at least one hour each day this is an indication of a clinical case of OCD. Another indication of OCD is if obsessions and compulsions interfere with a person’s ability to maintain a relationship, hold down a job or take part in social activities

There are several types of OCD behaviours:

There are several common types of OCD behaviours. Here are four:

1. Checking- Includes checking that the lights are off or that you have your purse or wallet

2. Contamination- This involves a fear of catching germs by, say, going to a restaurant, touching door handles, shaking hands or using public toilets

3. Hoarding- Keeping useless or worn-out objects, such as old newspapers or junk mail

4. Symmetry and orderliness- Getting objects lined up ‘just right’, such as having all the tins of food in your cupboard facing exactly the same way, or everything on your desk arranged in a neat order in the right places