Psychopathology

Unit I
Introduction to Psychopathology
Psychopathology is that part of psychology which seeks to explain disorders of
behaviour, including those of mental activity, in terms of psychological processes.
Psychopathology is the study of psychological disorders, including their symptoms,
etiology (i.e., their causes and origins), and treatment. It is a branch of psychology and
psychiatry that deals with the scientific study of mental distress, abnormal behavior, and
psychiatric disorders.

Psychodynamic Model:
The psychodynamic model stands as one of the foundational pillars in the realm of
psychology, offering a profound understanding of human behavior and mental health.
Spearheaded by Sigmund Freud and further developed by his successors, this model
delves into the intricate workings of the unconscious mind, the dynamics of personality,
and the origins of psychopathology.
1. Unconscious Mind: According to Freud, a significant portion of our mental activity
occurs outside our conscious awareness. The unconscious mind contains
thoughts, feelings, desires, and memories that are repressed or kept hidden from
awareness due to their disturbing or socially unacceptable nature. These
repressed thoughts can influence our behavior and mental health in subtle and
complex ways.
2. Psychosexual Development: Freud proposed that personality develops through
a series of psychosexual stages: oral, anal, phallic, latency, and genital. Each
stage is characterized by a focus on a different erogenous zone and involves
conflicts that must be resolved for healthy development to occur. Failure to resolve
these conflicts can lead to fixation at a particular stage, resulting in personality
traits and behaviors characteristic of that stage.
3. Defense Mechanisms: The psychodynamic model suggests that individuals
employ various defense mechanisms to cope with anxiety and protect themselves
from distressing thoughts and feelings. Defense mechanisms, such as repression,
denial, projection, and displacement, operate unconsciously and can sometimes
distort reality or lead to maladaptive behaviors.
4. Structural Model of Personality: Freud proposed a structural model of
personality consisting of three components: the id, ego, and superego. The id
operates on the pleasure principle, seeking immediate gratification of basic
desires and instincts. The ego operates on the reality principle, mediating between
the id's impulses, the superego's moral standards, and the demands of reality. The
superego represents internalized societal and parental values and serves as the
conscience, striving for moral perfection.
5. Psychopathology and Conflict Resolution: According to the psychodynamic
perspective, mental health problems arise from unresolved conflicts and repressed
 Psychopathology

thoughts and feelings. These conflicts often stem from early childhood
experiences, particularly related to parental relationships and the development of
sexuality. Symptoms of psychopathology, such as anxiety, depression, and
maladaptive behaviors, are seen as manifestations of these underlying conflicts.
6. Therapeutic Techniques: Psychodynamic therapy aims to bring unconscious
conflicts and repressed material into conscious awareness, allowing individuals to
gain insight into their thoughts, feelings, and behaviors. Techniques such as free
association, dream analysis, and interpretation of transference and resistance are
used to explore unconscious dynamics and facilitate the resolution of underlying
conflicts.
Critics of the psychodynamic model argue that its concepts are difficult to test empirically
and that its emphasis on early childhood experiences and unconscious processes may
oversimplify the complex nature of mental health. However, the psychodynamic
perspective continues to influence contemporary psychotherapy and our understanding
of human behavior and psychopathology.

Cognitive-Behavioral Model
The Cognitive-Behavioral Approach (CBA) to psychopathology provides a
comprehensive lens through which to understand the complex interplay between
cognitive processes and behavioral patterns in the development and persistence of
psychological disorders.
The Cognitive-Behavioral Approach to psychopathology is deeply rooted in the
understanding that maladaptive thought patterns and learned behaviors significantly
contribute to psychological distress. This approach draws from cognitive psychology and
behaviorism, blending theoretical principles from both disciplines to provide a
comprehensive framework for understanding and treating psychological disorders.
Central to the CBA is the recognition of cognitive processes, such as information
processing biases and negative automatic thoughts, and their interaction with learned
behavioral responses in shaping emotional experiences and symptomatology.
Notable figures in the development of the CBA include Aaron T. Beck and Albert Ellis,
whose pioneering work laid the groundwork for integrating cognitive and behavioral
principles in understanding psychopathology. Beck's cognitive therapy emphasized the
role of cognitive distortions in depression, while Ellis's rational emotive behavior therapy
focused on challenging irrational beliefs to alleviate emotional distress. The integration of
these cognitive and behavioral principles has provided clinicians with a versatile and
effective approach to addressing a wide range of psychological disorders.

The Cognitive-Behavioral Approach delineates several key components essential for

understanding psychopathology:
1. Cognitive Processes: Maladaptive thinking patterns, including cognitive distortions
(e.g., catastrophizing, overgeneralization) and negative automatic thoughts, play a
 Psychopathology

central role in shaping individuals' perceptions of themselves, others, and their

environment. These cognitive biases contribute to the amplification of negative
emotions and the maintenance of psychological disorders.
2. Behavioral Patterns: Learned behaviors, such as avoidance, safety behaviors, and
compulsions, serve to reinforce negative cognitions and perpetuate cycles of
distress. Behavioral responses to stressors or triggers can become entrenched
over time, leading to maladaptive coping strategies and impaired functioning.
3. Interpersonal Factors: Social interactions and relationship dynamics influence
individuals' cognitive and behavioral responses to stressors. Interpersonal
conflicts, social support networks, and attachment styles play a significant role in
the development and exacerbation of psychological symptoms, highlighting the
importance of considering relational factors in understanding psychopathology.
Therapeutic Techniques: The Cognitive-Behavioral Approach utilizes a range of
evidence-based techniques to modify maladaptive cognitions and behaviors:
1. Cognitive Restructuring: Therapists assist clients in identifying and challenging
irrational or distorted thoughts, replacing them with more adaptive and realistic
beliefs. Techniques such as cognitive reframing, Socratic questioning, and
cognitive-behavioral worksheets facilitate cognitive restructuring and promote
cognitive flexibility.
2. Exposure Therapy: Clients confront feared stimuli or situations in a gradual and
systematic manner, facilitating habituation and reducing anxiety. Exposure-based
techniques, such as systematic desensitization and in vivo exposure, help clients
confront their fears and challenge avoidance behaviors.
3. Behavioral Activation: Clients engage in pleasurable and meaningful activities to
counteract avoidance and withdrawal behaviors associated with depression.
Behavioral activation interventions, such as activity scheduling, goal setting, and
behavioral experiments, encourage clients to increase their level of activity and
engagement in rewarding activities.

Humanistic-Existential Approaches
Humanistic-Existential Approaches to Psychopathology offer a unique perspective on
understanding and addressing psychological distress, emphasizing the subjective
experience of individuals and their quest for meaning and fulfillment in life. These
approaches draw from humanistic psychology, which focuses on the innate potential for
growth and self-actualization, as well as existential philosophy, which explores questions
of existence, freedom, and responsibility. In the context of psychopathology, Humanistic-
Existential Approaches emphasize the importance of authenticity, self-awareness, and
personal agency in navigating life's challenges and overcoming psychological struggles.
Key Tenets:
1. Person-Centered Perspective: Humanistic-Existential Approaches prioritize the
subjective experiences of individuals, viewing them as unique beings with inherent
 Psychopathology

worth and dignity. Carl Rogers' person-centered therapy, a central component of

this approach, emphasizes the therapist's empathic understanding, unconditional
positive regard, and genuineness in fostering a therapeutic environment conducive
to self-exploration and growth. In the context of psychopathology, this perspective
highlights the importance of validating individuals' experiences and facilitating their
journey towards self-understanding and self-acceptance.
2. Existential Themes: Existential philosophy provides a framework for
understanding the existential concerns that underlie psychological distress, such
as the fear of death, the search for meaning, and the experience of existential
isolation. Existential therapists, like Irvin Yalom, explore these themes in therapy,
helping clients confront existential realities and embrace their freedom and
responsibility in creating meaning in their lives. In the context of psychopathology,
addressing existential concerns can provide individuals with a sense of purpose
and direction, mitigating feelings of existential angst and despair.
3. Authenticity and Self-Actualization: Humanistic-Existential Approaches
emphasize the importance of authenticity and self-actualization in fostering
psychological well-being. Abraham Maslow's hierarchy of needs posits that
individuals strive towards self-actualization, a process of realizing one's full
potential and becoming the best version of oneself. In therapy, the focus is on
helping clients identify and pursue their values, passions, and aspirations, thereby
enhancing their sense of fulfillment and psychological flourishing. In the context of
psychopathology, promoting authenticity and self-actualization can empower
individuals to transcend their struggles and live more meaningful and fulfilling
lives.
4. Responsibility and Freedom: Existential philosophy underscores the idea of
human freedom and responsibility in shaping one's destiny. Existential therapists
encourage clients to take ownership of their choices and actions, recognizing that
they have the power to create meaning and purpose in their lives. By embracing
their freedom and taking responsibility for their decisions, individuals can
transcend feelings of helplessness and victimhood, reclaiming agency and
authorship over their narratives. In the context of psychopathology, fostering a
sense of responsibility and empowerment can facilitate individuals' engagement in
the therapeutic process and promote meaningful change.
 Psychopathology

Unit II:
Schizophrenic Spectrum disorders
"Schizophrenia," is derived from Greek roots meaning "to split or crack" and "mind”.
Thus, in schizophrenia, there is a division within the intellect, between intellect and
emotion, and between intellect and external reality.
Schizophrenia is characterized by diverse symptoms, including extreme oddities in
perception, thinking, action, sense of self, and manner of relating to others. However, the
hallmark of schizophrenia is a significant loss of contact with reality, referred to as
psychosis.
Two general symptom patterns, or syndromes, of schizophrenia have been
differentiated. These are referred to as positive- and negative-syndrome schizophrenia.
Positive symptoms: These are those that reflect an excess or distortion in a normal
repertoire of behavior and experience, such as delusions and hallucinations.
1. Delusions: A delusion is an erroneous belief that is fixed and firmly held despite clear
contradictory evidence. The word delusion comes from the Latin verb ludere, which
means “to play.” In essence, tricks are played on the mind. People with delusions believe
things that others who share their social, religious, and cultural backgrounds do not
believe. A delusion therefore involves a disturbance in the content of thought.
Not all people who have delusions suffer from schizophrenia. However, delusions are
common in schizophrenia, occurring in more than 90 percent of patients at some time
during their illness. In schizophrenia, certain types of delusions or false beliefs are quite
characteristic. Prominent among these are beliefs that one’s thoughts, feelings, or
actions are being controlled by external agents, that one’s private thoughts are being
broadcast indiscriminately to others, that thoughts are being inserted into one’s brain by
some external agency. Other strange propositions, including delusions of bodily changes
(e.g., bowels do not work) or removal of organs, are also common. Sometimes delusions
are not just isolated beliefs. Instead, they become elaborated into a complex delusional
system.
2. Hallucinations: A hallucination is a sensory experience that seems real to the person
having it, but occurs in the absence of any external perceptual stimulus. The word comes
from the Latin verb hallucinere, meaning to “wander in mind” or “idle talk.” Hallucinations
can occur in any sensory modality (auditory, visual, olfactory, tactile, or gustatory).
However, auditory hallucinations (e.g., hearing voices) are by far the most common.
Hallucinations often have relevance for the patient at some affective, conceptual, or
behavioral level. Patients can become emotionally involved in their hallucinations, often
incorporating them into their delusions. In some cases, patients may even act on their
hallucinations and do what the voices tell them to do.
3. Disorganized Speech: Disorganized speech is the external manifestation of a
disorder in thought form. Basically, an affected person fails to make sense, despite
 Psychopathology

seeming to use language in a conventional way and following the semantic and syntactic
rules governing verbal communication. The failure is not attributable to low intelligence,
poor education, or cultural deprivation.
In disorganized speech, the words and word combinations sound communicative, but the
listener is left with little or no understanding of the point the speaker is trying to make. In
some cases, completely new, made-up words known as neologisms (literally, “new
words”) appear in the patient’s speech. An example might be the word detone, which
looks and sounds like a meaningful word but is a neologism.
4. Disorganized Behaviour: Disorganized behavior can show itself in a variety of ways.
Goal-directed activity is almost universally disrupted in schizophrenia. The impairment
occurs in areas of routine daily functioning, such as work, social relations, and self care,
to the extent that observers note that the person is not himself or herself anymore. For
example, the person may no longer maintain minimal standards of personal hygiene or
may exhibit a profound disregard of personal safety and health. In other cases, grossly
disorganized behavior appears as silliness or unusual dress (e.g., wearing an over coat,
scarf, and gloves on a hot summer day).
Catatonia is an even more striking behavioral disturbance. The patient with catatonia
may show a virtual absence of all movement and speech and be in what is called a
catatonic stupor. At other times, the patient may hold an unusual posture for an extended
period of time without any seeming discomfort.
Negative symptoms: These reflect an absence or deficit of behaviours that are normally
present. Current thinking is that negative symptoms fall into two broad domains.
One domain involves reduced expressive behavior—either in voice, facial expression,
gestures, or speech. The other domain concerns reductions in motivation or in the
experience of pleasure.
1. Avolition: Avolition refers to a lack of motivation and seeming absence of will/ interest
in the ability to do routine activities like self-care, work, and/or school. For example,
people with schizophrenia may become inattentive to grooming and personal hygiene,
may have uncombed hair, dirty nails, unbrushed teeth, and disheveled clothes.
2. Alogia: Alogia means significant reduction in the amount of speech i.e. people with
schizophrenia do not talk much. They may answer a question in one-two words and then
may stop responding.
3. Anhedonia: Anhedonia is a presumed loss of interest and experience of reported
pleasure in activities that are typically considered pleasurable for everyone, such as food,
socialization, sexual relations, hobbies, watching TV, etc.
4. Asociality: Some people with schizophrenia have severe impairments in social
relationships, for instance they have few friends, poor social skills, and very little interest
in being with other people. Instead, they wish to spend much of their time alone.
5. Flat Affect: Flat affect is the lack of outward expression of emotion. A person with this
symptom may appear to be inexpressive, have a poker face, stare lifelessly at others,
 Psychopathology

and the muscles of the face would lay motionless. Their voice is also flat and toneless
and they may even not look at others while replying to them.

Other Psychotic Disorders: Schizophrenia is a form of psychotic disorder, but it is not

the only one. There are a number of other types of psychotic disorders, such as
schizoaffective disorder, schizophreniform disorder, delusional disorder, and brief
psychotic disorder.
1. Schizoaffective Disorder: It is characterized by a combination of symptoms of
schizophrenia, such as hallucinations or delusions, and mood disturbances, such as
mania or depression.
Individuals with schizoaffective disorder experience a range of symptoms that include
psychotic features like hallucinations or delusions, along with significant mood
disturbances such as mania or depression. In essence, this disorder represents a unique
blend of schizophrenia and mood disorders, often presenting challenges in diagnosis and
treatment due to the overlapping symptoms. People with schizoaffective disorder may
exhibit periods of psychosis, characterized by disruptions in thought processes and
perceptions, alongside fluctuations in mood, energy levels, and behavior.

2. Schizophreniform Disorder: Schizophreniform disorder shares similarities with

schizophrenia but differs in terms of duration and functional impairment. It is diagnosed
when an individual experiences symptoms characteristic of schizophrenia for a period of
1 to 6 months. These symptoms typically include hallucinations, delusions, disorganized
thinking or speech, grossly disorganized or abnormal motor behavior, and negative
symptoms such as diminished emotional expression or avolition (lack of motivation).
3. Delusional Disorder: Delusional disorder is characterized by the presence of one or
more delusions that persist for at least one month or longer. Patients with delusional
disorder, like many people with schizophrenia, hold beliefs that are considered false and
absurd by those around them. People with delusional disorder may behave quite
normally. Their behavior does not show the gross disorganization and performance
deficiencies characteristic of schizophrenia, and general behavioral deterioration is rarely
observed in this disorder, even when it proves chronic. The DSM-5 outlines several types
of delusional disorder, including grandiose, erotomanic, jealous, somatic, etc.
4. Brief Psychotic Disorder: It involves the sudden onset of psychotic symptoms or
disorganized speech or catatonic behavior. Even though there is often great emotional
turmoil, the episode usually lasts only a matter of days (too short to warrant a diagnosis
of schizophreniform disorder). After this, the person returns to his or her former level of
functioning and may never have another episode again. Cases of brief psychotic disorder
are infrequently seen in clinical settings, perhaps because they remit so quickly.
 Psychopathology

Bipolar and Related Disorders

Bipolar disorders belong to the category of mood disorders which involve severe
alterations in mood for much longer periods of time. In such cases the disturbances of
mood are intense and persistent enough to lead to serious problems in relationships and
work performance. In all mood disorders, extremes of emotion or affect—soaring elation
or deep depression—dominate the clinical picture. Other symptoms are also present, but
abnormal mood is the defining feature.
The two key moods involved in mood disorders are depression, which usually involves
feelings of extraordinary sadness and dejection, and mania, often characterized by
intense and unrealistic feelings of excitement and euphoria.
Depressive Episode A depressive episode has features typical of major depression,
including depressed mood, anhedonia, psychomotor retardation, and feelings of
pessimism and guilt. Sleeping and eating often increase. Delusions of guilt accompanied
by self-loathings are common in psychotic depression, and some patients have
hallucinations.
Signs and symptoms of the depressive phase of bipolar disorder include persistent
feelings of sadness, anxiety, guilt, anger, isolation, or hopelessness; disturbances in
sleep and appetite; fatigue and loss of interest in usually enjoyable activities; problems in
concentration, loneliness, self-loathing, apathy or indifference; loss of interest in sexual
activity; shyness or social anxiety, irritability, chronic pain (with or without a known
cause); lack of motivation; and morbid suicidal ideation. In severe cases, the individual
may become psychotic – a condition also known as severe bipolar depression with
psychotic features.
Manic Episode A manic episode is defined as one or more than one week of a
persistently elevated, expansive, or irritable mood plus three or more than three of the
following additional symptoms: Inflated self-esteem or grandiosity, decreased need for
sleep, greater talkativeness than usual, persistent elevation of mood, flight of ideas or
racing of thoughts, distractibility, and increased goal-directed activity.
People suffering from bipolar disorder commonly experience an increase in energy and a
decreased need for sleep. A person’s speech may be pressured, with thoughts
experienced as racing. Attention span is low, and a person in a manic state may be
easily distracted. Judgment may become impaired, and sufferers may go on spending
sprees or engage in behaviour that is quite abnormal for them. They may indulge in
substance abuse, particularly alcohol or other depressants, cocaine or other stimulants,
or sleeping pills. Their behaviour may become aggressive, intolerant, or intrusive. People
may feel out of control or unstoppable. People may feel they have been “chosen” and are
“on a special mission” or have other grandiose or delusional ideas. Sexual drive may
increase. Manic patients may inexhaustibly, excessively, and impulsively involved in
various pleasurable, high-risk activities (e.g. gambling, dangerous sports, promiscuous
 Psychopathology

sexual activity) without insight into possible harm. Symptoms are so severe that they
impair functioning.
Hypomanic Episode A hypomanic episode is a less extreme variant of mania involving
a distinct episode that lasts four or more than four days and is distinctly different from the
patient’s usual nondepressed mood. Hypomania is generally a mild to moderate level of
mania, characterised by optimism, pressure of speech and activity, and decreased need
for sleep. Generally, hypomania does not inhibit functioning like mania. Many people with
hypomania are actually in fact more productive than usual. During the hypomanic period,
mood brightens, the need for sleep decreases, and psychomotor activity accelerates. For
some patients, hypomanic periods are adaptive because they produce high energy,
creativity, confidence, and supernormal social functioning. Many do not wish to leave the
pleasurable, euphoric state. Some function quite well, and in most, functioning is not
markedly impaired. However, in some patients, hypomania manifests as distractibility,
irritability, and labile mood, which the patient and others find less attractive.
Mixed Episode A mixed episode blends depressive and manic or hypomanic features;
the criteria for both mania and depression are met. For example, patients may
momentarily switch to tearfulness during the height of mania, or their thoughts may race
during a depressive period. In at least one third of people with bipolar disorder, the entire
episode gfis mixed.
1. Bipolar I Disorder Bipolar I Disorder is mainly defined by manic or mixed episodes
that last at least seven days, or by manic symptoms that are so severe that the person
needs immediate hospital care. Usually, the person also has depressive episodes,
typically lasting at least two weeks. The symptoms of mania or depression must be a
major change from the person’s normal behaviour. A person with bipolar disorder
experiences episodes of mania and, usually, major depressive episodes as well. Avery
small number of people may experience one or more periods of mania without ever
experiencing depression.
2. Bipolar II Disorder Bipolar II Disorder is defined by a pattern of depressive episodes
shifting back and forth with hypomanic episodes, but no full-blown manic or mixed
episodes. Hypomanic episodes do not go to the full extremes of mania (i.e., do not
usually cause severe social or occupational impairment, and are without psychosis), and
this can make bipolar II more difficult to diagnose, since the hypomanic episodes may
simply appear as a period of successful high productivity and is reported less frequently
than a distressing, crippling depression. Thus bipolar II disorder differs from Bipolar I in
that – rather than experiencing one or more florid, dramatic manic episodes – the manic
behaviour is present to a lesser degree. People who experience a hypomanic episode
may not see it as pathological, although those around them may be concerned about the
erratic behaviour they see.
3. Cyclothymia, or Cyclothymic Disorder, is a mild form of bipolar disorder. People
who have cyclothymia have episodes of hypomania that shift back and forth with mild
depression for at least two years. However, the symptoms do not meet the diagnostic
requirements for any other type of bipolar disorder. Symptoms of cyclothymic disorder
are depressed mood for most of the day, for more days than not, for one year, including
the presence of two of the following symptoms: poor appetite or overeating;
 Psychopathology

insomnia/hypersomnia; low energy/fatigue; poor concentration; feelings of hopelessness.

Symptoms are less severe than those of a major depressive episode but are more
persistent. A history of hypomanic episodes with periods of depression that do not meet
criteria for major depressive episodes There is a lowgrade cycling of mood which
appears to the observer as a personality trait, and interferes with functioning.

Depressive Disorders
Depressive disorders involve the presence of sad, empty, or irritable mood, accompanied
by related changes that significantly affect the individual’s capacity to function (e.g.,
somatic and cognitive changes in major depressive disorder and persistent depressive
disorder). What differs among them are issues of duration, timing, or presumed etiology.
1. Disruptive Mood Dysregulation Disorder: DMDD is primarily characterized by
chronic, severe persistent irritability in children, including frequent temper outbursts that
are disproportionate to the situation. These outbursts can be verbal, such as yelling or
screaming, or behavioral, involving physical aggression towards people or property. They
typically occur three or more times a week. Apart from these explosive reactions, the
affected child's mood between outbursts is marked by a persistent irritability or anger that
is evident most of the day, nearly every day, and noticeable to others like family
members, teachers, or peers.
For a diagnosis of DMDD, these symptoms must have been consistently present for 12
or more months without a break of more than three consecutive months. The condition
must first appear before the child is ten years old. It is also important that these
symptoms are observed in multiple settings—at home, at school, or with peers—and
must be severe in at least one of these contexts.
2. Major Depressive Disorder: Major depressive disorder (MDD) is diagnosed when
someone experiences at least one major depressive episode without a history of manic
or hypomanic episodes. A major depressive episode lasts for a minimum of 2 weeks and
involves either a consistently depressed mood or a loss of interest or pleasure in nearly
all activities throughout most of the day, nearly every day. In addition to these core
symptoms, individuals must experience at least four other symptoms drawn from a
specified list, such as changes in appetite, sleep patterns, energy levels, feelings of
worthlessness or guilt, difficulties with concentration, and thoughts of death or suicide.
These symptoms need to occur almost daily for the entire 2-week period and significantly
impact the person's ability to function in various areas of their life.
Fatigue and disturbances in sleep are frequently observed in cases of major depressive
disorder, while disruptions in psychomotor activity are less common but usually indicate
more severe cases. People experiencing a major depressive episode often describe their
mood as sad, hopeless, or discouraged. Some individuals may initially deny feelings of
sadness but may exhibit signs of depression when observed closely. Somatic complaints,
increased irritability (especially in children and adolescents), and diminished interest in
previously enjoyed activities are commonly reported.
 Psychopathology

Changes in appetite and sleep patterns are typical symptoms, with some individuals
experiencing reduced or increased appetite and disturbed sleep. Feelings of
worthlessness or guilt, impaired cognitive function, and thoughts of death or suicide are
also common. Even in less severe cases, there is usually a noticeable level of distress or
impairment in functioning. Symptoms may overlap with those of other medical conditions,
making accurate evaluation crucial. Definitions focusing on nonvegetative symptoms can
effectively identify individuals experiencing major depressive episodes.

3. Persistent Depressive Disorder: Persistent depressive disorder (formerly called

dysthymia) is a disorder characterized by persistently depressed mood most of the day,
for more days than not, for at least 2 years (1 year for children and adolescents).
Periods of normal mood may occur briefly, but they usually last for only a few days
to a few weeks (and for a maximum of 2 months). These intermittently normal moods are
one of the most important characteristics distinguishing persistent depressive disorder
from MDD. Nevertheless, in spite of the intermittently normal moods, people with
persistent depressive disorder, because of its chronic course, show poorer outcomes and
as much impairment as those with MDD.
Although persistent depressive disorder is distinct from MDD, the two disorders
sometimes co-occur in the same person, a condition given the designation- double
depression. People with double depression are moderately depressed on a chronic basis
(meeting symptom criteria for persistent depressive disorder) but undergo increased
problems from time to time, during which they also meet criteria for a major depressive
episode. Although nearly all individuals with double depression appear to recover from
their major depressive episodes (though usually just to their previous level of dysthymia),
recurrence often occurs. In DSM-5, double depression is classified as a form of
persistent depressive disorder. The average duration of persistent depressive disorder is
4 to 5 years, but it can last for 20 years or more.
4. Premenstrual Dysphoric Disorder: The essential features of premenstrual dysphoric
disorder are the expression of mood lability, irritability, dysphoria, and anxiety symptoms
that occur repeatedly during the premenstrual phase of the cycle and remit around the
onset of menses or shortly thereafter. These symptoms may be accompanied by
behavioral and physical symptoms. Symptoms must have occurred in most of the
menstrual cycles during the past year and must have an adverse effect on work or social
functioning. The intensity and/or expressivity of the accompanying symptoms may be
closely related to social and cultural background characteristics as well as religious
beliefs, social tolerance, attitude toward the female reproductive cycle, and female
gender role issues more generally. Typically, symptoms peak around the time of the
onset of menses. Although it is not uncommon for symptoms to linger into the first few
days of menses, the individual must have a symptom-free period in the follicular phase
after the menstrual period begins. While the core symptoms include mood and anxiety
symptoms, behavioral and somatic symptoms commonly also occur. However, the
presence of somatic and/or behavioral symptoms in the absence of mood and/or anxious
symptoms is not sufficient for a diagnosis. Symptoms are of comparable severity (but not
duration) to those of other mental disorders, such as a major depressive episode or
 Psychopathology

generalized anxiety disorder. In order to confirm a provisional diagnosis, daily

prospective symptom ratings are required for at least two symptomatic cycles. Symptoms
must cause clinically significant distress and/or an obvious and marked impairment in the
ability to function socially or occupationally in the week prior to menses.
5. Substance/Medication-Induced Depressive Disorder: Substance/Medication-
Induced Depressive Disorder is a mood disorder that is directly caused by the effects of
drugs, medications, or exposure to toxins. It is characterized by significant depressive
symptoms that develop during or soon after substance use or withdrawal, and which are
above and beyond what might be expected from intoxication or withdrawal effects alone.
The depressive symptoms can vary widely in severity but generally include feelings of
sadness, hopelessness, and a lack of enjoyment in life that are directly tied to substance
use or exposure.
6. Depressive Disorder Due to Another Medical Condition: Depressive Disorder Due
to Another Medical Condition is characterized by depressive symptoms directly caused
by a general medical condition. These symptoms include persistent sadness, loss of
interest or pleasure, changes in appetite or weight, sleep disturbances, fatigue, feelings
of worthlessness or guilt, cognitive impairments, and in severe cases, suicidal thoughts
or behaviors. It's important to distinguish these symptoms from the effects of the medical
condition itself.
Other Specified Major Depressive Episodes: In addition to the severity, psychotic, and
remission descriptions, additional symptom features (specifiers) can be used to describe
patients with various mood disorders.
(i) With melancholic features: This designation is applied when, in addition to
meeting the criteria for a major depressive episode, a patient either has lost
interest or pleasure in almost all activities or does not react to usually
pleasurable stimuli or desired events.
(ii) With psychotic symptoms: It is characterized by loss of contact with reality and
delusions or hallucinations, may sometimes accompany other symptoms of
major depression.
(iii) With atypical features: Major depressive episode with atypical features
includes a pattern of symptoms characterized by mood reactivity; that is, the
person’s mood brightens in response to potential positive events.
(iv) With marked psychomotor disturbances: Major depressive episode with
catatonic features includes a range of psychomotor symptoms, from motoric
immobility (catalepsy—a stuporous state) to extensive psychomotor activity, as
well as mutism and rigidity.
(v) With a seasonal pattern: In recurrent major depressive episode with a seasonal
pattern, also commonly known as seasonal affective disorder, the person must
have had at least two episodes of depression in the past 2 years occurring at
the same time of the year (most commonly fall or winter), and full remission
must also have occurred at the same time of the year (most commonly spring).
 Psychopathology

Obsessive-Compulsive and other anxiety related disorders

1. Obsessive Compulsive Disorder: OCD is characterized by the presence of
obsessions and/or compulsions. Obsessions are recurrent and persistent thoughts,
urges, or images that are experienced as intrusive and unwanted, whereas compulsions
are repetitive behaviors or mental acts that an individual feels driven to perform in
response to an obsession or according to rules that must be applied rigidly. Some other
obsessive-compulsive and related disorders are also characterized by preoccupations
and by repetitive behaviors or mental acts in response to the preoccupations. Other
obsessive-compulsive and related disorders are characterized primarily by recurrent
body-focused repetitive behaviors (e.g., hair pulling, skin picking) and repeated attempts
to decrease or stop the behaviors.
The most common types of obsessions involve themes of contamination, dirt or
illness (e.g., fearing that one will contract or transmit a specific disease, or a more
general, vague fear of not being clean enough), and pathological doubting (e.g., that
some action has not been performed adequately and will consequently result in harm to
self and/or others). Other common themes include the need for symmetry or orderliness,
somatic concerns, and aggressive, sexual, or religious ideation. Generally, patients try to
suppress or ignore the thoughts, and diagnostic criteria require that patients realize that
the obsessions are products of their own minds.
A compulsion is any purposeful, repetitive behavior or mental activity that is
performed in a ritualistic or stereotypical way, generally with the goal of reducing anxiety
associated with obsessive ideation. The most frequently reported compulsive behaviors
include repetitive washing (e.g., handwashing, showering, house cleaning) and checking
(e.g., of locks, appliances, numerical figures, or mathematical calculations). These
classes of behaviors generally are associated, respectively, with obsessive thoughts of
contamination and excessive doubting. Other common types of compulsions include
repeating rituals (e.g., getting up and down from a chair repeatedly, going in and out of
doorways), ordering/arranging behaviors, and hoarding.
The symptoms of OCD can significantly impair daily functioning and quality of life.
Individuals with OCD may spend hours each day engaged in compulsive rituals,
interfering with work, school, or social activities. They may feel intense shame or
embarrassment about their symptoms, leading to avoidance of certain situations or
withdrawal from social interactions. The distress caused by obsessions and compulsions
can also lead to emotional symptoms such as depression, anxiety, or irritability.
In addition to the overt symptoms of obsessions and compulsions, individuals with
OCD often experience cognitive distortions related to their symptoms. They may
 Psychopathology

catastrophize the consequences of not performing their rituals or believe that their
obsessions reflect a true threat. Despite recognizing that their obsessions and
compulsions are irrational or excessive, individuals with OCD feel powerless to control or
stop them.
The clinical presentation of OCD can vary widely among individuals. Some may
experience predominantly obsessional symptoms with minimal overt rituals, while others
may have severe compulsions that dominate their daily routines. The specific content of
obsessions and compulsions can also vary greatly, reflecting the individual's unique
fears, concerns, and values.
2. Body Dysmorphic Disorder: Body dysmorphic disorder is characterized by
preoccupation with one or more perceived defects or flaws in physical appearance that
are not observable or appear only slight to others, and by repetitive behaviors (e.g.,
mirror checking) in response to the appearance concerns. The appearance
preoccupations are not better explained by concerns with body fat or weight in an
individual with an eating disorder. Muscle dysmorphia is a form of body dysmorphic
disorder that is characterized by the belief that one’s body build is too small or is
insufficiently muscular. Individuals with BDD may focus intensely on one or more aspects
of their appearance, such as their skin, hair, nose, eyes, or body shape. Despite the
absence of noticeable abnormalities, they perceive themselves as disfigured, ugly, or
unattractive.
The symptoms of BDD extend beyond mere dissatisfaction with one's appearance;
they involve obsessive thoughts and repetitive behaviors related to the perceived flaws.
Individuals with BDD often engage in compulsive behaviors such as mirror checking,
excessive grooming, skin picking, or seeking reassurance from others about their
appearance. They may also avoid social situations or activities that expose their
perceived flaws, leading to social withdrawal and impaired functioning in various areas of
life.
The preoccupation with their appearance in BDD is distressing and time-
consuming, consuming several hours each day and significantly interfering with daily
activities, work, school, or relationships. Despite repeated attempts to conceal or
camouflage their perceived flaws, individuals with BDD may remain convinced of their
ugliness or deformity, leading to persistent distress and impaired self-esteem. Individuals
with BDD often experience intense feelings of shame, embarrassment, or self-
consciousness about their appearance, which may lead to social anxiety or avoidance of
social interactions. They may also have distorted perceptions of their appearance,
perceiving themselves as unattractive or abnormal even when others perceive them
differently.
3. Hoarding Disorder: Hoarding disorder is characterized by persistent difficulty
discarding or parting with possessions, regardless of their actual value, leading to
excessive accumulation of clutter that significantly impairs functioning and quality of life.
Individuals with hoarding disorder experience distress or anxiety at the thought of
discarding items and may feel a strong need to save items, resulting in cluttered living
spaces that interfere with daily activities and social relationships.
 Psychopathology

People affected by this disorder often have difficulty organizing possessions and may
experience intense emotional attachment to items, perceiving them as valuable or
irreplaceable. They may also exhibit perfectionistic tendencies, wanting to keep items
"just in case" they might need them in the future or to avoid making decisions about
discarding possessions. Individuals with Hoarding Disorder may struggle with decision-
making, finding it challenging to prioritize or categorize possessions and to discard even
seemingly trivial items. As a result, living spaces become overcrowded with clutter,
making it difficult to navigate, clean, or use functional areas of the home. Hoarded items
may include newspapers, magazines, clothing, household supplies, and even trash or
spoiled food.
Hoarding behaviors can lead to social isolation and strained relationships with family
members, friends, or neighbors who may be concerned about the living conditions or
safety hazards posed by cluttered environments. Individuals with Hoarding Disorder may
also experience financial difficulties due to excessive spending on unnecessary items or
an inability to maintain a job or housing. In severe cases, Hoarding Disorder can have
serious health and safety consequences, including increased risk of falls, fire hazards,
unsanitary living conditions, and structural damage to the home. Hoarded clutter may
block exits, obstruct ventilation, or harbor pests and mold, posing health risks to
occupants. Individuals with Hoarding Disorder may also experience feelings of shame,
embarrassment, or hopelessness about their living situation, further exacerbating social
isolation and mental health symptoms.
4. Trichotillomania: The essential feature of trichotillomania is the recurrent pulling out
of one’s own hair. Individuals with Trichotillomania experience an irresistible urge to pull
out their hair from any part of the body, most commonly the scalp, eyebrows, or
eyelashes, but it can also involve other areas such as the arms, legs, or pubic region.
There is tension or anxiety before pulling out hair, followed by a sense of relief or
gratification during the act of pulling. Despite attempts to resist or stop the behavior,
individuals with Trichotillomania may find it challenging to control their urges and may
continue pulling hair to the point of causing bald patches or noticeable hair loss.
Trichotillomania can have significant psychosocial implications and impact various
aspects of daily functioning. Individuals with Trichotillomania may experience distress or
impairment in social, occupational, or academic settings due to embarrassment, shame,
or self-consciousness about their appearance. They may also avoid social activities or
situations that involve close proximity to others to conceal their hair pulling behaviors or
resulting hair loss. Some individuals with Trichotillomania may also engage in additional
behaviors such as hair twisting, chewing, or swallowing hair (trichophagia), which can
lead to medical complications such as gastrointestinal problems in severe cases.
5. Excoriation (Skin-Picking) Disorder: It is characterized by recurrent and compulsive
picking, scratching, or digging at the skin, resulting in skin lesions, wounds, or scars.
Individuals with excoriation disorder experience an overwhelming urge to pick at their
skin, often in response to perceived imperfections, blemishes, or irregularities on the skin
surface.
 Psychopathology

Symptoms of excoriation disorder typically include repetitive and ritualistic skin-picking

behaviors, which may occur in various locations on the body but commonly affect the
face, arms, hands, and other accessible areas. Skin picking episodes are often preceded
by feelings of tension, anxiety, or discomfort, and individuals may experience a sense of
relief or gratification during the act of picking. Despite efforts to resist or control the
behavior, individuals with excoriation disorder may find it difficult to refrain from picking
and may continue the behavior to the point of causing tissue damage, scarring, or
infection.
In addition to the physical effects of skin damage and scarring, excoriation disorder can
have significant psychosocial implications and impact various aspects of daily
functioning. Individuals with excoriation disorder may experience distress,
embarrassment, or shame related to their skin-picking behaviors and may avoid social
activities or situations that involve exposure of affected areas. The visible signs of skin
picking may also lead to interpersonal difficulties, low self-esteem, and impaired quality of
life.

Anxiety Disorders: Anxiety disorders encompass a range of conditions characterized by

excessive and persistent worry, fear, and related behavioral disturbances. Each type of
anxiety disorder has unique symptoms, but they all share the core element of irrational
and excessive fear or anxiety.
1. Generalized anxiety disorder (GAD) is marked by chronic, exaggerated worrying
about everyday activities or events that seems disproportionate to the actual source of
stress. People with this disorder anticipate disaster and are overly concerned about
health, money, family, work, or other issues. They often exhibit physical symptoms such
as restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep
disturbances.
2. Panic disorder is characterized by recurrent, unexpected panic attacks—sudden
surges of overwhelming fear and discomfort that reach a peak within minutes. During a
panic attack, individuals might experience palpitations, pounding heart, or accelerated
heart rate; sweating; trembling or shaking; sensations of shortness of breath, smothering,
or choking; and feelings of impending doom. They may also experience fears of losing
control or “going crazy,” and avoid places where previous episodes have occurred.
3. Phobia-related disorders represent a persistent and irrational fear of a specific
object, situation, or activity that is generally considered harmless. People with these
disorders go to great lengths to avoid phobic situations. Specific phobias center on
particular objects and situations such as fear of flying, heights, animals, receiving
injections, or seeing blood. Social anxiety disorder (social phobia) involves high levels of
anxiety, fear, and avoidance of social situations due to feelings of embarrassment, self-
consciousness, and concern about being judged or viewed negatively by others.
4. Agoraphobia involves intense fear or anxiety triggered by real or anticipated exposure
to a wide range of situations including using public transportation, being in open or
enclosed spaces, standing in line, or being in a crowd. The individual fears these
situations due to thoughts that escape might be difficult or help might not be available in
 Psychopathology

the event of developing panic-like symptoms or other incapacitating or embarrassing

symptoms.
5. Separation anxiety disorder is characterized by excessive fear or anxiety concerning
separation from those to whom the individual is attached. The fear is excessive for the
individual's developmental level and interferes with their normal activities. Symptoms
include recurrent and excessive distress about anticipating or experiencing separation,
persistent worry about losing those to whom one is attached or about harms coming to
them, reluctance or refusal to go out, fear of being alone, and nightmares about
separation.

Trauma- and Stressor-Related Disorders

Trauma- and Stressor-Related Disorders encompasses conditions that are triggered by
exposure to traumatic or stressful events.
1. Reactive Attachment Disorder: Reactive attachment disorder is characterized by a
pattern of markedly disturbed and developmentally inappropriate attachment behaviors,
in which a child rarely or minimally turns preferentially to an attachment figure for comfort,
support, protection, and nurturance. The essential feature is absent or grossly
underdeveloped attachment between the child and putative caregiving adults.
RAD is characterized by a consistent pattern of emotionally withdrawn behavior by the
child towards his or her caregiver. A child with RAD rarely seeks comfort when distressed
and rarely responds to comfort if given. Children with RAD exhibit limited emotional
responses, are often bewildered or confused, and have unexplained episodes of sadness
and irritability. They may also be unhygienic and have underdeveloped motor
coordination. RAD stems from extremely insufficient care of the child.
A diagnosis of reactive attachment disorder should not be made in children who are
developmentally unable to form selective attachments. For this reason, the child must
have a developmental age of at least 9 months. Diagnostic assessment is enhanced by
multiple sources of input, supporting that the symptoms are apparent across contexts.
2. Disinhibited Social Engagement Disorder: The essential feature of disinhibited
social engagement disorder is a pattern of behavior that involves culturally inappropriate,
overly familiar behavior with relative strangers. This overly familiar behavior violates the
social boundaries of the culture. A diagnosis of disinhibited social engagement disorder
should not be made before children are developmentally able to form selective
attachments. For this reason, the child must have a developmental age of at least 9
months. DSED is also seen in children who have experienced early neglect or
maltreatment. Symptoms include indiscriminate social behavior, lack of social
boundaries, and overly familiar or intrusive interactions with strangers. Children with
DSED may exhibit a lack of fear or wariness in unfamiliar situations, which can put them
at risk for harm.
3. Posttraumatic Stress Disorder: The essential feature of posttraumatic stress
disorder (PTSD) is the development of characteristic symptoms following exposure to
one or more traumatic events. The clinical presentation of PTSD varies. In some
 Psychopathology

individuals, fear-based reexperiencing, emotional, and behavioral symptoms may

predominate. In others, anhedonic or dysphoric mood states and negative cognitions
may be most prominent. In some other individuals, arousal and reactive-externalizing
symptoms are prominent, while in yet others, dissociative symptoms predominate.
Finally, some individuals exhibit combinations of these symptom patterns.
Symptoms usually begin early, that is, within 3 months of the traumatic event, but, in
some cases, it has been seen that symptoms may begin almost a year afterward.
Symptoms must last more than a month and severe enough to hamper the occupational,
social and daily functioning of the individual. For some cases, recovery can be seen
within 6 months but for some it may take more time. In PTSD, “a traumatic event is
thought to cause a pathological memory” that is at the center of the defining clinical
symptoms that are associated with the disorder. These memories can be brief pieces of
the experience and may concern the events that happened just before the moment that
caused a huge emotional impact on the individual. For a PTSD diagnosis, these
symptoms need to last for more than a month and significantly affect a person's ability to
function in daily life. The severity of symptoms can vary, with some people experiencing
mild distress and others finding it hard to function at all.
To be diagnosed with PTSD, one must have the following symptoms for at least one
month:
At least one intrusion symptom (re-experiencing)
At least one avoidance symptom
At least two negative alterations in cognition and mood
At least two arousal and reactivity symptoms

In the following section, we would elaborate upon the above-mentioned symptoms:

1. Intrusive Symptoms: People with PTSD may have intrusive thoughts, memories,
or flashbacks of the traumatic event. These can pop into their mind unexpectedly,
making them feel like they're reliving the trauma. Nightmares related to the event
are also common.
2. Avoidance Symptoms: Individuals with PTSD often try to avoid anything that
reminds them of the traumatic experience. This might include avoiding certain
places, people, or activities, as well as avoiding talking or thinking about the event
altogether.
3. Negative Changes in Mood and Thinking: PTSD can lead to persistent negative
emotions like fear, guilt, or sadness. It can also cause changes in how a person
sees themselves, others, or the world around them. They may feel disconnected
from others or have a hard time feeling happy.
4. Arousal and Reactivity Symptoms: Those with PTSD may feel constantly on
edge, easily startled, or have trouble concentrating. They might also have angry
outbursts, trouble sleeping, or be overly vigilant, always on the lookout for danger.
4. Acute Stress Disorder: Acute Stress Disorder (ASD) is characterized by the presence
of symptoms following exposure to a traumatic event. These symptoms include intrusive
 Psychopathology

thoughts, memories, or dreams related to the trauma; avoidance of reminders of the

event; negative changes in mood or cognition; and increased arousal and reactivity. To
meet the diagnostic criteria, these symptoms must persist for a minimum of three days
and a maximum of one month after the traumatic event. If the symptoms persist beyond
this timeframe, the diagnosis may be changed to PTSD.
The symptoms of ASD are experienced during or immediately after trauma and
may last for a maximum of four weeks before the diagnosis must be reassessed. The
duration of symptoms is at least three days, but no longer than four weeks. If the
symptoms persist past four weeks, the person may be diagnosed with PTSD if the criteria
are met. However, a person may be diagnosed with PTSD without having been
previously diagnosed with ASD. Any symptoms manifesting immediately following the
trauma that are resolved within three days do not meet the criteria for ASD. The
manifestation of the disorder differs in every individual, but typically consists of anxiety
that includes some form of re-experiencing the trauma or reactivity related to the trauma.
5. Adjustment Disorder: An adjustment disorder is a psychological response to a
common stressor (e.g., divorce, death of a loved one, loss of a job) that results in
clinically significant behavioral or emotional symptoms. The stressor can be a single
event, such as going away to college, or involve multiple stressors, such as a business
failure and marital problems. People undergoing severe stress that exceeds their coping
resources may warrant the diagnosis of adjustment disorder. For the diagnosis to be
given, symptoms must begin within 3 months of the onset of the stressor. In addition, the
person must experience more distress than would be expected given the circumstances
or be unable to function as usual. In adjustment disorder, the person’s symptoms lessen
or disappear when the stressor ends or when the person learns to adapt to the stressor.
In cases where the symptoms continue beyond 6 months, the diagnosis is usually
changed to some other mental disorder. Adjustment disorder is probably the least
stigmatizing and mildest diagnosis a therapist can assign to a client.
6. Prolonged Grief Disorder: PGD is a condition characterized by persistent and severe
grief reactions following the death of a loved one. According to DSM-5, PGD includes
symptoms such as intense longing or yearning for the deceased, preoccupation with
thoughts or memories of the deceased, intense emotional pain or sorrow related to the
loss, difficulty accepting the death, feeling that life is empty or meaningless without the
deceased, and difficulty engaging in activities or social interactions. These symptoms
must persist for at least 12 months following the death to meet the criteria for PGD.

Personality Disorders: Personality Disorders encompass a group of mental health

conditions characterized by enduring patterns of inner experience and behavior that
deviate significantly from cultural expectations and cause distress or impairment in
functioning. The DSM-5-TR outlines specific diagnostic criteria for each personality
disorder. Here are the main personality disorders listed in the DSM-5-TR, along with brief
descriptions:
 Psychopathology

1. Paranoid Personality Disorder (PPD): Characterized by pervasive distrust and

suspicion of others, often interpreting benign actions as malevolent. Individuals
with PPD may be guarded, hypervigilant, and reluctant to confide in others.
2. Schizoid Personality Disorder (SPD): Marked by detachment from social
relationships and a restricted range of emotional expression. Individuals with SPD
often prefer solitary activities and may appear indifferent to praise or criticism from
others.
3. Schizotypal Personality Disorder (STPD): Features eccentric behavior, odd
beliefs or magical thinking, unusual perceptual experiences, and social anxiety.
Individuals with STPD may display peculiar speech patterns, eccentric dress, and
unusual beliefs.
4. Antisocial Personality Disorder (ASPD): Characterized by a disregard for and
violation of the rights of others, lack of empathy, and a history of antisocial
behavior. Individuals with ASPD may engage in deceitful or manipulative behavior
and show little remorse for their actions.
5. Borderline Personality Disorder (BPD): Defined by unstable relationships,
intense emotions, impulsivity, and an unstable sense of self. Individuals with BPD
may experience chronic feelings of emptiness, engage in self-destructive
behaviors, and have tumultuous interpersonal relationships.
6. Histrionic Personality Disorder (HPD): Marked by excessive emotionality,
attention-seeking behavior, and a need for approval. Individuals with HPD may be
dramatic, flirtatious, and exhibit rapidly shifting emotions.
7. Narcissistic Personality Disorder (NPD): Characterized by grandiosity, a need
for admiration, and a lack of empathy. Individuals with NPD may have an inflated
sense of self-importance, seek excessive admiration, and exploit others for
personal gain.
8. Avoidant Personality Disorder (AVPD): Features pervasive feelings of
inadequacy, social inhibition, and hypersensitivity to criticism or rejection.
Individuals with AVPD may avoid social or occupational activities due to fear of
disapproval or embarrassment.
9. Dependent Personality Disorder (DPD): Marked by an excessive need to be
taken care of, submissive and clingy behavior, and fears of separation. Individuals
with DPD may have difficulty making decisions or initiating activities without
reassurance or support from others.
10. Obsessive-Compulsive Personality Disorder (OCPD): Characterized by
perfectionism, preoccupation with orderliness and control, and rigid adherence to
rules and routines. Individuals with OCPD may be overly conscientious, inflexible,
and reluctant to delegate tasks.
 Psychopathology

Unit III:
Dissociative Disorders
In psychiatry, dissociation is defined as an unconscious defense mechanism involving
the segregation of any group of mental or behavioral processes from the rest of the
person's psychic activity.
Dissociative disorders involve this mechanism so that there is a disruption in one or more
mental functions, such as memory, identity, perception, consciousness, or motor
behavior. The disturbance may be sudden or gradual, transient, or chronic, and the signs
and symptoms of the disorder are often caused by psychological trauma.
They are characterized by a disruption of and/or discontinuity in the normal integration of
consciousness, memory, identity, emotion, perception, body representation, motor
control, and behavior. Dissociative symptoms can potentially disrupt every area of
psychological functioning.
1. Dissociative Identity Disorder: Dissociative identity disorder is characterized by a)
the presence of two or more distinct personality states or an experience of possession
and b) recurrent episodes of dissociative amnesia. The defining feature of dissociative
identity disorder is the presence of two or more distinct personality states or an
experience of possession. These different identities can control the person's behavior at
different times, with transitions from one personality to another often triggered by stress.
The primary symptom of DID is the fragmentation of identity. Unlike the common
misconception that these are fully separate personalities, the various identities represent
different aspects of the same person's psyche. Each identity may have its own name,
age, history, and self-image, including distinct postures, gestures, and ways of interacting
with the world.
 Psychopathology

Memory gaps are a common feature of DID. An individual may experience severe
amnesia, not just minor forgetfulness. These gaps occur across time and involve
personal history, everyday events, and traumatic experiences. The amnesia is not just for
distant memories but can be for recent events and necessary information, causing
significant disruptions to daily functioning.
Individuals with DID often report feelings of detachment or unreality, a symptom related
to dissociation. This can include feeling detached from their own body or sensations as if
they are observing their life from outside themselves. This detachment can also manifest
in an altered sense of reality, affecting their perception of the world around them.
The disorder often coexists with other mental health issues such as depression, anxiety,
and posttraumatic stress disorder. Emotional fluctuations are intense and unpredictable,
partly due to the differing emotional states of the various identities. Each identity may
react differently in similar situations, causing mood swings and inconsistent abilities.
Behavioral changes are also a hallmark of DID. An identity may emerge in specific
contexts, particularly under stress or threat, and can display behaviors and skills
uncharacteristic of the primary identity. For example, one identity may be very outgoing
and confident while another might be withdrawn and depressive.
These symptoms cause significant distress or problems in social, occupational, or other
important areas of functioning. The impact of DID can be profound, affecting all areas of
an individual's life and often necessitating long-term and specialized psychotherapeutic
treatment to help integrate the separate identities into one primary identity and address
the trauma underlying the disorder.
Dissociative fugues, with amnesia for travel, are common. Individuals may report
suddenly finding themselves in another city, at work, or even at home: in the closet,
under the bed, or running out of the house. Amnesia in individuals with dissociative
identity disorder is not limited to stressful or traumatic events; it can involve everyday
events as well. Individuals may report major gaps in ongoing memory (e.g., experiencing
“time loss,” “blackouts,” or “coming to” in the midst of doing something). Dissociative
amnesia may be apparent to others (e.g., the individual does not recall something others
witnessed that he or she did or said, cannot remember his or her own name, or may fail
to recognize spouse, children, or close friends). Minimization or rationalization of
amnesia is common.
2. Dissociative Amnesia: Dissociative amnesia is characterized by an inability to recall
autobiographical information that is inconsistent with normal forgetting. In other words,
Dissociative amnesia is characterized primarily by a temporary but significant memory
loss that goes beyond typical forgetfulness. This disorder often arises in response to
trauma or extreme stress. Unlike other memory issues, dissociative amnesia specifically
pertains to the inability to recall important personal information, usually of a traumatic or
stressful nature, which is too severe to be explained by ordinary forgetfulness.
The memory loss in dissociative amnesia can manifest in different forms. Some
individuals experience localized amnesia, where they cannot recall events that occurred
during a specific period, often immediately following a traumatic event. Others may
experience selective amnesia, remembering some but not all of the events during a
 Psychopathology

troubled period of their life. In more severe cases, someone might suffer from
generalized amnesia, forgetting who they are and losing awareness of their identity and
life history.
The onset of dissociative amnesia is typically sudden, and the duration can vary, with
some cases resolving quickly and others lasting longer. During episodes of amnesia,
individuals may still be able to function in their daily lives, albeit without a significant
portion of their personal memories. For example, they might retain knowledge of how to
perform their job but have no recollection of how they learned those skills in the first
place.
Additionally, individuals with dissociative amnesia might experience dissociative fugue,
where they suddenly travel away from their usual environments, sometimes assuming
new identities altogether. During a fugue state, they might appear normal to others,
despite not remembering their true identity or how they arrived at a new location.
The symptoms of dissociative amnesia generally cause significant distress and problems
in a person's social, occupational, or other important areas of functioning. People with
this disorder may feel confused, distressed, and helpless about their memory loss, which
can lead to further stress and anxiety. Recovery from dissociative amnesia may happen
spontaneously, often triggered by a specific event or reminder that brings back the lost
memories, though some individuals might not fully recover all of the forgotten information.
Therapy typically involves methods to help restore lost memories and to develop better
coping mechanisms for dealing with stress and trauma.
3. Depersonalization/Derealization Disorder: Derealization/depersonalization disorder
involves a persistent or recurrent feeling of being detached from one’s own body or
thoughts (depersonalization) or a sense of unreality about one's surroundings
(derealization). People experiencing this disorder often describe it as feeling like they are
an outside observer of their own life, or as though they are in a dream or movie. These
experiences can cause significant distress and impair normal functioning.
Individuals with depersonalization might feel as if they are robot-like, lacking control over
their speech or movements. They may report feeling emotionally and physically numb or
as though their memories lack the emotional depth they once had. This can make
personal memories feel as if they belong to someone else. Those experiencing
derealization describe the world as visually distorted, colorless, two-dimensional, or
artificial. Familiar places may seem unfamiliar, distorted, or visually foggy.
Despite the unreal experiences, individuals with this disorder maintain an awareness that
their sense of detachment is only a feeling and not reality. This ongoing awareness
differentiates derealization/depersonalization disorder from psychotic disorders, which
involve true delusional beliefs.
The symptoms can be very disturbing and might interfere with a person's relationships
and ability to function in daily life. For instance, the constant feeling of detachment can
lead to severe anxiety or depression. Moreover, the unpredictable nature of the
symptoms—often coming and going without any apparent triggers—can lead to a
persistent fear of losing touch with reality.
 Psychopathology

These symptoms not only cause psychological distress but can also affect physical well-
being, leading to difficulties in concentrating, dizziness, and fatigue, which compound the
challenges of managing day-to-day activities and responsibilities. The disorder often
begins in the teenage years or early adulthood and can be triggered by extreme stress,
major life transitions, or trauma. Treatment typically includes psychotherapy aimed at
understanding and changing the thoughts and behaviors that reinforce the symptoms,
and in some cases, medication may also be used to alleviate severe symptoms of
anxiety or depression associated with the disorder.

Feeding and Eating Disorders: These are characterized by a persistent disturbance of

eating or eating-related behavior that results in the altered consumption or absorption of
food and that significantly impairs physical health or psychosocial functioning.
1. Pica: Pica is characterized by the persistent eating of non-nutritive, non-food
substances over a period of at least one month that is developmentally inappropriate and
not part of culturally supported or socially normative practice. Examples of substances
ingested in pica include paper, soap, cloth, hair, string, wool, soil, chalk, talcum powder,
paint, gum, metal, pebbles, charcoal, ash, clay, starch, or ice. Pica can occur in
individuals of any age, but it is more common in children, pregnant women, and
individuals with intellectual disabilities.
2. Rumination Disorder: Rumination disorder involves the repeated regurgitation of
food, which may be re-chewed, re-swallowed, or spit out. This regurgitation typically
occurs within the first 30 minutes after a meal and is not associated with gastrointestinal
or other medical conditions. Rumination disorder is often preceded by an episode of
normal eating, and the regurgitated food may appear undigested or have an acidic taste.
The disorder can lead to weight loss, malnutrition, and other health complications.
Both Pica and Rumination Disorder can have serious consequences for physical
health, including nutritional deficiencies, gastrointestinal problems, dental issues, and
complications related to ingested non-food substances
3. Avoidant/Restrictive Food Intake Disorder: Avoidant/Restrictive Food Intake
Disorder (ARFID) is characterized by disturbances in eating or feeding that result in a
failure to meet appropriate nutritional or energy needs, leading to significant weight loss,
nutritional deficiency, dependence on enteral feeding, or marked interference with
psychosocial functioning. Individuals with ARFID may experience a variety of symptoms
and clinical features that impact their relationship with food and eating habits.
One of the primary symptoms of ARFID is a lack of interest in eating or food, often
accompanied by a reduced appetite or aversion to certain types of foods. Individuals with
ARFID may demonstrate a limited range of preferred foods and may refuse to eat foods
with specific textures, colors, or smells. This selective eating may lead to a restricted
dietary intake, resulting in inadequate nutrition and calorie consumption. It may also
involve anxiety or fear related to eating, particularly in social or public settings. Individuals
may experience anxiety or distress when presented with unfamiliar foods or eating in
front of others, leading to avoidance behaviors or mealtime rituals. This fear of eating
 Psychopathology

may stem from concerns about choking, vomiting, or adverse reactions to food, resulting
in avoidance of food altogether or restrictive eating patterns.
Children and adolescents with ARFID may demonstrate failure to meet expected
developmental milestones related to eating and feeding, such as difficulty transitioning to
solid foods, refusal to breastfeed or bottle-feed, or resistance to self-feeding. Parents or
caregivers may observe their child's reluctance or refusal to eat, resulting in mealtime
struggles, conflicts, or power struggles surrounding food. Physical symptoms of ARFID
may include significant weight loss or failure to gain weight as expected for age and
developmental stage, along with nutritional deficiencies or inadequate growth. Individuals
may present with fatigue, weakness, lethargy, or other signs of malnutrition due to
insufficient calorie intake and nutrient absorption. Psychological symptoms associated
with ARFID may include low self-esteem, poor body image, or negative attitudes toward
food and eating. Individuals may experience distress or frustration related to their eating
difficulties, leading to social isolation, withdrawal, or avoidance of situations involving
food.
4. Anorexia Nervosa: Anorexia nervosa is a serious eating disorder characterized by
significant weight loss, an intense fear of gaining weight or becoming fat, and a distorted
body image.
One of the hallmark symptoms of anorexia nervosa is severe restriction of food intake,
often accompanied by strict dieting, calorie counting, or avoidance of certain food groups.
Individuals may engage in excessive exercise as a means of burning calories or
compensating for food consumption. Despite being underweight or malnourished,
individuals with anorexia nervosa may perceive themselves as overweight or obese,
leading to persistent efforts to lose weight or maintain an extremely low body weight.
Physical symptoms of anorexia nervosa may include rapid weight loss, emaciation, or
being significantly underweight for one's age, height, and developmental stage.
Individuals may experience fatigue, weakness, dizziness, or fainting spells due to
inadequate calorie intake and malnutrition. Other physical signs may include thinning
hair, brittle nails, dry skin, and intolerance to cold temperatures.
Individuals with anorexia nervosa may exhibit altered eating habits or rituals, such as
avoiding meals or social gatherings involving food, cutting food into small pieces, or
hiding food to avoid eating it. Despite experiencing extreme hunger or physical
discomfort, individuals may resist eating or express fear or anxiety about consuming
food. Mealtime rituals, such as rearranging food on a plate or cutting food into tiny
portions, may prolong mealtime and contribute to further calorie restriction.
Psychological symptoms associated with anorexia nervosa may include preoccupation
with food, weight, and body image, as well as persistent thoughts about dieting, calories,
or body shape. Individuals may experience intense anxiety or distress related to weight
gain or eating certain foods, leading to avoidance behaviors or social withdrawal. Low
self-esteem, feelings of worthlessness, or a sense of control through food restriction may
also be present. Anorexia nervosa can have serious consequences for physical health,
including electrolyte imbalances, irregular heart rhythms, dehydration, gastrointestinal
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problems, and osteoporosis. Left untreated, anorexia nervosa can lead to life-threatening
complications and long-term health consequences.

5. Bulimia Nervosa: Bulimia nervosa is an eating disorder characterized by recurrent

episodes of binge eating followed by inappropriate compensatory behaviors to prevent
weight gain. Individuals with bulimia nervosa often experience a sense of loss of control
during binge-eating episodes and may consume large quantities of food in a short period,
typically feeling guilty, ashamed, or disgusted afterward. These binge-eating episodes
are accompanied by a marked lack of control over eating behavior, during which
individuals may eat much more food than most people would in a similar situation and
experience feelings of distress or discomfort.
Following binge-eating episodes, individuals with bulimia nervosa engage in
compensatory behaviors to prevent weight gain. These behaviors may include self-
induced vomiting, misuse of laxatives, diuretics, or enemas, fasting, or excessive
exercise. The use of these compensatory behaviors is driven by a desire to counteract
the effects of binge eating and may provide a temporary sense of relief or control over
weight and body shape.
Unlike individuals with anorexia nervosa, individuals with bulimia nervosa often maintain
a relatively normal body weight or may fluctuate within a normal weight range. However,
they may experience fluctuations in weight due to alternating periods of binge eating and
compensatory behaviors.
In addition to binge eating and compensatory behaviors, individuals with bulimia nervosa
may exhibit a range of psychological and behavioral symptoms. These may include
preoccupation with body shape, weight, and food, as well as feelings of guilt, shame, or
self-disgust following binge-eating episodes. Individuals may also experience mood
swings, irritability, or anxiety related to food and eating. Bulimia nervosa can have
serious consequences for physical health, including electrolyte imbalances, dehydration,
gastrointestinal problems, dental erosion, and hormonal disturbances. Over time,
repeated episodes of binge eating and purging can lead to long-term health
complications and may increase the risk of cardiovascular disease, gastrointestinal
disorders, and other medical conditions.
6. Binge-Eating Disorder: Binge eating disorder (BED) is characterized by recurrent
episodes of binge eating, during which an individual consumes a larger amount of food
than most people would in a similar time frame and under similar circumstances. These
episodes are accompanied by a sense of lack of control over eating behavior, during
which the individual feels unable to stop or control the amount of food they are eating.
Unlike bulimia nervosa, individuals with binge eating disorder do not regularly engage in
compensatory behaviors such as purging, fasting, or excessive exercise.
The binge eating episodes in BED occur regularly, typically at least once a week for a
duration of three months or more. During these episodes, individuals may consume large
quantities of food rapidly, often to the point of discomfort or physical distress. Binge
eating episodes are typically associated with feelings of guilt, shame, or distress following
the episode.
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Individuals with binge eating disorder may experience a range of psychological and
behavioral symptoms in addition to binge eating episodes. These may include
preoccupation with food, eating, and body weight, as well as feelings of embarrassment
or self-disgust related to eating behaviors. They may also experience fluctuations in
mood, such as depression, anxiety, or irritability, which may be triggered or exacerbated
by episodes of binge eating. Binge eating disorder can have significant consequences for
physical health, including weight gain, obesity, and related health conditions such as
diabetes, high blood pressure, and cardiovascular disease. It can also have profound
psychological and social impacts, leading to low self-esteem, social isolation, and
impaired quality of life.

Sleep-Wake Disorders: Sleep-wake disorders encompass a variety of conditions

characterized by disturbances in sleep patterns, behaviors, or the sleep-wake cycle.
These disorders can significantly impact an individual's quality of life, daily functioning,
and overall well-being. Here's an elaboration on the symptoms of each sleep-wake
disorder as outlined in the DSM-5:
1. Insomnia Disorder: Insomnia disorder involves persistent difficulty initiating or
maintaining sleep, or experiencing non-restorative sleep, despite adequate
opportunities for sleep. Symptoms include difficulty falling asleep, frequent
awakenings during the night, early morning awakenings, or experiencing non-
restorative sleep that does not leave the individual feeling refreshed or rested
during the day. These symptoms occur at least three nights per week for a
minimum of three months and result in significant distress or impairment in social,
occupational, or other important areas of functioning.
2. Hypersomnolence Disorder: Hypersomnolence disorder is characterized by
excessive daytime sleepiness or prolonged nighttime sleep, despite obtaining
adequate sleep duration. Individuals with hypersomnolence disorder may
experience recurrent episodes of excessive sleepiness during the day, prolonged
naps, difficulty awakening from sleep, or difficulty maintaining wakefulness during
activities that require alertness. These symptoms occur at least three times per
week for a minimum of three months and result in significant distress or
impairment in daily functioning.
3. Narcolepsy: Narcolepsy is a neurological disorder characterized by excessive
daytime sleepiness, sudden uncontrollable episodes of falling asleep (known as
"sleep attacks"), cataplexy (sudden loss of muscle tone triggered by emotions),
sleep paralysis (temporary inability to move or speak upon awakening or falling
asleep), and hypnagogic or hypnopompic hallucinations (vivid dream-like
experiences). Individuals with narcolepsy may also experience disrupted nighttime
sleep, fragmented sleep, or vivid dreams. These symptoms can significantly impair
daily functioning and may lead to safety concerns, particularly if sleep attacks
occur during activities such as driving or operating machinery.
4. Breathing-Related Sleep Disorders: Breathing-related sleep disorders
encompass conditions characterized by abnormalities in respiratory patterns
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during sleep, leading to disruptions in sleep continuity or quality. The most

common breathing-related sleep disorder is obstructive sleep apnea, which
involves repeated episodes of complete or partial obstruction of the upper airway
during sleep, resulting in snoring, choking or gasping during sleep, daytime
sleepiness, and fatigue. Other breathing-related sleep disorders include central
sleep apnea, sleep-related hypoventilation disorders, and sleep-related hypoxemia
disorders.
5. Circadian Rhythm Sleep-Wake Disorders: Circadian rhythm sleep-wake
disorders involve disruptions in the normal sleep-wake cycle, which may result in
insomnia, excessive daytime sleepiness, or other sleep-related symptoms. These
disorders are typically characterized by a misalignment between an individual's
internal biological clock and the external environment, leading to disturbances in
sleep timing, duration, or quality. Examples of circadian rhythm sleep-wake
disorders include delayed sleep-wake phase disorder, advanced sleep-wake
phase disorder, irregular sleep-wake rhythm disorder, non-24-hour sleep-wake
rhythm disorder, and shift work disorder.
6. Non-Rapid Eye Movement (NREM) Sleep Arousal Disorders: NREM sleep
arousal disorders are characterized by recurrent episodes of incomplete
awakening from sleep, accompanied by behaviors such as sleepwalking
(somnambulism), sleep terrors (night terrors), or sleep-related eating disorder.
These episodes typically occur during the first third of the night during NREM
sleep stages and may involve confusion, disorientation, or automatic behavior.
Individuals may have limited or no memory of the episodes upon awakening.
7. Nightmare Disorder: Nightmare disorder involves recurrent, distressing, and vivid
nightmares that significantly disrupt sleep and cause distress or impairment in
daily functioning. Nightmares typically involve frightening or threatening dream
content that elicits fear, anxiety, or other negative emotions upon awakening.
Individuals with nightmare disorder may experience difficulty falling back asleep
after awakening from a nightmare and may develop anxiety or fear of sleep.
8. Rapid Eye Movement (REM) Sleep Behavior Disorder: REM sleep behavior
disorder involves the absence of normal muscle paralysis during REM sleep,
leading to the enactment of dream content through vocalizations, gestures, or
complex motor behaviors. Individuals with REM sleep behavior disorder may
physically act out their dreams, which can result in injury to themselves or their
sleep partners. These behaviors typically occur during REM sleep and are often
vivid, intense, and emotionally charged. REM sleep behavior disorder is
associated with neurological conditions such as Parkinson's disease and may also
occur as an isolated disorder.
9. Restless Legs Syndrome (RLS): Restless legs syndrome is characterized by an
irresistible urge to move the legs, often accompanied by uncomfortable sensations
such as creeping, crawling, tingling, or burning sensations in the legs. Symptoms
typically worsen during periods of inactivity or rest, particularly in the evening or at
night, and are temporarily relieved by movement or activity. Individuals with RLS
may experience difficulty falling asleep or staying asleep due to the discomfort in
 Psychopathology

their legs, leading to insomnia or disrupted sleep patterns. RLS can significantly
impact quality of life and may contribute to daytime fatigue or impairment in daily
functioning.
10. Substance/Medication-Induced Sleep Disorder: Substance/medication-induced
sleep disorder involves disturbances in sleep patterns or behaviors that are
directly attributable to the effects of a substance or medication. These
disturbances may include insomnia, hypersomnia, parasomnias, or other sleep-
related symptoms resulting from the use or withdrawal of substances such as
alcohol, caffeine, sedatives, hypnotics, stimulants, or medications.
Substance/medication-induced sleep disorder is diagnosed when the sleep
disturbances are judged to be a direct physiological consequence of substance
use, intoxication, or withdrawal, and when they cause significant distress or
impairment in daily functioning.

Sexual Dysfunctions: Sexual dysfunctions encompass a range of difficulties related to

sexual arousal, desire, or response that cause distress or interpersonal difficulties. Here's
an elaboration on the symptoms of each sexual dysfunction:
1. Erectile Disorder (previously known as Erectile Dysfunction): Erectile disorder
involves persistent difficulty achieving or maintaining an erection sufficient for
satisfactory sexual performance. Symptoms may include difficulty achieving an
erection, difficulty maintaining an erection until completion of sexual activity, or a
marked decrease in erectile rigidity. These difficulties often lead to distress or
interpersonal difficulties.
2. Female Orgasmic Disorder: Female orgasmic disorder involves persistent
difficulty achieving orgasm despite adequate sexual stimulation. Symptoms may
include delay or absence of orgasm, reduced intensity of orgasmic sensations, or
marked delay in achieving orgasm. These difficulties cause distress or
interpersonal difficulties.
3. Delayed Ejaculation: Delayed ejaculation involves persistent delay or absence of
ejaculation during sexual activity, despite adequate sexual stimulation and desire
to ejaculate. Symptoms may include marked delay in ejaculation, infrequent
ejaculation, or an inability to ejaculate. These difficulties cause distress or
interpersonal difficulties.
4. Premature (Early) Ejaculation: Premature ejaculation involves persistent
ejaculation that occurs shortly after penetration and before the individual wishes it,
often with minimal sexual stimulation. Symptoms may include ejaculation within
one minute of penetration, inability to delay ejaculation, or recurrent ejaculation
before the individual desires it. These difficulties cause distress or interpersonal
difficulties.
5. Genito-Pelvic Pain/Penetration Disorder (previously known as Dyspareunia
and Vaginismus): Genito-pelvic pain/penetration disorder involves persistent or
recurrent difficulties with vaginal penetration during intercourse or attempted
 Psychopathology

intercourse. Symptoms may include significant genital pain, fear or anxiety related
to penetration, or involuntary tightening of the pelvic muscles preventing
penetration. These difficulties cause distress or interpersonal difficulties.
6. Substance/Medication-Induced Sexual Dysfunction: Substance/medication-
induced sexual dysfunction involves sexual difficulties that occur as a result of
substance use, intoxication, or withdrawal. Symptoms may include changes in
sexual desire, arousal, or response directly related to substance use. These
difficulties cause distress or interpersonal difficulties.
Substance abuse and addictive related disorders
1. Substance Use Disorder (SUD): SUD encompasses a wide range of behaviors
associated with the recurrent use of substances such as alcohol, drugs, or
medications. Individuals with SUD may experience a variety of symptoms,
including an intense desire or craving for the substance, unsuccessful attempts to
cut down or control use, spending a significant amount of time obtaining, using, or
recovering from the substance, and continued use despite experiencing negative
consequences such as health issues, relationship problems, or legal troubles.
2. Alcohol Use Disorder (AUD): AUD is characterized by a problematic pattern of
alcohol consumption leading to clinically significant impairment or distress.
Symptoms of AUD include a strong urge to drink, difficulty controlling alcohol
intake, tolerance (needing more alcohol to achieve the desired effect), withdrawal
symptoms when not drinking, and continued use despite negative consequences
such as job loss, financial problems, or interpersonal conflicts.
3. Caffeine Use Disorder: While caffeine is commonly consumed in various forms
such as coffee, tea, or energy drinks, excessive or problematic caffeine
consumption can lead to significant impairment or distress. Symptoms of caffeine
use disorder may include consuming larger amounts of caffeine than intended,
unsuccessful efforts to cut down or control use, and experiencing withdrawal
symptoms such as headache, fatigue, or irritability when attempting to reduce or
stop caffeine intake.
4. Cannabis Use Disorder: Cannabis use disorder involves problematic cannabis
(marijuana) consumption leading to clinically significant impairment or distress.
Symptoms of cannabis use disorder include craving or strong desire to use
cannabis, difficulty controlling cannabis use, tolerance (needing more cannabis to
achieve the desired effect), withdrawal symptoms when not using cannabis, and
continued use despite experiencing negative consequences.
5. Stimulant Use Disorder: Stimulant use disorder encompasses the problematic
use of stimulant substances such as cocaine, amphetamines, or
methamphetamine. Symptoms may include craving or strong desire to use
stimulants, unsuccessful efforts to cut down or control use, tolerance (needing
larger amounts of stimulants to achieve the desired effect), withdrawal symptoms
when not using stimulants, and continued use despite negative consequences
such as health problems or legal issues.
 Psychopathology

6. Hallucinogen Use Disorder: Hallucinogen use disorder involves the problematic

use of hallucinogenic substances such as LSD, psilocybin mushrooms, or MDMA
(ecstasy). Symptoms may include recurrent use of hallucinogens despite negative
consequences, craving or strong desire to use hallucinogens, tolerance, and
withdrawal symptoms such as mood disturbances or flashbacks.
7. Opioid Use Disorder: Opioid use disorder refers to problematic opioid
consumption leading to clinically significant impairment or distress. Symptoms of
opioid use disorder include craving or strong desire to use opioids, unsuccessful
efforts to cut down or control use, tolerance (needing larger amounts of opioids to
achieve the desired effect), withdrawal symptoms when not using opioids, and
continued use despite experiencing negative consequences.
8. Sedative, Hypnotic, or Anxiolytic Use Disorder: This disorder involves
problematic use of medications such as benzodiazepines (e.g., Xanax, Valium) or
other sedative-hypnotic drugs leading to clinically significant impairment or
distress. Symptoms may include using larger amounts of medication than
prescribed, unsuccessful efforts to cut down or control use, and continued use
despite experiencing negative consequences such as cognitive impairment,
physical health problems, or legal issues.
9. Tobacco Use Disorder: Tobacco use disorder refers to problematic tobacco
consumption leading to clinically significant impairment or distress. Symptoms
include craving or strong desire to use tobacco, difficulty controlling tobacco use,
tolerance (needing more tobacco to achieve the desired effect), withdrawal
symptoms such as irritability or restlessness when not using tobacco, and
continued use despite experiencing negative consequences such as respiratory
problems, cardiovascular disease, or cancer.