Psychological Disorders & Treatment

This is Unit Twelve of Psychology, Part One: what counts as a disorder, and anxiety. The unit opens with a question that has to be settled before any diagnosis is possible. What makes a pattern of thoughts, feelings or behaviors a disorder rather than a difference? The working answer is distress or impairment in daily functioning. There is a more precise attempt — that an internal mechanism has failed to work as designed and the failure harms the person — and the course immediately follows it with an entry saying that deciding what a mechanism was designed to do imports judgments that are not purely medical. Then the classification systems, and a fact worth carrying: there are two of them, they use different criteria and thresholds, and prevalence figures produced under one cannot be compared with figures produced under the other. And the second half is the anxiety disorders, which are told apart not by how much fear is present but by what the fear attaches to — a specific thing, being watched, everything, the attacks themselves, or the possibility of not being able to leave. By the end you will be able to do five things. One: say what makes a pattern a disorder. Two: say why the two systems' figures do not compare. Three: state what the diathesis-stress model claims. Four: tell the anxiety disorders apart by their object. Five: say why the obsessive-compulsive cycle holds.

Four entries, and the second and third are a pair worth watching closely. A precise definition is offered — and then the very next entry says that the precision is partly illusory, because one of its terms requires a judgment that is not medical.

The working definition.

Psych 1311 Psychological Disorder

A pattern of thoughts, feelings or behaviors causing significant distress or impairment in daily functioning. Distress or impairment — either one, and the pattern alone is never enough.

A more precise attempt.

Psych 1313 Harmful Dysfunction

A condition is a disorder when an internal mechanism fails to work as designed and the failure harms the person. Two requirements, and both have to hold.

And the judgment inside it.

Psych 1314 The Judgment Inside Harmful Dysfunction

Deciding what an internal mechanism was designed to do imports value judgments that are not purely medical. The definition sounds biological and one of its terms is not.

The cultural part.

Psych 1316 Culture and the Definition of Disorder

What counts as disordered behavior depends partly on cultural norms about acceptable and expected conduct. Partly — the entry claims influence rather than complete determination.

Four entries. Two diagnostic manuals in use, and the third entry states something that matters whenever anybody quotes a prevalence figure — the two systems use different criteria and thresholds, so their numbers are not directly comparable.

The first.

Psych 1318 The DSM

A manual listing diagnostic criteria used to classify psychological disorders in the United States. Criteria — the manual specifies what has to be present, not what causes it.

The second.

Psych 1319 The ICD

The World Health Organization's diagnostic system, used for mental disorders worldwide. A different manual, doing the same job elsewhere.

And the comparison problem.

Psych 1320 Comparing Across Diagnostic Systems

Prevalence figures produced under the two systems are not directly comparable, because their criteria and thresholds differ. Which means a difference in rates between countries can be a difference in manuals.

One complication.

Psych 1322 Comorbidity

The presence of more than one diagnosable disorder in the same person at the same time. Common enough that a single diagnosis is often incomplete rather than wrong.

Four entries. One model of how a disorder arises at all — a vulnerability meeting enough stress, with neither sufficient alone — and then three levels at which the causes get located, which are Unit One's perspectives applied here.

The model.

Psych 1324 The Diathesis-Stress Model

Disorders arise when an underlying vulnerability meets sufficient environmental stress. Neither one produces the outcome by itself, which is why two people with the same history differ.

The first level.

Psych 1326 The Biological Perspective on Disorders

Explaining disorders through genetics, neurotransmitter systems, and brain structure and function. Unit Two's material, doing causal work.

The second.

Psych 1328 The Psychological Perspective on Disorders

Explaining disorders through learning history, thought patterns, and unresolved conflict. Three traditions from Unit Ten, gathered into one level.

The third.

Psych 1329 The Sociocultural Perspective on Disorders

Explaining disorders through poverty, discrimination, family systems, and access to care. Access to care is on the list, which makes availability a causal factor rather than only a treatment issue.

Six entries. One category, and five disorders inside it — and the way to hold them is by what the fear attaches to, because the fear itself looks similar across all five.

The category.

Psych 1331 Anxiety Disorders

Excessive fear or anxiety out of proportion to the actual threat, impairing functioning. Out of proportion is the criterion — fear proportionate to a real threat is not this.

A particular thing.

Psych 1333 Specific Phobia

Intense, persistent fear of a particular object or situation, leading to avoidance and impairment. The object is specific and the avoidance is what produces the impairment.

Being watched.

Psych 1335 Social Anxiety Disorder

Intense fear of social situations in which one might be judged or scrutinised. The object is other people's evaluation rather than other people.

Everything.

Psych 1337 Generalized Anxiety Disorder

Persistent, excessive worry across many domains for at least six months. No single object — which is what distinguishes it from the two previous entries.

The attacks.

Psych 1339 Panic Disorder

Recurrent unexpected panic attacks, and persistent worry about further attacks. The second half is part of the diagnosis — the fear is of the experience itself.

And being unable to leave.

Psych 1341 Agoraphobia

Fear of situations where escape might be difficult or help unavailable, often leading to housebound avoidance. The object is the situation's structure rather than anything in it.

Four entries. One disorder whose name is used casually for a preference for tidiness — with its own error entry saying so — and then the mechanism that explains why the cycle is self-sustaining rather than merely persistent.

The disorder.

Psych 1343 Obsessive-Compulsive Disorder

Intrusive unwanted thoughts, and repetitive behaviors performed to reduce the distress those thoughts cause. Unwanted is in the definition — the thoughts are experienced as intrusions.

The casual use.

Psych 1344 The Casual Use of "OCD"

Describing a preference for order or tidiness as this disorder is an error. A preference is wanted; an obsession is not — which is the whole distinction.

And why it holds.

Psych 1346 Why the Obsessive-Compulsive Cycle Holds

The compulsion briefly relieves the distress the obsession causes, which reinforces the compulsion and guarantees the obsession returns. Unit Five's negative reinforcement, running as a trap.

After an event.

Psych 1348 Posttraumatic Stress Disorder

Can follow exposure to a traumatic event, and involves intrusion symptoms, avoidance, negative mood changes and heightened arousal. Four groups — and a diagnosis requires the event as well as the symptoms.

Five things you can now do, and Part Two takes up mood and psychotic disorders. You can say what makes a pattern a disorder — distress or impairment in daily functioning — and that the more precise definition imports a judgment about what a mechanism was designed to do, which is not purely medical. You can say why the two diagnostic systems' figures do not compare: their criteria and thresholds differ, so a difference in rates can be a difference in manuals. You can state the diathesis-stress model — a vulnerability meeting sufficient stress, with neither producing the outcome alone. You can tell the anxiety disorders apart by what the fear attaches to: a particular object, being evaluated, everything, the attacks themselves, or the difficulty of leaving. And you can say why the obsessive-compulsive cycle holds — the compulsion relieves the distress briefly, which reinforces it and guarantees the return.