Abnormal Psychology
DSM-5 Disorders, Diagnosis & Treatment Approaches
In This Section
1. Defining Abnormality
The 4 D's of Abnormality
Deviance
Behavior that differs from cultural/statistical norms
Distress
Subjective discomfort or suffering experienced
Dysfunction
Impairment in daily functioning (work, relationships)
Danger
Risk of harm to self or others
DSM-5 Overview
Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (2013) published by the American Psychiatric Association.
- • Moved from multiaxial to dimensional assessment
- • Reorganized chapters by shared vulnerabilities
- • Emphasis on spectrum disorders
- • Cultural formulation considerations
2. Mood Disorders
Major Depressive Disorder (MDD)
Criteria: ≥5 symptoms for ≥2 weeks, including depressed mood OR anhedonia
SIG E CAPS Mnemonic
- Sleep changes (insomnia/hypersomnia)
- Interest decreased (anhedonia)
- Guilt/worthlessness
- Energy decreased (fatigue)
- Concentration impaired
- Appetite/weight changes
- Psychomotor changes
- Suicidal ideation
Specifiers: with anxious distress, with melancholic features, with seasonal pattern, peripartum onset
Bipolar Disorders
Bipolar I
- • At least one manic episode
- • Manic: ≥1 week elevated/irritable mood + ≥3 symptoms
- • DIGFAST: Distractibility, Insomnia, Grandiosity, Flight of ideas, Activity, Speech (pressured), Thoughtlessness
Bipolar II
- • Hypomanic + Major depressive episodes
- • Hypomanic: ≥4 days, less severe
- • No psychotic features
- • No marked impairment
Other Mood Disorders
Persistent Depressive (Dysthymia)
- • Depressed mood most days
- • Duration: ≥2 years (adults)
- • Less severe than MDD
Cyclothymic Disorder
- • Chronic fluctuating mood
- • Hypomanic + depressive symptoms
- • Duration: ≥2 years
- • Never meet full criteria
3. Anxiety & Related Disorders
Anxiety Disorders
Generalized Anxiety Disorder (GAD)
- • Excessive worry about multiple events/activities
- • Duration: ≥6 months
- • ≥3 symptoms: restlessness, fatigue, concentration, irritability, muscle tension, sleep
- • Difficult to control worry
Panic Disorder
- • Recurrent unexpected panic attacks
- • Attack peaks within minutes
- • ≥4 symptoms: palpitations, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, chills, derealization, fear of dying
- • Persistent concern about additional attacks
Specific Phobia
- • Marked fear of specific object/situation
- • Types: Animal, Natural environment, Blood-injection-injury, Situational, Other
- • Immediately provokes anxiety
- • Avoidance or endured with intense distress
Social Anxiety Disorder
- • Fear of social situations with potential scrutiny
- • Fear of embarrassment/humiliation
- • Duration: ≥6 months
- • Performance only specifier
Obsessive-Compulsive & Related
OCD
Obsessions
- • Recurrent, intrusive thoughts
- • Cause anxiety/distress
- • Person attempts to suppress
- • Contamination, symmetry, taboo
Compulsions
- • Repetitive behaviors/mental acts
- • In response to obsession
- • Aim to reduce anxiety
- • Checking, washing, counting
Related disorders: Body Dysmorphic, Hoarding, Trichotillomania, Excoriation
Trauma & Stressor-Related
PTSD
Exposure to actual/threatened death, serious injury, or sexual violence
Intrusion
Flashbacks, nightmares, distress at reminders
Avoidance
Of memories, thoughts, reminders
Negative Cognitions/Mood
Blame, detachment, negative beliefs
Arousal/Reactivity
Hypervigilance, startle, irritability
Duration: >1 month. Acute Stress Disorder: 3 days to 1 month
4. Schizophrenia Spectrum
Schizophrenia
Criteria: ≥2 symptoms for ≥1 month (at least one must be 1, 2, or 3):
Positive Symptoms
- 1. Delusions
- 2. Hallucinations
- 3. Disorganized speech
- 4. Disorganized/catatonic behavior
Negative Symptoms
- 5. Diminished expression
- • Flat affect
- • Alogia (poverty of speech)
- • Avolition (lack of motivation)
- • Anhedonia
Duration: Signs persist ≥6 months (including ≥1 month active phase)
Types of Delusions
Persecutory
Being harassed, conspired against
Grandiose
Inflated worth, power, knowledge
Referential
Events refer personally to them
Erotomanic
Someone is in love with them
Nihilistic
Major catastrophe will occur
Somatic
Body functions/sensations
Related Disorders
| Disorder | Key Features | Duration |
|---|---|---|
| Schizophreniform | Same as schizophrenia | 1-6 months |
| Brief Psychotic | Sudden onset psychosis | 1 day to 1 month |
| Schizoaffective | Mood + schizophrenia symptoms | Continuous |
| Delusional Disorder | Delusions only; functioning intact | ≥1 month |
5. Personality Disorders
General Criteria
- • Enduring pattern of inner experience and behavior
- • Deviates markedly from cultural expectations
- • Onset in adolescence or early adulthood
- • Stable over time; pervasive across situations
- • Affects cognition, affectivity, interpersonal functioning, impulse control
Cluster A (Odd/Eccentric)
Paranoid PD
Pervasive distrust and suspiciousness; interprets motives as malevolent
Schizoid PD
Detachment from social relationships; restricted emotional expression; prefers solitude
Schizotypal PD
Social deficits; cognitive/perceptual distortions; eccentric behavior; magical thinking
Cluster B (Dramatic/Emotional)
Antisocial PD
Disregard for/violation of rights of others; deceit, impulsivity, irritability; lack of remorse. Age ≥18 with conduct disorder before 15
Borderline PD
Instability in relationships, self-image, affect; marked impulsivity; fear of abandonment; identity disturbance; chronic emptiness; self-harm
Histrionic PD
Excessive emotionality and attention seeking; theatrical; seductive; considers relationships more intimate than they are
Narcissistic PD
Grandiosity; need for admiration; lack of empathy; entitlement; exploitative; envious
Cluster C (Anxious/Fearful)
Avoidant PD
Social inhibition; feelings of inadequacy; hypersensitivity to negative evaluation; desires relationships but fears rejection
Dependent PD
Excessive need to be taken care of; submissive, clinging behavior; fear of separation; difficulty making decisions alone
Obsessive-Compulsive PD
Preoccupation with orderliness, perfectionism, control; rigidity; workaholism. Note: Different from OCD (no true obsessions/compulsions)
6. Neurodevelopmental Disorders
Autism Spectrum Disorder (ASD)
Social Communication Deficits
- • Deficits in social-emotional reciprocity
- • Nonverbal communication deficits
- • Difficulties in relationships
Restricted/Repetitive Behaviors
- • Stereotyped movements/speech
- • Insistence on sameness
- • Restricted interests
- • Hyper-/hypo-reactivity to sensory input
Severity levels: Level 1 (requiring support) to Level 3 (requiring very substantial support)
ADHD
Persistent pattern of inattention and/or hyperactivity-impulsivity before age 12
Inattention (≥6 symptoms)
- • Careless mistakes
- • Difficulty sustaining attention
- • Doesn't seem to listen
- • Fails to finish tasks
- • Disorganized
- • Avoids sustained mental effort
Hyperactivity/Impulsivity (≥6)
- • Fidgets, squirms
- • Leaves seat
- • Runs/climbs inappropriately
- • Unable to play quietly
- • Talks excessively
- • Blurts out, interrupts
Presentations: Combined, Predominantly Inattentive, Predominantly Hyperactive-Impulsive
Intellectual Disability
- Deficits in intellectual functions: Reasoning, problem-solving, abstract thinking (IQ ~70 or below)
- Deficits in adaptive functioning: Conceptual, social, practical domains
- Onset: During developmental period
- Severity: Based on adaptive functioning (Mild, Moderate, Severe, Profound)
7. Substance & Addictive Disorders
Substance Use Disorder
Problematic pattern leading to significant impairment. ≥2 criteria in 12 months:
Severity: Mild (2-3), Moderate (4-5), Severe (6+)
Gambling Disorder
Persistent and recurrent problematic gambling. ≥4 criteria in 12 months including: preoccupation, increasing amounts, restlessness when cutting down, gambling to escape, chasing losses, lying, jeopardizing relationships.
8. Treatment Approaches
Psychotherapy
CBT
- • Identify and change distorted thoughts
- • Behavioral experiments
- • Effective for depression, anxiety, OCD
- • Time-limited, structured
DBT
- • Developed for BPD
- • Mindfulness, distress tolerance
- • Emotion regulation
- • Interpersonal effectiveness
Exposure Therapy
- • For phobias, OCD, PTSD
- • Systematic desensitization
- • Flooding/implosion
- • ERP for OCD
Psychodynamic
- • Insight-oriented
- • Transference analysis
- • Free association
- • Longer-term treatment
Biological Treatments
| Class | Examples | Mechanism | Used For |
|---|---|---|---|
| SSRIs | Fluoxetine, Sertraline | Block serotonin reuptake | Depression, Anxiety, OCD |
| SNRIs | Venlafaxine, Duloxetine | Block serotonin + norepinephrine | Depression, GAD, pain |
| Antipsychotics | Risperidone, Olanzapine | Block dopamine D2 receptors | Schizophrenia, Bipolar |
| Mood Stabilizers | Lithium, Valproate | Various mechanisms | Bipolar disorder |
| Benzodiazepines | Alprazolam, Clonazepam | Enhance GABA | Anxiety (short-term) |
Key Takeaways
- ✓MDD: ≥5 symptoms for ≥2 weeks including depressed mood or anhedonia
- ✓Bipolar I requires manic episode; Bipolar II has hypomania
- ✓Schizophrenia: positive + negative symptoms for ≥6 months
- ✓Cluster A: odd; Cluster B: dramatic; Cluster C: anxious
- ✓PTSD: intrusion, avoidance, negative cognitions, arousal
- ✓OCD: obsessions (thoughts) + compulsions (behaviors)
- ✓SSRIs are first-line for depression and many anxiety disorders
- ✓DBT developed specifically for borderline personality disorder