 Axis I listed the primary or principal diagnoses that

needed immediate attention; this included recording of

clinical disorders as well as “Other Conditions That May
Be a Focus of Clinical Attention” (e.g., life stressors,
impairments in functioning; APA, 2000, p. 27).
 Axis II contained pervasive psychological issues such as
personality disorders, personality traits and mental
retardation (now intellectual disability disorder) that
shaped responses to Axis I disorders.
 Axis III was intended to cue reporting of medical or
neurological problems that were relevant to the
individual’s current or past psychiatric problems.
 Axis IV required clinicians to indicate which of nine
categories of psychosocial or environmental stressors
influenced client conceptualization or care (e.g., recent
divorce, death of partner, job loss).

 Finally, Axis V included the opportunity to provide a Global

Assessment of Functioning (GAF) rating, a number between 0
and 100 intended to indicate overall level of distress or
impairment.
 Axes I, II and III have been eliminated in the DSM-5 (APA,
2013). Clinicians can simply list any disorders or conditions
previously coded on these three Axes together and in
order of clinical priority or focus (APA, 2013).
 ANXIETY AND MOOD DISORDERS
Ch. 16 Psychological Disorders
ANXIETY DISORDERS
 anxiety disorders: psychological disorders
characterized by distressing, persistent anxiety or
maladaptive behaviors that reduce anxiety
 There are several types of anxiety disorders,
including:
 generalized anxiety disorder
 panic disorder
 phobias
 Former Anxiety disorders given their own separate
classification
 obsessive-compulsive disorder
 PTSD
The DSM-5 added a new category of disorders called
Obsessive-Compulsive and Related Disorders
(OCRDs) (also called Obsessive-Compulsive
Spectrum Disorders in the research literature).

The OCRDs category includes the familiar obsessive-

compulsive disorder. It also includes two newly defined
disorders with obsessive-compulsive features.
These are hoarding disorder and excoriation (skin-
picking) disorder. Also included in the new OCRD
category are body dysmorphic disorder
(previously classified as a Somatoform Disorder)
and trichotillomania (hair-pulling, previously
classified as an Impulse Control Disorder Not
Elsewhere Classified).
Generalized Anxiety
Disorder
 An anxiety disorder in which a person is
continually tense, apprehensive, and in a state of
autonomic nervous system arousal
 Tension and apprehension might be observable
through furrowed brows, twitching eyelids,
trembling, perspiration, fidgeting
 Concentration is difficult (worrying all the time)
 2/3 of the sufferers are women
Panic Disorder

 An anxiety disorder marked by minutes-long

episodes of intense dread in which a person
experiences terror and accompanying chest
pain, choking, or other frightening sensations
 The fear of having a panic attack becomes a
problem itself, possibly leading to agoraphobia
(fear or avoidance of situations in which escape
might be difficult or help unavailable when panic
strikes)
Panic Disorder
 Smokers have 2 to 4 times more risk of a first-time panic attack
Phobia
 An anxiety disorder marked by a persistent, irrational fear and
avoidance of a specific object or situation
 specific phobia: fears that are selective, persistent, out of
proportion (e.g. heights, seeing blood)
 social phobia: an intense fear of being scrutinized by others
 person avoids potentially
embarrassing social
situations
Phobias
Just the ‘A’s.
 Ablutophobia- fear of washing or bathing.
 Acousticophobia- fear of noise.
 Alektorophobia- fear of chickens.
 Alliumphobia- fear of garlic.
 Allodoxaphobia- fear of opinions.
 Amathophobia- fear of dust.
 Ambulophobia- fear of walking.
 Anthrophobia or Anthophobia- fear of flowers.
 Anuptaphobia- fear of staying single.
 Arachibutyrophobia- fear of peanut butter sticking to
the roof of the mouth.
 Arithmophobia- fear of numbers.
Obsessive-Compulsive
Disorder
 An anxiety disorder characterized by
 unwanted repetitive thoughts
(obsessions)
 and/or actions (compulsions)
 Obsessive thoughts and compulsive behaviors can be
called a disorder when they are so persistent that they
interfere with the way we live or when they cause distress
 For some people with the disorder, obsessions &
compulsions lessen over time
 Common Obsessions & Compulsions
Among Children & Adolescents with Obsessive-Compulsive
Disorder
Thought or Behavior % Reporting
Symptom
Obsessions (repetitive thoughts)
Concern with dirt, germs, or toxins 40%
Something terrible happening (fire, death, illness) 24
Symmetry, order, or exactness 17

Compulsions (repetitive behaviors)

Excessive hand washing, bathing, tooth brushing, 85
or grooming
Repeating rituals (in/out of a door, up/down from 51
a chair)
Checking doors, locks, appliances, car brake, 46
Howard Hughes, a
billionaire, developed
obsessive-compulsive
disorder. He was afraid of
germs, and so avoided
contact with possible
sources of dirt (including
other people) and
constantly washed his
hands.
He was obsessed with the
size of peas, and used a
special fork to sort them by
size. Also, he compulsively
said the same phrases over
and over again.
Explaining Anxiety
Disorders
 Freud’s psychoanalytic perspective assumed that,
starting in childhood, people repress intolerable
impulses, ideas, and feelings and that this
submerged mental energy sometimes produced
symptoms like anxiety
 Today’s psychologists have turned away from
Freud to two contemporary perspectives:

Learning
Biological
Explaining Anxiety Disorder:
Learning Perspective
 Fear conditioning:
 General anxiety is linked with classical
conditioning of fear
 Inthe laboratory, when rats were given
unpredictable electric shocks, they later
became anxious and apprehensive in their lab
environment
 58% of those with social phobia experienced
their disorder after a traumatic event
Explaining Anxiety Disorder
Learning Perspective
• Stimulus generalization:
– Remember that generalization is the tendency
(once a response has been conditioned) for
stimuli similar to the conditioned stimulus to bring
out similar responses
– ex. A person who is afraid of heights after falling
might later generalize that fear to planes
Explaining Anxiety Disorder
Learning Perspective
 Reinforcement:
 After phobias & compulsions develop,
reinforcements help maintain them
 Avoiding or escaping the feared
situation reduces anxiety thus
reinforcing the phobic behavior
 Compulsive behaviors similarly reduce
anxiety
 Observational learning:
 Learn fear by observing others’ fears
Explaining Anxiety Disorder
Biological Perspective
 Natural Selection:
 We are biologically prepared to fear
threats that had been faced by our
ancestors
 Therefore phobias focus on dangers
faced by our ancestors (e.g. snakes,
closed spaces, heights, storms,
darkness)
 Compulsive acts typically exaggerate
behaviors that help our survival
Explaining Anxiety Disorder
Biological Perspective
 Genes:
 Some people seem more genetically
predisposed to particular fears & high
anxiety
 Identicaltwins often develop similar
phobias, sometimes even when raised
separately
 Explaining Anxiety Disorder
Biological Perspective
• Physiology:
– Anxiety disorders are biologically measurable as
an overarousal of brain areas involved in impulse
control and habitual behaviors
– PET scans of people with obsessive-compulsive
disorder reveal unusually high activity in the frontal
lobes
– Fear learning experiences can traumatize the
brain, by affecting the amygdala
 PTSD – Post-Traumatic
Stress Disorder
 PTSDis an anxiety disorder that can develop after
going through a severely threatening, uncontrollable
event that included a sense of helplessness and fear
 e.g.war, assault, road accident, natural disaster,
rape
 Post-Traumatic Stress Disorder
 Symptoms include:
Haunting memories (flashbacks)
Nightmares
Social withdrawal
Jumpy anxiety
Insomnia
 Suffered by about 15% of war veterans (higher
among those who experienced heavy
combat), 50% of people kidnapped, tortured, or
raped, and 4% of people who experienced a
natural disaster
Post-Traumatic Stress Disorder

 Note that for many victims of post-traumatic

stress disorder (PTSD), anxiety increases with any
reminder of the trauma

 Some psychologists believe that PTSD is over-

diagnosed, and most people are quite resilient
to traumatic experiences
MOOD DISORDERS

 Mood disorders: psychological disorders

characterized by emotional extremes
 The changes to Depressive Disorders are a bit more substantial.
There are now four main disorders, rather than just two.
 We still have Major Depressive Disorder and Dysthymia; though, this is
now called Persistent Depressive Disorder. As the name implies,
Persistent Depressive Disorder features chronicity as its defining
symptom. It includes not only what was formerly known as
Dysthymia, but also chronic Major Depression.
 Research has been unable to find meaningful differences between
the two.
 Two new disorders have been added: Disruptive Mood
Dysregulation and Premenstrual Dysphoric Disorder.
 The DSM-5 no longer has a separate category of disorders for
children. Instead, disorders are grouped together into diagnostic
categories that share similar features and presumed etiologies. This
disorder applies to children up to age 18 with persistent and frequent
irritable episodes of behavioral dysregulation.

 The Grief/Bereavement exclusion for depression has been

removed!
 Mood Disorders

 Depression is the “common cold” of

psychological disorders.
In fact:
 Depression is the number one reason for
people to seek mental heath services
 It is the leading cause of disability
worldwide
Mood Disorders

 Depression is a response to past and current loss. (As opposed

to anxiety which a response to a future threat)
 It acts as a signal for our body to take protective measures!
 Two emotional extremes of mood disorder:
(1) major depressive disorder
(2) bipolar disorder
 A mood disorder in which a person

Major experiences 2 weeks or more of

-depressed moods
Depressive -feelings of worthlessness
Disorder: -decreased interest or pleasure in activities
-weight gain/loss
-inability to sleep or too much sleep
-thoughts of death/suicide
for no apparent reason.
(Dysthymic Disorder)
Persistent Depressive
Disorder:
 A depressed mood that lasts most of the day, nearly every
day, for two years or more
 It is less severe than major depressive disorder, but it lasts
longer
 Experience chronic low energy & self-esteem, have
difficulty concentrating or making decisions, and sleep &
eat too much or too little
Some depression facts:
 Compared with men, women are twice as
vulnerable to major depression, even more so if they
have been depressed before
 Most major depressive episodes self-terminate
 Stressfulevents related to work, marriage, and close
relationships often precede depression
 With each new generation, the rate of depression is
increasing
 Disorder is striking earlier (now often in late teens)
Depressed people, however, reach REM more rapidly,
generally in less than 45 minutes. They also tend to
awaken frequently during the night.
Most people feel slightly better during the summer (when the sun is out
most of the day) than during the winter (when there are fewer hours of
sunlight). People with seasonal affective disorder (SAD) feel good in the
summer and seriously depressed in the winter (or good in the winter and
depressed in the summer). Seasonal affective disorder is commonest in far
northern locations such as Scandinavia, where the summer days are very
long and bright and the winter days are very short and dark. The disorder is
unheard-of in tropical locations such as Hawaii, where the amount of
sunlight per day varies only slightly between summer and winter.
 Bipolar Disorder
 Manic episode: an episode marked by a
hyperactive, wildly optimistic state.
 Bipolar disorder: a mood disorder in which the
person alternates between the hopelessness &
lethargy of depression and the overexcited state
of mania
 Bipolar Disorder
 During the manic state in the bipolar disorder,
the person becomes highly talkative, overactive
and may engage in reckless activities (unsafe
sex, spending sprees, investments) with
dangerously soaring self-esteem.
 However, milder forms of mania can help
creativity:
George Frideric Handel, who was believed to
have suffered from bipolar disorder, composed
the four-hour-long Messiah during the three
weeks of his manic episode.
Other creative bipolar people include Edgar
Allan Poe, and Samuel Clemens (Mark Twain)…..
Bipolar Disorder
 Bipolar disorder is much less
common than major depression
 occursin about 1% of the
population
 afflicts
both men and women
equally
Explaining Mood Disorders

 Freud’s psychoanalytic theory (importance of

early childhood experiences and unconscious
impulses) suggests that depression occurs when
significant losses evoke feelings associated with
losses experienced in childhood

 Today’s bio-psycho-social perspective is replacing

Freudian explanations with biological & cognitive
explanations
Explaining Mood Disorders
Biological Perspective

 Genetic influences:
 mood disorders run in families
 risk of major depression & bipolar
disorder increases if you have a
depressed parent or sibling
 even if identical twins are raised in
different environments, they have
greater similarities for depressive
tendencies
Explaining Mood Disorders
Biological Perspective

 Depressed brain
 norepinephrine (a neurotransmitter
that increases arousal and boosts
mood) is overabundant during
mania and scarce during depression
 serotonin is scarce during depression
repetitive physical exercise
reduces depression
(it increases serotonin)
 PET scans show that brain energy
consumption rises and falls with emotional
swings of bipolar disorder

Depressed state Manic state Depressed state

 Explaining Mood Disorders
Biological Perspective
 Depressed brain
 neurological signs of depression
 many recent studies have found the brains of
depressed people to be less active
 left frontal lobe (active during positive emotions) is
likely to be inactive in depressed states
 MRI scans have shown frontal lobes to be 7% smaller in
severely depressed people
 hippocampus (memory processing center linked with
brain’s emotional circuitry) can be affected by stress-
related damage
Explaining Mood Disorders:
The Social-Cognitive
Perspective
 Self-defeating beliefs feed depression’s
vicious cycle.
 Self-defeating beliefs may arise from
learned helplessness through
uncontrollable painful events.
 Women are more often abused or made
to feel helpless than men, and they may
respond more strongly to stress.
 Explaining Mood Disorders
The Social-Cognitive
Perspective
 Negative thoughts feed negative moods; negative moods feed
negative thoughts (cycle)
 Depressed people tend to explain bad events in terms that are
 Stable (“its going to last forever”)
 Global (“Its going to affect everything I do”)
 Internal (“its all my fault”)
 Result of these pessimistic, over generalized, self blaming
attributions is a depressing sense of hopelessness.
 Social-Cognitive
Around The World

 Depression is common among young people in the

Western world because of epidemic hopelessness
stemming from the rise of individualism and decline
of commitment to religion and family.
 Self-focused individuals take on personal
responsibility for problems and have nothing to fall
back on for hope
 Non-western cultures encourage close-knit
relationships and cooperation  depression is less
common and less tied to self-blame.
Depression’s Vicious Cycle
Dude, where are your pink glasses?

 “A recipe for severe depression is

preexisting pessimism encountering
failure” –Martin Seligman.
 Depression can be brought on by
stressful experiences (losing a job,
getting divorced, suffering physical
traumas, etc.) that disrupt your
sense of who you are and why you
are a worthy human being.
Depression’s Vicious Cycle
Dude, where are your pink glasses?

 Brooding can be adaptive  gain insights during

the times of depressed inactivity can later lead to
more effective strategies for interacting with the
world.
 But when down, brooding amplifies negative
feelings  trigger depression’s other cognitive
and behavioral symptoms. This phenomenon may
explain women’s doubled risk of depression.
Depression: Women vs
Men
 Woman often have more vivid
memories for both wonderful
and horrid experiences than
men.
 Woman may fret and act
anxious or depressed, while a
man may distract himself by
drinking, acting out, delving
into work, or watching sports.
 Depression’s Vicious Cycle
Dude, where are your pink glasses?

 When bad things happen, those

who are pessimistic are more at risk
for depression. 

 If you are optimistic, failure or stress is

unlikely to provoke depression. Even
if you do fall into depression, you are
more likely to recover quickly! 
Depression’s Vicious Cycle
Dude, where are your pink glasses?

 Lauren Alloy and her collaborators monitored

Temple University and University of Wisconsin
students. Among those identified as having
optimistic thinking styles as they began college,
only 1% had a first episode of major depression,
compared to 17% of those who began college
with pessimistic views.
 Students who show optimism as they begin
college develop more social support  lowered
risk of depression.
Depression’s Vicious Cycle
1. Stressful
Experiences (Divorce,
job loss, etc)

4. Cognitive and 2. Negative

Behavioral Explanatory Style
Changes (Hopeless (Pessimism,
Attitude, Fatigue) self-blaming)

3. Depressed Mood