Psychological Disorders & Treatment

This is Unit Twelve of Psychology, Part Two: mood, psychosis, and personality. This part opens with the most common serious diagnosis in the field, and with the reason it gets missed. Depression is not sadness. The more visible feature is often a loss of interest and a loss of capacity — and somebody expecting to see sadness will not recognise it in a person who is still turning up and getting things done. There is a fact in here that matters more than most facts in this course. Mood disorders substantially elevate suicide risk, and asking somebody directly about suicidal thoughts does not increase that risk. The second half of that sentence is a research finding, and the belief it corrects stops people asking. Then psychosis, with an error entry about a confusion built into the word itself — the name means split mind and the disorder is not split personality. And the part closes on a procedure, which is where all of this becomes usable: a case gets checked against symptom count, duration, impairment, cultural context, and exclusions — in that order — before any diagnosis is named at all. By the end you will be able to do five things. One: say why expecting sadness misses a depression diagnosis. Two: say what separates the two bipolar diagnoses. Three: say what asking directly about suicidal thoughts does. Four: tell positive from negative symptoms. Five: check a case against criteria in order.

Four entries, and the middle two are the pair that matters clinically. The diagnosis is defined by more than mood — and the entry after it explains that expecting to see sadness is a common reason the diagnosis is missed entirely.

The diagnosis.

Psych 1350 Major Depressive Disorder

At least two weeks of depressed mood or loss of interest, alongside changes in sleep, appetite, energy, concentration, or self-worth. Or — the mood is not required if the loss of interest is present.

And the error.

Psych 1351 Depression Is Not Sadness

Equating the disorder with sadness is an error, since loss of interest and capacity is often the more visible feature. The two are different things.

What that costs.

Psych 1352 Why Expecting Sadness Misses the Diagnosis

Expecting visible sadness is a common reason the disorder goes unrecognised in people who continue functioning outwardly. Which makes this error a diagnostic failure rather than a vocabulary problem.

The longer form.

Psych 1354 Persistent Depressive Disorder

Depressed mood lasting at least two years, with symptoms that may be less severe than a major episode. Less severe and much longer — which is its own kind of difficult.

Three entries. Two diagnoses separated by exactly one thing — whether a full manic episode has occurred — and then a qualifier that is often talked about as a diagnosis of its own and is not.

The first.

Psych 1356 Bipolar I Disorder

Defined by at least one manic episode, typically alongside depressive episodes. The manic episode is the defining requirement.

The second.

Psych 1357 Bipolar II Disorder

At least one hypomanic episode and at least one major depressive episode, without a full manic episode. Not a milder version — a different diagnosis, defined by what has not occurred.

The qualifier.

Psych 1359 Seasonal Pattern in Mood Disorders

A specifier applied when depressive episodes recur at a characteristic time of year. It qualifies a diagnosis rather than being one.

Four entries handled carefully. One states a fact about asking that changes what a person can do with the rest of this unit. Then a reading skill — how to interpret a condition the manual lists as under study rather than settled — and one condition in exactly that position.

The fact about asking.

Psych 1361 Suicide Risk in Mood Disorders

Mood disorders substantially elevate suicide risk, and asking directly about suicidal thoughts does not increase that risk. Both halves are findings, and the second one removes the usual reason for not asking.

A reading skill.

Psych 1362 Reading a Section III Condition

A condition listed in the manual's third section has proposed criteria that are under study rather than a settled diagnosis. The section is the status, and the status is part of the information.

One condition.

Psych 1363 Non-Suicidal Self-Injury

Deliberate self-harm without suicidal intent, most often functioning to regulate overwhelming emotion. The function is named because it is what distinguishes the pattern.

And its status.

Psych 1364 The Diagnostic Status of Non-Suicidal Self-Injury

It appears in the manual's Conditions for Further Study rather than as a full diagnosis. Which is exactly what the previous reading skill is for.

Six entries. One diagnosis, an error entry about a confusion the name itself creates, and then two symptom classes that are told apart by direction — things added to normal functioning, and things taken away from it.

The diagnosis.

Psych 1365 Schizophrenia

Psychosis with symptoms such as delusions, hallucinations, disorganised speech and reduced emotional expression, lasting at least six months. The duration is part of the criteria.

The error.

Psych 1366 Schizophrenia Is Not Split Personality

Equating it with multiple or split personality is an error — that is a separate and far rarer diagnosis, covered later in this part.

The first class.

Psych 1368 Positive Symptoms

Experiences added to normal functioning, including delusions and hallucinations. Positive means added rather than good, which is the trap in the term.

The second.

Psych 1369 Negative Symptoms

Reductions in normal functioning, including flattened affect, reduced speech, and loss of motivation. These respond less well to treatment and are often the more disabling of the two classes.

One hypothesis.

Psych 1371 The Dopamine Hypothesis

That the disorder involves excess dopamine activity in specific brain pathways. Specific pathways — the claim is narrower than the transmitter's name suggests.

And the course.

Psych 1373 Prodrome and Course in Schizophrenia

It typically begins with a prodromal period of gradual functional decline before the first psychotic episode. Which means there is a window before the episode that is visible in hindsight.

Five entries. Two diagnoses involving discontinuity in identity or memory — the first being the one the psychosis error entry pointed at — and then the personality disorder category with two of its members.

The first.

Psych 1375 Dissociative Identity Disorder

Two or more distinct personality states, with gaps in recall of everyday events. The rarer diagnosis the schizophrenia error entry referred to.

The second.

Psych 1377 Dissociative Amnesia

An inability to recall important autobiographical information, typically of a traumatic nature, beyond ordinary forgetting. Beyond ordinary forgetting is the qualifier that does the work.

The category.

Psych 1379 Personality Disorders

An enduring, inflexible pattern of inner experience and behavior that deviates markedly from cultural expectation and causes impairment. Deviates from cultural expectation — which brings the earlier cultural entry directly into a diagnostic criterion.

The first.

Psych 1381 Borderline Personality Disorder

Instability in relationships, self-image and emotion, with marked impulsivity. Three domains of instability rather than one.

The second.

Psych 1383 Antisocial Personality Disorder

A persistent pattern of disregard for others' rights, deceit and lack of remorse, beginning before age fifteen. The age requirement is in the criteria.

Three entries. Two conditions present from development rather than arriving later — both with age and setting requirements in their criteria — and one pattern of use defined by control rather than by quantity.

The first.

Psych 1385 Attention-Deficit/Hyperactivity Disorder

Persistent inattention, hyperactivity or impulsivity appearing before age twelve and impairing functioning in more than one setting. More than one setting — behavior confined to a single context does not meet the criteria.

The second.

Psych 1387 Autism Spectrum Disorder

Persistent differences in social communication alongside restricted or repetitive behaviors and interests, present from early development. Differences is the word the criteria use.

And a pattern of use.

Psych 1389 Substance Use Disorder

A pattern of use leading to impairment or distress, marked by loss of control, continued use despite harm, and craving. Defined by control and consequence rather than by amount.

One procedure, and it is what turns everything in these two parts into something usable. Five checks in order — symptom count, duration, impairment, cultural context, and exclusion criteria — and no diagnosis gets named until all five have been made.

Watch a case get checked.

Psych 1391 Assessing a Case Against Diagnostic Criteria

Checking symptom count, duration, impairment, cultural context and exclusion criteria before naming any diagnosis. Recognising a pattern is the first step and it is nowhere near the last one.

Five things you can now do, and Part Three takes up treatment. You can say why expecting sadness misses a depression diagnosis — the more visible feature is often a loss of interest and capacity, in people who are still functioning outwardly. You can say what separates the two bipolar diagnoses: whether a full manic episode has occurred, which makes the second a different diagnosis rather than a milder one. You can say what asking directly about suicidal thoughts does — it does not increase risk, and mood disorders substantially elevate it. You can tell positive from negative symptoms by direction: experiences added to normal functioning, and reductions in it, with the second class often the more disabling. And you can check a case in order — count, duration, impairment, cultural context, exclusions — before naming anything.